A comparative study of misoprostol versus surgical management of incomplete and missed miscarriage

Verma, Monica; Thakur, Vibhuti; Awasiya, Pratibha

doi:10.18203/2320-1770.ijrcog20163506

Cited by 5 publications

(6 citation statements)

References 4 publications

(6 reference statements)

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“…The success rate observed in the misoprostol group is similar to that reported by Tasnim and colleagues in Pakistan [7] , Shuaib and Alharazi in Egypt [8] , Shaheen and colleagues in Pakistan [9] and Tahir and Aamir [10] . Similarly, Verma and colleagues [11] ; Ibiyemi and colleagues [12] ; Abdulmajeed and colleagues [13] found that success rate was in the range of 83-97% in misoprostol group and 95-99% in MVA group, our results were comparable with these studies. The high success rate observed in the misoprostol group suggests that the medical management of missed abortion in a well selected patient is an effective alternative to MVA.…”

Section: Discussionsupporting

confidence: 89%

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Allakany

2021

The Medical Journal of Cairo University

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Background: Manual vacuum aspiration (MVA) is a safe and effective technology for the treatment of missed miscarriage but it is not widely available and affordable in rural areas particularly in low resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of missed miscarriage. Aim of Study:The purpose of this study was to compare the effectiveness, patient satisfaction and hematocrit drop of misoprostol versus MVA to understand the potential role of misoprostol as a first line for treatment of first trimester missed miscarriage.Patients and Methods: A Randomized Controlled Trial was conducted from January 2020 to January 2021 at Mansoura University Maternity Hospital. Included 70 participants were randomized to treatment with either MVA or 800 µg vaginal misoprostol. The main outcome measures assessed at 1 week follow up were complete uterine evacuation, patient's acceptability and satisfaction.Results: There is no statistically significant difference between studied groups regarding success rate and mean patient satisfaction score immediately and after one week, 82.9% of misoprostol group and 94.3% of MVA group successes. The mean hemoglobin and hematocrit after treatment illustrated statistically significant lower mean value among misoprostol group than MVA group (10.07 & 10.91, respectively for Hb) and (30.75 & 33, respectively for hematocrit value). Hemoglobin drop for both groups illustrated no statistically significant difference between studied groups. There is statistically significant negative correlation between endometrial thickness/mm and satisfaction after one week among both group. Conclusion:Both misoprostol and MVA had high rates of satisfaction and complete uterine evacuation, which could ultimately reduce maternal complications from abortion. Medical treatment is as effective as surgical treatment of first trimester missed miscarriages.Recommendations: Although misoprostol is a very effective drug, the health care professional should have thorough knowledge of the dose, side effects, complications and con-

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Section: Discussionsupporting

confidence: 89%

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Allakany

2021

The Medical Journal of Cairo University

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“…In our study, success rate in Misoprostol group was 88 % and in MVA group, it was 98 %, the difference is not statistically significant. In similar studies 6,11,12 , success rate was in the range of 83-97% in Misorprostol group and 95-99% in MVA group. Our results were comparable with these studies.…”

Section: Discussionmentioning

confidence: 74%

“…4,5 Many studies have proposed medical treatment with misoprostol as an effective alternative to conventional surgical treatment for missed abortion. [6][7][8][9][10][11][12] Misoprostol, due to the ease of handling and storing it, as well as its non-invasiveness and proven cost-effectiveness, offers several advantages within abortion care. It reduces the need for skilled surgical abortion providers, equipment, sterilization and anaesthesia, while offering a highly acceptable option to pregnant individuals.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks

Swati¹,

Sonali

Shrinivas

et al. 2020

Nepal J Obstet Gynaecol

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Aims: To compare the safety and efficacy of Misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks. Methods: This is comparative study where Misoprostol 800 μg was administered sublingually four hourly till expulsion of products or maximum of three doses in one group and 400 μg misoprostol followed by manual vacuum aspiration 4 hours later was done under local anaesthesia in another group from October 2019 to March 2020 at Government Medical College and Hospital, Aurangabad, Maharashtra. Unpaired t-test and Chi squared test were performed with alpha-error set at 0.05. Results: The success rate in Misoprostol group was 88 % and in the MVA group, it was 98%. Mean duration of hospital stay in Misoprostol group was 2.46±1.18 days and in MVA group was 1.55 ± 1.52 days (p= 0.3). Mean induction abortion interval in Misoprostol group was 8.125±3.29 and 4.46±0.44 hours in MVA group (p=0.000). One woman from MVA group had perforation of uterus which could be attributed to previous LSCS with tight os. Conclusion: Single dose of Misoprostol followed by manual vacuum aspiration is better than the multiple dosage of Misoprostol for the treatment of first trimester missed abortion in terms of duration of treatment but not for the individual success rate. Hospital stay is similar. Keywords: manual vaccum aspiration, misoprostol, missed abortion

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“…This was consistent with ndings in a study done in Nepal where 77% of the patients managed surgically reported severe pain (18). Another study in India also showed that up to 98% of patients managed surgically experienced excruciating pain while only 28% of those managed medically reported pain that was cramp like in nature (21). According to the same study, the pain during MVA can be so severe to cause vasovagal syncope that may lead to irreversible shock if not recti ed early as it was experienced in 1 of the participants in the same study.…”

Section: Discussionmentioning

confidence: 89%

Outcomes of Medical versus Surgical Management of Incomplete Abortion in Uganda. an Open Labeled Randomized Clinical Trial

Otieno

Byonanuwe

Bonet

et al. 2022

Preprint

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Background: Management decision on whether to use medical or surgical method in women diagnosed with incomplete abortion particularly in the first trimester has been a controversial topic in Uganda and the world in general with no local studies comparing effectiveness and secondary outcomes between the two approaches. This has posed a big challenge to the attending clinicians as regards making informed management options when encountered with such cases.Methods: A five months prospective open labeled randomized clinical trial involving 100 consecutively recruited participants was conducted from June 1st, 2018 to October 30th, 2018. Ethical clearance was obtained from KIUREC and UNCST. Data collection was achieved using an investigator administered questionnaire; in-depth face to face interviews as well as laboratory and ultrasound scan report forms. Baseline demographic and clinical characteristics were assessed using univariate analysis. Statistical difference was considered when p<0.05. Numerical variables were summarized using means, medians for non-normally distributed variables, and frequencies or proportions for categorical variables. All statistical analysis was carried out using IBM SPSS Statistics software version 23.0. Results: The effectiveness of surgical management was higher than that of medical management (RRR=11.7%; p=0.043). Majority in the medical arm reported mild pain (64% vs 4%; p<0.001) while most of those in surgical arm reported severe pain (78% vs 8%; p<0.001). Bleeding was prolonged in the medical arm method with majority of those in surgical arm reporting bleeding for less than six hours (94% vs 46%; p=0.0002). Although medical method had longer bleeding, it was associated with lesser symptoms of headache, dizziness, syncope and blood transfusion. 90% of those in medical arm and only 50% of those in surgical method would recommend the method assigned (p<0.001). Fever, chills and nausea were more common in medical method. Average hospital stay was longer in medical method (p=0.03). Only one participant in surgical arm developed infection while no patient had genitourinary trauma. There was no statistical significant difference between the satisfaction levels in the two arms. Conclusion: Surgical management is more effective than medical management. Although medical management has prolonged expulsion bleeding, prolonged hospital stay and increased fevers, chills and nausea that are self-limiting; it has reduced pain. Most patients are satisfied with and would recommend medical management.

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A comparative study of misoprostol versus surgical management of incomplete and missed miscarriage

Cited by 5 publications

References 4 publications

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Safety and efficacy of misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks

Outcomes of Medical versus Surgical Management of Incomplete Abortion in Uganda. an Open Labeled Randomized Clinical Trial

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