Experiences in the use of misoprostol in the management of first trimester missed abortion in a low resource setting

Abstract

Background: The use of misoprostol in the management of first trimester abortion is an evolving clinical practice in most parts of sub-Saharan Africa. Objective: To determine the effectiveness and acceptability of misoprostol in the evacuation of the uterus in first trimester missed abortion. Study Design: This was a non-randomized trial. Setting: This study was conducted in the Gynecologic Unit, Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Nigeria. Materials and Methods: Consented consecutive patients with first trimester missed abortion were recruited in the study. Each patient was given sublingual misoprostol 600 µg to be repeated after 6 hours if abortion process was not initiated. They were followed-up after two weeks and offered contraceptive counseling. However, if active vaginal bleeding persisted, patients were reviewed after 1 week, scanned and offered surgical evacuation (manual vacuum aspiration) on confirmation of residual products of conception. Telephone review was conducted for patients who defaulted follow-up. Data were analyzed using the Statistical Package for the Social Sciences version 16. P value was considered significant at a Results: Sixty-one patients with missed abortion were managed between 1 st January and December 2013 with a mean age, parity and gestational age of 27.6 ± 5.6 years, 3.6 ± 2.3 and 7.6 ± 2.0 weeks, respectively. Fifty-six patients (92%) achieved complete evacuation. Mean interval between the first dose of misoprostol and abortion was 5.1 ± 2.2 hours and mean duration of vaginal bleeding was 5.9 ± 1.6 days (range: 3-14 days). Side effects were minor mainly nausea/vomiting, and all the patients with complete evacuation showed satisfaction with the method and preferred it to surgical evacuation. Conclusion: Misoprostol is very effective in the management of first trimester missed abortion in our setting and should be the treatment method of first choice.