Low-dose vaginal misoprostol in the management of intrauterine fetal death

Abstract

Objectives. To assess the effectiveness and side effects of vaginal misoprostol (Vagiprost® tablet) termination of second and third trimester pregnancy complicated with intrauterine fetal death (IUFD).Design. A prospective observational cohort study.Setting. Tanta University Hospital.Patients. The study carried out on 324 women with fetal demise in the second and third trimesters, from January 2008 to December 2009.Intervention. All patients were subjected to history taking, physical examination, and the Bishop Scoring. Application of 25 μg misoprostol in the posterior fornix of the vagina, this was repeated every 4 h over 24 h. We assessed the adverse effects, progress, and outcomes.Results. The success rate was 90% and 45% in women in the third and second trimesters, respectively. The mean induction-termination interval was 8.95 ± 2.63 and 15.3 ± 5.37 h for women in the third and second trimesters, respectively. The induction termination interval correlated negatively with the duration of gestation. Approximately, 90% of second trimester and 55% of third trimester women required oxytocin augmentation. The mean value of total required dose of misoprostol was 166.3 ± 7.5 and 120 ± 28.79 μg for women in the second and third trimesters, respectively.Conclusion. Vagiprost appears to be a safe, effective, practical, and inexpensive method for termination of third trimester pregnancy complicated with of IUFD.