Outcomes of Early Pregnancy Loss Induced by Sublingual Misoprostol: A Clinical Evaluation

Open Access

Abstract

Background: 15-20% of pregnancies diagnosed are lost in early pregnancy loss, and management can be expectant, medical, or surgical. The study aimed to evaluate the effectiveness and safety of sublingual misoprostol in the treatment of early pregnancy loss. Methods & Materials: The prospective observational study was carried out at Shaheed Suhrawardy Medical College Hospital, Dhaka, from January 2025 to June 2025. One hundred women between 18 and 45 years with ultrasound-diagnosed missed miscarriage at ≤13 weeks gestation were included. Participants were given 600 micrograms of sublingual misoprostol, repeated every 3 hours as required. Complete expulsion was checked by ultrasound on the seventh day after the first treatment. Demographic details, clinical parameters, treatment outcomes, and side effects were recorded and analyzed using SPSS version 20.0. Results: Successful expulsion was achieved in 80% of patients, and most of the expulsions (56%) were between 13-18 hours from initial dosing. The majority of them (61%) required three or more doses of misoprostol, and only 3% were responsive to a single dose. Of the failed ones, 90% had porous services despite incomplete expulsion. The most frequent side effects were nausea (69%), severe pain (40%), and diarrhea (14%), and rare serious adverse effects were excessive bleeding (6%) and hyperpyrexia (5%). The risk factors identified were PCOS (22%), thyroid disease (21%), hypertension (16%), and antiphospholipid antibody syndrome (16%). Conclusion: Sublingual misoprostol offers a safe and less invasive option compared to surgery in the treatment of early pregnancy loss, particularly useful in low-resource settings where surgical facilities are not readily available. Multiple doses are typically required, with expulsion typically 7-18 hours after administration.