title: Immediate versus delayed medical treatment for first-trimester miscarriage: a randomized trial.
abstract: OBJECTIVE
  To compare immediate vs delayed medical treatment for first-trimester miscarriage.
  
  
  METHODS
  Randomized open-label trial in a university hospital gynecologic emergency department. Between April 2003 and April 2006, 182 women diagnosed with spontaneous abortion before 14 weeks' gestation were assigned to immediate medical treatment (oral mifepristone, followed 48 hours later by vaginal misoprostol, n = 91) or sequential management (1 week of watchful waiting followed, if necessary, by the above-described medical treatment, n = 91). Vacuum aspiration was performed in case of treatment failure, hemorrhage, pain, infection, or patient request.
  
  
  RESULTS
  Compared with immediate medical treatment, sequential management resulted in twice as many vacuum aspirations overall (43.5% vs 19.1%; P < .001), 4 times as many emergent vacuum aspirations (20% vs 4.5%; P = .001), and twice as many unplanned visits to the emergency department (34.1% vs 16.9%; P = .009).
  
  
  CONCLUSIONS
  Delaying medical treatment of first-trimester miscarriage increases the rate of unplanned surgical uterine evacuation.
authors.affiliation: EA 2493, Paris Ile de France Ouest School of Medicine, University Versailles Saint-Quentin en Yvelines, Guyancourt, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Torre
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.forename: Laurence
authors.initials: L
authors.lastname: Bussieres
authors.forename: Elise
authors.initials: E
authors.lastname: Machevin
authors.forename: Erick
authors.initials: E
authors.lastname: Camus
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fauconnier
mesh_terms: D000019:Abortifacient Agents / Q000627:therapeutic use*; D000022:Abortion, Spontaneous / Q000188:drug therapy*; D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000628:therapy; D015735:Mifepristone / Q000627:therapeutic use*; D016595:Misoprostol / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016896:Treatment Outcome; D014619:Vacuum Curettage
chemical_list: D000019:Abortifacient Agents; D016595:Misoprostol; D015735:Mifepristone