***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The purpose of this study was to estimate whether the efficacy of treatment with intravaginal misoprostol for first-trimester pregnancy failure is enhanced by the addition of saline solution . STUDY DESIGN Eighty women with embryonic/fetal death or anembryonic pregnancy were assigned r and omly to receive either 800 microg of misoprostol with saline solution ( group I , 41 women ) or without ( group II , 39 women ) . Treatment was repeated on day 3 if the gestational sac remained . Curettage was performed if the gestational sac remained on day 8 or as necessary during at least 30 days of follow-up . Data were analyzed with the Student t test and the chi(2 ) or Fisher exact test . RESULTS By the first follow-up visit , 73 % ( group I ) and 64 % ( group II ) of women passed the gestational sac ( P=.38 ) . By the second follow-up visit , expulsion rates were 83 % and 87 % , respectively ( P=.59 ) . Five subjects in each group underwent curettage . CONCLUSION Misoprostol is effective for the treatment of failed first-trimester pregnancy . The expulsion rate is not improved by adding saline solution BACKGROUND We aim ed to compare patients ' health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management . METHODS A multicentre r and omized clinical trial was performed in The Netherl and s. In all , 154 women with early pregnancy failure confirmed at ultrasonography who had been managed expectantly unsuccessfully for > or = 1 week were r and omly assigned to undergo either treatment with misoprostol ( n=79 ) or curettage ( n=75 ) . The main outcome measures were health-related quality of life and satisfaction with treatment . RESULTS In the misoprostol strategy 47 % of the women needed additional curettage  , as compared to 4 % after curettage . In both groups , health-related quality of life was impaired most severely 2 days after treatment . In the misoprostol group , health-related quality of life was more severely impaired ; after 2 days this was due to more pain and after 2 and 6 weeks this was due to a worse general health perception . Health-related quality of life was temporarily significantly more impaired in women in whom misoprostol failed as compared to women in whom misoprostol treatment was successful . In both treatment groups , an equal percentage of women ( 58 % ) would choose the same treatment in the future . In women treated with misoprostol , however , this choice depended on the initial success of misoprostol : in cases where misoprostol had caused complete evacuation , 76 % of the women would opt for the same treatment , whereas only 38 % of women who needed curettage after unsuccessful misoprostol would do so ( P<0.01 ) . CONCLUSION Our study shows that , although both the misoprostol strategy and the curettage strategy result ed in complete evacuation in the end , women are willing to accept some disadvantages of misoprostol to avoid curettage . A treatment inconvenience using misoprostol is accepted as long as initial evacuation rate is high . This finding should be an integral part of counselling women when deciding upon management of early pregnancy failure BACKGROUND Responses to miscarriage range from relief to devastation , yet there have been no r and omized controlled studies that demonstrate significant effects of counseling with women who miscarry . OBJECTIVE To test the effects of caring-based counseling , measurement , and time on the integration of loss ( miscarriage impact ) and women 's emotional well-being ( moods and self-esteem ) in the first year after miscarrying . METHOD ANCOVA was used in this r and omized , longitudinal Solomon four-group experimental investigation . Enrolled were 242 ; 185 completed . Outcomes included : self-esteem , overall emotional disturbance , anger , depression , anxiety , confusion , overall miscarriage impact , personal significance , devastating event , lost baby , and isolated . RESULTS During the first year after loss ( a ) caring was effective in reducing overall emotional disturbance , anger , and depression ; and ( b ) time passing led to increased self-esteem and decreased anxiety , depression , anger , confusion , and personal significance of loss . CONCLUSION Caring , measurement , and time had some positive and significant effects on the integration of loss and enhancement of well-being in the first year subsequent to miscarrying BACKGROUND Dilatation and curettage ( D&C ) has been the usual treatment for early pregnancy failure ( EPF ) . Medical