Comparison of Vaginal Versus Sublingual Misoprostol in The Treatment First Trimester Missed Miscarriage

  • Afnan Rizwan Assistant Professor, Department of Obstetrics & Gynaecology, Akbar Niazi Teaching Hospital Bara Kahu Islamabad
  • Kinza Alam Professor and HoD, Department of Obstetrics & Gynecology Unit-1, WAH medical college, NUMS, POF hospital, Wah Cantt
  • Taqdees Iftikhar Associate Professor, Department of Gynecology. Akhter Saeed Medical College, Islamabad Campus
  • Sahar Farooq Graded Gynecologist, POF hospital, Wah Cantt
Keywords: Misoprostol, Sublingual Misoprostol, Vaginal Misoprostol, Miscarriage


Objective: To assess the efficiency of misoprostol administered sublingually versus vaginally in the treatment of missed miscarriages in the first trimester.

Methodology: This Randomized Controlled Trial study was conducted gynecology and obstetrics department of Akbar Niazi Teaching Hospital, Islamabad from June 2021 to June 2022. In accordance with the FIGO protocol, patients were randomly divided into two groups based on whether misoprostol was administered orally or vaginally. Both the sublingual 600 microgram 3 hourly and the vaginal 800 microgram 3 hourly dosages were used. After 24 hours, patients were checked for vaginal bleeding and expulsion; if neither occurred, the dose was repeated. If significant vaginal bleeding persisted after a maximum of two cycles, surgical evacuation was used to treat the failure of the treatment as determined by the USG. To confirm, an ejection pelvic USG was performed.

Results: The mean age (26.76 ± 5.83 vs. 25.85 ± 5.61), parity (3.21 ± 0.58 vs. 3.42 ± 0.64), gestational age (8.95 ± 1.73 vs. 9.27 ± 1.58) and duration of induction to abortion interval (13.86 ± 3.54 vs. 12.92 ± 3.12) were comparable in both groups, with no statistically significant (P-value > 0.05) difference between groups. Higher no. of doses (4.18 ± 0.95 vs. 3.36 ± 1.13, P-value < 0.05) was required for complete miscarriage in vaginal misoprostol group. A higher level of comfort (P-value < 0.05) during the administration of drug was observed in sublingual group (88.33%) as compared to vaginal misoprostol group (55%). The rate of success was significantly (P-value < 0.05) higher in sublingual misoprostol group (76.67%) in contrast to (58.33%) in vaginal misoprostol group. The side effects like vaginal bleeding (68.33% vs. 93.33%), bleeding > menstruation (31.67% vs. 83.33%), diarrhea (31.67% vs. 60.00%) were found to be significantly (P-value < 0.05) associated with sublingual use of misoprostol.

Conclusions: Sublingual misoprostol is more effective than vaginal misoprostol. Patients respond more favorably to the sublingual route and are more satisfied with it.

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