Oral Misoprostol Versus Vaginal Surgical Evacuation of First Trimester Incomplete Abortion; A comparative Study

Abstract

background: Vaginal surgical evacuation of retained products of conception was the main stay of treatment for a long time for patients with first trimester incomplete abortion. Misoprostol as a thermo stable prostaglandin E1 analogue has been previously tested in the management of incomplete miscarriage in different regimens and setting. Overall results indicate efficacy, effectiveness and acceptability in most of these studies.Objectives: To assess the effectiveness and acceptability of using oral misoprostol for management of first trimester spontaneous incomplete abortion as an alternative to direct vaginal surgical evacuation.Methods: This is a comparative study performed on 84 patients with first trimester incomplete abortion between 6 -12 weeks of gestation requesting medical management .They were divided into two groups; group (1) received misoprostol tablet 200 μg [misotac ,SIGMA] two tablets every 4 h for a maximum of four doses while group (2) underwent surgical vaginal evacuation directly under general anesthesia.Results: In 100% of cases , misoprostol was successful in 79% (p= 0.0006). The overall satisfaction was slightly higher in the surgical group but almost equal percentage of both groups mentioned that they will recommend the method to a friend. No serious side effects or complications were reported in misoprostol group. The incidence of excessive post-abortive bleeding was more in the misoprostol group than the surgical evacuation group (p=0.336). Also endometrial thickness using ultrasonography was significantly thicker in the misoprostol group than group (2) [p=0.0071].Conclusion: Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to do surgical management.