Assessing the Effectiveness and Safety of Surgical and Medical Management in First-Trimester Pregnancy Loss

INTRODUCTION: To compare the short- and long-term outcomes of medical (misoprostol) and surgical (vacuum aspiration) management in patients with first-trimester pregnancy loss.
METHODS: This retrospective cohort study included patients diagnosed and treated for spontaneous abortion under 14 gestational weeks between January 2019 and January 2025 at a tertiary center. Patients were divided into two groups according to treatment modality: Medical (misoprostol) or surgical (vacuum aspiration). Demographic characteristics, treatment success rates, hospitalization duration, hemoglobin/hematocrit changes, complication rates, and subsequent fertility outcomes were compared.
RESULTS: A total of 368 patients were included, with 114 receiving medical treatment and 254 undergoing surgical management. The overall success rate was significantly higher in the surgical group (99.2%) compared with the medical group (50%) (p<0.001). The surgical group had a shorter hospital stay (p=0.014), lower hemoglobin drop (p<0.001), and fewer complications (p=0.01). The most common complications in the medical group were retained products of conception and pelvic infection. Treatment success was consistently higher with surgical management across both missed and incomplete abortion subtypes (p<0.001).
DISCUSSION AND CONCLUSION: Surgical management with vacuum aspiration appears more effective and safer than medical management with misoprostol for first-trimester pregnancy losses. These findings may support individualized decision-making based on gestational age, clinical stability, and resource availability. Limitations include the retrospective design and lack of standardized misoprostol protocols.

Keywords: Fertility outcome, first-trimester pregnancy loss, misoprostol, pregnancy loss, treatment outcome, vacuum aspiration.