Vaginal Misoprostol in Early Pregnancy Failure

Abstract

Early pregnancy failure (EPF) occurs in 10-15% of clinically diagnosed pregnancies. 65% of these women are not willing for surgical evacuation. Medical evacuation is gaining acceptance as a treatment of option than surgical or expectant management. This is a prospective clinical trial of 150 pregnant women with EPF of <13weeeks gestation managed by 400µg of vaginal misoprostol 4hourly to a maximum of 3 doses. Failure to expel the products of conception in 24 hours, excessive bleeding per vagina and incomplete expulsion were managed by surgical evacuation. Complete and incomplete evacuation was confirmed by transvaginalsonography (TVS). All surgical evacuations done under I.V. sedation required no anesthesia because of the cervical priming effect of misoprostol. Tolerable prostaglandin side effects were seen and no women required blood transfusion. Acceptance of medical management is 89%. Successful complete medical evacuation occurred in 86%, completely failed in 7.3%, incomplete evacuation in 3.3% and 3.3% underwent emergency surgical evacuation for excessive bleeding per vagina. Misoprostol, an antiulcer drug is still not approved by FDA for EPF management. But acceptance of medical management in EPF is 89%, it is economical without the surgical complication of anesthesia, uterine perforation, infection and uterine adhesions. Thus instead of going for expectant management, medical management has definitely a role in EPF in women not willing for surgical evacuation.

Keywords

• medical evacuation
• vaginal misoprostol
• early pregnancy failure