Use of Misoprostol in the Management of Early Pregnancy Loss

Abstract

aims:To evaluate the effectiveness of Misoprostol administered vaginally to assist complete evacuation in early pregnancy losses (incomplete abortion, missed abortion and blighted ovum). Methods:It is a descriptive study conducted in the Department of Ob/Gyn and Emergency Department Tribhuvan University Teaching hospital. All women with clinical/USG diagnosis of incomplete abortion, missed abortion and blighted ovum ≤12 weeks POG either from last menstrual period (LMP) or USG were inserted tab. misoprostol 800 mcg in the posterior fornix. Same dose was repeated when the evacuation was incomplete on day 3 of follow-up. Manual vacuum aspiration (MVA) was offered on day 14 if evacuation was incomplete or any complications like excessive bleeding/severe pain occurred during this period.results: A hundred and thirty three women with incomplete/missed/blighted ovum were reported, of which 112 (84.3%) were analyzed as 21(15.7%) lost to follow up. Among the 112, 51 (45.5%) were incomplete abortion, 34(30.3%) blighted and 27 (24.1%) missed abortion. Complete evacuation was achieved in 98/112 (87.5%) cases [73 (65%) cases with single dose & 25(22.3%) with double doses]. Evacuation was failed in 14(12.5%) cases [incomplete abortion 6 (42%), blighted 7 (50%) & missed abortion 1 (7.1%)]. Failure for complete evacuation (n=14) related to gestational age: 10-12 weeks 9/14(64%), 7-9 weeks 5 (35%) and none in the ≤6 weeks. Although the plan was to evacuate on day 14 of follow-up for incomplete evacuation which was applicable only in 11(78.5%) cases, 3(21.5%) cases were surgically (MVA) treated beforehand (2 for excessive bleeding, 1 for severe pain). No severe complications and side effects requiring treatment were observed. Conclusions:Vaginal Misoprostol is proved to be effective and safe in cases of incomplete abortion, missed abortion and blighted ovum. In the cases that failed to achieve complete evacuation by medical means using misoprostol were subjected to surgical manual vacuum aspiration (MVA) on day 14 of follow-up.

Use of Oral Misoprostol for the Treatment of Incomplete Abortion

“…In another study similar results were reported with the success rate of 100% in 6 weeks or less, 86.3% in 7 to 9 weeks and 87% in 10 to 12 weeks. 13 Tang et al 14 reported the commonest side effect of Misoprostol to be diarrhea.…”

“…13 One case of anaemia with prolonged bleeding came to hospital only on the 17 th day with heavy bleeding and required three pints of blood transfusion and there were three cases of surgical evacuation done within 24 hours due to excessive bleeding (Table 3). So the medical evacuation should be used in selected cases whostay close to health facility with proper set up, where emergency surgical evacuation can be done specially for those cases with higher gestation.…”

Penggunaan Off-Label Misoprostol Pada Pasien Obstetri-Ginekologi Di Rumah Sakit Swasta Kab. Banyumas

“…Misoprostol juga diberikan pada beberapa kasus Abortion Incomplete karena telah terdapat bukti efektif, aman dan dapat diterima bagi pasien yang tidak memungkinkan dilakukan pembedahan atau menghindari prosedur invasif [32]. Pada kasus missed abortion hanya ditemukan 1 pemberian di RS X. Walaupun sedikit, penggunaan off-label Misoprostol pada indikasi ini memiliki keberhasilan yang paling tinggi diantara kasus aborsi lainnya [33]. Selain itu, penanganan menggunakan obat juga dinilai lebih berhasil daripada penanganan secara natural pada kasus keguguran pada trimester pertama [32,34].…”