Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial

Am J Obstet Gynecol. 2007 Jan;196(1):31.e1-7. doi: 10.1016/j.ajog.2006.07.053.


Objective: The purpose of this study was to describe bleeding patterns after misoprostol or curettage for early pregnancy failure (EPF).

Study design: 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.

Conclusion: Bleeding is heavier and more prolonged after medical treatment with misoprostol than with curettage for EPF; however, bleeding rarely requires intervention.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Abortifacient Agents, Nonsteroidal / adverse effects*
  • Abortion, Spontaneous / drug therapy*
  • Abortion, Spontaneous / surgery*
  • Adult
  • Curettage*
  • Female
  • Humans
  • Misoprostol / adverse effects*
  • Pregnancy
  • Uterine Hemorrhage / epidemiology*


  • Abortifacient Agents, Nonsteroidal
  • Misoprostol