misoprostol and Abortion--Missed

Miscarriage, defined as the spontaneous loss of a pregnancy before 24 weeks' gestation, is common with approximately 25% of women experiencing a miscarriage in their lifetime. An estimated 15% of pregnancies end in miscarriage. Miscarriage can lead to serious morbidity, including haemorrhage, infection, and even death, particularly in settings without adequate healthcare provision. Early miscarriages occur during the first 14 weeks of pregnancy, and can be managed expectantly, medically or surgically. However, there is uncertainty about the relative effectiveness and risks of each option.. To estimate the relative effectiveness and safety profiles for the different management methods for early miscarriage, and to provide rankings of the available methods according to their effectiveness, safety, and side-effect profile using a network meta-analysis.. We searched the Cochrane Pregnancy and Childbirth's Trials Register (9 February 2021), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (12 February 2021), and reference lists of retrieved studies.. We included all randomised controlled trials assessing the effectiveness or safety of methods for miscarriage management. Early miscarriage was defined as less than or equal to 14 weeks of gestation, and included missed and incomplete miscarriage. Management of late miscarriages after 14 weeks of gestation (often referred to as intrauterine fetal deaths) was not eligible for inclusion in the review. Cluster- and quasi-randomised trials were eligible for inclusion. Randomised trials published only as abstracts were eligible if sufficient information could be retrieved. We excluded non-randomised trials.. At least three review authors independently assessed the trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for the primary outcomes of complete miscarriage and composite outcome of death or serious complications. The certainty of evidence was assessed using GRADE. Relative effects for the primary outcomes are reported subgrouped by the type of miscarriage (incomplete and missed miscarriage). We also performed pairwise meta-analyses and network meta-analysis to determine the relative effects and rankings of all available methods.. Our network meta-analysis included 78 randomised trials involving 17,795 women from 37 countries. Most trials (71/78) were conducted in hospital settings and included women with missed or incomplete miscarriage. Across 158 trial arms, the following methods were used: 51 trial arms (33%) used misoprostol; 50 (32%) used suction aspiration; 26 (16%) used expectant management or placebo; 17 (11%) used dilatation and curettage; 11 (6%) used mifepristone plus misoprostol; and three (2%) used suction aspiration plus cervical preparation. Of these 78 studies, 71 (90%) contributed data in a usable form for meta-analysis. Complete miscarriage Based on the relative effects from the network meta-analysis of 59 trials (12,591 women), we found that five methods may be more effective than expectant management or placebo for achieving a complete miscarriage: · suction aspiration after cervical preparation (risk ratio (RR) 2.12, 95% confidence interval (CI) 1.41 to 3.20, low-certainty evidence), · dilatation and curettage (RR 1.49, 95% CI 1.26 to 1.75, low-certainty evidence), · suction aspiration (RR 1.44, 95% CI 1.29 to 1.62, low-certainty evidence), · mifepristone plus misoprostol (RR 1.42, 95% CI 1.22 to 1.66, moderate-certainty evidence), · misoprostol (RR 1.30, 95% CI 1.16 to 1.46, low-certainty evidence). The highest ranked surgical method was suction aspiration after cervical preparation. The highest ranked non-surgical treatment was mifepristone plus misoprostol. All surgical methods were ranked higher than medical methods, which in turn ranked above expectant management or placebo. Composite outcome of death and serious complications Based on the relative effects from the network meta-analysis of 35 trials (8161 women), we found that four methods with available data were compatible with a wide range of treatment effects compared with expectant management or placebo: · dilatation and curettage (RR 0.43, 95% CI 0.17 to 1.06, low-certainty evidence), · suction aspiration (RR 0.55, 95% CI 0.23 to 1.32, low-certainty evidence), · misoprostol (RR 0.50, 95% CI 0.22 to 1.15, low-certainty evidence), · mifepristone plus misoprostol (RR 0.76, 95% CI 0.31 to 1.84, low-certainty evidence). Importantly, no deaths were reported in these studies, thus this composite outcome was entirely composed of serious complications, including blood transfusions, uterine perforations, hysterectomies, and intensive care unit admissions. Expectant management and placebo ranked the lowest whe

