Management of early missed abortion by methotrexate and/or misoprostol

ABSTRACT

The purpose of this study was to compare the efficacy and side effects of the use of either intramuscular [i.m.] methotrexate or vaginal misoprostol alone or in combination in women with early 1[st] trimester missed abortion. Ninety women with early missed 1[st] trimester intrauterine pregnancy at < 9 weeks gestation were included in this study. The study sample was randomized into 3 groups. The 1[st] group included 30 women who received 50mg/m[2] i.m. methotrexate on day 1 and then followed up at weekly intervals up to day 21. The 2[nd] group included 30 women who received 800 micro g vaginal misoprostol on day 1 and if there was no response on day 4, they received a repeat dose and were reassessed on day 7. The 3[rd] group included 30 women who received 50 mg/m[2] i.m. methotrexate followed 3 days later by 800 micro g vaginal misoprostol and were reassessed on day 7. All women were recruited from the attendants of Gynecology Department, El-Minia University Hospital. Complete abortion occurred in 53.33% in 1[st] group, 86.66% in 2[nd] group and 93.33% in the 3[rd] group. The complete abortion rate in the 3[rd] group was significantly higher than that of both 1[st] and 2[nd] groups [p < 0.05]. The failure rate was 46.66% in 1[st] group, 13.33% in 2[nd] group and 6.66% in the 3[rd] group. No serious side effects were found in all study groups. The combination of methotrexate and misoprostol is more effective method for early missed abortion than when either drug is used alone