A comparison between two different doses of sublingual misoprostol in the management of first trimester incomplete miscarriage

Abstract

*Department of Obstetrics & Gynecology, College of medicine, Hawler Medical University, Erbil, Iraq **Erbil directory of health, Erbil, Iraq. Introduction The term is synonymous to spontaneous and is often used with patients, because the word abortion is associated with elective termination.1 Miscarriage or is variably defined as the expulsion or extraction of a fetus (embryo) weighing less than 500 grams equivalent to approximately 20-22 weeks gestation or as termination before 24 weeks of gestation with no evidence of life.2 Incomplete miscarriage is a type of miscarriage in which some, but not all of the products of conception have been passed. Retained products may be part of the fetus, placenta, or membranes. It can result from either spontaneous or induced pregnancy loss.3 Incomplete miscarriage continues to contribute to maternal morbidity and mortality in much of the developing world.4 The complications which arise from incomplete miscarriage are hemorrhage and infection which occur because of remained tissue of conception or instrumentation through the cervix.2 So safe and effective treatment for incomplete miscarriage is an important way to reduce related morbidity and mortality.3’4 Incomplete miscarriage can be treated with expectant management, or active management using medical or surgical methods.5 Medical treatment of incomplete miscarriage has been categorized as a noninvasive option as it Background and objective: Various methods have been described for management of first trimester incomplete miscarriage. The active methods include surgical methods that are highly effective but are associated with anesthetics and surgical risks. Medical methods by Misoprostol had been shown to be effective, acceptable and widely used treatment for incomplete miscarriage. The aim of this study was to compare the efficacy, patients' acceptability and the side effects of sublingual administration of single dose of 400mcg with single dose of 600mcg of misoprostol in the treatment of first trimester incomplete miscarriage. Methods: This study was conducted from April 1, 2011 to February 1, 2012 in the Maternity Teaching Hospital in Erbil city, Kurdistan region, Iraq. The study included 120 patients with incomplete miscarriage at a gestational age ≤12 weeks. They randomly received either single dose of 400mcg or 600mcg of misoprostol sublingually. Patients returned for follow-up and re-evaluation of status after 7 days. Patients with a continuous incomplete miscarriage underwent surgical evacuation. Results: The success rate in the first and second group was 90% and 91.7%, respectively, while patients' acceptability in the first and second group was 96.7% and 95%, respectively with no difference between both groups. Gastrointestinal side effects like nausea and diarrhea were more in the second group. Conclusion: Single dose of 400 mcg of sublingual misoprostol is preferred on 600mcg of sublingual misoprostol regarding the development of side effects.