Objective
To compare immediate vs delayed medical treatment for first-trimester miscarriage.
Study Design
Randomized open-label trial in a university hospital gynecologic emergency department.
Between April 2003 and April 2006, 182 women diagnosed with spontaneous abortion before
14 weeks' gestation were assigned to immediate medical treatment (oral mifepristone,
followed 48 hours later by vaginal misoprostol, n = 91) or sequential management (1
week of watchful waiting followed, if necessary, by the above-described medical treatment,
n = 91). Vacuum aspiration was performed in case of treatment failure, hemorrhage,
pain, infection, or patient request.
Results
Compared with immediate medical treatment, sequential management resulted in twice
as many vacuum aspirations overall (43.5% vs 19.1%; P < .001), 4 times as many emergent vacuum aspirations (20% vs 4.5%; P = .001), and twice as many unplanned visits to the emergency department (34.1% vs
16.9%; P = .009).
Conclusion
Delaying medical treatment of first-trimester miscarriage increases the rate of unplanned
surgical uterine evacuation.
Key words
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Article info
Publication history
Published online: December 19, 2011
Accepted:
December 12,
2011
Received in revised form:
September 11,
2011
Received:
June 27,
2011
Footnotes
Funding was provided by Assistance Publique-Hôpitaux de Paris.
Trial registration number: ClinicalTrials.gov NCT00190294.
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Torre A, Huchon C, Bussieres L, et al. Immediate versus delayed medical treatment for first-trimester miscarriage: a randomized trial. Am J Obstet Gynecol 2012;206:215.e1-6.
Identification
Copyright
© 2012 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
