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.