The management of missed miscarriage in an outpatient setting: 800 versus 600 μg of vaginal misoprostol

Abstract

Background: Many misoprostol regimens have been used to treat early pregnancy loss as an alternative to surgical evacuation, with differing adverse event and success rates.

Aims: This study sought to compare the effectiveness and adverse effects of 800 and 600 μg of misoprostol administered vaginally for the treatment of early pregnancy failure in an outpatient setting.

Methods: A retrospective, observational study of 946 women with a missed miscarriage <12 weeks' gestation was performed: 487 women received 800 μg (group 1) and 459 women received 600 μg (group 2) of vaginal misoprostol every 24 h for two days. The first follow-up was seven days after treatment. Women were asked about symptoms, and a transvaginal ultrasound was performed. If an incomplete miscarriage or gestational sac was still found, then an additional dose of intravaginal misoprostol was prescribed, and a second follow-up visit was arranged for seven days later. Surgical evacuation was scheduled for women who did not wish to continue medical treatment after the first or second follow-up visit.

Results: The total rate of complete miscarriage was 90.6% after 800 μg and 87.8% after 600 μg of intravaginal misoprostol. The percentage of women who underwent surgical evacuation after medical treatment was 9.4% for group 1 and 12.2% for group 2.

Conclusions: Complete uterine evacuation after a missed miscarriage was effectively induced by both 600 and 800 μg of misoprostol. The overall success of medical treatment with intravaginal misoprostol demonstrates that the treatment is safe in an outpatient setting.