SUBLINGUAL MISOPROSTOL: A RATIONAL CHOICE FOR TREATING FIRST TRIMESTER MISSED MISCARRIAGE IN OUTPATIENT SETTINGS

Main Article Content

Nasreen Kishwar
Rukhsana Karim
Samreen
Saman Mudassir
Laila Nazir

Abstract

Objective:


To evaluate the role of sublingual misoprostol in first trimester missed miscarriage among women seeking medical management as outpatient.


Methodology:


A descriptive cross sectional study was conducted at Hayatabad Medical Complex, Gynecology department, involving 179 women recruited through consecutive sampling. Eligible participants were women of reproductive age (20-40years) with singleton first-trimester miscarriage (<13 weeks gestation), residing near the hospital (at 15-30min distance) having >10Hb, hemodynamically stable and no active ongoing blood loss. The selected women received a single dose of 600 µg sublingual misoprostol in crushed form and were followed up for clinical and sonographic assessment of complete expulsion of conceptus.Data entry and analysis were performed using SPSS version 22.


Results:


Out of 179 women, 119 expelled the conceptus completely. Remaining patients switched over to other options due to retained products of conception or heavy bleeding.Success rate of sublingual misoprostol was found to be 66.5% .Satisfaction and acceptability is high for medical management of miscarriage 76.67% and 68.33% respectively,with statistically significant difference for satisfaction (p=0.004).


Conclusion:


Sublingual misoprostol is found to be effective in first trimester missed miscarriage among women seeking medical management as out patient.

Article Details

How to Cite
1.
Kishwar N, Karim R, Samreen, Mudassir S, Nazir L. SUBLINGUAL MISOPROSTOL: A RATIONAL CHOICE FOR TREATING FIRST TRIMESTER MISSED MISCARRIAGE IN OUTPATIENT SETTINGS. J Postgrad Med Inst [Internet]. 2024 Feb. 17 [cited 2024 Apr. 28];38(1):42-8. Available from: https://jpmi.org.pk/index.php/jpmi/article/view/3308
Section
Original Article

References

Christine I, Ekechi and CatrionaM.Stalder. Spontaneous miscarriage. In: Edmonds DK, editor. Dewhurst's textbook of obstetrics and gynecology; UK: Black well publishing, 9th edition 2018. P 559-66.

Rabiei S, Khansari S, Fallah M, Ajand M. Comparison of sublingual versus vaginal misoprostol in the management of missed abortion. Biomed Res and therapy.2019;6(10):3391-5.

Kumar G, Kumar B. Early Pregnancy Issues for the MRCOG and Beyond. 2014. Cambridge University Press

Delabaere A, Huchon C, Lavoue V, Lejeune V, Iraola E, Nedellec S etal. Definition of pregnancy losses: Standardization of terminology from the French National College of Obstetricians and Gynecologists (CNGOF). J Gynecol Obstet Biol Reprod (Paris). 2014;43(10):756-63. DOI: 10.1016/j.jgyn.2014.09.010.

Jayashree V, Latha K, Mahalakshmi S. Comparative study between Manual vacuum aspiration and dilatation & curettage in the surgical management of early incomplete abortion in RMMCH Tamil Nadu: Arandomised controlled trial. Int J Clin Obstet. 2018:2(5):14-8.

Chu JJ, Devall AJ, Beeson LE, Hardy P, Cheed V, Sun Y, et al. Mefipristone versus misoprostol alone for management of missed miscarriage: Arandomised double-blind controlled trial. Lancet 2020;396(10253):770-8. DOI: 10.1016/S0140-6736(20)31788-8.

Kishwar N, Ali S, Sadaf R, Azeem T. Efficacy of manual vacuum aspiration versus conventional evacuation and curettage. J Gandhara Med Dent Sci. 2022;9(3):75-81.

Wu H, Marwah S, Wang O, Wang Q, Chenxu. Misoprostol for medical treatment of missed miscarriage: A systematic review and network meta-analysis. Sci Rep. 2017.

Amini M, Reis M, Wide Swenson D.A relative Bioavailability study of two misoprostol formulations following a single oral or sublingual administration. Front pharmacol. 2020;11:50. DOI: 10.3389/fphar.2020.00050.

Khurshid N, Awan AS, Akhter N, Riaz M. Efficacy of misoprostol for miscarriages using FIGO protocols. J Soc Obstet Gynecol Pak. 2018;8(2):76-80.

Ehrnsten L, Altman D, Ljungblad A, Kallner HK. Efficacy of mifepristone and misoprostol for medical treatment of missed miscarriage in clinical practice - A Cohort study. Acta Obstet Gynecol Scand. 2020;99(4):488-93. DOI: 10.1111/aogs.13780.

Nielsen S, Hahlin M, Platz-Christensen JJ. Unsuccessful treatment of missed miscarriage with a combination of anti progesterone and a prostaglandin E1 analogue. Br J Obstet Gynecol.1997;104:1094-6.

Rizwan A, Alam K, Iftikhar T, Farooq S. Comparison of vaginal versus Sublingual misoprostol in the Treatment of first trimester of missed miscarriage. J Soc Obstet Gynaecol Pak. 2022;12(4):304-8.

Ehsan N, Shoaib M, Salam R, Naeem S, Saifullah S. Efficacy of vaginal Misoprostol versus Sublingual Misoprostol in the management of early miscarriage. Pak J Med Health Sci. 2020;14(2):266-8

Elsalem SA, Al Saad DT, Abdulrauf PV, Ahmed AA, Alhail MS. Misoprostol USe in Medical evacuation of spontaneous miscarriage: Pilot drug use evaluation study done at the Women’s Hospital in Qatar. Qatar Med J. 2016(1):5. DOI: 10.5339/qmj.2016.5

Khurshid N, Awam AS, Akhtar N, Riaz M. Efficacy of Misoprostol for miscarriages using FIGO protocol: Initial experience at Fauji Foundation Hospital. J Soc Obstet Gynaecol Pak. 2018; 8(2):76-80

Morris JL, Winikoff B, Dabash R, Weeks A, Faundes A, GemzellKetal. FIGO’s updated recommendation for misoprostol used alone in gynaecology and obstetrics. Int J Gynaecol Obstet. 2017;138:363-6. DOI: 10.1002/ijgo.12181.

Saeed S, Manzoor RU, Tazion S, Butt F, Badar N. Misoprostol for 1st trimester miscarriage: efficacy of vaginal versus oral misoprostol. Pak J Med Health Sci. 2018;12(2):849-52.

Latif S, Usmani SY, Fatima N. Comparison of sublingual of sublingual and vaginal routes of misoprostol in termination of first trimester missed abortion. Pak J Med Health Sci. 2014;8(2):434-37.

Sharma P, Sharma S, Sharma M. Comparison between sublingual and vaginal route of Misoprostol in management of 1st trimester missed abortion. lnt J Med Health Res. 2018;11(4):101-3

Jha R, Rungta M, Jha S. Missed Abortion in a Tertiary Hospital of Eastern Nepal: Efficacy of Sublingual versus Vaginal Misoprostol. JCMS Nepal. 2021; 17(4); 347-51.

Emarah MSA. Safety & efficacy of vaginal Misoprostol in treatment of first trimester miscarriage. Advances Social Sci Res J. 2020;7(3):138-44

Lemmers M, Verschoor MA, Kim BV, Hickey M, Vazquez JC, Mol BW, et al. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database of Systematic Reviews. 2019(6). DOI: 10.1002/14651858.

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