Sublingual versus vaginal misoprostol for the management of missed abortion.

AIM: To evaluate the efficacy of two routes of misoprostol administration (sublingual and vaginal) for the treatment of missed abortion. METHODS: Two hundred and twenty women with confirmed missed abortion who received 400 microg/6 h misoprostol either sublingually or vaginally, were included in this randomized control trial. All women were admitted to hospital for follow-up care for 2 days. If the pregnancy was not completely evacuated during this time, the patient underwent immediate surgical completion. Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention. RESULTS: The effectiveness was high in the sublingual group and statistically different (sublingual 84.5%, vaginal 46.4% P = 0.000 RR = 0.54 95%CI = 0.442-0.681). The groups differed in terms of complications like bleeding (88.2% vs 65.5%), pain (85.5% vs 56.4%), diarrhea (69.1% vs 36.4%) and fever (23.6% vs 13.3%) in the sublingual group versus the vaginal group, but the mean time to expulsion was shorter (9.68 h SD = 5.51 95%CI = 8.61-10.57) in the sublingual group than the vaginal group (16.64 h SD = 14.01 95%CI = 13.8-19.48), P = 0.000. Women in the sublingual group were highly satisfied with the method. CONCLUSION: Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects.

Intravaginal misoprostol 600 microg and 800 microg for the treatment of early pregnancy failure.

OBJECTIVE: To compare the respective effectiveness and safety of 600 microg and 800 microg of intravaginal misoprostol for complete abortion in cases of early pregnancy failure (occurring in the first 12 weeks). METHOD: A total of 114 women with a diagnosis of early pregnancy failure made by transvaginal ultrasonography at Rajavithi Hospital between November 25, 2002 and July 31, 2003, were assigned randomly to 2 groups of equal size. In one group the women received 600 microg of misoprostol and in the other 800 microg of misoprostol intravaginally. RESULTS: The rate of complete abortion within 24 h was significantly higher in the group that received 800 microg of misoprostol (68.4%) than in the other group (45.6%) (P<0.05). There were no significant differences between the 2 groups regarding time interval between misoprostol insertion and complete abortion or side effects. CONCLUSION: Intravaginal misoprostol 800 microg is significantly more effective than vaginal misoprostol 600 microg for the termination of an early pregnancy failure, with no significant differences in side effects.

Intramuscular (15S)-15-methyl prostaglandin F2alpha for midtrimester and missed abortions.

The efficacy of intramuscular 15-me-PGF2alpha as an abortifacient was evaluated in 40 women between 14 and 20 weeks of gestation and 6 patients with missed abortions. Pregnancy was successfully terminated in all the cases. The injection-abortion interval was significantly lower in 20 patients (Group II) who had intracervical laminaria insertion prior to treatment with 15-me-PGF2alpha than in 10 women (Group I) without laminaria insertion (t = 7.2; P less than .001). Abortion was also accomplished in 10 women with ruptured membranes and 6 patients with missed abortions. Gastrointestinal side effects were minimal and acceptable when premedication with antiemetics and an antidiarrheal was used. This study demonstrates the availability of the intramuscular route--a simple, safe, reliable means of terminating pregnancy, especially during the early midtrimester period.

Medical treatment of missed abortion using misoprostol.

OBJECTIVE: To compare the efficacy of two routes of misoprostol administration (oral and vaginal) for treatment of missed abortion. METHODS: Two hundred women with confirmed missed abortion received 800 mcg misoprostol either orally or vaginally. All women returned for follow-up care 2 days later. If the pregnancy was not completely evacuated at this time, women could wait an additional 5 days or undergo immediate surgical completion. Efficacy was defined as the percent of women discharged from the study without need for surgical intervention. RESULTS: Efficacy was high in both groups and not statistically different (oral=89.0%, vaginal=92.9%). While the groups did not differ in terms of the completion rate by day 2 (oral=41.6%, vaginal=52.7%), the mean time to expulsion was longer (21.04 h) in the oral group than the vaginal group (13.47 h), p=0.041. Women in both groups were highly satisfied with the method. CONCLUSIONS: Medical management of missed abortion with either oral or vaginal misoprostol is highly effective and highly acceptable.

[Use of mifepristone (RU 486) in pregnancy (excluding abortion on demand). The first clinical trials]. / Utilisation de la mifépristone (RU 486) dans la grossesse (IVG exceptée). Premiers essais thérapeutiques.