Topics: Abortion, Incomplete; Abortion, Missed; Abortion, Spontaneous; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Network Meta-Analysis; Oxytocics; Placebos; Pregnancy; Pregnancy Trimester, First; Randomized Controlled Trials as Topic; Suction; Vacuum Curettage; Watchful Waiting

The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were included in our analysis. Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug, lower-dose regimens (200 ug or 400 ug) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours. In terms of efficacy, the most effective treatment was sublingual misoprostol of 600 ug and the least effective was oral misoprostol of 400 ug. In terms of tolerability, vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects. Misoprostol is a non-invasive, effective medical method for completion of abortion in missed abortion. Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose. The ideal dose and medication interval of misoprostol however needs to be further researched.

Topics: Abortion, Missed; Female; Humans; Misoprostol; Pregnancy

Misoprostol, although originally introduced as a therapy for gastric ulcers, is now widely used in reproductive health. For some indications it is now the optimal choice, whilst for others it provides an important alternative, especially in low-resource settings. The optimal dose varies widely from 20 to 600 mcg depending on the indication and gestation. Use of the correct dose is important, too low a dose will be ineffective and overdosage can be dangerous for mother and baby. Evidence-based information about the safest regimens for multiple pregnancy indications are therefore provided in this review.

Topics: Abortion, Incomplete; Abortion, Induced; Abortion, Missed; Evidence-Based Medicine; Female; Fetal Death; Humans; Labor, Induced; Misoprostol; Obstetrics; Oxytocics; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Preoperative Care

Early pregnancy failure is a common pregnancy complication. This paper reviews the terminology, diagnosis, and treatment of early pregnancy failure. Although surgical curettage has been the standard of care for more than 50 years, additional treatment options exist which appear to be satisfactory to patients. Manual vacuum curettage in the office is an effective alternative to electric vacuum curettage in an operating room. Nonsurgical treatments, including expectant and medical management, are reasonable alternatives depending on the clinical situation and the patient's desires. Clinicians need to understand how these options compare to provide appropriate counseling to patients.

Topics: Abortifacient Agents; Abortion, Missed; Combined Modality Therapy; Dilatation and Curettage; Female; Humans; Mifepristone; Misoprostol; Patient Satisfaction; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Vacuum Extraction, Obstetrical

The frequency of intrauterine fetal death (IUFD) with retained fetus varies, but is estimated to occur in 1% of all pregnancies. The vast majority of women will spontaneously labor and deliver within three weeks of the intrauterine death. The complexity in medical management increases significantly when the cervix is unripe or unfavorable, or when the woman develops disseminated intravascular coagulation. Misoprostol regimens for the induction of labor for second and third trimester IUFDs, range from 50 to 400 microg every 3 to 12 h, and are all clinically effective. Nevertheless, the current scientific evidence supports vaginal misoprostol dosages, which are adjusted to gestational age: between 13-17 weeks, 200 microg 6-hourly; between 18-26 weeks, 100 microg 6-hourly; and more than 27 weeks, 25-50 microg 4-hourly. In women with a previous cesarean, lower doses should be used and doubling of doses should not occur. Clinical monitoring should continue after delivery or expulsion because of the risk of postpartum atony and/or placenta retention.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Drug Administration Schedule; Female; Fetal Death; Humans; Misoprostol; Pregnancy; Pregnancy Trimesters

