USA: Treatment of early pregnancy failure

This study compares quality of life and acceptability of medical versus surgical treatment of early pregnancy failure. 

This randomised clinical trial of treatment for early pregnancy failure (EPF) compared misoprostol vaginally versus vacuum aspiration (VA). It was a multisite trial at four US Urban University Hospitals.

A total of 652 women with an EPF were randomised to treatment. Participants completed a daily symptom diary and a questionnaire 2 weeks after treatment. The questionnaire assessment included subscales of the Short Form-36 Health Survey Revised for QOL and measures of wellbeing, recovery difficulties, and treatment acceptability.

The results found that the two groups did not differ in mean scores for quality of life (QOL) except bodily pain; medical treatment was associated with higher levels of bodily pain than VA (P < 0.001). Success of treatment was not related to QOL, but acceptability of the procedure was decreased for medical therapy if unsuccessful (P = 0.003). Type of treatment was not associated with differences in recovery, and the two groups reported similar acceptability except for cramping (P = 0.02), bleeding (P < 0.001), and symptom duration (P = 0.03).

The authors concluded that despite reporting greater pain and lower acceptability of treatment-related symptoms, QOL and treatment acceptability were similar for medical and surgical treatment of EPF. Acceptability, but not QOL, was influenced by success or failure of medical management.

Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA.

Quality of life and acceptability of medical versus surgical management of early pregnancy failure. Harwood B, Nansel T; National Institute of Child Health and Human Development Management of Early Pregnancy Failure Trial. BJOG. 2008 Mar;115(4):501-8.