Misoprostol to treat missed abortion in the first trimester

Abstract

Missed abortion in the first trimester is characterized by the arrest of embryonic or fetal development. The cervix is closed and there is no or only slight bleeding. Ultrasound examination shows an empty gestational sac or an embryo/fetus without cardiac activity. Based on a review of the published literature a single dose of 800 microg vaginal misoprostol may be offered as an effective, safe, and acceptable alternative to the traditional surgical treatment for this indication. Alternatively, 600 microg misoprostol can be administered sublingually. After administration of misoprostol, hospitalization is not necessary and the time to expulsion varies considerably. Bleeding may last for more than 14 days with additional days of light bleeding or spotting. The woman should be advised to contact a provider in case of heavy bleeding or signs of infection. A follow-up is recommended after 1 to 2 weeks.

A pilot study on environmental and behavioral factors related to missed abortion

“…A diagnosis of missed abortion cases was made using clinical B ultrasound, which showed an empty gestational sac or an embryo/fetus without cardiac activity [10]. The assessment of missed abortion was performed by physicians who did not take part in the research and who were blind to the patient's job stress and levels of risk factors.…”

The medical management of missed miscarriage: outcomes from a prospective, single‐centre, Australian cohort

“…Finally, recent data show that misoprostol combined with a vaginal exam to detect an open cervical os can replace more costly treatment approaches that involve ultrasound, anesthesia, and surgical evacuation. 15 …”

Prise en charge des fausses couches spontanées du premier trimestre

“…L'efficacité du misoprostol à provoquer l'expulsion du produit de conception sans le recours au geste chirurgical dépend largement du mode d'administration, de la dose administrée et du délai entre le début de la procédure et la décision de son échec [3,4,20,21] (Tableau 2). L'utilisation de la voie orale en dose unique ou répétée n'est pas recommandée en raison d'une trop grande variation des taux de succès (25-95 %) et des effets secondaires plus fréquents (pic de concentration plasmatique : 30 minutes, durée d'action sur le myomètre : deux heures [22]).…”

“…L'utilisation d'une dose vaginale unique est aussi efficace que des doses répétées à intervalle régulier [3,4,20]. Elle a l'avantage de simplifier le protocole thérapeutique et de permettre plus aisément la prise en charge ambulatoire [21,23]. L'administration d'une dose vaginale de 800 mg, renouvelée si besoin à 48 heures, permet d'obtenir un taux d'expulsion complète compris entre 80 et 90 % [3,4].…”