Sublingual versus vaginal misoprostol for the management of missed abortion

Tanha, Fatemeh Davari; Feizi, Mohadeseh; Shariat, Mamak

doi:10.1111/j.1447-0756.2010.01229.x

Cited by 25 publications

(21 citation statements)

References 31 publications

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“…Sublingual route is more effective in successful evacuation than the vaginal route, but the main point of weakness here is delayed action. Another study showed a similar result to that of Tanha FD et al who showed that the effectiveness was higher in the sublingual group and the difference statistically significant (sublingual 84.5 %, vaginal 46.4 %, P = 0.000, RR = 0.54, 95 % CI = 0.442-0.681) [15] and the study by Shah et al found that there was no significant difference in the complete evacuation rates between the sublingual misoprostol and the vaginal misoprostol groups (52 vs. 48 %, P = 0.571) [10]. The explanation for this difference was that the last study had a fewer numbers of cases and it had extended the gestational age of cases up to 20 weeks.…”

Section: Discussionsupporting

confidence: 73%

“…Shah et al found that the mean times to expulsion were also similar in respect of both groups (13.07 ± 6.95 h for sublingual versus 13.29 ± 5.63 h for vaginal group) [10], while Tanha et al found that the mean time to expulsion was shorter (9.68 h, SD = 5.51, 95 % CI = 8.61-10.57) in the sublingual group than that in the vaginal group (16.64 h, SD = 14.01, 95 % CI = 13.8-19.48), P = 0.000 [15]. The reason for the contradiction between the previous two studies and this study, in relation to rapid action of vaginal route, is that those studies have used higher doses of misoprostol than the present study.…”

Section: Discussionmentioning

confidence: 99%

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Comparison Between Sublingual and Vaginal Administration of Misoprostol in Management of Missed Abortion

Sokkary

2015

J Obstet Gynecol India

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Aim The aim of the present study is to compare between sublingual administration of misoprostol and vaginal administration in the management of missed abortion. Materials and Methods The study was conducted in ElShatby Maternity Hospital on 160 patients diagnosed as missed abortion by ultrasonographic examination. Cases were divided into two groups according to the methods of misoprostol administration, whether sublingual or vaginal. Patients of the two groups were observed for the times of uterine colic starting, cervical dilation, and conceptus expulsion, along with recording of any side effects. Result During the follow-up of our cases we found that sublingual route is more effective than vaginal route in the management of missed abortion. The difference between the two groups in percentage of conceptus expulsion was statistically significant. The most common side effects were nausea which was present in 55 % of cases in group I (sublingual) and in 40 % of cases in group II (vaginal) then severe pain in 25 % of cases in group I (sublingual) and in 20 % of cases in group II (vaginal) and hyperpyrexia in 15 % of cases in group I (sublingual) and in 5 % of cases in group II (vaginal

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Comparison Between Sublingual and Vaginal Administration of Misoprostol in Management of Missed Abortion

Sokkary

2015

J Obstet Gynecol India

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“…The security of waiting at home needs further researched, especially for the incidence of excessive bleeding. For women needed emergency operation, cervical ripening was prepared due to the medical treatment and it is convenient to perform dilatation and curettage 24, 26 .…”

Section: Discussionmentioning

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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“…A higher intravaginal dosage (800 vs 600 μg) was found to result in increased rates of complete abortion within 24 h and was not associated with a higher rate of side‐effects . The sublingual route was found to be more effective than the oral or intravaginal routes but at the same time was associated with a higher rate of side‐effects . Sonographic parameters, such as gestational sac size, gestational age, and fetal size, have all been additionally suggested as factors influencing success rates …”

Section: Introductionmentioning

confidence: 99%

Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure

Chill

Malyanker

Karavani

et al. 2017

J of Obstet and Gynaecol

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Sublingual versus vaginal misoprostol for the management of missed abortion

Abstract: Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects.

Cited by 25 publications

References 31 publications

Comparison Between Sublingual and Vaginal Administration of Misoprostol in Management of Missed Abortion

Comparison Between Sublingual and Vaginal Administration of Misoprostol in Management of Missed Abortion

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

Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure

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