title: Misoprostol for medical evacuation of early pregnancy failure.
abstract: OBJECTIVE
  To determine whether misoprostol (a prostaglandin E1 analogue) 400 micrograms orally (group 1) or 800 micrograms vaginally (group 2) will cause complete uterine evacuation in women with early pregnancy failure.
  
  
  METHODS
  Twenty subjects were recruited for a prospective, non-blinded, randomized clinical trial. Early pregnancy failure was diagnosed by transvaginal ultrasound examination; only women with a closed cervical os and minimal vaginal bleeding were enrolled. Subjects returned 24 hours after misoprostol administration for a transvaginal ultrasound examination. If the gestational sac was still present, the misoprostol dose was repeated and the subject returned again 24 hours later. Subjects who failed to expel the pregnancy were offered a suction curettage.
  
  
  RESULTS
  Twelve and eight women were randomized to groups 1 and 2, respectively. Complete uterine evacuation occurred in three of 12 [25%, 95% confidence interval (CI) 1%, 50%] and seven of eight (88%, 95% CI 65%, 100%, P = .010) subjects in groups 1 and 2, respectively. Vomiting occurred in 30% and 13%, respectively, and diarrhea in 50% and 38%, respectively.
  
  
  CONCLUSIONS
  Vaginal misoprostol 800 micrograms is more effective than oral misoprostol 400 micrograms for uterine evacuation of early pregnancy failure and may be an effective alternative to dilation and curettage.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pennsylvania, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Creinin
authors.forename: R
authors.initials: R
authors.lastname: Moyer
authors.forename: R
authors.initials: R
authors.lastname: Guido
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000030:Abortion, Missed / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010865:Pilot Projects; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D014463:Ultrasonography; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol