Vaginal Versus Combined Sublingual and Vaginal Misoprostol in Management of First Trimester Fetal Demise
Abstract
ABSTRACT
Background: Misoprostol is a commercially available prostaglandin E1 (PGE1) analogue
used to decrease the ulcerogenic effect of non-steroidal anti-inflammatory drugs.
Objective: This study was done to compare the effectiveness of vaginal misoprostol
versus combined sublingual and vaginal misoprostol route for management of first
trimester fetal demise.
Methods: This study performed from the 1st of April 2013 to the 31st of March 2014 at Al-
Yarmouk teaching hospital in Baghdad, a clinical comparative study was done on 200
patients who had first trimester fetal demise (missed abortion and blighted ovum), group 1
(100 patients) were assigned to receive vaginal misoprostol tablets in dose of two tablets
(400μg) of misoprostol vaginally. If products of conception had not passed, further doses
(200μg) of misoprostol were administered vaginally at four-hourly intervals up to a
maximum of four doses in total in the first 24 hours, if there was no response the regimen
repeated in the next day. Group 2 administered two tablets (400μg) of misoprostol
sublingual and after 4 hours if expulsion not occur a farther doses of 200μg misoprostol
were given vaginally at four-hourly intervals for a maximum of four doses in total, if there
was no response the regime repeated in the next day. In this study, failure of response is
considered if the patient did not abort within 48 hours.
Results: The mean induction to abortion interval was significantly shorter for group 2
(19.5 ± 4.7 hours versus 31.0 ± 5.924 hours, P<0.001). More patients in the combined
group aborted within 24 hours (84% versus 68%, P-value=0.008). Complete abortion rate
in combined group was (74 cases), while it was (56 cases) in the vaginal group. The
abortion rate was higher in combined group, the difference was statistically significant
(P=0.009).
Conclusion: Combined route of administration of misoprostol (sublingual and vaginal) is
better in terms of efficacy than the vaginal route alone in management of first trimester
fetal demise.
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