A comparative study of misoprostol versus surgical management of incomplete and missed miscarriage
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20163506Keywords:
Incomplete abortion, Missed abortion, Misoprostol, Vaginal evacuationAbstract
Background: The aim of this study is to assess the effectiveness and acceptability of using vaginal Misoprostol for management of spontaneous incomplete and missed miscarriage as an alternative to direct vaginal surgical evacuation in our setting and also to compare the efficacy and patient satisfaction of the medical method with surgical method in same.
Methods: this is a prospective comparative study performed on randomly divided 200 patients in two groups. Each group of patients are case of missed or incomplete abortion in first trimester.(5-12 weeks). Group one received Misoprostol tablet 600 mcg single dose per vaginally, and second group underwent surgical vaginal evacuation directly under local anesthesia (para-cervical block . both groups were compared in terms of success, complications, pain and patient satisfaction.
Results: 97% success rates were obtained in the medical treatment group. Surgical group had 95% success rates. 3 patients underwent repeat surgical evacuation in the medical group. Bleeding was more and prolonged in the patients managed by Misoprostol, 27% patients had moderate bleeding. Though bleeding was less in the surgical group but there was excruciating pain and weakness as the procedure being done under local anesthesia, 98% patients experienced pain in surgical group. Satisfaction rates in the misoprostol group were 100%.
Conclusions: Misoprostol is effective in complete evacuation of uterus in incomplete and missed miscarriage. Patients are highly satisfied with the misoprostol treatment as they didn’t have to get hospitalized. The bleeding was more or less like menstrual bleeding which did not affect the daily chores of the women. It is as effective as surgical evacuation and patient satisfaction is much more than the surgical evacuation.
References
Steer C, Campbell S, Davies M, Mason B, Collins WP. Spontaneous abortion rates after natural and assisted conception. BMJ. 1989;299:1317-8.
Gilda S, Jonathan B, Susheela S, Akinrinola B, Popinchalk A, Ganatra B, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. The Lancet. 2016.
Sedgh G, Singh S, Shah IH, Ahman E, Henshaw K, Bankole A. Induced abortion: Incidence and trends worldwide from 1995 to 2008 (PDF). The Lancet. 2012;379(9816):625-32.
Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE. Unsafe abortion: the preventable pandemic. Lancet. 2006;368:1908-19.
Singh S. Hospital admissions resulting from unsafe abortion: Estimates from 13 developing countries. Lancet. 2006;368:1887-92.
Lohr PA, Fjerstad M, Desilva U, Lyus R. Abortion. BMJ. 2014;348:f7553.
Shah I, Ahman E. Unsafe abortion: global and regional incidence, trends, consequences, and challenges (PDF). J Obstet Gynaecol Can. 2009;31(12):1149-58.
Madagascar: Adapting the 400 mcg sublingual misoprostol regimen for PAC into national reproductive health norms. A large maternity hospital in Madagascar recently completed a study comparing a 400 mcg sublingual dose to a 600 mcg oral dose of misoprostol for treatment of incomplete abortion.
Shokry M, Fathalla M, Hussien M, Ashraf A. Eissa Vaginal misoprostol versus vaginal surgical evacuation of first trimester incomplete abortion: Comparative study. Middle East Fertility Society Journal. 2013.
Teixeira-da-Silva BJ, Campos I. Vaginal misoprostol in the management of first-trimester missed abortions. International Journal of Gynecology and Obstetrics. 2000;71:53-7.
Addisso A, Jacobsen G, Sandhu R. Medical management of non-viable early first trimester pregnancy. Int J Gynaecol Obstet. 1999;67:9-13.
Chung TK, Lee DT, Cheung LP. Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol. Fertil Steril. 1999;71(6):1054-9.
Unedited Draft Report of the 17th Expert Committee on the Selection and Use of Essential Medicines. Geneva, Switzerland: World Health Organization. 2009.
Neilson JP, Gyte GM, Hickey M, Vazquez JC, Dou L. Medical 226 treatments for incomplete miscarriage (less than 24 weeks). 227 Cochrane Database Syst rev. 2010(1):CD007223. http://dx.doi.org/10.1002/14651858. CD007223.pub2. Review. Update in: http://www.ncbi.nlm.nih.gov/pubmed/23543549 Cochrane Database Syst Rev. 2013(3):CD007223.
