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Volume 2008, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

To study the effectiveness of a regimen of repeated doses of vaginal misoprostol in the management of first trimester missed abortion, one hundred andfour pregnant women with first trimester non-viable pregnancies were treated with an initial dose of800 g of vaginal misoprostol followed after four hours by further doses of400 ! g fourhourly for a maximum of three doses. The complete expulsion rate was 85.6%. Fifty of the 104 (48.1%) women underwent surgical evacuation. In 14 (135%) women, gestational products were obtained and confirmed by histopathological examination. In 36 (34.6%) there were minimal or no products obtained and these were considered to be complete miscarriages. The cervical os was found open in all (135%) the incomplete miscarriages. Severe abdominal pain was experienced by 10.6% of the patients and excessive vaginal bleeding occurred in 135% of them. A fall in hemoglobin of more than one gramldl occurred in 5.8% of the women and another 5.8% of them had fever > 38°C. The stay in hospital was two days for 87 (83.7%) women and three days for 15 (14.4%) women. One (1%) woman stayed four days and another stayed less than one day. None of the women had any complications. This study demonstrated the efficacy and safety of vaginal misoprostol as a medical treatment for first trimester non-viable pregnancies using an initial dose of 800 g, followed after four hours by further doses of 400 ! g four-hourly for a maximum of three doses. This management also provided adequate cervical dilatation for surgical evacuation when complete expulsion did not occur.

© 2008 Seyam, Flamerzi, Abdallah, Ahmed, licensee Bloomsbury Qatar Foundation Journals.
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2008-06-01
2024-04-19
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References

  1. Laferia JJ. Spontaneous abortion. Clin Obstet Gynecol. 1986; 13::105–114.
     [Google Scholar]
  2. Hammerslough CR. Estimating the probability of spontaneous abortion in the presence of induced abortion and vice versa. Public health Rep. 1992; 107::269–277.
     [Google Scholar]
  3. Nielsen S, Hahlin M, Platz-Christensen JJ. Unsuccessful treatment of missed abortion with a combination of antiprogesterone and a prostaglandin El analogue. Br J Obstet Gynecol. 1997; 104::1094–1096.
     [Google Scholar]
  4. Haines CJ, Chung T, Leung DYL. Transvaginal sonography and the conservative management of spontaneous abortion. Gynecol obstet Invest. 1994; 37::14–17.
     [Google Scholar]
  5. Nielsen S, Hahlin M. Expectant management of first trimester spontaneous abortion. Lancet. 1995; 345::84–86.
     [Google Scholar]
  6. Hinshaw HKS. Medical management of miscarriage. In: Grudzinskas JGO'Brian PMS, eds. Problems in early pregnancy: Advances in diagnosis and management. London: RCOG press 1997;:284–295.
     [Google Scholar]
  7. Autry A, Jacobson G, Sandhu R, Isbil K. Medical management of non-viable early first trimester pregnancy. Int J Gynecol Obstet. 1999; 67::9–13.
     [Google Scholar]
  8. Templeton A. Misoprostol for all ? Br J Obstet Gynecol. 1998; 105::937–939.
     [Google Scholar]
  9. Chung TKH, Cheung LP, Leung TY, Haines CJ, Chang AMZ. Misoprostol in the management of spontaneous abortion. Br J Obstet Gynaecol. 1995; 102::832–835.
     [Google Scholar]
  10. Chung TKH, Lee DTS, Cheung LP, Haines CJ, Chang AMZ. Spontaneous abortion: A randomized controlled trial comparing surgical evacuation with conservative management using misoprostol. Fertil Steril. 1999; 71::1054–1059.
     [Google Scholar]
  11. Zalanyi S. Vaginal misoprostol alone is effective in the treatment of missed abortion. Br J Obstet Gynecol. 1998; 105::1026–1035.
     [Google Scholar]
  12. Ngai SW, Chan YM, Tang OS, HO PC. Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage. Hum Reprod. 2001; 16::1493–1496.
     [Google Scholar]
  13. El Refaey H, Dhamnasekar R, Abdalla M, Calder L, Templeton A. Induction of abortion with mifepristone (RU486) and oral or vaginal misoprostol. N Engl J Med. 1995; 332::983–987.
     [Google Scholar]
  14. Creinin MD, Moyer R, Guido R. Misoprostol for medical evacuation of early pregnancy failure. Obstet Gynecol. 1997; 89::768–772.
     [Google Scholar]
  15. Tang OS, Lau WNY, Ng EHY, Lee SWH, Ho PC. A prospective randomized study to compare the use of repeated doses of vaginal with sublingual misoprostol in the management of first trimester silent miscarriages. Hum Reprod. 2003; 18::176–181.
     [Google Scholar]
  16. Bernard KG, Cooperberg PL. Sonographic differentiation between blighted ovum and early viable pregnancy. Am J Roentgenol. 1985; 144::597–602.
     [Google Scholar]
  17. Tang OS, Schweer H, Seyberth HW, Lee SWH, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002c; 17::332–336.
     [Google Scholar]
  18. Grimes DA. Medical abortion in early pregnancy: A review of evidence. Obstet Gynecol. 1997; 89::790–796.
     [Google Scholar]
  19. Singh K, Fong YF, Dong F. A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks. RCOG Br J Obstet Gynecol. 2003; 110::175–180.
     [Google Scholar]
  20. Chung T, Leung P, Cheung LP, Haines C, Chang AMZ. A medical approach to management of spontaneous abortion using misoprostol treatment to a maximum of 48 hours can further improve evacuation of retained products of conception in spontaneous abortion. Acta Obstet Gyencol Scand. 1997; 76::248–251.
     [Google Scholar]
  21. Aryes de Campos D, Teixeira- da Silva J, Campos I, Patricio B. Vaginal misoprostol in the management of first trimester missed abortions. Int J Gynecol Obstet. 2000; 71::53–57.
     [Google Scholar]
  22. Demetroulis C, Saridogan E, Kunde D, Naftalin AA. A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure. Hum Reprod. 2001; 16::365–369.
     [Google Scholar]
  23. Wagaarachchi PT, Ashok PW, Narvekar N, Smith NC, Templeton A. Medical Management of early fetal demise using a combination of mifepriston and misoprostol. Hum Reprod. 2001; 16::1849–1853.
     [Google Scholar]
  24. Lawrie A, Penney G, Templeton A. A randomized comparison of oral and vaginal misoprostol for cervical priming before suction termination of pregnancy. Br J Obstet Gynecol. 1996; 103::1117–1119.
     [Google Scholar]
  25. Singh K, Fong TF, Prasad RN, Dong F. Randomized trial to determine optimal dose of vaginal misoprostol for pre-abortion cervical priming. Obstet Gynecol. 1998; 92::795–798.
     [Google Scholar]
  26. Ankum WM, Waard MW, Bindels PJE. Management of spontaneous miscarriage in the first trimester: An example of putting informed shared decision making into practice. Br Med J. 2001; 322::1343–1346.
     [Google Scholar]
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  • Article Type: Research Article

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