Quality of life and acceptability of medical versus surgical management of early pregnancy failure*

OBJECTIVE: This study compares quality of life (QOL) and acceptability of medical versus surgical treatment of early pregnancy failure (EPF). DESIGN: A randomised clinical trial of treatment for EPF compared misoprostol vaginally versus vacuum aspiration (VA). SETTING: A multisite trial at four US Urban University Hospitals. POPULATION: A total of 652 women with an EPF were randomised to treatment. METHODS: Participants completed a daily symptom diary and a questionnaire 2 weeks after treatment. MAIN OUTCOME MEASURES: The questionnaire assessment included subscales of the Short Form-36 Health Survey Revised for QOL and measures of wellbeing, recovery difficulties, and treatment acceptability. RESULTS: The two groups did not differ in mean scores for QOL except bodily pain; medical treatment was associated with higher levels of bodily pain than VA (P < 0.001). Success of treatment was not related to QOL, but acceptability of the procedure was decreased for medical therapy if unsuccessful (P = 0.003). Type of treatment was not associated with differences in recovery, and the two groups reported similar acceptability except for cramping (P = 0.02), bleeding (P < 0.001), and symptom duration (P = 0.03). CONCLUSIONS: Despite reporting greater pain and lower acceptability of treatment-related symptoms, QOL and treatment acceptability were similar for medical and surgical treatment of EPF. Acceptability, but not QOL, was influenced by success or failure of medical management.