Sublingual versus vaginal misoprostol for the management of missed abortion.
OBJECTIVE
To evaluate the efficacy of two routes of misoprostol administration (sublingual and vaginal) for the treatment of missed abortion.


METHODS
Two hundred and twenty women with confirmed missed abortion who received 400 microg/6 h misoprostol either sublingually or vaginally, were included in this randomized control trial. All women were admitted to hospital for follow-up care for 2 days. If the pregnancy was not completely evacuated during this time, the patient underwent immediate surgical completion. Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention.


RESULTS
The effectiveness was high in the sublingual group and statistically different (sublingual 84.5%, vaginal 46.4% P = 0.000 RR = 0.54 95%CI = 0.442-0.681). The groups differed in terms of complications like bleeding (88.2% vs 65.5%), pain (85.5% vs 56.4%), diarrhea (69.1% vs 36.4%) and fever (23.6% vs 13.3%) in the sublingual group versus the vaginal group, but the mean time to expulsion was shorter (9.68 h SD = 5.51 95%CI = 8.61-10.57) in the sublingual group than the vaginal group (16.64 h SD = 14.01 95%CI = 13.8-19.48), P = 0.000. Women in the sublingual group were highly satisfied with the method.


CONCLUSIONS
Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects.
Tanha
Fateme Davari
FD
Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Mirza Kochak Khan Hospital, Valiasr Reproductive Health Research Center, Tehran, Iran. fatedavari@yahoo.com
Feizi
Mohadeseh
M
Shariat
Mamak
M
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods*; D000030:Abortion, Missed / Q000188:drug therapy*; D000282:Administration, Intravaginal; D000286:Administration, Sublingual; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000627:therapeutic use; D017060:Patient Satisfaction; D011247:Pregnancy; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol