Misoprostol as a sole agent for medical management of incomplete miscarriage and early fetal demise : a protocol used in Dubai Hospital

Abstract EN

Objective: This study aims to assess the efficacy of misoprostol alone in the management of incomplete miscarriage and early fetal demise.

Methods: Data of 94 women with miscarriage underwent medical evacuation of uterus were collected from the files of admission at Dubai hospital, Department of Obstetrics and Gynecology, Dubai, UAE.

Each woman received misoprostol (Cytotec, a synthetic prostaglandin analogue, Pharmacia) through vaginal route at certain dose and frequency following the department protocol.

Women who failed to pass the products of conception after having the standard doses of misoprostol were offered a repeat dose or to be sent home for further follow up after three weeks.

Success rate of this management was defined as complete uterine evacuation within 3 weeks, without the need for surgical evacuation.

Results: Among the ninety four patients who were enrolled in the study, eighty five had complete miscarriage within 3 weeks of medical management, using misoprostol alone.

This gave an overall success rate of (90.4%).

Among the nine patients (9.6%), who had failure of this medical management, three (3.2%), chose to go for surgical treatment before finishing their regime, another three (3.2%) had excessive bleeding during the course of medical treatment which necessitated immediate surgical evacuation, two (2.1%) chose to go for surgical evacuation after finishing their regime and did not want to go home for further observation.

The remaining one patient (1.1%) was followed up after 3 weeks and found to have incomplete miscarriage for which surgical evacuation was done.

Conclusions: Misoprostol alone following a protocol, derived from evidence based guidlines, can be effective in the medical evacuation of uterus in cases of early fetal demise and incomplete miscarriage.