- If uterine size at the time of treatment is equivalent to a pregnancy of gestational age 13 weeks or less, either vacuum aspiration or treatment with misoprostol is recommended for women with incomplete abortion. The recommended regimen of misoprostol is a single dose given either sublingually (400 μg) or orally (600 μg).
(Strength of recommendation: strong)
- Expectant management of incomplete abortion can be as effective as misoprostol, but the process takes more time. The decision for treatment or expectant management of incomplete abortion should be based on the clinical condition of the woman and her preferences for treatment.
- This recommendation is extrapolated from research conducted in women with reported spontaneous abortion. Missed abortion is a different condition from incomplete abortion following either spontaneous or induced abortion.
- Based on the recommendation for surgical abortion through the first trimester, vacuum aspiration may also be used in women with a uterine size of 14 weeks of gestation.
- Misoprostol may also be used vaginally. Studies of vaginal misoprostol have used doses ranging from 400 μg to 800 μg, and comparative dosing trials have not been reported.
- The quality of the evidence based on randomized controlled trials is low.