Vaginal misoprostol in the management of first-trimester missed abortions.
OBJECTIVE
To evaluate the efficacy of a regimen of vaginal misoprostol in causing the complete expulsion of first-trimester missed abortions, or alternatively dilating the cervix for surgical evacuation.


METHODS
Seventy-four women with a transvaginal ultrasound diagnosis of a first-trimester missed abortion and no more than slight vaginal bleeding were consecutively enrolled. Misoprostol (600 microg) was administered vaginally and repeated 4 h later if necessary. Surgical evacuation was performed when complete expulsion was not documented on the ultrasound 10-12 h after treatment.


RESULTS
Complete medical evacuation occurred in 42 women (56.8%), 11 (14.9%) of which required only one dose. Seventy women (94.6%) experienced abdominal pain, 73 (98.6%) vaginal bleeding, 10 (13.5%) nausea, 4 (5.4%) vomiting, 5 (6.8%) diarrhea, and 4 (5.4%) transient hyperthermia. There was one case of heavy vaginal bleeding requiring emergency surgical evacuation, and one re-admission for incomplete abortion at 30 days. All but 4 (5.4%) women had permeable cervices at the time of surgery.


CONCLUSIONS
The described regimen of vaginal misoprostol is safe and reasonably effective in inducing complete evacuation in missed abortions. When this does not occur, it almost always provides adequate cervical dilatation for surgery.
Ayres-de-Campos
D
D
Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina do Porto, Hospital de S. João, Porto, Portugal. sisporto@med.up.pt
Teixeira-da-Silva
J
J
Campos
I
I
Patrício
B
B
D015746:Abdominal Pain / Q000139:chemically induced; D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000030:Abortion, Missed / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D003967:Diarrhea / Q000139:chemically induced; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D009325:Nausea / Q000139:chemically induced; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol