The Use of Vaginal Misoprostol in the Management of Early Pregnancy Failure Up to Eight Weeks Gestation on an Outpatient Basis

Jassim Al-izzi, Fadia

	The Use of Vaginal Misoprostol in the Management of Early Pregnancy Failure Up to Eight Weeks Gestation on an Outpatient Basis
IRAQI JOURNALOF COMMUNITY MEDICINE
Article 1, Volume 23, Issue 4, 2010, Pages 302-306
Author
Fadia Jassim Al-izzi
Abstract
Abstract: Background: the medical management is an effective alternative in the management of early pregnancy failure and this may be undertaken successfully on an outpatient basis. This study is a single arm prospective study designed to use one of regimen of medical termination of early pregnancy failure up to 8 weeks gestation on outpatient basis. Patients & Methods: In Al-Yermouk Teaching Hospital-Outpatient Clinic, a total of 100 women with an early pregnancy failure were enrolled in this study, all of them were below 8 weeks gestation, they had Hb more than 10 gm /l, haemodynamically stable, no history of clotting disorder or were using anticoagulant (aspirin not included), no previous scar, Rh positive group and they had no previous attempt to terminate the current pregnancy with other obstetricians. Four 200 microgram tablets (800 micro.) of misoprostol (cytotec) were inserted into posterior fornix through a speculum. A second dose was given after 24 hours if expulsion of the products of conception was not complete. On day 8(range, 6-10), if the expulsion of products of conception was still not complete, surgical evacuation was offered. The women were returned on day 15 for assessment including hemoglobin level and ultrasound. Results: A total of 100 women were enrolled. The mean age was 29.5±7.3 years. The mean gestational age was 40.96±3.20days; 86% were successfully treated and aborted by day 8. Two patients refused surgical evacuation by day 8 after they failed to response to medical management, with follow up they showed a response by day 15. The other (12%) needed surgical evacuation. Two women had been hospitalized as emergency cases, one with bleeding; the second one was admitted because of endometritis. 5% of women recorded fever after misoprostol, 26% had nausea, 11% had vomiting, and 10% had diarrhea. Almost all the patients had abdominal pain but 34% of them used tramadol. 93% were satisfied with medical management, 80% would recommend this treatment for their relatives or they would use it in the future. Conclusion: Two doses of 800 micrograms of misoprostol administered vaginally is an option for the medical management of early pregnancy failure up to 8 weeks gestation on an outpatient basis, with success rate of 88% and tolerable side effects. 93% were satisfied with medical management, 80% of the enrolled women would recommend this treatment for their relatives or they would use it in the future. Key word: Vaginal misoprostol, early pregnancy failure.
Keywords
Vaginal misoprostol; early pregnancy failure

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