Kala Bahuleyan Santha1, Radhamani Mavunkal Viswanathan2, Bessy Binu Sam3, Lisy Sivadasan4, Anu Susan Sam5
BACKGROUND
Missed miscarriage is one of the common cases encountered by the practicing obstetricians all over the world. Diagnosis is made early due to increased use of ultrasound. Medical management is as effective as surgical management, but many still resort to surgical management due to concerns about adherence of products to uterine wall. This may result in complications like perforation, infection, cervical injury and may affect future fertility. Mifepristone followed by misoprostol is well accepted in medical abortion. Misoprostol alone is as efficient as the combination in missed miscarriage. In India, studies with misoprostol alone are limited. Hence, this study was conducted to evaluate the outcome of medical management in patients with first trimester miscarriage with misoprostol alone.
MATERIALS AND METHODS
After approval of Institutional Review Board, a total of 100 women with first trimester miscarriage were recruited for the study after satisfying inclusion and exclusion criteria. After necessary investigations and consent, they were treated with 800 micrograms of vaginal misoprostol followed by 600 micrograms after 3 hours. Main outcome measured was successful resolution without surgical intervention. Secondary outcomes measured were the induction delivery interval, incidence of pain, excess vaginal bleeding, infection, pyrexia and other gastrointestinal side effects.
RESULTS
Complete expulsion occurred in 89% patients and surgical evacuation needed in 11%. Mean induction delivery interval was 6-12 hours. Incidence of complete expulsion was more among primigravida than multigravida. In multi, complete expulsion was observed in patients with previous normal delivery than caesarean. Majority of patients had bleeding for less than 7 days. None of them had major side effects like sepsis or heavy bleeding. Minor side effects were fever, nausea, diarrhoea and abdominal pain.
CONCLUSION
Medical management with misoprostol is efficient, acceptable and cost-effective method for first trimester miscarriage.
KEYWORDS
Medical Management, Missed Abortions, Misoprostol, Surgical Management, Expectant.
