Randomised trial comparing expectant with medical management
for first trimester miscarriages
Department of OB/GYN, Tehran University of Medical Sciences,
Objective: To compare the efficacy of prostaglandin E
analogue (misoprostol) for rapid evacuation of pathologic miscarriages.
Design & Methods: The study group was selected from
women attending the OB/GYN clinic at Shariati University Hospital. Inclusion
criteria was healthy women with pathological pregnancy (1. an intact but empty
gestational sac on two occasion and at least one week interval; 2. gestational
sac with a non-viable fetus) and an estimated gestational age of less than 13
weeks and closed cervix on clinical examination. Women randomised to misoprostol
treatment were admitted at hospital and received 800 mg misoprostol vaginally
(n=30) or expectant management (n=30). They had surgical evacuation if they had
severe bleeding or pain or retained products of conception with a diameter above
15 mm one week after inclusion. Comparisons between groups were performed by
Fisher’s test, two tailed test and p 50.05 was considered significant.
Results: There were no significant differences in women’s
characteristics between the two groups. Eighty percent of the women randomized
to misoprostol and 20% of those randomized to expectant management had an empty
uterine cavity after one week that reached significant difference. Fifty percent
of both groups needed surgical evacuation based on transvaginal ultrasound.
Women who had a complete miscarriage without intervention were satisfied with
either method and women who did not have empty uterus after a week requested
Conclusion: Medical intervention with misoprostol was
associated with rapid resolution, more satisfaction, so less patient’s anxiety.