Abstract
Author(s): Hameed Jameel Hamzah, Tahsin Hadi Husain, Akhlas Hashem Salman*, Russul Daad Abd Oun and Al-Sharifi AZ
Background: Missed abortion is a gestational sac containing a dead embryo without clinical symptoms of expulsion (death and retention). Misoprostol is a synthetic prostaglandin analog that has been shown to stimulate uterine contractility in early pregnancy.
Objective: This study aims to decide the characteristics of the patient that got greater benefit from using misoprostol in termination of 1st-trimester missed abortion, taking into consideration the limitations of using misoprostol and the possible adverse reactions.
Methods: A single-blind clinical trial was performed in the Obstetrics and Gynecology Department of Al-Yarmouk Teaching Hospital. Totally, 133 patients with 1st trimester missed abortions were referred from our consultant clinic. Were detailed history and full medical and obstetric examinations were carried out. The demographic characteristic of each patient was assessed including Age (years), body weight, gravidity, parity, history of previous abortion, previous uterine scar, previous medical disorders, any vaginal bleeding, and gestational age that was determined by LMP and U/S. Our study regimen by using misoprostol as a monotherapy to ripen and dilate the cervix before surgical evacuation, or achieve complete medical abortion. Following a digital vaginal examination, a (400 µg) Misoprostol tablet was inserted.
Results: The mean age of patients was (25.99) years and the mean body mass index was within the normal range. Twenty-eight out of ninety-five (29.4%) were primigravida and 71.6% (67 out of 95 patients) were multigravida; eight of them had a history of previous uterine scar and 17 of the multigravida women had a history of surgical abortion. The obstetrics history and examination revealed that the median gestation age was 10 weeks (assessed by the last menstrual period) or 8 weeks (assessed by ultrasonography). Closed cervical oss was observed in 47 out of 95 cases (49.5%) and the minority presented with vaginal bleeding (9.5%). The majority of patients received either one dose (400 µg), two doses (800 µg), or three doses (1200 µg). The endpoint effects of misoprostol were observed in terms of cervical dilatation, vaginal bleeding, and the expulsion of gestation products. Complete expulsion of gestation product was observed in 38 out of 95 cases (40%) with different doses and times.
Conclusion: Younger age, low BMI, multi parity, initial cervical dilatation, short time fetal death as well as absent previous history of uterine scar, all are the criteria of the patient with the best outcome when using misoprostol vaginally for 1st trimester missed abortion and can be a reliable predictor to uterine response for vaginal misoprostol when used for 1st trimester missed abortion. Intra-vaginal misoprostol alone as monotherapy at a dose of 400 µg every 6 hours is an effective regimen to achieve successful termination of 1st trimester missed abortion. Moistening of misoprostol by normal saline is more effective than dry misoprostol. 2nd and 3rd dose effectiveness of misoprostol was observed. The adverse effects of misoprostol are minimal and dose-related and self-limiting.