The comparison of two different routes of misoprostol
administration in cases of first trimester fetal
deaths
S. Dilbaz, Y. Tasci, O. Ozdegirmenci, B. Dilbaz, A.
Haberal
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.
