title: Buccal misoprostol for treatment of fetal death at 14-28 weeks of pregnancy: a double-blind randomized controlled trial.
abstract: OBJECTIVE
  To assess whether buccal misoprostol is effective for the treatment of intrauterine fetal death.
  
  
  METHODS
  This double-blind randomized trial was conducted at five tertiary-level hospitals in the United States and Vietnam. One hundred fifty-three women with an intrauterine fetal death at 14-28 weeks of pregnancy received either 100 mcg buccal misoprostol or 200 mcg buccal misoprostol every 6 h for a maximum of 8 doses. The main outcome measure was the fetal-placental delivery rate within 48 hours of prostaglandin commencement without any additional intervention.
  
  
  RESULTS
  Most of the women (140/153) were recruited at the study site in Vietnam. Expulsion of both fetus and placenta within 48 hours of prostaglandin commencement without any additional interventions occurred in 61.8% (47/76) of women receiving misoprostol 100 mcg and 77.9% (60/77) of women receiving misoprostol 200 mcg. The 200 mcg dose was significantly more effective than the 100 mcg dose at expelling the fetus and placenta within 48 h [RR 0.68 (95% CI: 0.50-0.92; p=.03)]. The mean time to expulsion was significantly shorter using the 200 mcg dose (18.5±11.9 h) than the 100 mcg dose (23.9±12.5 h) (p=.02). Most women in both groups found the procedure satisfactory or very satisfactory (100 mcg: 76.7% (56/73); 200 mcg: 89.5% (68/76) [RR 0.86 (95% CI: 0.74-1.00)].
  
  
  CONCLUSIONS
  Buccal misoprostol is an effective method for medical induction of labor after intrauterine fetal demise. A 200 mcg dose is significantly more effective than 100 mcg for evacuating the uterus within 48h. The treatment is highly acceptable to women.
  
  
  CONCLUSIONS
  Administration of 200 mcg buccal misoprostol every six hours is an effective and acceptable method to effect the delivery of a demised fetus at 14-28 weeks that can be feasibly implemented in a wide variety of settings.
authors.affiliation: Gynuity Health Projects, New York, NY 10010, USA. Electronic address: hbracken@gynuity.org.
authors.forename: Hillary
authors.initials: H
authors.lastname: Bracken
authors.affiliation: Center for Research and Consultancy in Reproductive Health, 16D Luy Ban Bich. Tan thoi Hoa Tan Phu, Hochiminh City, Vietnam.
authors.forename: Nguyen Thi Nhu
authors.initials: NT
authors.lastname: Ngoc
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY 10461, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Banks
authors.affiliation: Family Planning Services and Research, Stanford University, Stanford, CA 94305-5317, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blumenthal
authors.affiliation: Christiana Care Health System, Department of OB/GYN Research, Newark, DE 19718, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.affiliation: Department of Obstetrics and Gynecology, JH Stroger Jr. Hospital of Cook County, Chicago, IL 60622, USA.
authors.forename: Ashlesha
authors.initials: A
authors.lastname: Patel
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY 10461, USA.
authors.forename: Marji
authors.initials: M
authors.lastname: Gold
authors.affiliation: Gynuity Health Projects, New York, NY 10010, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000278:Administration, Buccal; D000328:Adult; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D005260:Female; D005313:Fetal Death / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000379:methods; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010121:Oxytocin / Q000008:administration & dosage; D011247:Pregnancy; D016896:Treatment Outcome; D014481:United States; D014744:Vietnam
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D010121:Oxytocin
keywords: Buccal misoprostol; Intrauterine fetal demise