Misoprostol for 1st Trimester Miscarriage: Efficacy of Vaginal Versus Oral Misoprostol

Aim: This study was conducted to compare the efficacy and safety of vaginal versus oral misoprostol in 1st trimester miscarriage. Study Design: It was a quasi-experimental interventional study. Place and Duration of Study: Our study was conducted in Sharif Medical City Hospital affiliated with Sharif Medical and Dental College, Lahore from August 2015 to July 2017. Methodology: Women with 1st trimester miscarriage were admitted. Gestational age was assessed by menstrual history and the size of gestation was estimated on recent ultrasound. They were assigned randomly to vaginal and oral group. These patients were given tablet misoprostol (200 microgram) four hourly up to a maximum of four doses if needed. Side effects were noted. After 4th dose, patients were observed for next 24 hours and pelvic ultrasound was done. Medical evacuation was considered successful if ultrasound showed empty uterus. If patient did not miscarry at all or the ultrasound showed retained products of conception or endometrial thickness of 1.5 cm or more, evacuation and curettage was performed. Results: Although there was no statistically significant difference in the start of miscarriage in vaginal 40(80%) and oral 42(84%) groups (p=0.603) but need of evacuation and curettage was less in the oral 20(40%) as compared to vaginal 30(60%) group (p=0.046). Doses of misoprostol needed in vaginal (3.58 +/- 0.785) and oral (3.62 +/- 0.697) groups showed no statistically significant difference (p=0.788). Misoprostol to miscarriage interval in vaginal (14.65 +/- 4.769 hours) and oral (13.69 +/- 4.285) groups was also not statistically different (p=0.340). The percentage of complications and side effects on the whole was 12(24%) in vaginal group and 10(20%) in oral group. In vaginal group excessive bleeding was the most frequent complication 5(10%), followed by vomiting 3(6%), excessive abdominal pain 3(6%) and diarrhoea 1(2%). In oral group excessive abdominal pain was the commonest side effect 4(8%), followed by excessive bleeding 3(6%), fever 2(4%) and diarrhoea 1(2%). No cases of uterine rupture or sepsis were seen in either group. There was no statistically significant difference in any of these complications and side effects (all having p>0.05). Conclusion: Although the need of surgical evacuation was more in the vaginal group but there was no statistically significant difference in other parameters of outcome including miscarriage rate, number of misoprostol doses needed and time interval from misoprostol to miscarriage. The complication and side effect rate was also found to be comparable in both groups.