Vaginal misoprostol in the management of first trimester non-viable pregnancy

ABSTRACT

To study the effectiveness of a regimen of repeated doses of vaginal misoprostol in the management of first trimester missed abortion, one hundred and four pregnant women with first trimester non-viable pregnancies were treated with an initial dose of 800 ! g of vaginal misoprostol followed after four hours by further doses of 400 ! g four-hourly for a maximum of three doses. The complete expulsion rate was 85.6%. Fifty of the 104 [48.1%] women underwent surgical evacuation. In 14 [13.5%] women, gestational products were obtained and confirmed by histopathological examination. In 36 [34.6%] there were minimal or no products obtained and these were considered to be complete miscarriages. The cervical os was found open in all [13.5%] the incomplete miscarriages. Severe abdominal pain was experienced by 10.6% of the patients and excessive vaginal bleeding occurred in 13.5% of them. A fall in hemoglobin of more than one gram/dl occurred in 5.8% of the women and another 5.8% of them had fever >38°C. The stay in hospital was two days for 87 [83.7%] women and three days for 15 [14.4%] women. One [1%] woman stayed four days and another stayed less than one day. None of the women had any complications. This study demonstrated the efficacy and safety of vaginal misoprostol as a medical treatment for first trimester non-viable pregnancies using an initial dose of 800 ! g, followed after four hours by further doses of 400 ! g four-hourly for a maximum of three doses. This management also provided adequate cervical dilatation for surgical evacuation when complete expulsion did not occur