The Efficacy of Vaginal Misoprostol in Treatment of Missed Abortions

Missed Abortion is a important obstetric and gynecology complication because of its serious outcomes such as DIC, infection, shock, hemorrhage & death. There are various medical and surgical methods for treatment of missed abortion. Medical treatment of missed abortion is safe, effective, acceptable and an inexpensive alternative. Misoprostal is a synthetic prostaglandin (E1) and recommended by FDA for treatment of missed abortion. There are different views about its safety, dosage and effectiveness.

This study was designed in order to determine the efficacy of vaginal misoprostol for termination of pregnancy in women with missed abortions admitted in Shahid Sadoughi, Madar and Mojibian hospitals of Yazd from 2003 to 2004. The method of study was semi-experimental. (Clinical trial without control group) 50 women with missed abortion and the required criteria (age 15 – 45 years, gestational age ≤ 25 weeks, no previous medical or surgical complication and confirmation of missed abortion on sonography) were selected. The data was collected by a questionnaire filled at the onset of study and after treatment (Misoprostol, (200 micrograms/dose) repeated every 4 hours till expulsion of pregnancy products for maximum of 4 doses).The data analysis was done by statistical tests such as x2 and ANOVA.

The mean duration of medical treatment in the group with complete expulsion (44%) and incomplete expulsion (56%) was 12.63± 9.13 hours and 8.81± 2.9 hours, respectively, which was significantly different. (P value = 0.037). Of the total, 29 women had received two tablets of misoprostol, but the highest rate of complete expulsion was observed in women who had received four tablets. This difference in result was statistically significant. (p ≈ 0.000 ). Observed side effects included headache (26%), nausea (16%), uterine cramps (12%) and diarrhea. (6%) There was no serious complication such as uterine rupture, excessive vaginal bleeding, DIC, prolonged PT or PTT.

This study confirmed that medical evacuation of missed abortion with vaginal misoprostol is an effective, safe and cost efficient method without any serious complications and can be a suitable alternative to surgery.