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Medical management of early pregnancy failure in a patient with coronary artery disease.

Hackney DN, Creinin MD, Simhan H

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. dhackney@mail.magee.edu

OBJECTIVE: To describe a case of early pregnancy failure in a patient who was not an optimal candidate for suction aspiration because of her body habitus and history of a myocardial infarction that was treated medically with misoprostol. DESIGN: Case report. SETTING: Academic tertiary-care hospital. PATIENT: A 43-year-old woman with morbid obesity, coronary artery disease, previous myocardial infarction, obstructive sleep apnea, and other medical problems who presented with an early pregnancy failure. INTERVENTION: Medical management with 800 microg of vaginal misoprostol in an inpatient setting with cardiac monitoring. MAIN OUTCOME MEASURE(S): Ultrasonographic resolution of intrauterine pregnancy, vaginal bleeding, and cardiac events. RESULT(S): No gestational sac was visualized by ultrasound on the second hospital day, the patient's hemoglobin value at discharge was 12.1 mg/dL, and no adverse cardiac events occurred. CONCLUSION(S): Medical management with misoprostol on an inpatient basis is a possible alternative to dilation and curettage in patients with complex medical problems and early pregnancy failure.

Published 6 July 2007 in Fertil Steril, 88(1): 212.e1-3.
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