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; Published 1/12/2011

DOI Link: https://doi.org/10.17656/jsmc.10014 



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. 


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.


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.


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.


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


1. Villar J, Gumezogla A.M, Evidence based reproductive health in developing countries, NO.8. Geneva: World Health Organization.

2. Ash Monga. , disorders of early pregnancy, Gynecology by ten teachers, London by Holder education, 2006; 18th ed. p 93-95

3. Sara H.garmel,MD, Early pregnancy risks , Alan H.Decherney, MD, Lauren Nathan,MD,(editors),Current obstetric  and gynecologic  Diagnosis and Treatment, medical publishing division, 2003 ,9th ed. Vol 1,Ch.14, p273.

4. Farell, R.G., Stonington, D.T.and Ridgeway, R.A, Incomplete and inevitable abortion: treatment by suction curettage in the emergency department .Ann.Emerg.Med, 1982; vol.2:652-658.

5. Heisterberg L., Hebjorn S., Andersen L.F. and Pertersen, H, Sequelae of induced first trimester abortion. Am.J.Obstet.Gynecol.1986;  155:76-80.

6. Verkuyl DA, Suctions versus conventional curettage in incomplete abortion; a randomized controlled trial. S Afr Med J 1993; 83:13-5.

7. Joanne Topping and Roy G. Farquarson, Spontaneous miscarriage, D.Keith Edmonds Dewhurst’s Textbook of obstetrics & gynecology, Blackwell publisher, 2006; 7th ed., p 95-98.

8.Schauberger CW,Mathiason MA&Rooney BL, Ultrasound assessment of first trimester bleeding Obstet Gynecol 2005 ;  105(2):333-8.

 9. EI-Rafaey, H., Rajasekar,D. Induction of abortion with mifepristone(RU 486) and oral or vaginal misoprostol. NEJM  1995 ; 332:983-987.

10. Ho.P.C., Ngai S.W, Vaginal misoprostol compared with oral misoprostol in the termination of second trimester pregnancy.  Obstet.Gynecol.1997; 90:735-738.

11. Tang OS, Miao BY, Lee SWH and Ho PC, Pilot study on the use of repeated doses of sublingual misoprostol in termination of pregnancy up to 12 weeks of gestation: efficacy and acceptability. Hum Reprod, 2002a; 17:652–658.

12. Tang OS, Xu J, Pilot study on the use of sublingual misoprostol with mifepristone in termination of first trimester pregnancy up to 9 weeks of gestation. Hum Reprod 2002b; 17: 1738–1740.

13. Tang OS, Schweer H., Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod  2001c; 17: 332–336.

14. Ngai SW, Chan YM, Tang OS and Ho PC, Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage. Hum Reprod  2001; 16:1493–1496.

15. ChungT., Leung P, A medical approach to management of spontaneous abortion using misoprostol. Acta Obstet. Gynecol. Scand 1997; 76: 248–251.

Full Text

 © The Authors, published by University of Sulaimani, College of Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.