Clinical Question:Which regimen of misoprostol is more effective for the treatment of incomplete abortion among women who would otherwise undergo surgical evacuation?

Setting:Inpatient (any location) with outpatient follow-up

Study Design:Randomized controlled trial (nonblinded)

Synopsis:Watchful waiting and surgical evacuation are traditional options for women with incomplete first-trimester abortion. In this Thai study, 169 women were randomized (allocation concealed) to receive one or two 600-mcg doses of misoprostol orally for the management of their incomplete first-trimester abortion. Participating women were reevaluated two days after misoprostol treatment when ultrasonography was used to determine whether the abortion was complete. If still incomplete at the two-day follow-up, women were given the option of waiting an additional five days. Surgical evacuation was performed if abortion was still incomplete at one week after misoprostol administration.

Side effects were not significantly different between groups. Complete abortion without surgical intervention occurred in 66 percent of women who received one dose of misoprostal and in 70 percent of women who received two doses (P = not significant). More than 90 percent of women in both groups found any side effects tolerable.

Bottom Line: A single 600-mcg dose of oral misoprostol results in completion of a first-trimester abortion within one week in two thirds of cases. A two-dose regimen is not significantly more effective. Misoprostol also may prove useful in women with a diagnosis of missed abortion. A placebo-controlled trial is needed. (Level of Evidence: 1b–)