Treatment Response and Safety Profile of Combined Intravaginal Misoprostol and Intracervical Foley Catheter in Second-Trimester Missed Abortion

Open Access

Abstract

Introduction: Second-trimester missed abortion is associated with increased risks of hemorrhage, infection, prolonged induction, and incomplete expulsion. Misoprostol is widely used for medical management; however, the addition of an intracervical Foley's catheter may enhance cervical ripening and improve treatment outcomes. Aim of the Study: To determine the treatment response and safety profile of combined intravaginal Misoprostol and intracervical Foley's catheter in the management of second-trimester missed abortion. Methods & Materials: This single-arm descriptive study was conducted in the Department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, between January 2023 and June 2024. A total of 53 women aged 18-35 years with missed abortion between 13 and 24 weeks of gestation received 400 µg intravaginal Misoprostol combined with an intracervical Foley's catheter. Treatment outcomes included successful expulsion, induction-expulsion interval, Misoprostol dose requirement, need for surgical intervention or additional uterotonics, blood transfusion, and adverse effects. Data were analyzed using descriptive statistics and presented as frequency, percentage, mean, and standard deviation. Results: The mean age and gestational age were 26.13 ± 5.16 years and 16.92 ± 2.02 weeks, respectively. Successful expulsion was achieved in 51 participants (96.2%), while 2 (3.8%) had failed expulsion. The mean induction-expulsion interval was 13.27 ± 3.83 hours, with most participants (58.5%) achieving expulsion within 12-18 hours. Among successful cases, the mean number of Misoprostol doses required was 2.98 ± 0.65, and most participants (58.8%) required three doses. Surgical intervention and additional oxytocin were required in 2 participants (3.8%) each. Overall, 24 participants (45.3%) experienced at least one side effect, most commonly nausea/vomiting (13.2%) and diarrhea (11.3%). Blood transfusion was required in 4 participants (7.5%). Conclusion: Combined intravaginal Misoprostol and intracervical Foley's catheter demonstrated a high rate of successful expulsion with a favorable induction-expulsion interval, low requirement for surgical intervention, and an acceptable safety profile in women with second-trimester missed abortion.