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Using Prostaglandins Following Miscarriage

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When a woman experiences a miscarriage or has a termination during the first trimester, a dilation and curettage (D&C) is commonly used to remove the remaining tissue. However, if future pregnancies are being considered, other treatment options should be discussed as the procedure has recently been linked to preterm (less than 36 weeks) and very preterm (less than 32 weeks) delivery. The consequences of such early delivery can be serious and long lasting.

One alternative to the D&C is medical treatment using synthetic hormones known as prostaglandins. This approach is less invasive since the drug can either be taken orally or inserted into the vagina. It is also less expensive than surgery (like a D&C) and may be done as an outpatient.

For women who prefer such minimal intervention, treatment typically begins with the prostaglandin misoprostol. The drug successfully induces labor and completes pregnancy expulsion in approximately 66% to 99% of women who experience incomplete or delayed pregnancy loss in their first trimester.

Not all women can use prostaglandins — including women who have previously had a cesarean delivery or other uterine surgery to avoid increasing the possible risk of uterine tearing or rupture.

Common side effects include gastro-intestinal distress and fever or chills. Bleeding occurs as a patient experiences the passing of tissue, often described as heavier than the usual menstrual flow, lasting approximately 3 or 4 days, followed by vaginal spotting. Doctors may worry about the possibility of acute blood loss requiring an emergency room visit when using the drug on an outpatient basis. This concern increases with gestational age but appears less a risk than when a D&C is performed.

The best approach is determined by several factors: gestational age, if the pregnancy loss is delayed or incomplete, maternal blood pressure, the presence of infection, and, most importantly, patient preference.

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