Trimester Incomplete Abortion Research Articles

Study Comparing Between Surgical Evacuation and Medical Management with Vaginal Misoprostol for Early Pregnancy Loss

Background: Early pregnancy loss is one of the most common clinical problems that is encountered in dailygynaecological practice. The aim of this study is to assess the effectiveness and acceptability of using vaginalmisoprostol for management of first trimester spontaneous incomplete abortion as an alternative to direct vaginalsurgical evacuation in our setting. Methods: This prospective randomized study was carried out in the Department of Obstetrics and Gynaecology inShaheed Ziaur Rahman Medical College Hospital, Bogra. from January 2008 to December 2008. This study performedon 400 patients with first trimester incomplete abortion between 8 and 12 weeks requesting medical management. Theywere divided into two groups according to patients’ choice; group (I) received 800 microgram misprostol vaginally bydigital insertion into the posterior fornix while group (II) underwent surgical vaginal evacuation directly under generalanesthesia. Results: Although vaginal surgical evacuation was successful in solving the problem in 100% of cases, misoprostol wassuccessful in 70% after 1st dose and remained incomplete 30% after administration of 2nd dose. The overall satisfactionwas slightly higher in the surgical group. No serious side effects or complications were reported in the misoprostolgroup. The incidence of excessive post-abortive bleeding was more in the misoprostol group than in the surgicalevacuation group (p = 0.049). Conclusion: Although vaginal surgical evacuation is more effective than misoprostol in solving the problem stillmedical treatment is effective and acceptable especially when surgical management is not available or risky or patientsrefuse to do surgical management. Bangladesh Crit Care J March 2023; 11 (1): 19-23

Oral Misoprostol for Treatment of 1st Trimester Incomplete Abortion

Background: Abortion or miscarriage is a common health intervention. Incomplete abortion is a term given to miscarriage where there are retained product of conception still within uterus. Complications of incomplete abortion includes haemorrhage, infection, shock even DIC (Disseminated intravascular coagulation). Treatment of incomplete abortion has traditionally been surgery like D&C or MVA. Though these treatments are effective but they require specialized equipment, trained person and associated with dangers like uterine trauma, perforation, bleeding to instrumentation, infection & reaction to anaesthesia. For these reasons determining an effective nonsurgical approach for treatment of incomplete abortion is important. Materials & Methodology: During the period of June 2021 to December 2022, 100 women diagnosed as incomplete abortion, were selected in Popular Diagnostic Centre (Badda, Dhaka) and in US-Bangla Medical College Hospital (Narayanganj) as per inclusion criteria and treated with Tablet Misoprostol 6ooµg orally and success to treatment was noted. Results: Treatment was found successful in 94% cases. 6% Cases needed MVA. Among 94% cases 32% was successful after 1st dose of Misoprostol and 62% was after 2nd dose of Misoprostol. Conclusions: Oral Misoprostol is very effective method with high patient satisfaction.

Evaluating women’s acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians: a mixed methods study

BackgroundStudies evaluating task sharing in postabortion care have mainly focused on women in first trimester and many lack a qualitative component. We aimed to evaluate patient acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians and also gained a deeper understanding of the patients’ lived treatment experiences in Uganda.MethodsOur mixed methods study combined 1140 structured interview data from a randomized controlled equivalence trial and in-depth interviews (n = 28) among women managed with misoprostol for second trimester incomplete abortion at 14 public health facilities in Uganda. Acceptability, our main outcome, was measured at the 14-day follow-up visit using a structured questionnaire as a composite variable of: 1) treatment experience (as expected/ better than expected/ worse than expected), and 2) satisfaction - if patient would recommend the treatment to a friend or choose the method again. We used generalized mixed effects models to obtain the risk difference in acceptable post abortion care between midwife and physician groups. We used inductive content analysis for qualitative data.ResultsFrom 14th August 2018 to 16th November 2021, we assessed 7190 women for eligibility and randomized 1191 (593 to midwife and 598 to physician). We successfully followed up 1140 women and 1071 (94%) found the treatment acceptable. The adjusted risk difference was 1.2% (95% CI, − 1.2 to 3.6%) between the two groups, and within our predefined equivalence range of − 5 to + 5%. Treatment success and feeling calm and safe after treatment enhanced acceptability while experience of side effects and worrying bleeding patterns reduced satisfaction.ConclusionsMisoprostol treatment of uncomplicated second trimester incomplete abortion was equally and highly acceptable to women when care was provided by midwives compared with physicians. In settings that lack adequate staffing levels of physicians or where midwives are available to provide misoprostol, task sharing second trimester medical PAC with midwives increases patient’s access to postabortion care services.Trial registrationClinicalTrials.gov NCT03622073.