To quantify the relative benefits and harms of different management options for first-trimester miscarriage.. MEDLINE, EMBASE, and Cochrane Controlled Trials Register searches (1966 to July 2004), including references of retrieved articles.. Randomized trials assigning women with first-trimester missed or incomplete miscarriage to surgical, medical, or expectant management were included. Primary outcomes were successful treatment and patient satisfaction. Secondary outcomes included moderate or severe bleeding, blood transfusion, emergency curettage, pelvic inflammatory disease, nausea, vomiting, and diarrhea. Comparisons used the risk difference. Between-study heterogeneity and random effects summary estimates were calculated.. Complete evacuation of the uterus was significantly more common with surgical than medical management (risk difference 32.8%, number needed to treat 3, success rate of medical management 62%) and with medical than expectant management (risk difference 49.7%, number needed to treat 2). Success rate with expectant management was spuriously low (39%) in the latter comparison. Analysis of cases with incomplete miscarriage only showed that medical management still had two thirds the chance to induce complete evacuation compared with surgical management, but it was better than expectant management. Data from studies that evaluated outcome at 48 hours or more after allocation indicated again that medical management had a better success rate than expectant management but a worse success rate than surgical management; expectant management probably had much lower success rates than surgical evacuation, but data were very sparse. Patient satisfaction data were sparse. Moderate or severe bleeding was less common with medical than expectant management (risk difference 3.2%) and possibly surgical management (risk difference 2.1%). There was a considerable amount of missing information, in particular for secondary outcomes.. One additional success can be achieved among 3 women treated surgically rather than medically. Expectant management has had remarkably variable success rates across these studies, depending probably on the type of miscarriage. Greater standardization of outcomes should be a goal of future research.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Missed; Abortion, Spontaneous; Adolescent; Adult; Dilatation and Curettage; Female; Follow-Up Studies; Humans; Methotrexate; Misoprostol; Pregnancy; Pregnancy Trimester, First; Risk Assessment; Treatment Outcome; Vacuum Curettage

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Incomplete; Abortion, Induced; Abortion, Missed; Cervical Ripening; Drug Therapy, Combination; Empirical Research; Female; Government Regulation; Humans; Labor, Induced; Methotrexate; Mifepristone; Misoprostol; Mobius Syndrome; Oxytocics; Postpartum Hemorrhage; Pregnancy; Pregnant Women

Approximately one in four women will experience a miscarriage during her lifetime. For more than 50 years, the standard management of early pregnancy failure has been a dilatation and curettage (D & C). Typically, the procedure is performed in an operating room, which significantly increases cost. There is little objective information in the modem literature to prove that a D & C for all patients will lower morbidity or improve emotional well being. Treatment options include expectant management, D & C in an outpatient setting, and medical management with misoprostol (not approved by the U.S. Food and Drug Administration for treatment of early pregnancy failure). The medical literature supports that expectant management may result in more complications, including the need for "emergent" curettage, if clinicians do not understand the true normal course of expectant management. In general, women prefer some form of active management. Dilatation and curettage can be performed safely in the office or other outpatient setting using manual vacuum aspiration. Vaginal misoprostol will cause expulsion in 80% to 90% of women up to 13 weeks' uterine size or gestation, including patients who have a gestational sac present. However, these data come from only three trials involving a total of 42 subjects treated with vaginal misoprostol, and another study of 42 women who received vaginal misoprostol for "missed abortion" before a scheduled D & C. There is a significant lack of information from large-scale studies about when treatment is necessary and the relative efficacy, rates of side effects, and acceptability of these various treatment options for early pregnancy failure.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Dilatation and Curettage; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Treatment Outcome; Vacuum Curettage

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Incomplete; Abortion, Missed; Abortion, Spontaneous; Dilatation and Curettage; Female; Humans; Mifepristone; Misoprostol; Pregnancy

To evaluate the efficacy of combined mifepristone and misoprostol compared to misoprostol alone in outpatient medical treatment of first trimester miscarriage. Additionally, the study intends to compare the rate of complications, adverse effects, and treatment acceptability between groups.. Single-center double-blind randomized placebo-controlled trial including women with diagnosis of missed first trimester miscarriage up to 9 weeks of gestation.. Between April 2019 and November 2021, 216 women diagnosed with first trimester miscarriage up to 9 weeks of gestation were randomly assigned to mifepristone group or to misoprostol-alone group. Data from 105 women in mifepristone group and 103 women in misoprostol-alone group were analyzed, with no differences in baseline characteristics. The median time between medications (oral mifepristone/placebo and vaginal misoprostol) was nearly 43 h in both groups (p = 0.906). The median time to first follow-up was 2.6 weeks (IQR 1.0) in mifepristone group and 2.4 weeks (IQR 1.0) in misoprostol-alone group (p = 0.855). The overall success rate of medical treatment was significantly higher in the mifepristone-group comparing to misoprostol-alone group (94.3% vs. 82.5%, RR 1.14, 95% CI, 1.03-1.26; p = 0.008). Accordingly, the rate of surgical treatment was significantly lower in the mifepristone-group (5.7% vs.14.6%, RR 0.39, 95% CI, 0.16-0.97; p = 0.034). The composite complication rate was similar and lower than 4% in both groups. No case of complicated pelvic infection, hemodynamic instability or inpatient supportive treatment was reported. There were no significant differences in the rates of adverse events, median score for vaginal bleeding intensity or analgesics use. Despite the same median value, the score of abdominal pain intensity was significantly higher in the mifepristone-group (p = 0.011). In both groups, more than 65% of the women classified the treatment as "good" and 92% would recommend it to a friend on the same clinical situation.. The mifepristone plus vaginal misoprostol combined treatment for medical resolution of first trimester miscarriage resulted in significant higher success rate and lower rate of surgical uterine evacuation comparing to misoprostol-alone treatment, with no relevant differences in adverse events or treatment acceptability.

