Drug Cytotec as good as surgery at expelling tissue following failed pregnancy

Aug 25 2005

According to test results just released, the drug Cytotec is almost as effective as surgery for removing tissue that can remain in the uterus after a failed pregnancy.

Apparently the drug, which is also known by its generic name Misoprostol, had a success rate of around 85 percent, according to the National Institute of Child Health and Human Development.

Jun Zhang, the chief author of the study, says the treatment, which can be done on an outpatient basis, is less risky than surgery and the pills which only cost 50 cents, can be inserted into the vagina at home.

In an accompanying editorial in the New England Journal of Medicine, Beverly Winikoff says the treatment may be an option for many women that is preferable to surgery.

Apparently roughly one in four women will have a spontaneous abortion or some other type of failed pregnancy, and if some tissue is left in the uterus, doctors may advise waiting up to a month so it can be expelled naturally, but that does not always work.

A traditional alternative for women who don't want to wait, has been a dilation and curettage (D&C) and involves a surgical scraping of the uterus.

A newer technique uses a vacuum to clean the uterus.

In order to evaluate whether Cytotec, which causes uterine contractions, and is given after the abortion pill RU-486, is a safe and acceptable alternative, the Zhang team gave it to 491 women who had residual tissue after their pregnancies failed.

They found that by the third day it had worked in 71 percent of the women.

The remaining women were given a second 800 microgram dose, and the success rate increased to 84 percent by the eighth day.

The surgery was successful in 97 percent of the 161 who received the vacuum technique.

It seems eighty-three percent of the Cytotec recipients said they would recommended it to women in the same situation.

Zhang says that the drug is quite effective, and usually takes effect in four hours, when uterine contractions and cramplike abdominal pain occurs.

Usually the abdominal pain then disappears quickly.

Side effects such as some nausea, diarrhea and vomiting can be experienced.

Winikoff, who is president of the Gynuity Health Projects in New York, says there are still some questions about the best dose to use, and whether the cause of the failed pregnancy should influence the dose.

The study is published in the New England Journal of Medicine.

Cytotec is produced by drug manufacturer G.D. Searle and Pfizer.