The efficacy of a 600-microgram misoprostol regimen for the evacuation of missed abortions

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Objective: To evaluate the efficacy of a 600-μg misoprostol regimen for the evacuation of first-trimester missed abortions. Materials and Methods: Stable patients with missed abortion diagnosed between 6 and 14 weeks of gestation were given three treatment options. Patients in Group I chose misoprostol, 600 μg, intravaginally; Group II chose surgical dilation and curettage (D&C), and group III choose spontaneous resolution. After the options were presented to them, patients selected a group. In Group I, large cotton swabs were used to remove blood and mucus from the vaginal vault and cervix. Tablets of misoprostol were placed in the posterior fornix under direct visualization and 2–5 cc of normal saline was used to dissolve the tablet. Patients were observed for 2 hours for untoward side effects and discharged to home with instructions to follow up after 48 hours. Explanation of drug side effects and precautions about bleeding and infection also were provided. Multiple gestation was the only exclusion criterion. Results: A total of 110 patients were recruited for the study. Fifty-four patients (49%) chose Group I treatment, 5 (5%) selected Group II, and 51 (46%) selected Group III. Of the patients in Group I (n = 54), 45 (83%) successfully evacuated, 3 (6%) failed to evacuate and received surgical D&C, 9 patients (17%) required a second dose of misoprostol, and 6 (11%) were lost to follow-up after drug placement. Correcting for noncompliance in Group I (n = 48), the success rate increased from 83% to 94% for successful evacuation of the uterus. In group III, 25 patients (49%) spontaneously aborted and 26 (51%) did not return for follow-up. There were no major complications observed in patients who returned for follow-up, regardless of group. Conclusion: A 600-μg dose of misoprostol dissolved intravaginally followed by a rescue dose, when necessary, is highly successful and well tolerated in stable patients desiring prompt uterine evacuation for first-trimester pregnancy loss.