management with misoprostol may be an effective alternative . Bleeding patterns during and after medical management of EPF are unknown . METHODS A prospect i ve cohort study was conducted at University-based clinics and physician offices . Eighty women < 11 weeks estimated gestational age with a diagnosis of missed abortion or fetal demise were enrolled . Treatment consisted of either 800 micro g of moistened ( 2 ml of saline ) or dry vaginal misoprostol . Self-reported bleeding and sanitary product usage were recorded in a daily 2 week diary . Haemoglobin was assessed at enrollment and 2 weeks later . RESULTS After misoprostol treatment , patients reported bleeding or spotting every day for the 14 days observed . Self-assessed heavy bleeding days were few ( median 3 ) and usually occurred immediately after treatment . Sanitary pad use was highly variable ( mean 30.5 , range 2 - 125 pads over the 2 week period ) and not related to changes in haemoglobin . The mean decrease in haemoglobin was 0.5 g/dl ( SD 1.2 ) . Complete expulsion without D&C occurred in 85 % of subjects . CONCLUSIONS Bleeding for at least 2 weeks after vaginal misoprostol for EPF is common . Heavy bleeding is usually limited to a few days after treatment . Clinical ly important changes in haemoglobin are rare OBJECTIVE The purpose of this study was to compare the psychologic impact and client satisfaction of routine surgical evacuation of the uterus with medical evacuation in cases of spontaneous abortion . STUDY DESIGN This was a prospect i ve , r and omized controlled trial . Two hundred eighteen women who were admitted to a university teaching hospital after spontaneous abortion and who consented to the study were r and omized to routine surgical evacuation  or medical evacuation of the uterus with the use of misoprostol .  General psychologic well-being , level of depression , fatigue symptoms , psychiatric morbidity , social functioning , client satisfaction , and acceptance were measured in the 2 groups . RESULTS The 2 groups did not differ in any of the measured psychological outcomes . Significantly more participants who experienced successful evacuation of the uterus with the misoprostol protocol would choose the same mode of treatment if they were able to choose again . However , participants for whom the medical treatment failed to evacuate the uterus and subsequent surgical evacuation was required are significantly less satisfied with the treatment . CONCLUSION Medical treatment of spontaneous abortion with misoprostol is psychologically safe and more compatible with the ethnomedical beliefs of our Chinese participants .  Client satisfaction and acceptance should be taken into consideration in the evaluation of treatment outcomes OBJECTIVE To evaluate serial hormone concentrations in subjects treated with vaginally administered misoprostol for early pregnancy failure . DESIGN As part of a r and omized clinical trial , serum was collected on treatment days 1 , 3 , 8 , and 15 . SETTING Multicenter clinical trial . PATIENT(S ) Women with a nonviable first-trimester pregnancy . INTERVENTION(S ) Serum concentrations of human chorionic gonadotropin ( hCG ) , progesterone , and sex hormone binding globulin ( SHBG ) were evaluated . MAIN OUTCOME MEASURE(S ) A logistic regression model was constructed to assess the associations of percent and complete expulsion of the gestational sac and /or successful management . RESULT ( S ) The percent change from the day of treatment until the first follow-up visit was predictive for complete expulsion for progesterone ( P ) ( P<.005 ) and hCG ( P<.005 ) , but not for SHBG . The actual value was not significantly associated with complete expulsion or successful management . A decrease ( day 1 - 3 ) of 79 % for both hCG and P was associated with a 90 % probability of complete passage of the gestational sac . A 90 % probability of successful management was noted if P decreased by 78 % on day 3 or 59 % on day 7 , or hCG decreased by 74 % on day 3 or 78 % on day 7 compared with pretreatment values . CONCLUSION ( S ) Percent change , but not absolute change , in serial hormone values are strongly associated with both the complete expulsion of the gestational sac with one dose of misoprostol and ultimate success BACKGROUND The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process . Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is therefore performed . METHODS We performed a cost-minimization analysis alongside a multicentre r and omized trial . Clinical data and data on the use of medical re sources were obtained from a r and omized trial comparing misoprostol and curettage , which had shown that misoprostol reduced the need for curettage in 53 % . In a sensitivity analysis the percentage of women who needed curettage after misoprostol varied between 25 and 90 % . RESULTS Direct costs per case were significantly lower in the misoprostol group ( mean 433 ) than in the curettage group ( mean 683 ) ( mean difference 250 , 95 % CI 184 to 316 , P < 0.001 ) . These significant differences existed under a wide range of alternative assumptions about unit costs . The differences in direct cost in favour of misoprostol were large for women who had complete evacuation after initial misoprostol treatment as compared to those who needed additional curettage after failed misoprostol .  Mean indirect costs were equal for both groups ( misoprostol mean 486 ; curettage mean 428 ; mean difference 60 , 95 % CI -61 to 179 , P = 0.51 ) . The mean total costs for a strategy starting with misoprostol was 915 versus 1107 for curettage , with a mean difference between both groups of 192 ( 95 % CI 33 to 351 , P = 0.04 ) . An increase of the complete evacuation rates for initial misoprostol therapy to 90 % in the sensitivity analysis increased the cost difference between misoprostol and curettage to 550 . CONCLUSION The use of misoprostol for early pregnancy failure after failed expectant management is less costly than curettage Objectives To compare fertility rates after the three methods of managing early miscarriage in women recruited to the MIST ( miscarriage treatment ) r and omised controlled trial . Setting Early pregnancy clinics of acute hospitals in the south west region of Engl and . Participants 1199 women who had had an early miscarriage ( < 13 weeks ) confirmed by scan . Intervention Expectant , medical , or surgical management . Main outcome measures Self reported pregnancy rates and live birth rates . Results Of 1199 women recruited to the trial , 1128 consented to follow-up . Of these , 762 women replied giving pregnancy details ( 68 % response rate ) . Respondents were representative of the trial participants . The live birth rate five years after the index miscarriage was similar in the three management groups : 177/224 ( 79 % , 95 % confidence interval 73 % to 84 % ) in the expectant management group , 181/230 ( 79 % , 73 % to 84 % ) in the medical group , and 192/235 ( 82 % , 76 % to 86 % ) in the surgical group . There was also no significant difference according to previous birth history . Older women and those with previous miscarriages were significantly less likely to subsequently give birth . Conclusion Method of miscarriage management does not affect subsequent pregnancy rates with around four in five women giving birth within five years of the index miscarriage . Women can be reassured that long term fertility concerns need not affect their choice of miscarriage management . Trial registration National Research Register N0467011677/N0467073587 Objective To estimate and compare the costs of  surgical and medical treatment of miscarriage to the National Health Service OBJECTIVES To assess if there was any potential relationship between endometrial thickness and final treatment outcome in women successfully treated with misoprostol for a first trimester anembryonic gestation , embryonic demise or fetal demise . METHODS Eighty women were treated with up to two doses of misoprostol 800 microg vaginally for early pregnancy failure . Subjects were scheduled to return 2 ( range 1 - 4 ) , 7 ( range 5 - 9 ) and 14 ( range 12 - 17 ) days after treatment .  Transvaginal ultrasonography  was performed at each follow-up visit . RESULTS The median endometrial thickness at each of the follow-up visits for women who had expelled the gestational sac was 14 mm , 10 mm , and 7 mm , respectively . The endometrial thickness at the first follow-up visit exceeded 15 mm in 20 subjects ( 36 % ) and 30 mm in four subjects ( 7 % ) . Only three women had a suction aspiration for bleeding after documented expulsion . The endometrial thickness for these women was 11 , 13 , and 14 mm at the first follow-up visit . CONCLUSIONS There is no obvious relationship between increasing endometrial thick 
    Output:
    
Limited evidence suggests that women generally seem satisfied with their care .
The available evidence suggests that medical treatment , with misoprostol , and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service re sources to support all three approaches .