Vaginal misoprostol corrected missed abortion in small study. (Outpatient Treatment).

LOS ANGELES -- A single 800-[micro]g dose of vaginal misoprostol resulted in successful outpatient treatment of missed abortion in 21 of 28 women within 24 hours, lending credence to the notion that medical management could become a safe alternative to surgery for many women.

An initial 800-[micro]g dose was five times more likely than a 400-[micro]g dose of misoprostol to be successful in medically managing missed abortion on an outpatient basis, according to Dr. Michael J. Heard of Baylor College of Medicine, Houston.

Currently, early pregnancy failures are often treated by dilatation and curettage, a surgical procedure that poses certain risks, including hemorrhage, uterine perforation, cervical tears, retained products of conception, and infection. Outpatient management would be more convenient, less expensive, and arguably safer for patients, Dr. Heard said in an interview at the annual meeting of the American College of Obstetricians and Gynecologists, where his study was presented in poster form.

Researchers evaluated use of vaginal misoprostol in 49 women, each of whom met eligibility criteria that included absence of fetal cardiac activity, a gestational age of 8 weeks or less, a closed cervical os, and minimal vaginal bleeding.

Women were randomly assigned to receive either a single 400-[micro]g dose or a single 800-[micro]g dose of vaginal misoprostol. They returned in 24 hours to fill out a questionnaire and undergo an ultrasound and pelvic examination. Those who had not successfully passed the gestational sac were given a second dose of misoprostol in an identical dosage to the first they received.

Among 21 women who received the 400-[micro]g dose, 8 (38%) passed the products of conception within 24 ...