Comparison of different regimes of misoprostol for the termination of early pregnancy failure

Seervi, Nandaram; Hooja, Nupur; Rajoria, Lata; Verma, Asha; Malviya, Kusum; Mehta, Neha

doi:10.1016/j.mjafi.2014.08.012

Cited by 6 publications

(8 citation statements)

References 15 publications

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“…A single dose of 800 micrograms of misoprostol by vaginal or oral for missed abortion was recommended by National Institute for Health and Care Excellence (NICE) 20 . However some studies reported converse opinion, by pointing out that a lower dose or different routes of misoprostol may be equally effective 21 , 22 .…”

Section: Introductionmentioning

confidence: 99%

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Marwah

Wang

et al. 2017

Sci Rep

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The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were included in our analysis. Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug, lower-dose regimens (200 ug or 400 ug) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours. In terms of efficacy, the most effective treatment was sublingual misoprostol of 600 ug and the least effective was oral misoprostol of 400 ug. In terms of tolerability, vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects. Misoprostol is a non-invasive, effective medical method for completion of abortion in missed abortion. Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose. The ideal dose and medication interval of misoprostol however needs to be further researched.Missed abortion is defined as unrecognized intrauterine death of the embryo or fetus without expulsion of the products of conception. It constitutes approximately 15% of clinically diagnosed pregnancies 1 . Women experiencing a missed abortion may have no self-awareness due to the lack of obvious symptoms.With around 95% success rate, surgical evacuation is regarded as the standard treatment for missed abortion, which had been widely performed all over the world in the past 50 years 2 . However, the costs of surgery and hospitalization, as well as the complications associated with surgery and anaesthesia are a major unresolved concern. Besides infection and bleeding, decreased fertility caused by intrauterine adhesions may be unacceptable for women with missed abortion, who have not yet fulfilled their motherhood desires. Some studies have thus suggested that expectant or medical management might be more suitable instead of surgical evacuation 3,4 .Expectant management has been reported with unpredictable success rate ranging from 25-76% 5-7 . Waiting for spontaneous expulsion of the products of conception would waste much time, during which women may suffer uncertainty and anxiety 5 . When additional surgical evacuation is needed owing to failure, they may suffer from an emotional breakdown. It is thus not recommended for missed early miscarriage due to the risks of emergency surgical treatment and blood transfusion 8 .Misoprostol is a synthetic prostaglandin E1 analogue which was originally developed to prevent non-steroidal anti-inflammatory drugs related gastric ulcers. However it has been used for various other indications in obstetrics and gynaecology. Medical manag...

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Section: Introductionmentioning

confidence: 99%

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Marwah

Wang

et al. 2017

Sci Rep

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“…7 Early pregnancy failure is common, occurring in 15-20% of known pregnancy. 5 Termination of early pregnancy failure can be achieved by expectant management, surgical evacuation or medical management. 4 There is no definite protocol with evidence-based efficacy, safety and acceptability for termination of eary pregnancy failure in woman with a scarred uterus.…”

Section: Discussionmentioning

confidence: 99%

“…4 However the appropriate dose and route of administration are not welldetermined. 5 Here we present a case of first trimester ruptured uterus in a woman with a scarred uterus after induced abortion with mifepristone and misoprostol.…”

Section: Introductionmentioning

confidence: 97%

First Trimester Rupture of Scarred Uterus After Use of Mifepristone, Misoprostol A-Case Report.

Begum¹,

Akhter²,

Shakil³

2019

KYAMC j.

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Uterine rupture is a disastrous obstetric complication, occurring mostly in second and third trimesters. The risk of uterine rupture markedly increases with previous uterine surgeries. Termination of early pregnancy failure by misoprostol is common. However, its use in women with scarred uterus is speculative and usually puts the obstetricians in a stressful condition. Here we present a case of rupture of a scared uterus in the first trimester after using mifepristone and misoprostol. A 25 years old parous lady presented with uterine rupture after taking mifepristone and misoprostol by herself to induce abortion for unwanted pregnancy. Immediate laparotomy was done and the defect was repaired. Termination of pregnancy in a woman with scarred uterus by mifepristone and misoprostol can lead to uterine rupture. It should be used cautiously under close supervision or other routes (vaginal or oral). KYAMC Journal Vol. 10, No.-1, April 2019, Page 57-59

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“…7 Early pregnancy failure is common, occurring in 15-20% of known pregnancies. 5 It is a perplexing complication especially in women with previous uterine surgery. Termination of early pregnancy failure can be achieved through expectant management, surgical evacuation, or medical management.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, the appropriate dose and route of administration is not well-determined. 5 Here, we present a case of a first…”

Section: Introductionmentioning

confidence: 99%

First-trimester rupture of a scarred uterus after use of sublingual misoprostol: a case report

Abbas

Sheha

Hussein

et al. 2016

Proc Obstet Gynecol

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Uterine rupture is a disastrous obstetric complication, occurring mostly in the second and third trimesters. The risk of uterine rupture markedly increases with previous uterine surgeries. Termination of early pregnancy failure using misoprostol is common. However, its use in women with a scarred uterus is speculative and usually puts the obstetricians in a stressful situation. Here we present a case of rupture of a scarred uterus in the first trimester after sublingual misoprostol. A 35 years old multiparous woman presented with uterine rupture after administration of small doses of sublingual misoprostol for termination of early pregnancy failure. Immediate laparotomy was done and the defect was repaired. Termination of early pregnancy failure, in women with a scarred uterus, using sublingual misoprostol can lead to uterine rupture. Sublingual misoprostol should be used cautiously under close supervision or other routes (vaginal or oral) should be used instead.

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Comparison of different regimes of misoprostol for the termination of early pregnancy failure

Cited by 6 publications

References 15 publications

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

First Trimester Rupture of Scarred Uterus After Use of Mifepristone, Misoprostol A-Case Report.

First-trimester rupture of a scarred uterus after use of sublingual misoprostol: a case report

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