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First trimester failure is a common event accruing in 15-20% of pregnancies that has traditionally been treated by surgical curettage. An alternate therapy is medical treatment using misoprostol, a synthetic analog of prostaglandin E1. Numerous studies have been carried out comparing treatment by misoprostol with a placebo. They have found a significant advantage to misoprostol mode of treatment. Other studies comparing surgical and medical treatment found the surgical treatment to be superior to the latter. It must be noted that the medical mode of treatment was indeed found to be successful in over 80% of cases. No significant differences were noted in the complication rates of the two groups. Misoprostol therapy has been found to be effective when administered orally or vaginally, although vaginal therapy is slightly superior. No large scale studies have been carried out to date testing the safety of this treatment in patients with a scarred uterus (due to Cesarean section or hysterotomy). However, on the basis of reported facts, it seems plausibLe to suggest misoprostoL treatment for these patients.

Cervical carcinoma is one of the most common malignancies diagnosed during pregnancy since about 30% of diagnosed women are in their fertile years. Diagnosis of cervical cancer during pregnancy superimposes ethical dilemmas on the clinical considerations. Both maternal and fetal outcome should be considered when managing such a case. Is it necessary to discontinue the pregnancy? What are the implications of delayed treatment? How does the treatment affect the fetus and newborn? This article reviews the practical aspects of these issues and suggests management proposals.