Evaluation of intravaginal misoprostol for medical management of pregnancies less than 20 weeks of gestation with absent cardiac activity

Aim: To assess the efficacy and side-effects of misoprostol (800 mu g used intravaginally) for terminating non-viable pregnancies up to 20 weeks of gestation. Methods: Sixty five patients with non-viable pregnancies up to 20 weeks of gestation were given 800 mu g misoprostol intravaginally on day 1. A second dose of 800 mu g was repeated after 24 h if complete abortion was not attained with one dose. Primary outcome measure was success (defined as complete abortion in 48 h without surgical intervention). Duration and amount of blood loss, fall in hemoglobin, and other side-effects (pain, vomiting, diarrhea, fever and chills) were studied as secondary outcome measures. Results: 73.8% of our patients had a gestational age < 12 weeks (group A) and 26.2% had a gestational age between 12 and 20 weeks (group B). Success rate after one dose was 66.1% and rose to 84.6% after the second dose. Success rate was higher with increasing gestation (81.2% in group A vs 94.1% in group B). Mean induction abortion interval was 18.8 +/- 11.6 h in group A and 10.8 +/- 6.2 h in group B. Mean duration of bleeding was 9.4 +/- 2.3 days. Average blood loss was 134.9 +/- 113.2 mL. No patient required blood transfusion. Mean fall in hemoglobin was 0.56 +/- 0.48 g/dL. Most patients had mild pain. Only 6.2% had severe pain requiring injectable narcotic analgesics. Other side-effects were minimal. Patients who failed to abort completely with misoprostol underwent surgical evacuation. Conclusion: 800 mu g vaginal misoprostol is an effective regimen for termination of non-viable pregnancies < 20 weeks of gestation. It has minimal side-effects and avoids surgical intervention.