A Comparative Study to Evaluate the Efficacy of Vaginal vs Oral Prostaglandin E 1 Analogue (Misoprostol) in Management of First Trimester Missed Abortion

摘要

Introduction: Missed miscarriages, occurring in upto 15% of allclinically recognized pregnancies are a cause of concern for thepatients. Though many researchers in the past have comparedthe surgical and medical approaches in management of suchpatients, only a few have executed an appraisal of two routesof misoprostol at equal dosages in treatment of first trimestermissed miscarriages.Aim: To compare the efficacy of misoprostol by vaginal and oralroute, for the management of first trimester missed abortion;and to recognize the utility of misoprostol for cervical dilationprior to any surgical termination of pregnancy.Materials and Methods: A randomized prospective trial,comparing the efficacy of misoprostol, by vaginal and oralroutes, for termination of first trimester missed abortion wasconducted in the Department of Obstetrics and Gynecology,Government Multi-Specialty Hospital, Chandigarh over oneyear. Hundred subjects satisfying the inclusion criteria from 213consecutive women presenting to the institute with first trimestermissed abortion were hospitalized. The study participantswere randomly assigned to one of the two treatment groups,using sequentially numbered envelopes, to receive 400mcgmisoprostol vaginally or orally to a maximum of three dosessix hours apart, and outcome documented. Patients werefollowed up on Day 14 and 6 weeks after discharge. Primaryoutcome evaluated was drug-induced complete expulsion ofProducts of Conception (POCs). Secondary outcomes measuredwere induction expulsion interval, number of doses required,classification of failures, cervical canal permeability in womenrequiring surgical evacuation, side effects, hemoglobindrop, duration and amount of post-abortal bleeding, time ofresumption of menses, experience with side effects, patientsatisfaction and acceptability to treatment.Results: Both routes were highly effective (vaginal=92%,oral= 74%, p=0.032), safe and acceptable with tolerable sideeffects. The mean time to expulsion was longer (13.24hrs) inthe oral than vaginal group (10.87hrs). All 4 unsuccessful casesin vaginal group and 12 of 13 in oral group had permeablecervices prior to surgical evacuation. Most women labeled theside effects as tolerable in both the groups. Overall acceptancerate to treatment was high in both the groups A and B (76%and 70%).Conclusion: Vaginal misoprostol is more effective than oralmisoprostol for first trimester missed abortion.