Medical termination of missed abortion

Abstract

Missed abortions are a common occurrence and represent a heavy gynaecological emergency workload to both medical and nursing staff. The conventional method using vacuum aspiration of uterus is associated with morbidity and mortality. Medical termination of pregnancy is accepted as a safe and effective alternative method. However, medical evacuation of uterus in missed abortions had not been fully investigated. In this study we hope to examine the efficacy of medical methods for terminating missed abortions. Mifepristone and misoprostol prescribed to 100 women with an ultrasonically confirmed missed abortion was compared with 100 women who had surgical evacuation under general anaesthesia for their missed abortion. The disparity in complications between medical and surgical groups was not significantly different (Student's t-test, P=0.5). This study showed medical evacuation of missed abortion to be an effective, safe and cost-effective, alternative to surgical evacuation of the uterus and is particularly suited to women not wanting hospital admission or a surgical procedure under general anaesthesia. It represents an option of management that can be less intrusive and gives the woman some control but is both safe and effective.

Medical versus surgical treatment for early pregnancy loss in infertile patients: Which approach facilitates more rapid return to subsequent treatment cycle?

“…This was not statistically significant. While other studies have confirmed procedure success using a follow-up ultrasound to rule out the presence of RPOC or to confirm endometrium thickness ˂ 15 mm [2,4,7], this was to our knowledge new information and is quite helpful in the counseling of our patients.…”

“…Patient satisfaction is higher in patients treated with misoprostol compared to D & C [3,12]. Medically treated women experience a few more days of bleeding [7] and pain [2] controlled by either oral or intramuscular analgesia. Although there are clear differences in these managements, neither of the treatment options has been reported to affect future fertility [12].…”

“…Miscarriage is the most common gynecological emergency (accounting for 75% of gynecological Emergency Room Visits in the United Kingdom [2]; and two previous studies demonstrated that 15% of patients who miscarry do so spontaneously in the first trimester [3,4]. Approximately one in four women will have an early pregnancy failure during her lifetime [4].…”

Role of Misoprostol in Missed Abortion

“…10,11 Most of the reports shown misoprostol to be relatively safe for use in women with 1 st and 2 nd trimester and even in women with prior caesarean section . 42 Misoprostol is widely available. It is of low cost and stable at room temperature.…”

Comparison Between Sublingual and Vaginal Administration of Misoprostol in Management of Missed Abortion

“…Transvaginal ultrasound was repeated after 24 h after the last dose and after expulsion of parts of conception to assure complete evacuation of the uterine cavity. The absence of remnant of conception or endometrial interface thickness less than 15 mm is mandatory to diagnose complete abortion [14].…”