Topics: Abortion, Missed; Abortion, Spontaneous; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First

Missed abortion can be treated with medication or aspiration curettage. A Karman aspiration cannula is another option. We evaluated its success in evacuating retained products of conception (RPOC) based on symptoms, endometrial thickness, endometrial irregularity, and blood flow seen on Doppler ultrasound (indicative of placenta).. This prospective, randomized, nonblinded trial was conducted in a university-affiliated medical center. It included 40 women diagnosed with missed abortion and two failed courses of 600 µg buccal misoprostol, one  week apart, randomly assigned to treatment or controls. One week after the second misoprostol course, immediately after evaluating endometrial thickness, endometrial irregularity using Doppler ultrasound, and with blood flow indicative of RPOC, women in the aspiration group underwent endometrial suction with a Karman aspiration cannula. The 5-6 mm cannula attached to a 60 mL syringe was inserted into the uterus under ultrasound guidance. The contents were aspirated until the uterus was empty. Control group patients did not receive additional treatment. All were scheduled for ambulatory, operative hysteroscopy under anesthesia 1 month later (departmental protocol). On that day, all women with RPOC on Doppler ultrasound underwent hysteroscopy. Bleeding days, days with pain, pain according to visual analog scale, length of hospitalization, and infection rate were recorded. NIH clinical trial registration number NCT02917785.. In the study group, 90% did not need hysteroscopy, compared with 50% of controls (p = 0.014). No complications were noted. At all visits, we used Doppler ultrasound to exclude or confirm RPOC. Pathology revealed RPOC in all women who underwent aspiration. Average visual analog scale score for office aspiration (n = 20) was 4.9 ± 3.6. vs. 6.3 ± 3.4 for the first (p = 0.157) and 4.7 ± 3.3 for the second (p = 0.836) misoprostol treatment cycle. The treatment group experienced 6.1 days of bleeding and the control group experienced 1.4 days (p = .006).. Based on our criteria of diagnosing RPOC according to symptoms, endometrial thickness, endometrial irregularity, and blood flow indicative of placental tissue seen on Doppler ultrasound and histo-pathological confirmation, aspiration using Karman cannula can be an effective therapeutic approach. It may be a safe alternative for women with RPOC after misoprostol failure.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Adolescent; Adult; Female; Humans; Misoprostol; Placenta, Retained; Pregnancy; Prospective Studies; Vacuum Curettage

To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage.. Within-trial economic evaluation and model-based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS).. Twenty-eight UK NHS early pregnancy units.. A cohort of 711 women aged 16-39 years with ultrasound evidence of a missed miscarriage.. Treatment with mifepristone and misoprostol or with matched placebo and misoprostol tablets.. Cost per additional successfully managed miscarriage and quality-adjusted life years (QALYs).. For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI 0.7-12.5%) per successfully managed miscarriage and a QALYs difference of 0.04% (95% CI -0.01 to 0.1%). The average cost per successfully managed miscarriage was lower in the MifeMiso arm than in the placebo and misoprostol arm, with a cost saving of £182 (95% CI £26-£338). Hence, the MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that the MifeMiso intervention is preferable, compared with expectant management, and this is the current medical management strategy. However, the model-based evidence suggests that the intervention is a less effective but less costly strategy than surgical management.. The within-trial analysis found that based on cost-effectiveness grounds, the MifeMiso intervention is likely to be recommended by decision makers for the medical management of women presenting with a missed miscarriage.. The combination of mifepristone and misoprostol is more effective and less costly than misoprostol alone for the management of missed miscarriages.

Topics: Abortifacient Agents; Abortion, Missed; Adolescent; Adult; Cost-Benefit Analysis; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Young Adult

To determine whether addition of letrozole to a misoprostol-based abortion regimen can increase the rate of complete abortion.. The randomized, placebo-controlled, double-blind trial enrolled women with missed abortion in the first trimester of pregnancy attending Sadooghi Hospital, Isfahan, Iran, from 2016 to 2018. The women were randomly assigned to the study group, which received 10 mg of letrozole daily for 3 days, followed by two doses of 800 μg of vaginal misoprostol at a 4-hour interval, or the control group, which received a placebo, followed by the same dose of misoprostol. Sonography was performed to check the abortion status.. In total, 120 women completed the study: 60 in the misoprostol plus letrozole group, and 60 in the misoprostol only group. Complete abortion was documented for 93 (77.5%) women: 48 (80.0%) in the misoprostol plus letrozole group and 45 (75.0%) in the misoprostol only group (P=0.80). The mean duration of induction in the misoprostol plus letrozole and misoprostol only groups was 7.35 ± 3.54 hours and 8.2 ± 3.8 4hours, respectively (P=0.21).. Administration of misoprostol alone was found to be as effective as the administration of misoprostol plus letrozole for first-trimester missed abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Iran; Letrozole; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prenatal Care; Treatment Outcome; Young Adult

The study aimed to compare the efficacy and safety of sublingual and vaginal misoprostol for termination of pregnancy in women with first trimester missed abortion.. A single-blind, parallel group, randomised clinical trial (ClinicalTrials.gov NCT02686840) was conducted in a university hospital between 1 February 2016 and 31 January 2017. All women who presented with first trimester missed abortion were invited to participate in the study and were randomised to one of two groups: one group received sublingual misoprostol in three doses of 800 μg every 4 h, while a second group received vaginal misoprostol in the same dosage regimen. The primary outcome of the study was the rate of complete abortion within 7 days after initiation of treatment.. The study included 200 women (100 in each arm). By day 7, successful complete abortion was significantly more frequent in the sublingual misoprostol group (71.4%) than in the vaginal misoprostol group (51.5%) (p = .006). By day 30, the rate of complete abortion was higher in the sublingual misoprostol group (90.6%) than in the vaginal misoprostol group (83.9%), but with no statistically significant difference (p = .164). The mean length of the induction-expulsion interval in the sublingual misoprostol group was significantly shorter compared with the vaginal misoprostol group (12.3 ± 3.1 h vs 16.4 ± 4.2 h, respectively; p = .001) and the sublingual misoprostol group had a smaller drop in haemoglobin level (p = .001). The side effects of misoprostol were significantly more frequent in the sublingual group compared with the vaginal group.. Sublingual misoprostol is more effective than vaginal misoprostol in completing first trimester missed abortion, with a shorter induction-expulsion time. Sublingual misoprostol is, however, associated with more side effects, such as unpleasant taste, gastrointestinal symptoms and fever, compared with vaginal misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Administration, Sublingual; Adult; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Single-Blind Method; Time Factors; Treatment Outcome; Young Adult

Comparing the efficacy of low-dose sublingual misoprostol plus laminaria to medium-dose sublingual misoprostol alone for cervical dilation before surgical management of late first trimester missed abortions.. Randomized, controlled trial evaluated 70 women with missed abortion, admitted for surgical termination of pregnancy. The patients were randomly assigned to receive 200 μg sublingual misoprostol with cervical laminaria (intervention group) or 400 μg sublingual misoprostol without laminaria (control group), four hours before surgical process. The study is registered at www.irct.ir (IRCT2014070711020N4).. More patients in the intervention group achieved the desired cervical dilation (≥Hegar7) before surgical process than the control group (91.4% versus 17.1%, p < 0.001). Patients in the intervention group experienced less pain during the waiting period (mean Visual Analog Scale scores: 30.8 ± 3.7 versus 43.7 ± 5.9, p < 0.001), and had higher satisfaction level (highly satisfied: 97.1% versus 77.1%, p = 0.02). Four patients in the intervention group and none in the control group had spontaneous expulsion of pregnancy products (p = 0.11).. Compared to medium-dose sublingual misoprostol alone, using a combination of cervical laminaria plus low-dose sublingual misoprostol before surgical process is associated with significantly more effective and rapid cervical dilation, lower requirement for mechanical dilation, lower abdominal pain and discomfort during the waiting period and higher patients' satisfaction.

