Objective: To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion.
Design: A prospective, randomized, controlled trial.
Setting: A university teaching hospital.
Patient(s): Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization.
Intervention(s): Routine surgical evacuation or medical evacuation of the uterus using misoprostol.
Main outcome measure(s): Immediate, short-term (2-3 weeks), and medium-term (6 months) medical complications.
Result(s): There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia.
Conclusion(s): Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications.