Abstract
Objective: To compare the efficacy of medical evacuation using intravaginal Misoprostol 800 mcg eight-hourly in 24 hours with surgical evacuation in treating first trimester incomplete miscarriages. Study design: Randomised controlled trial for one-year duration in a tertiary hospital. One hundred women with first trimester incomplete miscarriage were randomised to undergo either medical evacuation with intravaginal Misoprostol 800 mcg eight-hourly up to three doses or surgical evacuation. Main outcome measures: Successful evacuation between intravaginal Misoprostol and surgical evacuation in treating first trimester incomplete miscarriages. Results: Successful evacuation was achieved in 94% of patients undergoing medical evacuation with intravaginal Misoprostol compared to 98% in the surgical evacuation group (p=0.617). Duration of bleeding between both groups was not significantly different (p=0.491). There was a statistically significant drop in haemoglobin day 1 post treatment in the surgical evacuation group compared to Misoprostol group (0.7 g/dl vs 0.2 g/dl, p= 0.015). There were more patients complained of diarrhea (p=0.001) and fever (p= 0.001) in the Misoprostol group but this was minor and did not require any treatment. Conclusions: Intravaginal Misoprostol 800 mcg eight hourly within 24 hours is an effective and safe alternative treatment to surgical evacuation in treating first trimester incomplete miscarriages.
Highlights
Pregnancy failure is not uncommon and it occurs in up to 20% of all recognized human pregnancies [1] and that one out of four women will experience at least one miscarriage in their lifetime [2]
Successful evacuation was achieved in 94% of patients undergoing medical evacuation with intravaginal Misoprostol compared to 98% in the surgical evacuation group (p=0.617)
There was a statistically significant drop in haemoglobin day 1 post treatment in the surgical evacuation group compared to Misoprostol group (0.7 g/dl vs 0.2 g/dl, p= 0.015)
Summary
Pregnancy failure is not uncommon and it occurs in up to 20% of all recognized human pregnancies [1] and that one out of four women will experience at least one miscarriage in their lifetime [2]. It is of great concern especially in the low resource countries as it can result in excessive bleeding and infection with maternal morbidity and even mortality [3]. Surgical curettage is the standard treatment for spontaneous miscarriages [5], which carry risks of uterine perforation, infections, intrauterine adhesions and cervical. Expectant and medical management is getting more popular
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