A 28-year-old woman who has never been pregnant missed a menstrual period 4 weeks ago, an unusual circumstance for her. She has been using a barrier method of contraception. Until the past week she noticed nausea, but yesterday she passed much blood and now says she feels better, although she is still bleeding. Her beta-hCG level was 2,500 mIU, but the test was repeated 48 hours later and the level found to be 1,000 mIU. Pelvic examination is negative for adnexal mass and tenderness. Transvaginal pelvic ultrasound reveals ntrauterine tissue. You diagnose missed spontaneous abortion. The patient’s vital signs are normal and her hemoglobin is within normal limits. She is not seriously concerned and in little pain. Which of the following is the best decision for management in the near future?
(A) Expectant observation
(B) Intravaginal misoprostol, 800 g
© Surgical evacuation of the uterus
(D) Naproxen, 500 mg twice daily if needed to control uterine cramps
(E) Initiation of oral contraceptive medication