Medical management of early pregnancy failure: how to treat and what to expect.

Medical management is gaining acceptance as a treatment option for women with early pregnancy failure (EPF). We reviewed randomized trials comparing misoprostol for EPF with surgical (dilation and curettage) or expectant management. Overall, approximately 85% of women with EPF can expect complete uterine evacuation after one or two doses of 600 or 800 microg misoprostol without surgery. Medical management is safe. As with surgical therapy, serious complications are rare. Women undergoing medical management of EPF may expect moderate pain and bleeding for several days, which may persist for 2 weeks or longer. Side effects associated with misoprostol are common; however, acceptability of medical management remains high.