{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:10:51Z","timestamp":1777342251201,"version":"3.51.4"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,12,5]],"date-time":"2017-12-05T00:00:00Z","timestamp":1512432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Swedish government (\u2018ALF-medel\u2019, \u2018regionalt forskningsst\u00f6d Region Sk\u00e5ne\u2019)"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare vaginal misoprostol treatment with expectant management in early non\u2010viable pregnancy with vaginal bleeding with regard to complete evacuation of the uterine cavity within 10\u2009days after randomization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a parallel randomized controlled, open\u2010label trial conducted in Sk\u00e5ne University Hospital, Sweden. Patients with anembryonic pregnancy or early fetal demise (crown\u2013rump length\u2009\u2264\u200933\u2009mm) and vaginal bleeding were randomly allocated to either expectant management or treatment with a single dose of 800\u2009<jats:italic>\u03bc<\/jats:italic>g misoprostol administered vaginally. Patients were evaluated clinically and by ultrasound until complete evacuation of the uterus was achieved (no gestational sac in the uterine cavity and maximum anteroposterior diameter of the intracavitary contents &lt;\u200915\u2009mm as measured by transvaginal ultrasound on midsagittal view). Follow\u2010up visits were planned at 10, 17, 24 and 31\u2009days. Dilatation and evacuation (D&amp;E) was recommended if miscarriage was not complete within 31\u2009days, but was performed earlier at patient's request, or if there was excessive bleeding as judged clinically. Analysis was by intention to treat. The main outcome measure was number of patients with complete miscarriage without D&amp;E \u2264\u200910\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010four patients were randomized to misoprostol treatment and 95 to expectant management. After exclusion of three patients and withdrawal of consent by two patients in the expectant management group, 90 women were included in this group. Miscarriage was complete \u2264\u200910\u2009days in 62\/94 (66%) of the patients in the misoprostol group and in 39\/90 (43%) of those in the group managed expectantly (risk difference (RD)\u2009=\u200923%; 95% CI, 8\u201337%). At 31\u2009days, the corresponding figures were 81\/94 (86%) and 55\/90 (61%) (RD\u2009=\u200925%; 95% CI, 12\u201338%). Two patients from each group underwent emergency D&amp;E because of excessive bleeding and one of these in each group received blood transfusion. The number of patients undergoing D&amp;E at their own request was higher in the expectantly managed group, 15\/90 (17%) <jats:italic>vs<\/jats:italic> 3\/94 (3%) in the misoprostol group (RD\u2009=\u200914%; 95% CI, 4\u201323%), as was the number of patients making out\u2010of\u2010protocol visits, 50\/90 (56%) <jats:italic>vs<\/jats:italic> 27\/94 (29%) (RD\u2009=\u200927%; 95% CI, 12\u201340%). Compared with the expectant management group, more patients in the misoprostol group experienced pain (71\/77 (92%) <jats:italic>vs<\/jats:italic> 91\/91 (100%); RD\u2009=\u20098%; 95% CI, 1\u201317%) and used painkillers (59\/77 (77%) <jats:italic>vs<\/jats:italic> 85\/91 (93%); RD\u2009=\u200917%; 95% CI, 5\u201329%). No major side effect was reported in any group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In women with early non\u2010viable pregnancy and vaginal bleeding, misoprostol treatment is more effective than is expectant management for complete evacuation of the uterus. Both methods are safe but misoprostol treatment is associated with more pain than is expectant management. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.18940","type":"journal-article","created":{"date-parts":[[2017,10,26]],"date-time":"2017-10-26T10:17:02Z","timestamp":1509013022000},"page":"24-32","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Misoprostol treatment <i>vs<\/i> expectant management in women with early non\u2010viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial"],"prefix":"10.1002","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1773-9488","authenticated-orcid":false,"given":"A.","family":"Fernlund","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital, Lund University  Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0758-3507","authenticated-orcid":false,"given":"L.","family":"Jokubkiene","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital, Lund University  Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9563-8135","authenticated-orcid":false,"given":"P.","family":"Sladkevicius","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital, Lund University  Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3830-6414","authenticated-orcid":false,"given":"L.","family":"Valentin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital, Lund University  Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,12,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00606-6"},{"key":"e_1_2_6_3_1","first-page":"1","article-title":"Spontaneous abortion risks in man: Data from reproductive histories collected in a medical genetics unit","volume":"16","author":"Warburton D","year":"1964","journal-title":"Am J Hum Genet"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dei167"},{"key":"e_1_2_6_5_1","first-page":"Cd007223","article-title":"Medical treatments for incomplete miscarriage","volume":"1","author":"Kim C","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10109"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10075"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10108"},{"key":"e_1_2_6_9_1","unstructured":"National Guideline Clearinghouse. 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