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Milwaukee Journal Sentinel
MILWAUKEE - The decision on the best medical management of a miscarriage during the first trimester is often difficult for women, particularly when the shock of what's happening is still so fresh.
But for those who choose to complete the process in the privacy of their homes, a new study shows that the uterus-contracting drug misoprostol is a safe alternative to surgery.
However, experts encourage women to discuss each option with their physicians to decide what's best for them.
"Like in all medicine, you need to understand the patients' needs to guide them through this difficult and emotional process, and to allow them to end the pregnancy in the easiest way for themselves, both physically and emotionally," said Brian Bear, an obstetrician and gynecologist at St. Joseph Regional Medical Center in Milwaukee.
Miscarriage, or pregnancy loss before 20 weeks, occurs in 15 percent to 20 percent of all diagnosed pregnancies. It is most common during the first 12 weeks and is believed to primarily result from a chromosomal abnormality in the fetus. However, other factors such as infections and maternal health problems may contribute to the problem.
Women who miscarry have three options, said Grace Janik, associate clinical professor with the Medical College of Wisconsin and co-director of the Reproductive Specialty Center at Columbia St. Mary's, Milwaukee Campus.
Those are to pass the tissue naturally, which can take two to three weeks; remove it surgically through dilation and curettage, or D&C; or to vaginally insert misoprostol and complete the process in about two days but with the possibility of another dosage or a D&C.
Misoprostol is approved by the Food and Drug Administration to prevent stomach ulcers in patients taking certain arthritis or pain medicines. It also is used "off-label" to induce labor and to terminate pregnancies.
The study, published last month in the New England Journal of Medicine, found that misoprostol completed the miscarriage within three days in 71 percent of women taking it. For those who require an additional dosage, completion occurred in 60 percent of women by day eight. However, 16 percent of women in the group still required surgery.
"It's not uncommon for some patients to say `I'll wait a day or two to think about this,'" said Fredrik Broekhuizen, a professor of obstetrics and gynecology at the Medical College of Wisconsin. A miscarriage "is not considered a medical emergency, so there's some time to be able to deal with this."
"This is a grieving process because you first have to come to terms with what's happening," Janik said. "It's not something you need to decide right away."
Janik, who is an infertility specialist, said most women who come to her office decide to let the miscarriage proceed naturally. She said she diagnoses about two miscarriages a week and uses misoprostol about 10 times a year. Surgery is chosen even less, she said.
"Once they understand that not having surgery reduces the risk of scarring and that having surgery won't really hurry up their process of getting pregnant again, they're willing to take the time to let the body do it naturally," she said.
Still, misoprostol is a viable option for many, Broekhuizen said.
"Many patients, especially those who previously experienced spontaneous miscarriage, choose misoprostol," he said. "It allows miscarriage to take place at home - a much more private setting to go through a pregnancy loss than in a surgical suite."
But administering the drug means that the physician and staff must be available at all times to answer questions as the woman goes through the process, Bear said.
(c) 2005, Milwaukee Journal Sentinel. Distributed by Knight Ridder/Tribune News Service.