A Comparative Study of Misoprostol Versus Surgical Management of Incomplete and Missed Abortion in Early First Trimester

Abstract

BACKGROUND Safe and effective treatment for incomplete abortion is an important way to reduce abortion related morbidity and mortality. Medical methods for treatment of incomplete abortion require few resources, are cost effective and can be administered by low and midlevel providers. Surgical methods are highly effective for treatment of incomplete abortion. The aim of this study is to compare efficacy of using vaginal Misoprostol for management of incomplete and missed abortion in ≤ 9 weeks of pregnancy as an alternative to surgical evacuation in our setting and also to assess the patient acceptability and satisfaction for the medical method with surgical method in the same. MATERIALS AND METHODS This is a randomised controlled trial performed on randomly divided 100 patients with missed and incomplete abortion in ≤ 9 weeks in two groups. On the basis of previous study, the success rate of medical group being 80.7% and 100% in surgical group. Group one received Misoprostol tablet 800 mcg single dose per vaginally and second group underwent surgical vaginal evacuation directly under sedation. Both groups were compared in terms of success, complications, pain and patient's satisfaction. RESULTS In medical treatment group, success rates were 92% as compared to surgical group which had 98% success rates. Bleeding was more and prolonged in the patients managed by Misoprostol, 36% patients had moderate bleeding, but no patient required hospitalisation. Though bleeding was less in the surgical group, but all of them required the use of sedation and antibiotics. In the Misoprostol group 56% were very satisfied, while in surgical group 22% were moderately satisfied according to VAS score. CONCLUSION Misoprostol is effective in complete evacuation of uterus in both incomplete and missed abortion. It is as effective as surgical evacuation with much more patient satisfaction, especially where demand for services is high, but availability of skilled providers and resources is often scarce.