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

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 (800g) 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.