Outcome of Single-dose Vaginal Misoprostol in Early Missed Miscarriage

Abstract

Objective: To evaluate the outcome of single vaginal dose of misoprostol treatment for first trimester–missed miscarriage.
Methods: This was a retrospective study on the use of misoprostol treatment for first trimester–missed miscarriage. During the period from 1 January 2009 to 31 December 2009, misoprostol (800 μg vaginally) was given as primary treatment to 198 cases in Tuen Mun Hospital, Hong Kong. Of these, 13 patients were excluded because they defaulted follow-up or were twin pregnancy miscarriages. Thus, outcomes of the remaining 185 cases were analysed.

Results: In 2009, of the patients diagnosed with first trimester–missed miscarriage in Tuen Mun Hospital, 65% (n=198) received vaginal misoprostol as the principal treatment, of whom 13 were excluded; 70% (n=129) of the remaining 185 patients achieved complete evacuation after an 800-μg single vaginal dose of misoprostol, while another 3% (n=5) achieved complete evacuation after a repeated dose (600 μg orally). In total, 72% (n=134) had successful medical treatment. Having a previous miscarriage (odds ratio=0.64, p=0.001) was the only factor having a significant negative influence on the success of the vaginal misoprostol treatment. The miscarriage status (embryonic miscarriage instead of fetal demise) and a report of tissue mass passage within 24 hours increased the chance of successful medical evacuation (odds ratio=1.24, p=0.584 and odds ratio=1.44, p=0.292, respectively), although the results were not significant. Approximately 4% (n=7) received antibiotic treatment for suspected infection, while 2% (n=4) had positive culture results confirming infection. No patient suffered any major consequence. The infection rate was comparable to reports from other studies on medical treatment of early miscarriages.
Conclusion: Our data support the use of 800-μg misoprostol (via the vaginal route) as effective management for first trimester–missed miscarriage. Further evaluation of this approach is needed to assess patient acceptability, and use of repeated doses to achieve more effective results. The complication rate (localised infection, systemic sepsis, significant haemorrhage treated by emergency uterine curettage or blood transfusion) was low.