A drug first used to reduce the risk of stomach ulcers in people taking certain types of painkillers offers an alternative to surgery after miscarriage, according to a study by researchers at the National Institute of Child Health and Human Development of the National Institutes of Health and other research institutions.

The study appears in the August 18, 2005, New England Journal of Medicine.

The drug, misoprostol, has been used to reduce the risk of stomach ulcers that occur in people who take certain pain relievers for arthritis. Misoprostol is now more commonly used to induce labor, as it stimulates contractions of the uterus.

In recent years, physicians have begun prescribing misoprostol in place of surgery to women who have experienced a miscarriage. Until the current study, however, no large-scale studies have been undertaken to evaluate the safety and effectiveness of the drug in treating miscarriage.

“This is the first comprehensive study to show that misoprostol is an effective alternative to surgery in the treatment of miscarriage,” said Duane Alexander, M.D., Director of the NICHD. “Unlike conventional surgery, which is usually conducted in an operating room, treatment with misoprostol can be done on an out-patient basis.”

The study authors wrote that pregnancy failure, or miscarriage, occurs in 15 percent of pregnancies. With miscarriage, in some cases, a fetus dies in the womb, explained the study’s first author, Jun Zhang, M.D., Ph.D., an investigator in the Epidemiology Branch of NICHD’s Division of Epidemiology, Statistics, and Prevention Research. In other cases, a fetus may no longer be present, and women may carry a placenta and sac of amniotic fluid.

In all of these cases, the standard treatment is a surgical procedure known as vacuum aspiration. In this procedure, the cervix is dilated, and a suction device is used to remove the uterine contents. As an alternative, women and their doctors may choose 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.