Frequency of Need for Evacuation and Curettage Following Medical Termination by Misoprostol for Missed Miscarriage

Abstract

Background: Missed miscarriage, characterized by the intrauterine death of an embryo or fetus without immediate expulsion, affects approximately 15% of clinically diagnosed pregnancies. While traditional management involves surgical evacuation, medical management using misoprostol has gained popularity as a less invasive alternative. Objective: To evaluate the frequency of surgical intervention following medical management with misoprostol for missed miscarriage. Materials and Methods: This descriptive study was conducted at Hayatabad Medical Complex, Peshawar, from January 9, 2021, to June 9, 2021. A total of 179 women aged 18 to 45 years with missed miscarriage were included. Patients were administered misoprostol and monitored for the need for subsequent surgical intervention. Data were collected and analyzed using SPSS version 23, with results presented in tables and graphs. Results: Out of 179 participants, 60 (33.5%) required evacuation and curettage (D&C), while 119 (66.5%) did not. Ultrasound findings were the primary reason for D&C in 38 (63.3%) cases, with persistent bleeding accounting for the remaining 22 (36.7%). The mean endometrial thickness on ultrasound was 11.08 mm. The mean hospital stay was 48 hours. By the sixth week, 86.5% of women had resumed normal menstrual cycles. Conclusion: Evacuation and curettage were required in 33.5% of patients following medical management with misoprostol for missed miscarriage, indicating that misoprostol effectively manages missed miscarriages in most cases, reducing the need for surgical intervention. Future studies with larger sample sizes and multicenter trials are recommended to confirm these findings and improve management protocols.