Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial.
OBJECTIVE
The purpose of this study was to describe bleeding patterns after misoprostol or curettage for early pregnancy failure (EPF).


METHODS
This was a randomized trial that included women (n = 652) with EPF. Participants were assigned to vaginal misoprostol (800 microg) or curettage in a 3:1 ratio. Participants completed a bleeding diary. We measured hemoglobin levels at baseline and 2 weeks after the treatment.


RESULTS
Decreases in hemoglobin levels were greater after misoprostol (-0.7 g/dL; SD, 1.2) than curettage (-0.2 g/dL; SD, 0.9; P < .001). Large changes in hemoglobin levels (at least 2 g/dL) or low nadir hemoglobin levels (< 10 g/dL) were more frequent after misoprostol (55/428 women; 12.8%) than after curettage (6/135 women; 4.4%; P = .02). More participants in the misoprostol group reported "any bleeding" or "heavy bleeding" every study day. Four women who were treated with misoprostol required blood transfusion.


CONCLUSIONS
Bleeding is heavier and more prolonged after medical treatment with misoprostol than with curettage for EPF; however, bleeding rarely requires intervention.
Davis
Anne R
AR
Columbia University, Department of Obstetrics & Gynecology, 622 West 168th St, PH 16 Room 80, New York, NY 10032, USA. ard4@columbia.edu
Hendlish
Sarah K
SK
Westhoff
Carolyn
C
Frederick
Margaret M
MM
Zhang
Jun
J
Gilles
Jerry M
JM
Barnhart
Kurt
K
Creinin
Mitchell D
MD
D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects*; D000022:Abortion, Spontaneous / Q000188:drug therapy* / Q000601:surgery*; D000328:Adult; D003475:Curettage; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000009:adverse effects*; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000453:epidemiology*
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol