Outpatient Management of Missed Abortion with Vaginal Misoprostol*

Can we use a lower intravaginal dose of misoprostol in the medical management of miscarriage? A randomised controlled study

“…Current recommendations 15,18,26,27 for the medical management of miscarriage reference only clinical trials comparing medical management to either surgical 3,5,7-10 or expectant 2,6 management. The published randomised studies [20][21][22][23] comparing different doses were designed as superiority trials and were hampered by small sample size and brief follow-up. We report the findings of a large randomised equivalence study to guide recommendations for the medical management of miscarriage.…”

“…Medical management should be considered for the management of uncomplicated early pregnancy loss; [15][16][17][18] however, it has not been widely implemented into clinical practice in developed countries. 19 This may result from the fact that published studies have involved different doses, routes of administration and treatment protocols, [1][2][3][4][5][6][7][8][9][10][11][12][13][20][21][22][23][24] such that it has become difficult to determine an optimal protocol for the medical management of miscarriage. 25 Current recommendations reflect this -600 lg orally or 400 lg sublingually are recommended for incomplete miscarriage; 15,18,26 800 lg vaginally or 600 lg sublingually are recommended for missed miscarriage.…”

“…18,27 These recommendations are based on clinical trials comparing medical management to other methods 3,5,9,10 but not studies specifically comparing outcomes between different doses. [20][21][22][23] We report the findings of a study comparing the effectiveness and side effect profile of two misoprostol doses administered per vaginum (PV) in women requesting medical management of miscarriage on an outpatient basis.…”

Misoprostol to treat missed abortion in the first trimester

“…In these trials vaginal misoprostol was administered in doses of 400 μg, 600 μg, or 800 μg. Lower-dose regimens of vaginal misoprostol were tested in 2 RCTs and have shown to be less effective in inducing expulsion, but with a similar incidence of nausea [4,5].…”

“…• Coagulation disorder/currently taking anticoagulants. [20] • • [2,3,21,22] • • [23][24][25] • • [6,7,26] • Comparing different dosages [4,5] • • Methotrexate ± vaginal misoprostol [13] • • [15] • • • Mifepristone + oral misoprostol versus expectant [16] • • • [17]…”