Comparison of the effectiveness and safety of treatment of incomplete second trimester abortion with misoprostol provided by midwives and physicians: a randomised, controlled, equivalence trial in Uganda

SummaryBackgroundTo address the knowledge gaps in the provision of post-abortion care by midwives for women in the second trimester, we investigated the effectiveness and safety of treatment for incomplete second trimester abortion with misoprostol, comparing care provision by midwives with that provided by physicians in Uganda.MethodsOur multicentre, randomised, controlled, equivalence trial undertaken in 14 health facilities in Uganda recruited women with incomplete abortion of uterine size 13–18 weeks. We randomly assigned (1:1) women to clinical assessment and treatment by either midwife or physician. The randomisation sequence was computer generated, in blocks of four to 12, and stratified for study site. Participants received sublingual misoprostol (400 μg once every 3 h for up to five doses). The study was not concealed from the health-care providers and study participants. Primary outcome was complete abortion within 24 h that did not require surgical evacuation. Analysis was per-protocol and intention to treat; the intention-to-treat population consisted of women who were randomised, received at least one dose of misoprostol, and reported primary outcome data, and the per-protocol population excluded women with unexplained discontinuation of treatment. We used generalised mixed-effects models to obtain the risk difference. The predefined equivalence range was –5% to 5%. The trial was registered at ClinicalTrials.gov, NCT03622073.FindingsBetween Aug 14, 2018, and Nov 16, 2021, 1191 eligible women were randomly assigned to each group (593 women to the midwife group and 598 to the physician group). 1164 women were included in the per-protocol analysis, and 530 (92%) of 577 women in the midwife group and 553 (94%) of 587 women in the physician group had a complete abortion within 24 h. The model-based risk difference for the midwife versus physician group was –2·3% (95% CI –4·4 to –0·3), and within our predefined equivalence range (–5% to 5%). Two women in the midwife group received blood transfusion.InterpretationClinical assessment and treatment of second trimester incomplete abortion with misoprostol provided by midwives was equally effective and safe as when provided by physicians. In low-income settings, inclusion of midwives in the medical management of uncomplicated second trimester incomplete abortion has potential to increase women's access to safe post-abortion care.FundingSwedish Research Council and THRiVE-2.

Exploring health care providers' experiences of and perceptions towards the use of misoprostol for management of second trimester incomplete abortion in Central Uganda.

IntroductionWomen living in low- and middle-income countries still have limited access to quality second trimester post abortion care. We aim to explore health care providers’ experiences of and perceptions towards the use of misoprostol for management of second trimester incomplete abortion.MethodsThis qualitative study used the phenomenology approach. We conducted 48 in-depth interviews for doctors and midwives at 14 public health facilities in central Uganda using a flexible interview guide. We used inductive content analysis and made code frequencies based on health care provider cadre, and health facility level and then abstracted themes from categories.ResultsWell trained midwives were perceived as competent to manage second trimester post abortion care stable patients, however doctor’s supervision in case of complications was considered important. Sometimes, midwives were seen as offering better care than doctors given their stronger presence in the facilities. Misoprostol received unanimous support and viewed as: safe, effective, cheap, convenient, readily available, maintained patient privacy, and saved resources. Challenges faced included: side effects, prolonged hospital stay, treatment failure, inclination to surgical evacuation, heavy work load, inadequate space, lack of medical commodities, frequent staff rotations which affects the quality of patient care. To address these challenges, respondents coped by: giving patients psychological support, analgesics, close patient monitoring, staff mentorship, commitment to work, team work and patient involvement in care.ConclusionMisoprostol is perceived as an ideal uterine evacuation method for second trimester post abortion care of uncomplicated patients and trained midwives are considered competent managing these patients in a health facility setting with a back-up of a doctor. Health care providers require institutional and policy environment support for improved service delivery.

