Medical treatments for incomplete miscarriage (less than 24 weeks)

Neilson, James P; Gyte, Gillian ML; Hickey, Martha; Vázquez, Juan C

doi:10.1002/14651858.cd007223

Cited by 8 publications

(6 citation statements)

References 48 publications

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“…This study, as has been observed in another study, demonstrated higher cases of pyrexia, nausea and chills among the misoprostol versus the MVA group 19. These symptoms are common side effects of misoprostol, with pyrexia being the most common side effect as a result of the drug’s action (prostaglandin E1 analogue) on the central thermoregulatory centre 22.…”

Section: Discussionsupporting

confidence: 83%

“…The success rate of 600 μg oral misoprostol in this study was comparable with findings from varying dosages and routes of administration of misoprostol used in other studies 8,17,18. Similarly, a recent Cochrane Database Systematic Review that compared different routes of administration of misoprostol with MVA showed no clear evidence to suggest that one regimen was superior to another 19. Contrary to this and other findings, Weeks et al .’s study in Uganda found a slightly higher success rate among the misoprostol group than the MVA group, although the difference was not statistically significant (96.3% versus 91.5%; P = 0.43) 13.…”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital

Ibiyemi

Ijaiya

Adesina

2019

Sultan Qaboos Univ Med J

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Objectives: This study aimed to compare the efficacy of oral misoprostol with manual vacuum aspiration (MVA) in first trimester incomplete abortions. Methods: This randomised controlled trial study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between April 2014 and November 2015. Pregnant women who presented with clinical features of incomplete abortion at a gestational age of 13 weeks or less were included. Patients who had profuse vaginal bleeding, an intrauterine device in situ, signs of pelvic infections or who were younger than 18 years old and had no accompanying adults to give informed consent were excluded. A total of 200 participants were randomly and equally allocated to either the MVA or misoprostol treatment group. The treatment group were given 600 μg of misoprostol orally. The primary outcome measure was complete uterine evacuation, while secondary outcome measures included the need for additional surgical evacuation for failed treatment, adverse effects/complications, acceptability of and satisfaction with the treatment. Results: Both misoprostol and MVA had high complete evacuation rates, yet MVA was significantly higher (99% versus 83%, relative risk [RR]: 0.84, confidence interval [CI]: 0.766–0.918; P <0.001). Significantly more women in the misoprostol group required additional MVA for failed treatment than in the MVA treatment group (17% versus 1%, RR: 16.67, CI: 2.260–12.279; P <0.001). No significant difference was found between the misoprostol and MVA treatment groups in terms of satisfaction (92.7% versus 89.8%, RR: 1.04, CI: 0.946–1.127; P = 0.473). Conclusion: Treatments with misoprostol and MVA had high complete uterine evacuation rates, as well as high rates of acceptability and satisfaction. However, MVA had a significantly higher complete evacuation rate than misoprostol.Keywords: Misoprostol; Abortion Techniques; First Trimester; Incomplete Abortion; Nigeria.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 82%

Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital

Ibiyemi

Ijaiya

Adesina

2019

Sultan Qaboos Univ Med J

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“…El aborto espontáneo e incompleto es una grave preocupación de salud pública, ocurre en 10 a 15% de los embarazos (40) y su falta de tratamiento adecuado puede provocar alta morbilidad e incluso la muerte. El principal peligro del aborto incompleto no infectado es el shock hipovolémico (41) .…”

Section: Resultsunclassified

“…El principal peligro del aborto incompleto no infectado es el shock hipovolémico (41) . Existen diferentes formas de resolver el aborto incompleto mediante métodos quirúrgicos, dentro de los cuales la regla de oro hasta ahora viene siendo la aspiración manual endouterina (42) ; sin embargo, es evidente que el tratamiento médico mediante el uso del misoprostol viene ganando cada vez más terreno y se ha convertido en una opción importante para tal fin, no solo en los embarazos de 12 semanas o menos, sino también en aquellos menores de 22 semanas, lo que libera a la mujer de una intervención quirúrgica y el manejo se hace ambulatoriamente, con el valor agregado de un costo menor (40,(43)(44)(45) . Así mismo, el misoprostol ha sido demostrado como medicamento muy eficaz en el tratamiento del aborto fallido o retenido (46,47) .…”

Section: Resultsunclassified

Regulación del uso obstétrico del misoprostol en los países de América Latina y El Caribe

Orozco

Alvarado²

2013

Rev peru ginecol obstet.

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Objetivos: Actualizar la información sobre regulaciones para el uso obstétrico del misoprostol en América Latina y El Caribe. Metodología: Se elaboró un formato semiestructurado de encuesta, que fue enviado a informantes clave en los países de América Latina y El Caribe. Los informantes consultaron diferentes fuentes en el sector público y privado de cada país. Las encuestas contestadas fueron incorporadas dentro de una base de datos que permitió obtener la frecuencia de cada una de las variables estudiadas. Resultados: De los 19 países a los que se envió la encuesta, 18 respondieron. En el caso de México se utilizó dos formularios, para el Distrito Federal y para el resto del país. Todos los países de América Latina y El Caribe cuentan con regulaciones para usar el misoprostol en obstetricia, mayoritariamente elaboradas por el Ministerio de Salud. El misoprostol está indicado mayormente para la inducción del parto con feto vivo y con feto muerto; pero más de la mitad de los países lo utilizan en la prevención y manejo de la hemorragia posparto, en el manejo del aborto incompleto y en la inducción del aborto dentro del marco legal. La norma se cumple bastante bien en los países, pero también es evidente que mantienen control sobre su uso, puesto que en 11 de ellos se retiene la receta, en dos el uso del medicamento es solo institucional y en uno la receta se retiene ocasionalmente. Los médicos que no usan el medicamento según la Norma lo hacen principalmente por desinformación, falta de capacitación y temor; la objeción de conciencia y la falta de acceso al medicamento están presentes en un tercio de los países. Conclusiones: El misoprostol es un fármaco que se utiliza en todos los países de América Latina y El Caribe, y su uso en obstetricia está regulado. Los profesionales lo vienen usando regularmente según lo establecido en la Norma.Palabras clave: Misoprostol, regulación del uso del misoprostol en América Latina y El Caribe, misoprostol en Obstetricia.

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“…17 The available Cochrane systematic review evidence suggest that expectant care as well as medical treatment with Misoprostol are acceptable alternatives to routine vaginal surgical evacuation. 18 Despite the fact that so many studies prove the benefits of medical treatment, the services go unreached to many strata of population owing to the widespread illiteracy and the unmet availability of resources and trained personnel, that many are lost for follow-up as well as availability of Misoprostol over-the-counter in our country has led to misuse of this wonder drug. Limitations This study was done on a small and restricted population group.…”

Section: Discussionmentioning

confidence: 99%

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

Gupta¹,

Aggarwal²,

Chadha³

et al. 2018

jemds

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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.

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Medical treatments for incomplete miscarriage (less than 24 weeks)

Cited by 8 publications

References 48 publications

Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital

Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital

Regulación del uso obstétrico del misoprostol en los países de América Latina y El Caribe

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

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