Comparative Effectiveness of Pregnancy Failure Management Regimens

Inclusion Criteria: * between 5 and 12 completed weeks gestation * 18 years or older * hemodynamically stable * confirmed diagnosis of intrauterine embryonic/fetal demise or anembryonic gestation (ultrasound examination demonstrates a fetal pole without cardiac activity measuring between 5.3 and 40 mm or an abnormal growth pattern diagnostic of early pregnancy failure) * willing and able to give informed consent Exclusion Criteria: * diagnosis of incomplete or inevitable abortion (absent gestational sac and/or active bleeding, open cervical os) * contraindication to mifepristone (chronic corticosteroid administration, adrenal disease) * contraindication to misoprostol (glaucoma, mitral stenosis, sickle cell anemia, or known allergy to prostaglandin) * cardiovascular disease (angina, valvular disease, arrhythmia, or cardiac failure) * most recent hemoglobin \<9.5 g/dL * diagnosis of porphyria * known clotting defect or receiving anticoagulants * pregnancy with an intrauterine device (IUD) in place * breastfeeding during the first 7 days of study participation * unwilling to comply with the study protocol and visit schedule * any evidence of viable pregnancy * possibility of ectopic pregnancy * known or suspected pelvic infection * concurrent participation in any other interventional trial