Vaginal versus oral misoprostol in the management of first trimester missed abortion among admitted patients in a tertiary level hospital
No Thumbnail Available
Date
2025-04
Journal Title
Journal ISSN
Volume Title
Publisher
Scholars Publisher
Abstract
Background: Missed abortion is a common first-trimester pregnancy complication requiring effective medical management. Misoprostol, a prostaglandin E1 analog, is widely used through oral or vaginal administration. However, the comparative efficacy, required doses, expulsion time, and side-effect profile between these two routes remain subjects of ongoing research, particularly in low-resource settings like Bangladesh. Objective: The objective of the study was to compare the efficacy, required doses, time to expulsion, side effects, and cervical permeability between oral and vaginal misoprostol in the management of first-trimester missed abortion. Methods: This randomized controlled trial was conducted in a tertiary-level hospital in Bangladesh, involving 118 women diagnosed with first-trimester missed abortion. Participants were randomly assigned to receive either oral misoprostol (Group A, n = 59) or vaginal misoprostol (Group B, n = 59). Primary outcomes included complete expulsion rates, time to expulsion, number of doses required, and side effects. Statistical analysis was performed using Pearson’s Chi-square test for categorical data and independent t-tests for continuous variables, with significance set at P < 0.05. Results: Vaginal misoprostol demonstrated significantly higher complete expulsion rates (76.27% vs. 37.29%, P < 0.001), required fewer doses (mean: 1.69 vs. 2.41, P < 0.001), and had a shorter time to expulsion (7.69 ± 2.89 vs. 9.45 ± 1.40 h, P = 0.032) compared to oral misoprostol. Nausea and vomiting were more frequent with oral misoprostol, but other side effects were comparable. Cervical permeability among unsuccessful cases did not differ significantly between groups (P = 0.6985). Conclusion: Vaginal misoprostol is more effective than oral administration, offering higher expulsion rates, faster expulsion, and requiring fewer doses, with a similar safety profile. These findings support vaginal misoprostol as the preferred route for the medical management of first-trimester missed abortion. Future research should explore sublingual routes, adjunctive mifepristone therapy, and patient-centered factors to further optimize treatment strategies.
Description
Keywords
Misoprostol, missed abortion, vaginal administration, oral administration, medical abortion, expulsion rate.
Citation
Abid Taslima, Sultana Surovi, Khatun Nofisa, Kulsum Umme, Rumpa Farhana Yesmin . Vaginal versus oral misoprostol in the management of first trimester missed abortion among admitted patients in a tertiary level hospital. Annals of International Medical and Dental Research. 2025 Apr; 11(2): 35-42