A Comparison of Using Oral Misoprostol and Manual Vacuum Aspiration (MVA) in the First Trimester Incomplete Abortion

Background: Misoprostol, a synthetic prostaglandin E1 analogue, may workas an alternative to manual vacuum aspiration (MVA) in incomplete abortion, which is easy to administer orally, andhelps to increase access to post abortion care.Objective: To compare the effectiveness, safety and acceptability by the patients of using oral misoprostol therapy and manual vacuum aspiration technique for the treatment of incomplete abortion in the first trimester of pregnancy.Methods: This cross-sectional study was conducted in Department of Obstetrics & Gynaecology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh, between January and July of 2016. A total of 200 patients (women with incomplete abortion ≤12weeks) were enrolled in the study. 100 Patients were randomly selected and treated with oral misoprostol 600mcg (group I), while the other 100 were treated with manual vacuum aspiration (MVA) (group II). They were followed up for 1-3 days before discharge. Participants were asked to return to the clinic for follow-up after 1 week. In follow-up visit, if abortion was not found complete, an immediate surgical evacuation was performed.Results: The mean age of the participants were 28.59±10.44 and 28.24±9.40 in group I and II respectively. In group I, 94% had complete abortion, while 6% had incomplete abortion or continued pregnancy. However, in group II, 100% had complete abortion (P>0.05). Per vaginal normal and heavy bleeding were 35% and 12% in group I, while 9% and 1% in group II respectively (P<0.001). Pain, nausea, vomiting and gastrointestinal issues were more observed in group I than that of group II (P<0.001). However, incidence of fever, headache and vertigo were similar in both groups (P<0.001). In group I, 98% stated that the treatment was ‘satisfactory/very satisfactory’, while in group II, 99% found the procedure ‘satisfactory/very satisfactory’. The difference between the groups is not statistically significant (P>0.05). In group I, 98% stated that they would select this method again, if needed and recommend it to a friend or relative, while in group II, 88% stated that they would choose this method again and 86% would like to recommend to a friend or relative. The difference between the groups is statistically significant (P<0.001).Conclusion: Our data suggest that oral misoprostol therapy can be used effectively ensuring safety and patients’ satisfaction for treatment of incomplete abortion in the first trimester as compared to manual vacuum aspiration technique.International Journal of Human and Health Sciences Vol. 06 No. 02 April’22 Page: 173-177

Role of Manual Vacuum Aspiration Versus Sublingual Misoprotol in First Trimester Miscarriage in a Tertiary Care Hospital PMC, Nawabshah

Objective: To compare the efficacy of manual vacuum aspiration versus sublingual misoprostol in first trimester miscarriage at people's medical college hospital Nawabshah. Study Design: Randomized Controlled Trial. Settings: Department of Gynaecology and Obstetrics, Peoples Medical University & Hospital Nawabshah. Duration of Study: 7th April 2021 to 6th October 2021. Materials & Methods: A total of 100women with first trimester incomplete abortion, 18 to 45 years of age were included. Patients having allergy to misoprostol or other prostaglandins, contraindication to prostaglandin therapy (asthma, hypertension, glaucoma) and suspected ectopic pregnancy assess on ultrasound were excluded. Group A received a single dose of 600 microgram of sublingual misoprostol every three hours and group B who underwent MVA for evacuation of retained products of conception. Efficacy was noted. Results: The mean age of women in group B was 30.14 ± 4.12 years and in group A was 30.20 ± 3.69 years. Majority of the patients 51 (51.0%) were between 18 to 30 years of age. The mean gestational age in group B was 7.92 ± 2.42 weeks and in group A was 7.48 ± 2.32 weeks. In this study, success was seen in 46 (92.0%) women in group B (manual vacuum aspiration) and 37 (74.0%) women in group A (sublingual misoprostol) with p-value of 0.017. Conclusion: This studyconcluded that manual vacuum aspiration (MVA) is effective and safe procedure as compared to sublingual misoprostol in first trimester incomplete abortion. Keywords: first trimester incomplete abortion, manual vacuum aspiration, misoprostol

Comparison of Use of Misoprostol versus Manual Vacuum Aspiration in the Treatment of Incomplete Abortion

Introduction: Early pregnancy failure is a major health problem throughout the world. Expulsion of some but not all products of conception before 20 weeks of pregnancy abortion is incomplete abortion. This study was to find about the safety, efficacy, and acceptability of misoprostol in comparison to manual vacuum aspiration for the treatment of incomplete abortion so the safe and convenient method can be used in diverse settings in different parts of our country.Materials and Methods: A prospective comparative interventional study carried out between October 2011 to March 2012 AD (Kartik 2068 to Chaitra 2068 BS) in Paropakar Maternity and Women’s Hospital, Thapathali. All eligible women with a diagnosis of incomplete abortion of < 13 weeks of gestation either from LMP or Ultrasound were divided into two groups. Group 1 includes all odd numbers of cases under study group to whom 600 mcg Misoprostol was given orally. Group 2 includes all even the number of cases under study group to whom manual vacuum aspiration was done.Results: Out of 60 women enrolled in the study, 30 were enrolled in Group 1(Misoprostol P.O.) and 30 in Group 2 (manual vacuum aspiration). The study showed no significant difference in the efficacy of the Misoprostol as compared to manual vacuum aspiration (93.33% vs. 100%).Conclusions: The efficacy of oral Misoprostol is as effective as manual vacuum aspiration in the treatment of first trimester incomplete abortion with comparable success rate.

Early second trimester incomplete abortion with undiagnosed placenta accreta encountered as an acute gynecological emergency: a case report

Early second trimester incomplete abortion with undiagnosed placenta accreta encountered as an acute gynecological emergency: a case report

Efficacy and Safety of Para Cervical Block in Manual Vacuum Aspiration (MVA) - in Low Resource Setting

Objective (s): To determine the safety and effectiveness of para-cervical block for cervical dilatation and uterine evacuation by MVA.Materials and methods: This descriptive (cross-sectional) study was conducted in a low resource set-up at Homna, Upzilla Health Complex Comilla between January 2016 and June 2016. Forty five patients of 1st trimester incomplete abortion of 12 weeks gestation were the target population for manual vacuum aspiration (MVA) for this study. All patients received para cervical block before MVA procedure. Three minutes after application of block, suction and evacuation of uterus was done. Perioperative oral analgesic (Ibuprofen) and anxiolytic (diazepam) were used 30 minutes before procedure in all patients. Before the procedure, all the women were asked to evaluate the level of pain on a visual analog scale ranged from 0-10. Thirty minutes after the procedure, the patient was asked to describe the pain that she had been feeling during MVA by using the same visual analog scale. Visual analog scale was described by: no pain (0 points), slight pain (1-3 points), moderate pain (4-6 points) and severe pain (7-10 points). Patients were followed up for 7 days and were evaluated for complications before leaving the facility and on the 7th day after procedure. A routine USG of lower abdomen was done on 7th post-evacuation day in all patients, which revealed completeness of the procedure. Informed consent was taken from all the patients.Results: All were first trimester incomplete abortion cases. MVA was performed with para cervical block. Para cervical block reduced pain sensation on cervical dilatation. According to VAS 30 (66.67%) patients had mild pain, 3(6.67%) patients had moderate pain and 12(26.67%) patients had no pain during the procedure. Six (13.33%) patients had mild pain and others had no pain after the procedure. There was no severe pain before or after the procedure. Thirty (75.56%) patients discharged before 4 hours and 11 (24.44%) patients discharged after 4 hours of the procedure. No patients had any complications like pervaginal bleeding, infection or retention of product. The cost was minimum and patient’s satisfaction was high.Conclusion: Paracevical block is effective in reducing pain sensation during MVA with a reasonable cost of the procedure.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 70-74

Women's Acceptability of Misoprostol Treatment for Incomplete Abortion by Midwives and Physicians - Secondary Outcome Analysis from a Randomized Controlled Equivalence Trial at District Level in Uganda.

ObjectiveThis study aimed to assess women´s acceptability of diagnosis and treatment of incomplete abortion with misoprostol by midwives, compared with physicians.MethodsThis was an analysis of secondary outcomes from a multi-centre randomized controlled equivalence trial at district level in Uganda. Women with first trimester incomplete abortion were randomly allocated to clinical assessment and treatment with misoprostol by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and stratified for health care facility. Acceptability was measured in expectations and satisfaction at a follow up visit 14–28 days following treatment. Analysis of women’s overall acceptability was done using a generalized linear mixed-effects model with an equivalence range of -4% to 4%. The study was not masked. The trial is registered at ClinicalTrials.org, NCT 01844024.ResultsFrom April 2013 to June 2014, 1108 women were assessed for eligibility of which 1010 were randomized (506 to midwife and 504 to physician). 953 women were successfully followed up and included in the acceptability analysis. 95% (904) of the participants found the treatment satisfactory and overall acceptability was found to be equivalent between the two study groups. Treatment failure, not feeling calm and safe following treatment, experiencing severe abdominal pain or heavy bleeding following treatment, were significantly associated with non-satisfaction. No serious adverse events were recorded.ConclusionsTreatment of incomplete abortion with misoprostol by midwives and physician was highly, and equally, acceptable to women.Trial RegistrationClinicalTrials.gov NCT01844024

A Study of Incomplete Abortion Following Medical Method of Abortion (MMA).

Medical method of abortion (MMA) is a safe, efficient, and affordable method of abortion. However, incomplete abortion is a known side effect. To study incomplete abortion due to medication abortion and compare to spontaneous incomplete abortion and to study referral practices and prescriptions in cases of incomplete abortion following MMA. Prospective observational study of 100 women with first trimester incomplete abortion, divided into two groups (spontaneous or following MMA), was administered a questionnaire which included information regarding onset of bleeding, treatment received, use of medications for abortion, its prescription, and administration. Comparison of two groups was done using Fisher exact test (SPSS 21.0 software). Thirty percent of incomplete abortions were seen following MMA; possible reasons being self-administration or prescription by unregistered practitioners, lack of examination, incorrect dosage and drugs, and lack of follow-up. Complications such as collapse, blood requirement, and fever were significantly higher in these patients compared to spontaneous abortion group. The side effects of incomplete abortions following MMA can be avoided by the following standard guidelines. Self medication, over- the-counter use, and prescription by unregistered doctors should be discouraged and reported, and need of follow-up should be emphasized.

Use of Oral Misoprostol for the Treatment of Incomplete Abortion

Aims: This study was done to assess the feasibility and acceptability of use of Misoprostol 600 mcg orally for treatment of incomplete abortion. Methods: A hospital based prospective study was carried out in the Department of Obstetrics and Gynaecology of Nepal Medical College Teaching Hospital from 1st November 2010 to 30th May 2013. All cases of first trimester incomplete abortion diagnosed clinically or by ultrasonogram were included in the study. They were given 600 mcg of Misoprostol orally. They were sent home, with advice to come for follow up after one week. Routine Ultrasound was carried out on follow up visit to confirm complete abortion. The side effects, complications and patient satisfaction was assessed and recorded. Results: Out of 86 patients, 8.1% (7) had to undergo surgical evacuation. So the success rate was 91.9% (79 cases). All the cases which needed evacuation were of higher gestation, that is, nine weeks or more. The commonest side effect was severe abdominal pain (81.4%). Three cases required emergency surgical evacuation within 24 hours due heavy bleeding.Conclusions: It is feasible and acceptable to use Misoprostol orally for medical evacuation, especially in earlier gestation of first trimester incomplete abortion. Side effects were common but were acceptable and tolerable by the patients. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 30-33 DOI: http://dx.doi.org/10.3126/njog.v8i2.9766

Vaginal misoprostol versus vaginal surgical evacuation of first trimester incomplete abortion: Comparative study

The aim of this study is to assess the effectiveness and acceptability of using vaginal misoprostol for management of first trimester spontaneous incomplete abortion as an alternative to direct vaginal surgical evacuation in our setting. This is a prospective comparative study performed on 147 patients with first trimester incomplete abortion between 8 and 12 weeks requesting medical management. They were divided into two groups according to patients’ choice; group (I) received misoprostol tablet 400 mcg (Cytotec, Serono) every 4 h for a maximum of three doses while group (II) underwent surgical vaginal evacuation directly under general anesthesia. Only 54 patients in group I and 51 patients in group II completed their follow up and included in the analysis. Although vaginal surgical evacuation was successful in solving the problem in 100% of cases, misoprostol was successful in 79.6% ( p = 0.0006). The overall satisfaction was slightly higher in the surgical group but almost equal percentage of both groups mentioned that they will recommend the method to a friend. No serious side effects or complications were reported in the misoprostol group. The incidence of excessive post-abortive bleeding was more in the misoprostol group than in the surgical evacuation group ( p = 0.0336). Also endometrium using transvaginal ultrasonography was significantly thicker in the misoprostol group than in group II ( p = 0.0071) but with no clinical importance as it was not associated with severe vaginal bleeding necessitating medical or surgical interventions. Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to do surgical management.

Role of mesoprostol in the management of first trimester incomplete abortion

Background and objectives: Surgical treatment has been a traditional way of treatment of incomplete abortion. Expectant management and medical treatment can reduce costs and complications generated by surgery. Current study was designed to determine the success rate of treatment of incomplete abortion by mesoprostol thus avoiding surgical intervention. Moreover, factors which can impair efficacy of the treatment were investigated. Method: The sample size included 100 patients with first trimester incomplete abortion attending Maternity Teaching Hospital in Erbil city/ Kurdistan Region / North of Iraq between October, 1st 2009 and March, 1st 2010 being assigned to receive 400 µg mesoprostol orally. A week later the patients were specifically examined to verify that complete abortion had been occurred. A second dose was administered if complete abortion was not yet achieved, provided that the patient was hemo-dynamically stable and notably no substantial bleeding or infection been noticed. Results: The success rate of the treatment was 62% and 93% after first and second dose respectively. The difference in response to the treatment was related to the difference in endometrial thickness and gestational age. No any serious complication was reported. Conclusion: Mesoprostol administered orally is an effective method in treating first trimester incomplete abortion.

O186 The use of paracervical block anesthesia for pain control in first trimester incomplete abortion

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S146-S146 Free communication (oral) presentations O186 The use of paracervical block anesthesia for pain control in first trimester incomplete abortion N. Gorgonio, N. GorgonioSearch for more papers by this authorJ. Corpuz, J. CorpuzSearch for more papers by this authorL. Purnamsidi, L. PurnamsidiSearch for more papers by this author N. Gorgonio, N. GorgonioSearch for more papers by this authorJ. Corpuz, J. CorpuzSearch for more papers by this authorL. Purnamsidi, L. PurnamsidiSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60558-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S146-S146 RelatedInformation

Expectant management of incomplete abortion in the first trimester

Objective To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion. Methods A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded. Results The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious. Conclusion Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion.

Medical Evacuation of First Trimester (Twelve Weeks Gestation) Incomplete Abortion and Missed Abortion

The objective was to assess the feasibility of nonsurgical evacuation of first trimester pregnancy wastage. A randomized control trial involving three groups: (1) dilatation and curettage (D&C) only, (2) intramuscular prostaglandin methyl-F2a, 500 μg in a single injection (PGmF2α, 500 μg IM), (3) oral Trilostane, 120 mg every 6 hours on four occasions, together with PGmF2α, 500 μg IM administered with the third trilostane dosage. Sixteen patients were referred to the Coombe Hospital and diagnosed ultrasonographically as having an incomplete miscarriage or missed abortion of < 12 weeks gestation. Treatment failures were subjected to D&C. The main outcome measures included the number of complete evacuations diagnosed ultrasonographically, analgesic requirements, side effects, and symptoms at 6 weeks after treatment. Using a reduction in uterine cavity surface area to < 6 cm2 as success following treatment, complete evacuation occurred in 100% of women treated with Trilostane and prostaglandin, 50% of women treated with prostaglandin only, and 40% of women treated by D&C only. The combination of Trilostane and prostaglandin is very effective in evacuating first trimester incomplete miscarriage or missed abortion. However, further dosage refinements are necessary to minimize prostaglandin side effects. (J GYNECOL SURG 8:159, 1992)