Comparative Study of Oral versus Vaginal Misoprostol in Management of Missed Abortion

Résumé

Introduction: Missed abortion is a complication of pregnancy, which is usually evacuated surgically. But  now it seems that medical methods such as oral/vaginal misoprostol are quite effective in expulsion of  product of conception. The present study was done to compare the effectiveness of oral versus vaginal  misoprostol in missed abortion. Methods: A total of 60 patients with missed abortion were studied in Begum  Khaleda Zia Medical College and Shaheed Shurawardy Hospital, Dhaka, from May 2008 to December  2008. Among 60 patients, 30 patients were given oral misoprostol and another 30 patients were given  vaginal misoprostol; selection was done randomly using two different colored cards in sealed envelopes.  Results: Patients of oral misoprostol group needed mean dose of 2.33 ± 0.71 tablets i.e. about 400 μg of  misoprostol, whereas patients of vaginal misoprostol group needed mean dose of 2.26 ± 0.78 tablets i.e.  approximate 400 μg of misoprostol, resulting in spontaneous expulsion in 53.3% in oral group and 60% in  vaginal misoprostol group. Mean medication to expulsion time was 9.26 ± 2.69 hours in oral group and 9.73  ± 1.91 hours in vaginal group. There is no significant difference in effectiveness between oral and vaginal  route of administration of misoprostol. However, a large number of patients (33-40%) needed surgical  evacuation due to incomplete expulsion of product of conception and about 7% patient needed surgical  evacuation for failed expulsion. Conclusion: From the result of this study it is suggested that oral or vaginal
misoprostol may be used as first option for the treatment of missed abortion after proper counseling about  the failure rate and side effect.