Aftermath of Miscarriage: Drug Offers Alternative to Surgical Treatment

The study appears in the August 18, 2005, New England Journal of Medicine.

In recent years, physicians have begun prescribing misoprostol in place of surgery to women who have experienced a miscarriage. Until the current study, however, no large-scale studies have been undertaken to evaluate the safety and effectiveness of the drug in treating miscarriage.

The study authors wrote that pregnancy failure, or miscarriage, occurs in 15 percent of pregnancies. With miscarriage, in some cases, a fetus dies in the womb, explained the study’s first author, Jun Zhang, M.D., Ph.D., an investigator in the Epidemiology Branch of NICHD’s Division of Epidemiology, Statistics, and Prevention Research. In other cases, a fetus may no longer be present, and women may carry a placenta and sac of amniotic fluid.
In all of these cases, the standard treatment is a surgical procedure known as vacuum aspiration. In this procedure, the cervix is dilated, and a suction device is used to remove the uterine contents. As an alternative, women and their doctors may choose to wait for the uterus to expel the tissue without additional medical treatment. Such expulsion is by no means certain, and may take more than a month. Many women, grieving from the failed pregnancy, may prefer not to wait. Occasionally, the uterus may fail to expel the remaining fetal tissue, and in some of these cases, the uterus may become infected.

Misoprostol treatment provides an effective alternative for women who prefer to avoid the surgical procedure. Moreover, because it can be performed on an out-patient basis, the misoprostol treatment is less expensive and can provide women more privacy and convenience than vacuum aspiration. Misoprostol is inexpensive and does not need to be refrigerated,” Dr. Zhang said. “It could provide treatment for miscarriage in developing countries where safe surgical treatment may not be readily accessible.”

Message posted by: Rashmi Nemade