Topics: Abortion, Induced; Abortion, Missed; Administration, Intravaginal; Administration, Sublingual; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Labor Stage, First; Laminaria; Misoprostol; Oxytocics; Pregnancy; Pregnancy Trimester, First; Preoperative Care; Treatment Outcome

In order to simplify management of early pregnancy loss, our goal was to elucidate predictors of successful medical management of miscarriage with a single dose of misoprostol. In this secondary analysis of data from a multicenter randomized controlled trial, candidate biomarkers were compared between 49 women with missed abortion who succeeded in passing their pregnancy with a single dose of misoprostol and 46 women who did not pass their pregnancy with a misoprostol single dose. We computed the precision of trophoblastic protein and hormone concentrations to discriminate between women who succeed or fail single dose misoprostol management. We also included demographic factors in our analyses. We found overlap in the concentrations of the individual markers between women who succeeded and failed single-dose misoprostol. However, hCG levels ≥ 4000 mIU/mL and ADAM-12 levels ≥ 2500 pg/mL were independently associated with complete uterine expulsion after one dose of misoprostol in our population. A multivariable logistic model for success included non-Hispanic ethnicity and parity <2 in addition to hCG ≥ 4000 mIU/mL and ADAM-12 ≥ 2500 pg/mL and had an area under the receiver operating characteristic (ROC) of 0.81 (95% confidence interval: 72-90%). Categorizing women with a predicted probability of ≥ 0.65 resulted in a sensitivity of 75.0%, specificity 77.1% and positive predictive value of 81.8%. While preliminary, our data suggest that serum biomarkers, especially when combined with demographic characteristics, may be helpful in guiding patient decision-making regarding the management of early pregnancy failure (EPF). Further study is warranted.

Topics: Abortion, Incomplete; Abortion, Missed; ADAM Proteins; ADAM12 Protein; Administration, Intravaginal; Adult; Biomarkers; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Logistic Models; Membrane Proteins; Misoprostol; Oxytocics; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, First; ROC Curve; Sensitivity and Specificity; Tablets; Ultrasonography; Young Adult

To report the prospective outcomes of medical management of missed miscarriage before 13 weeks' gestation from an Australian cohort.. Descriptive study of a cohort selected out of a randomised controlled trial.. Outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010.. 264 women requesting medical management of missed miscarriage.. Number of doses of misoprostol required, unscheduled visits for care, findings at ultrasound follow-up, requirement for surgical management, number of cases of gestational trophoblastic disease (GTD), and self-reported patient experience.. 107 women (40.5%) received a repeat dose of misoprostol, and 79 women (29.9%) made unscheduled visits for care. Among the 241 women with Day 7 ultrasound follow-up, a gestational sac was found in 32 women (13.3%), indicating failure of medical management. Complete miscarriage was induced without the need for surgery in 206 women (78.0%). Surgery was performed as an emergency in 13 women (4.9%). Twelve women (4.5%) had surgery for ongoing bleeding after medical management, and four of these did not have chorionic villi on histopathological examination. Five women (1.9%) had GTD, which was managed incidentally under the protocol. Among those who returned patient questionnaires, 73.0% participants (116/159) indicated that they would recommend medical management of miscarriage to other women, while 18.2% (29/159) indicated that they would undergo surgery next time.. The medical management of missed miscarriage on an outpatient basis is safe and effective.. ACTRN12612000150842.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Oral; Adult; Cohort Studies; Female; Humans; Misoprostol; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Risk Assessment; Treatment Outcome; Young Adult