The use of RH 486 in terminating missed abortions, in inducing labour for therapeutic abortions and in cases of fetal death in utero. Mifepristone (RU 486) is an anti-progesterone steroid and it is known to be effective in terminating early pregnancies. The authors report 34 cases of evacuation of the uterus after pregnancy has ceased to progress (because of an empty sac or the loss of fetal heart beat) using Mifepristone, after prostaglandins had been inserted. In eleven out of 18 cases Mifepristone by itself was adequate to empty the uterus with the preliminary administration of prostaglandin analogues. In 5 cases the uterus had to be curetted. In 3 cases this was not necessary. Mifepristone given 48-72 hours before prostaglandin is first administered in order to procure a termination of pregnancy makes it possible to empty the uterus within 6 to 15 hours after first giving the prostaglandins. It lessens the dose of prostaglandins needed and shortens the labour. There was no haemorrhage or obstetric complication in our cases. We cannot make any conclusion about fetal death in utero because our series is too small, but it does seem to confirm the works of Cabroll et al.

A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure.

OBJECTIVE: To compare the effectiveness and safety of misoprostol and mifepristone, followed when needed by misoprostol, for the treatment of women with early pregnancy failure. DESIGN: Prospective randomized nonblinded controlled trial. SETTING: University-affiliated tertiary medical center. PATIENT(S): One hundred fifteen consecutive women diagnosed as having a blighted ovum or missed abortion of <9 weeks of gestation enrolled. INTERVENTION(S): The patients received orally 600 mg mifepristone (group I) or orally 800 microg misoprostol (group II). Most patients in both groups subsequently received 48 hours later orally 800 microg misoprostol. MAIN OUTCOME MEASURE(S): Failure was defined as surgical intervention due to retained gestational sac 48 hours after completion of the drug protocol, severe symptoms, or suspected retained products of conception after the menstrual period. RESULT(S): The success rate was similar in groups I and II: 38 of 58 patients (65.5%) versus 42 of 57 patients (73.6%), respectively. No cases of severe infection or bleeding necessitating blood transfusion occurred. CONCLUSION(S): Misoprostol is an effective and safe treatment for early pregnancy failure and could replace surgical curettage in over two-thirds of the patients. Mifepristone offers no advantage compared with misoprostol as initial treatment.

High-dose misoprostol used in outpatient management of first trimester spontaneous abortion.

AIM: The aim of this study was to evaluate the efficacy and tolerance of a high dose of vaginal misoprostol for outpatient medical management of missed abortion. METHODS: Three doses of 400 mug misoprostol were administered intravaginally every 4 h daily, for a maximum period of 3 days, to 108 women with uneventful first trimester pregnancy failure. RESULTS: A total of 98 women (90.7%) were managed successfully, with 74 (68.5%) of them within the first 24 h. The mean dose of misoprostol administered was 1,113.0 microg (range 400-3,600 microg), and the mean time required was 19.5 h (range 7-65 h). Only 6 out of 108 women (9.3%) required surgical intervention as the result of retained products of conception. The side effect profile was minimal. CONCLUSION: This protocol of 400 mug intravaginally misoprostol every 4 h as three daily doses for a maximum of 3 days, may offer an efficacious and safe alternative to the outpatient management of first-trimester missed abortion.

[Use of misoprostol in the termination of missed abortion]. / Zastosowanie misoprostolu w indukcji poronienia u kobiet z ciaza obumarla.

The efficiency of misoprostol in the termination of missed abortion was estimated. The group of 66 patients aged 19 - 37, who received 400 microg of vaginal misoprostol for termination of missed abortion was subjected. The overall success rate for a complete abortion was 30.3%, for incomplete abortion 25.8% and in a group of 27.2% women there was no need for cervix canal dilatating during the excochleation of uterus cavity. 16.7% cases failed. The results obtained in this study led us to the conclusion that 400 microg of vaginal misoprostol can induce the termination of missed abortion or dilatation of the uterus' canal.

Medical termination of missed abortion.

Missed abortions are a common occurrence and represent a heavy gynaecological emergency workload to both medical and nursing staff. The conventional method using vacuum aspiration of uterus is associated with morbidity and mortality. Medical termination of pregnancy is accepted as a safe and effective alternative method. However, medical evacuation of uterus in missed abortions had not been fully investigated. In this study we hope to examine the efficacy of medical methods for terminating missed abortions. Mifepristone and misoprostol prescribed to 100 women with an ultrasonically confirmed missed abortion was compared with 100 women who had surgical evacuation under general anaesthesia for their missed abortion. The disparity in complications between medical and surgical groups was not significantly different (Student's t-test, P=0.5). This study showed medical evacuation of missed abortion to be an effective, safe and cost-effective, alternative to surgical evacuation of the uterus and is particularly suited to women not wanting hospital admission or a surgical procedure under general anaesthesia. It represents an option of management that can be less intrusive and gives the woman some control but is both safe and effective.