The comparison of two different routes of misoprostol administration in cases of first trimester fetal deaths

The comparison of two different routes of misoprostol

administration in cases of first trimester fetal


S. Dilbaz, Y. Tasci, O. Ozdegirmenci, B. Dilbaz, A.


Department of Obstetrics and Gynaecology, SSK Maternity and

Women’s Health Hospital, Ankara, Turkey

Introduction: To compare the vaginal and oral plus

vaginal misoprostol administration for abortion of first trimester pregnancies

complicated with fetal death.

Aims and Methods: A total of 43 women who were diagnosed

as fetal death by transvaginal ultrasound examination with gestations

between 7 to 12 weeks were recruited in the study. Women were randomly allocated

to one of the following groups:

vaginal administration of 800 mg misoprostol or 400 mg intravaginal plus 400 mg

oral misoprostol up to a maximum of two main

doses every 12 hours for abortion. In case of no abortion occuring within the

first 12 hours, a second dose of misoprostol

repeated with the same dose at the end of first 12 hours. Success was defined as

the non-surgical evacuation of the products of

conception, including complete abortion. Failure was defined as the recourse to

surgical abortion in cases of misoprostol resistance

including incomplete abortion. Outcomes assessed included demographic

characteristics, side-effects, mean abortion time,

complete or incomplete abortion of conception, changes in hemoglobin levels,

complications related with the procedure and the

data of the two groups were compared statistically.

Results: The demographic characteristics of the two

groups were similar. Five patients in Group A (21.7%), six patients in

Group B (55%) required a second dose. Within the first 12 hours, 3 patients in

Group A (13%), one patient from Group B (5%)

had complete abortion and the rate of incomplete abortion was 65.2% in group A

and 40% in Group B. At the end of 24 hours

one patient from Group A (4.3%), five patients from Group B (25%) had ongoing

fetal death pregnancies. Overall complete

abortion rate was 13% for Group A, 10% for Group B and the rates for incomplete

abortion were 82.6% and 65% respectively.

There was no statistically significant difference between two groups for the

time of abortion (Group A; mean 8.5+4.6 hr,

median 7.3 hr, range 2–20 hr and Group B; mean 10.8+5.7 hr, median 8 hr, range

4–22 hr; t=1.368, p=0.18). There was a

statistically significant difference in hemoglobin levels of patients before and

after administration in Group A ( t=7.120, p

50.001 ) while in Group B no statistically significant difference was seen (

t=0.786, p=0.445). The frequencies of side effects

such as nausea, vomitting, diarrhea and chills reported by women in two groups

were similar. No complications related with the

procedure were observed.

Conclusion: Although both routes of misoprostol have

similar side effects and mean abortion time, due to lower failure rate of

800 mg intravaginal misoprostol, it can be used safely and effectively for

abortion of fetal death, up to 12 weeks gestation.

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