A Comparative Study to Assess the Efficacy and Safety of Prostaglandin-E1 Analogue (Misoprostol) Given Oral Vs Vaginal in the Management of First Trimester Missed Abortion

Abstract

Objectives: The objectives of the study were to compare the efficacy and safety of oral and vaginal misoprostol among the patients with missed abortion.

Methodology: A Randomized Controlled study was conducted in the Department of Obstetrics and Gynecology, Gomal Medical College, Dera Ismail Khan.  The current study was conducted for a period of 6 months commencing from 5th March 2021 to 5th September 2021. A total of 106 patients with the diagnosis of missed miscarriage were enrolled in the study after ethical approval and obtaining informed consent. In group A, patients were given 50 mL of water with 400μg of oral misoprostol as a single dose. In group B, patients received 400μg of misoprostol 4 hourly vaginally up to a maximum of five doses. Efficacy, safety, and comparison of gestational ages were noted in both groups.

Results: Out of a total, 106 Subjects The efficacy was observed in 39 (73.6%) patients of group A as compared to n=48 (90.6%) patients in group B (P= 0.022) while Safety was observed in 42 (79.2%) patients in group A as compared to n=52 (98.1%) patients in group B (P= 0.002). The mean gestational age was 15.528±2.26 weeks in Group A and 15.509±2.15 weeks in Group B, highlighting the later detection of missed miscarriage. The safety was compared in both groups the comparison showed 68.0% in group A, while 91.7% in group B with a gestational age of 15-20 weeks. While the gestational age less than 15 weeks showed 786% safety in group A, and 89.7% in group B with a p-value of 0.25.

Conclusion: Misoprostol has been widely used in gynecology and obstetrics for multiple indications.  Our study showed that the misoprostol vaginal route is more efficacious than the oral route in missed abortion among pregnant women. The medication abortion and missed abortions are well managed by the misoprostol alone is effective, and safer.  To enable the access of essential health services to the patients is the basic need of developing countries like Pakistan.