title: Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial.
abstract: 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.
authors.affiliation: Columbia University, Department of Obstetrics & Gynecology, 622 West 168th St, PH 16 Room 80, New York, NY 10032, USA. ard4@columbia.edu
authors.forename: Anne R
authors.initials: AR
authors.lastname: Davis
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Hendlish
authors.forename: Carolyn
authors.initials: C
authors.lastname: Westhoff
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Frederick
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Jerry M
authors.initials: JM
authors.lastname: Gilles
authors.forename: Kurt
authors.initials: K
authors.lastname: Barnhart
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Creinin
mesh_terms: 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*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol