DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184498

Effectiveness of misoprostol for induction of first and early second trimester spontaneous miscarriages in parous women

Tamima Al-Dughaishi, Amjad Hamed Al-Haddabi, Mussab Mussab Mubarak Hamed Al-Jabri, Vaidyanathan Gowri

Abstract


Background: Medical termination of missed miscarriage and incomplete miscarriage with misoprostol, are an alternative to surgical evacuation (dilatation and curettage). This study aimed to evaluate the effectiveness of misoprostol in highly parous woman for incomplete and missed miscarriage.

Methods: This was a retrospective study was conducted in two different time lines (2010 and 2014). All patients admitted to the Sultan Qaboos University hospital, Muscat, Oman, for the management of first-trimester miscarriages (missed and incomplete types) during the study period were included. Some women were moved to dilation and curettage even after misoprostol. The effect of gravidity and parity on those women in whom misoprostol was not effective was studied.

Results: The overall success rate of misoprostol for the management was 62.14% in 2010 and 53.8% 2014. In nulliparous woman the success rate of misoprostol was slightly higher than parous women. There was no apparent effect of gravidity and parity of ≥ 5 or ≥ 5 on the success of misoprostol.

Conclusions: Misoprostol reduced the rate of surgical evacuation among the study subjects. In highly parous and multigravid women (≥ para 5 and gravida ≥5) the success was not significantly different compared to less parous women.


Keywords


Dilation and curettage, First trimester pregnancy, Incomplete abortion, Miscarriage, Misoprostol

Full Text:

PDF

References


Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(5):839-54.

Wilcox, A., Weinberg, C., O'Connor, J., Baird, D., Schlatterer, J., Canfield, R., Armstrong, E. and Nisula, B. Incidence of Early Loss of Pregnancy. New Eng J Med. 1988;319(4): 189-94.

Niinimäki M, Karinen P, Hartikainen AL, Pouta A. Treating miscarriages: a randomised study of cost-effectiveness in medical or surgical choice. BJOG 2009;116(7):984-90.

WHO model list of essential medicine 18th Ed. Available at http://www.who.int/medicines/publications/essentialmedicines/18th_EML_Final_web_8Jul13.pdf.

Rausch M, Lorch S, Chung K, Frederick M, Zhang J, Barnhart K. A cost effectiveness analysis of surgical versus medical management of early pregnancy loss. Fertil Steril. 2012;97(2):355-360.

Tang J, Kapp N, Dragoman M, de Souza JP. WHO recommendations for misoprostol use for obstetric and gynaecologic indications. Int J Gynecol Obstet. 2013;121(2):186-9.

National Institute for Health and Care Excellence. Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage (CG154). London: NICE; 2012.

Graziosi GC, Mol BW, Ankum WM, Bruinse HW. Management of early pregnancy loss. Int J Gynaecol Obstet 2004;86(3):337-46.

ELkholi DG, Hefedab MM. Potential predictors for successful misoprostol treatment for early pregnancy failure: Clinical and color Doppler imaging study Middle east. Fertilty Society J 2015;20(3): 144-53

Borgatta L, French A, Vragovic O, Burnhill MS. Early Medical Abortion with Methotrexate and Misoprostol: Outcomes and Satisfaction Among Women Aged 15–21 Years. J Ped Adole Gynecol. 2001;14(1):9-16.

Creinin MD, Vittinghoff E, Keder L, Darney PD, Tiller G. Methotrexate and misoprostol for early abortion: a multicenter trial. I. Safety and efficacy. Contracep. 1996;53(6):321-7.

Lefebvre P, Cotte M, Monniez N and Norel G.The role of parity in medical abortion up to 49 days of amenorrhoea. Europ J Contracep Reproduct Health Care. 2008;13(4):404-11,

Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States. New Eng J Med. 1998;338(18):1241-7.

Verma M, Thakur V, Awasiya P. A comparative study of misoprostol versus surgical management of incomplete and missed miscarriage. International J Reproduct, Contracep, Obstet Gynecol. 2016;5(11):3654-8.

Tan TC, Yan SY, Chua TM, Biswas A, Chong YS. A randomised controlled trial of low‐dose misoprostol and dinoprostone vaginal pessaries for cervical priming. BJOG: Int J Obstet Gynaecol. 2010;117(10):1270-7.