The ulcer treatment drug misoprostol -- which also is used in medical abortion procedures to induce uterine contractions -- can be a safe alternative to surgery to remove tissue in the uterus after a miscarriage, according to a study published on Thursday in the... New England Journal of Medicine, the Wall Street Journal reports. Jun Zhang, an investigator for the National Institute of Child Health and Human Development's Epidemiology Branch, and colleagues studied 652 women who miscarried before 13 weeks' gestation. Researchers gave 491 of the women misoprostol and the remaining 161 women received the standard surgery, called vacuum aspiration (Zimmerman, Wall Street Journal, 8/25). Researchers found that 71% of the women taking misoprostol expelled the remaining uterine tissue by the third day after taking the drug. The women who had not experienced complete expulsion were given a second dose of the drug on day three, which increased the percentage of women with complete expulsion to 84% by the eighth day. Vacuum aspiration successfully removed the tissue in 97% of the patients. Eighty-three percent of the women who took misoprostol in the study said they would recommend the drug to women in the same situation. The drug -- which is sold under the brand name Cytotec by G.D. Searle and Pfizer -- can have side effects of diarrhea, nausea and vomiting (Emery, Reuters, 8/24). FDA has warned physicians that the combination of misoprostol and mifepristone for medical abortions can cause rare but potentially fatal blood infections, but none of the study participants experienced such infections. Less than 1% of the women in each group developed excessive uterine bleeding or uterine lining infection (Bowman, Knoxville News-Sentinel, 8/24).

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Zhang said that using misoprostol instead of vacuum aspiration is a "safe, effective alternative to early pregnancy failure" that can be conducted on an outpatient basis at a lower cost. In an accompanying NEJM editorial, Beverly Winikoff, president of the reproductive health technology research group Gynuity Health Projects, said the findings could be especially useful in developing countries where vacuum aspiration is neither accessible nor safe. She added that misoprostol also is being studied for use in postpartum hemorrhaging and miscarriage after failed abortion, which is common in developing countries (Wall Street Journal, 8/25). Study co-author Mitchell Creinin, director of gynecologic specialties at the University of Pittsburgh School of Medicine, said the combination of mifepristone and misoprostol could be more effective in removing miscarried tissue than misoprostol alone, but restrictions on the use of mifepristone are hampering efforts to study the combination's effectiveness (Spice, Pittsburgh Post-Gazette, 8/25).

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