A comparison of medical management with misoprostol and surgical management for early pregnancy failure

N Engl J Med. 2005 Aug 25;353(8):761-9. doi: 10.1056/NEJMoa044064.


Background: Misoprostol is increasingly used to treat women who have a failed pregnancy in the first trimester. We assessed the efficacy, safety, and acceptability of this treatment in a large, randomized trial.

Methods: A total of 652 women with a first-trimester pregnancy failure (anembryonic gestation, embryonic or fetal death, or incomplete or inevitable spontaneous abortion) were randomly assigned to receive 800 microg of misoprostol vaginally or to undergo vacuum aspiration (standard of care) in a 3:1 ratio. The misoprostol group received treatment on day 1, a second dose on day 3 if expulsion was incomplete, and vacuum aspiration on day 8 if expulsion was still incomplete. Surgical treatment (for the misoprostol group) or repeated aspiration (for the vacuum-aspiration group) within 30 days after the initial treatment constituted treatment failure.

Results: Of the 491 women assigned to receive misoprostol, 71 percent had complete expulsion by day 3 and 84 percent by day 8 (95 percent confidence interval, 81 to 87 percent). Treatment failed in 16 percent of the misoprostol group and 3 percent of the surgical group (absolute difference, 12 percent; 95 percent confidence interval, 9 to 16 percent) by day 30. Hemorrhage or endometritis requiring hospitalization was rare (1 percent or less in each group), with no significant differences between the groups. In the misoprostol group, 78 percent of the women stated that they would use misoprostol again if the need arose and 83 percent stated that they would recommend it to others.

Conclusions: Treatment of early pregnancy failure with 800 microg of misoprostol vaginally is a safe and acceptable approach, with a success rate of approximately 84 percent.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Abortifacient Agents, Nonsteroidal / adverse effects
  • Abortifacient Agents, Nonsteroidal / therapeutic use*
  • Abortion, Spontaneous / drug therapy*
  • Abortion, Spontaneous / surgery*
  • Adult
  • Endometritis / etiology
  • Female
  • Fetal Death
  • Hemorrhage / etiology
  • Humans
  • Misoprostol / adverse effects
  • Misoprostol / therapeutic use*
  • Postoperative Complications
  • Pregnancy
  • Pregnancy Trimester, First
  • Vacuum Curettage


  • Abortifacient Agents, Nonsteroidal
  • Misoprostol