Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol

Objective: To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion. Design: A prospective, randomized, controlled trial. Setting: A university teaching hospital. Patient(s): Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization. Intervention(s): Routine surgical evacuation or medical evacuation of the uterus using misoprostol. Main Outcome Measure(s): Immediate, short-term (2-3 weeks), and medium-term (6 months) medical complications. Result(s): There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia. Conclusion(s): Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications. (Fertil Steril(R) 1999;71: 1054-9. (C)1999 by American Society for Reproductive Medicine.).