Role of oral misoprostol in first trimester pregnancy failure

ABSTRACT

To prove the effectiveness and safety of oral Misoprostol in first trimester pregnancy failure. Prospective interventional study. Obstetrics and Gynaecology department, Fatima Memorial Hospital Lahore. A period of 4 months from June 2006 to September 2006. A total of 64 women at 7 to 12 weeks of gestation with confirmed pregnancy failure were enrolled. Every woman included in the study was prescribed tablet Misoprostol 400 ugm by oral route followed by 200 ugm every 4 hourly up to 4 doses and instructed to report back in case of side effect such as nausea, vomiting abdominal pain or vaginal bleeding. Follow up was scheduled on day 2 and day 7. The course of same regimen was repeated if process did not start in 48 hours. Dilatation and curettage was done in case of incomplete expulsion or heavy bleeding. Major outcome measures were complete expulsion rate, need for surgical evacuation and cervical dilatation and side effects. Forty seven [73.43%] women had complete expulsion at one week while 43.75% [28] achieved it within 48 hours. Fifteen [23.43%] women needed surgical intervention out of which 40% needed cervical dilatation prior to evacuation. Forty [62.50%] women had pre-abortion bleeding which was mild to moderate in nature in 82% of cases while 53.12% [34] had abdominal pain. Rest of the side effects were transient and well tolerated. Oral Misoprostol is safe and effective mode of medical management for first trimester pregnancy failure and repeating the second course after 48 hours has significantly increased expulsion rate