• Long-term conception rate and pregnancy outcomes are similar for women who undergo medical or surgical evacuation.
• Postinfection rates are lower with medical vs. surgical management.

• Misoprostol: Most common agent for inducing passage of tissue in missed or incomplete abortion:
  • Not approved by the FDA for treatment of early pregnancy failure
  • Efficacy: complete expulsion of products of conception in 71% by day 3, 84% by day 8
  • Efficacy depends on route of administration, gestational age of pregnancy, and dose.
  • Recommended dose is 800 μg vaginally (3)[A]; alternate regimens include the World Health Organization (WHO) regimen of 600 μg sublingually q3h for up to 3 doses; multidose regimens and oral dosing (including buccal and sublingual) may result in increased side effects. Concerns related to possible increased risk for C. sordelii infection with vaginal route are unproven but many protocols have switched to buccal route as a result.
• Common adverse effects include abdominal pain/cramping, nausea, and diarrhea. Pain increases at higher doses but is manageable with oral analgesia. There is no increase in nausea/diarrhea with a higher dose.
• Recommended for stable patients who decline surgery but do not want to wait for spontaneous passage of products of conception

Second Line
Rh-negative patients should be given Rh immunoglobulin (RhoGAM) following a spontaneous abortion.