( to wait for the uterus to expel the ti...)Sleeping Sickness Epidemic Spreading in Uganda

to wait for the uterus to expel the tissue without additional medical treatment. Such expulsion is by no means certain, and may take more than a month. Many women, grieving from the failed pregnancy, may prefer not to wait. Occasionally, the uterus may fail to expel the remaining fetal tissue, and in some of these cases, the uterus may become infected.

Within the last few years, physicians have used misoprostol to treat pregnancy failure, and some researchers have conducted a few small studies of the drug’s effectiveness in treating that condition. However, no definitive evidence existed to determine whether the drug was safe and effective enough for routine medical practice.

For the current study, Dr. Zhang and colleagues at several institutions enrolled 652 women who experienced pregnancy failure. Of these, 491 were assigned at random to receive misoprostol. The rest of the women underwent vacuum aspiration. The women in the misoprostol group were treated with 4 vaginal doses of misoprostol, each containing 200 mcg. of the drug. If the uterus had not expelled its contents by the end of three days, the women received a second misoprostol treatment. If, after 5 more days had passed, the uterine contents still had not been expelled, the women were offered vacuum aspiration.

By the end of the third day, 71 percent of the women receiving misoprostol experienced complete uterine expulsion. After 5 more days had passed, a total of 84 percent of the misoprostol group had complete uterine expulsion. The misoprostol treatment failed for 16 percent of the group, however. In contrast, 3 percent of the vacuum aspiration group experienced treatment failure, and needed to undergo the procedure a second time. Complications from either misoprostol or vacuum aspiration ?uterine hemorrhage and infection of the uterine lining ?were rare, occurring in less than 1 percent of each group.

Of the women in the misoprostol group, 78 percent said they would c
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