title: Outpatient versus inpatient intravaginal misoprostol for the treatment of first trimester incomplete miscarriage: a randomised controlled trial.
abstract: BACKGROUND
  Study objective To assess the efficacy of outpatient misoprostol administration versus inpatient misoprostol administration for the treatment of first trimester incomplete miscarriage.
  
  
  METHODS
  A prospective randomised controlled trial was conducted at a tertiary hospital from May 2012 to April 2013. A total of 154 patients with first trimester incomplete miscarriage were randomised to receive misoprostol either as outpatient or inpatient. Intra-vaginal misoprostol 800 mcg was administered eight hourly to a maximum of three doses. Complete evacuation is achieved when the cervical os was closed on vaginal examination or ultrasound showed no more retained products of conception evidenced by endometrial thickness of less than 15 mm. Treatment failure was defined as failure in achieving complete evacuation on day seven hence surgical evacuation is offered.
  
  
  RESULTS
  Outpatient administration of misoprostol was as effective as inpatient treatment with success rate of 89.2 and 85.7 % (p = 0.520). The side effects were not significantly different between the two groups. Side effects that occurred were minor and only required symptomatic treatment. Duration of bleeding was 6.0 days in both groups (p = 0.317). Mean reduction in haemoglobin was lesser in the outpatient group (0.4 g/dl) as compared to in the inpatient group (0.6 g/dl) which was statistically significant (p = 0.048).
  
  
  CONCLUSIONS
  Medical evacuation using intra-vaginal misoprostol 800 mcg eight hourly for a maximum of three doses in an outpatient setting is as effective as in inpatient setting with tolerable side effects.
authors: Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, 56000, Kuala Lumpur, Malaysia, nbk_9955@yahoo.com.
authors: Beng Kwang
authors: BK
authors: Ng
authors: Ramanathan
authors: R
authors: Annamalai
authors: Pei Shan
authors: PS
authors: Lim
authors: Sulaiman
authors: S
authors: Aqmar Suraya
authors: Abdul Ghani
authors: AG
authors: Nur Azurah
authors: Mohd Yassin
authors: MY
authors: Muhammad Abdul Jamil
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000027:Abortion, Incomplete / Q000188:drug therapy*; D000028:Abortion, Induced / Q000379:methods; D000282:Administration, Intravaginal; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D002584:Cervix Uteri; D005260:Female; D006801:Humans; D007297:Inpatients; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010045:Outpatients; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol