Evaluation of intravaginal misoprostol for medical management of pregnancies less than 20 weeks of gestation with absent cardiac activity.
OBJECTIVE
To assess the efficacy and side-effects of misoprostol (800 microg used intravaginally) for terminating non-viable pregnancies up to 20 weeks of gestation.


METHODS
Sixty five patients with non-viable pregnancies up to 20 weeks of gestation were given 800 microg misoprostol intravaginally on day 1. A second dose of 800 microg was repeated after 24 h if complete abortion was not attained with one dose. Primary outcome measure was success (defined as complete abortion in 48 h without surgical intervention). Duration and amount of blood loss, fall in hemoglobin, and other side-effects (pain, vomiting, diarrhea, fever and chills) were studied as secondary outcome measures.


RESULTS
73.8% of our patients had a gestational age <or=12 weeks (group A) and 26.2% had a gestational age between 12 and 20 weeks (group B). Success rate after one dose was 66.1% and rose to 84.6% after the second dose. Success rate was higher with increasing gestation (81.2% in group A vs 94.1% in group B). Mean induction abortion interval was 18.8 +/- 11.6 h in group A and 10.8 +/- 6.2 h in group B. Mean duration of bleeding was 9.4 +/- 2.3 days. Average blood loss was 134.9 +/- 113.2 mL. No patient required blood transfusion. Mean fall in hemoglobin was 0.56 +/- 0.48 g/dL. Most patients had mild pain. Only 6.2% had severe pain requiring injectable narcotic analgesics. Other side-effects were minimal. Patients who failed to abort completely with misoprostol underwent surgical evacuation.


CONCLUSIONS
800 microg vaginal misoprostol is an effective regimen for termination of non-viable pregnancies <20 weeks of gestation. It has minimal side-effects and avoids surgical intervention.
Kochhar
Puneet K
PK
Department of Obstetrics and Gynecology, Lok Nayak Hospital, New Delhi, India. sonia.k20@gmail.com
Gandhi
Gauri
G
Batra
Swaraj
S
Zutshi
Vijay
V
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol