Sublingual misoprostol for management of empty sac or missed miscarriage: The first two years' experience at a metropolitan Australian hospital.
BACKGROUND
Misoprostol management of miscarriage is only now becoming widely used in Australia.


OBJECTIVE
To review the efficacy, safety and the popularity of outpatient sublingual misoprostol in empty sac/missed miscarriage management over its first two years of availability in a metropolitan Australian hospital.


METHODS
A retrospective cohort review was undertaken of women choosing sublingual misoprostol 600 μg (three tablets) × three doses for miscarriage management. Principal outcomes assessed were miscarriage resolution without the need for curettage and complications. Additionally, the relative popularity of misoprostol versus surgery by place of birth and over time, and the return of pregnancy tissue for histology were analysed.


RESULTS
Between 1 December 2012 and 30 November 2014, 279 women chose sublingual misoprostol for nonurgent miscarriage management, while 420 chose surgery (40 and 60%, respectively). Of the misoprostol cohort, 269 had complete data; 239 of 269 (88.8%) had resolution without curettage, nine (3.3%) had acute curettage, 21 (7.8%) had nonacute curettage, 30 (11.15%) had unplanned emergency department presentation, 11 (4.1%) had unplanned admission, three (1.1%) had blood transfusion and one (0.4%) had an infection requiring admission. Misoprostol was as popular with Australian-born as overseas-born women; 53.5% of patients returned histopathology specimens; one (0.7%) demonstrated partial hydatidiform mole.


CONCLUSIONS
Outpatient management of missed/empty gestational sac miscarriage using sublingual misoprostol is associated with a high rate of avoiding curettage and the low rate of complication. It is equally popular with Australian-born and overseas-born women. Just over 50% returned pregnancy tissue for analysis.
Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
Therese M
TM
Mcgee
Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
Hayley
H
Diplock
Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
Ania
A
Lucewicz
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000030:Abortion, Missed / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000286:Administration, Sublingual; D000328:Adult; D000553:Ambulatory Care; D001315:Australia; D006786:Hospitals, Urban; D006801:Humans; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D057240:Patient Preference / Q000208:ethnology; D012189:Retrospective Studies; D013048:Specimen Handling; D014619:Vacuum Curettage; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
gestational trophoblastic disease; medical management; miscarriage; misoprostol