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

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 μg 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.