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    Thursday, August 25, 2005

    Pills vs. Extraction: Researchers say that misoprostol, the drug used to induce uterine contractions after giving RU-486, is as safe as surgery for the treatment of miscarriage. (Note: This study did not involve RU-486, which is mifepristone):

    The G.D. Searle and Pfizer Inc. drug Cytotec is almost as effective as surgery for removing tissue that can remain in the uterus after a failed pregnancy, a test released on Wednesday has shown.

    The drug, also known by its generic name misoprostol, had a success rate of around 85 percent, said Jun Zhang of the National Institute of Child Health and Human Development, the chief author of the study.

    The treatment, which can be done on an outpatient basis, is less risky than surgery and the pills costing up to 50 cents can be inserted into the vagina at home, he told Reuters.

    At 50 cents a pill, it's certainly less expensive than surgical extraction, but is it safer and more effective? The research says no:

    Of the women who completed the trial according to the protocol, 84 percent (95 percent confidence interval, 81 to 87 percent) were successfully treated with misoprostol and 97 percent (95 percent confidence interval, 94 to 100 percent) were successfully treated with vacuum aspiration. The absolute difference in success rates between the two treatments was 12 percentage points (95 percent confidence interval, 9 to 16 percent).

    Surgical treatment appears to have the upperhand in effectiveness. And as to side effects, when it comes to infection rates and fever, the two are about the same. But bleeding and abdominal pain are another matter:

    Our study defined success a priori as the absence of the need for vacuum aspiration for any reason within 30 days after the initial treatment with misoprostol. Four women (all from the misoprostol group), however, underwent vacuum aspiration after day 30 for heavy bleeding or persistent bleeding.

    ...The percentage of women who made unscheduled visits to the hospital was slightly but not significantly higher in the misoprostol group than in the vacuum-aspiration group (23 percent vs. 17 percent, P=0.09). A decrease in hemoglobin of at least 3 g per deciliter occurred more frequently in the misoprostol group than in the vacuum-aspiration group (5 percent vs. 1 percent, P=0.04). Women who received misoprostol were also more likely to report nausea, vomiting, abdominal pain, and more severe pain.

    The justification for the claim that the pill is just as good as the procedure lies with the fact that the same percentage of patients in both groups would recommend it to their friends, even patients who had experienced both types of procedures recommend the pill:

    ....among 190 women who had undergone vacuum aspiration in previous pregnancies but who received misoprostol during the current pregnancy, 80 percent stated that they would recommend misoprostol treatment and 73 percent stated that they would use misoprostol again if needed.

    But they didn't ask them which they preferred - the pill or the surgery. I know if I had to chose, based on the data presented in the paper, I would chose the surgical treatment, even if I had to pay for it myself. We shouldn't underestimate the importance of minimizing trauma and pain in the aftermath of a miscarriage. The drug therapy just seems too drawn out and, frankly messy and painful.

    UPDATE: From a reader who has experience both:

    I agree with you an the D&C vs. misoprostol choice. Last spring I had a "missed miscarriage" at 8 weeks. My OB gave me the misoprostol to use at home, and about 5 hours after using it, I went in the the ER for a D&C because I couldn't handle the pain. Two Tylenol 3s didn't touch it. (Or if they did, I don't want to know what it would have been like without them.) I might point out that I've had two vaginal deliveries; one didn't need any anesthesia, and the second, back labor, only needed one dose of Stadol. I don't think I'm that much of a wimp, although pain is easier to deal with when you have a pretty good idea how long it's going to last, and there is a happy goal, neither of which was the case here. As I said to my doctor afterwords, if, God forbid, this ever happens again, we're going straight to the D&C. Far, far less painful, and took a lot less time, for me at any rate. I will never use the misoprostol again, and I would strongly recommend anyone I knew to stay away from it also.

    I do remember wondering at the time how much of a role the drug played in the deaths of those women who had used it with the RU-486.

    posted by Sydney on 8/25/2005 09:07:00 AM 0 comments


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