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jsmc-10014


COMPARATIVE STUDY BETWEEN VAGINAL AND SUBLINGUAL MISOPROSTOL IN THE MANAGEMENT OF FIRST TRIMESTER SILENT MISCARRIAGES


Sallama Kamel Nasir *, Hana AL-Ani *, Sundus Y. Kellow * and Kanda Nawzad Ali **


*   Department of Gynecology and Obstetrics, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.
** Sulaimani Directorate of Health. 


Submitted: 11/6/2011; Accepted: 11/9/2011


ABSTRACT


Background 

Surgical evacuation is the traditional method for termination of first trimester silent (missed) miscarriage. But serious complications may occur after surgical evacuation e.g. perforation, bleeding infection and later infertility. Now a day medical termination of first trimester silent miscarriage is well recognized as an effective treatment option. Misoprostol tablet is a drug which can be used & it has been found to be effective by different routes; orally, vaginally & sublingually

Objective 

This study was conducted to evaluate the effectiveness of sublingual versus vaginal misoprostol in the management of first trimester silent miscarriage.Patients and Methods 

Patients and Methods 

This is a prospective randomized comparative clinical study, included pregnant women who have first trimester silent miscarriage, attending Sulaimani Maternity Teaching Hospital over a period of 8 months (from 1st January 2009 till 1st September 2009). These pregnant women were divided into two groups as follow: Group 1 included 44 patients, who received 600μg (3 tablets) of Misoprostol sublingually, every 3 h for a maximum of 3 doses. Group 2 included 44 patients, who received 600μg (3 tablets ) of Misoprostol vaginally every 3 hr for a maximum of 3 doses. These women were followed up for 24 hr to see whether they pass any product of conception or not, if no abortion takes place, the women were given a second course of treatment, and followed up for another 24 hr to see the results.

Results
 

All the women included in the study (no= 88) passed product of conceptions after receiving the first course of the treatment .The complete abortion rate was significantly higher in sublingual group 22 (50%) compared to vaginal group 6 (13.63%), (p=0.000).The mean time interval between induction to passage of product of conception was significantly shorter in sublingual group (6.68 h) compared to vaginal group (8.61 h), (p<0.002). No significant difference in the incidence of side effects was observed in both groups.

Conclusion 

This study shows that sublingual misoprostol was more effective than vaginal misoprostol in inducing complete abortion for silent miscarriage in the first trimester, with no significant difference in the side effects.

KEYWORDS

First trimester, Silent miscarriage, Sublingual Misoprostol, Vaginal Misoprostol.