Efficacy of Misoprostol for Miscarriages using FIGO Protocol: Initial Experience at Fauji Foundation Hospital
Objective: To evaluate the safety and efficacy of initiating misoprostol using latest International Federation of Gynecology and Obstetricians (FIGO) protocol in the management of first and second trimester miscarriages.
Study Design: A prospective observational study, conducted at Fauji foundation hospital in the department of obstetrics and gynaecology Unit 1 from 1st May 2017 to 31st Dec 2017.
Methodology: All patients diagnosed with first and second trimester miscarriage or undergoing termination of pregnancy < 24 weeks were given misoprostol through vaginal route only with the dose as described by FIGO. Patients with a scarred uterus were given half the dose of misoprostol for the given gestational age. The efficacy of misoprostol was considered to be a complete miscarriage up to 12 hours after completing the tablets course as an inpatient.
Results: Total of 55 patients diagnosed with miscarriage were included in the study. 76.4% of patients were given misoprostol for first trimester miscarriage while 23.6% were given the drug for second trimester miscarriage. The main indications for medical termination in the first trimester was 37 (67.5 %) missed miscarriage followed by 5 (9.1%) with incomplete miscarriage. While in the second trimester 8 (14.5%) cases were for a missed miscarriage and 5 patients (9.1 %) were for lethal fetal abnormality. The overall success rate as defined by competing uterine evacuation demonstrated by pelvic scan was seen in 41.8 % of cases. No serious adverse effects were seen in any of the patients.
Conclusion: Medical termination of pregnancy using misoprostol by FIGO protocol is a safe and effective option. Adherence to FIGO protocol maximizes success rate while keeping complication rate to the lowest level. Medical termination as outpatient procedure should be encouraged along with consistent patient counselling regarding follow up.
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