Comparison of different regimes of misoprostol for the termination of early pregnancy failure

Abstract

Background: Nearly 20% of all confirmed pregnancies end in spontaneous abortion. Misoprostol's use in early pregnancy failure is varied and dose and route are not well established. The aim of this study was to compare the efficacy and the side effects of different regimes of misoprostol in causing expulsion of products of conception in early pregnancy failure.

Method: Women patients with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were divided into two, Group-A: tab. Misoprostol 800 mcg 6 hourly vaginally, upto 3 doses. Group-B tablet misoprostol 600 mcg 6 hourly, sublingually for 3 doses. All observations were noted and statistical analyzed.

Results: Mean gestational age was 7.93 weeks. Mean induction abortion interval 18.183 h. Women patients with less than six weeks gestational age had least mean induction-abortion interval time, 15.75 ± 2.82 h in vaginal group but was highest in sublingual group 22 ± 2 h and 18.43 h in overall (P = 0.02). Though after 8 weeks, both routes were equally effective. Mean dose required in group-A was 20044 mcg and in group-B was 1564 mcg (P < 0.001). Efficacy of protocol was 88.89% in group-A and 92.85% in group-B.

Conclusion: Both regimes had comparable efficacy, acceptability (90%) and side effects. In women patients less than six weeks period of gestation, the vaginal (800 mcg) route was distinctly superior, in women patients with 6-8 weeks the sublingual (600 mcg) route was more advantageous. The correct dose must be used for the route chosen. The route of administration should be decided in accordance with the preference of the patient and the clinical situation.

Keywords: Blighted ovum; Early pregnancy failure; Missed abortion.