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.