To compare the efficacy of Laminaria tents with Misoprostol for cervical ripening before surgical process in missed abortion.. In a prospective study, 70 women with missed abortion were assigned to have either insertion of a 3 mm intracervical Laminaria tent (n = 35) or vaginal Misoprostol 400 μg (n = 35) on the day prior to suction dilation and curettage (D/C). The women were interviewed just prior to the D/C with regard to pain, vaginal bleeding, and cervical dilator preference.. Cervical dilation was greater in the Laminaria group but not significantly different from that in the Misoprostol group. However, additional cervical dilation before D/C was required in more patients in the Misoprostol group (45.7 vs 14.3%, P = 0.001). Women who received Laminaria reported significantly more pain at the time of insertion (62.8% in Laminaria group vs 22.8% in Misoprostol group) compared with women who received Misoprostol. Conversely, Misoprostol was associated with more nausea, vomiting, diarrhea and vaginal bleeding.. Laminaria tents are more effective cervical dilators than vaginal Misoprostol when inserted the day prior to suction D and C. Vaginal Misoprostol insertion is more comfortable, although it is associated with an increased risk of vaginal bleeding.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Cervical Ripening; Diarrhea; Dilatation and Curettage; Female; Humans; Labor Stage, First; Laminaria; Misoprostol; Nausea; Pain; Pregnancy; Uterine Hemorrhage; Vomiting; Young Adult

To compare the efficacy of sublingual and vaginal misoprostol in the medical management of missed miscarriage.. Fifty women diagnosed as having missed miscarriage of gestational age less than 20 weeks were assigned randomly to receive 400 microg of either sublingual or vaginal misoprostol every three hours, up to a maximum of five doses. The primary outcome measures were, complete evacuation of products of conception, mean induction to delivery time and the occurrence of side effects.. There was no significant difference in complete evacuation rates between the sublingual misoprostol and the vaginal misoprostol groups (52% vs. 48%, p = 0.571) mainly within the first 24 hours. Mean induction to delivery time was also similar for both groups (13.07 +/- 6.95 hours for sublingual versus 13.29 +/- 5.63 hours for vaginal group) as was the total number of doses required (4.44 +/- 1.04 for sublingual versus 4.52 +/- 0.96 for vaginal misoprostol). Side effects were seen in 18 women (72%) in the sublingual group compared to 5 women (20%) in the vaginal group (p < 0.001). The incidence of unpleasant taste was significantly higher in the sublingual group than in the vaginal group (60% versus 4%, p = < 0.001).. Sublingual misoprostol is as effective as vaginal misoprostol for medical management of missed miscarriage but is associated with an increased risk of side effects especially an unpleasant taste.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Administration, Sublingual; Adult; Female; Humans; Misoprostol; Prospective Studies; Young Adult

To evaluate the efficacy of two routes of misoprostol administration (sublingual and vaginal) for the treatment of missed abortion.. Two hundred and twenty women with confirmed missed abortion who received 400 microg/6 h misoprostol either sublingually or vaginally, were included in this randomized control trial. All women were admitted to hospital for follow-up care for 2 days. If the pregnancy was not completely evacuated during this time, the patient underwent immediate surgical completion. Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention.. The effectiveness was high in the sublingual group and statistically different (sublingual 84.5%, vaginal 46.4% P = 0.000 RR = 0.54 95%CI = 0.442-0.681). The groups differed in terms of complications like bleeding (88.2% vs 65.5%), pain (85.5% vs 56.4%), diarrhea (69.1% vs 36.4%) and fever (23.6% vs 13.3%) in the sublingual group versus the vaginal group, but the mean time to expulsion was shorter (9.68 h SD = 5.51 95%CI = 8.61-10.57) in the sublingual group than the vaginal group (16.64 h SD = 14.01 95%CI = 13.8-19.48), P = 0.000. Women in the sublingual group were highly satisfied with the method.. Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Administration, Intravaginal; Administration, Sublingual; Female; Humans; Misoprostol; Patient Satisfaction; Pregnancy; Treatment Outcome

To compare the efficacy and safety of vaginal applications of three different principles of cervical priming prior to first trimester curettage, isosorbide mononitrate (ISMN), misoprostol and Dilapan-S, a hygroscopical cervical dilator.. Pregnant women with missed abortion between 6 and 12 gestational weeks were included and randomly assigned to receive either 80 mg ISMN vaginal gel (group 1) or 200 microg of misoprostol vaginal gel (group 2) or Dilapan-S, a hygroscopical cervical dilator (group 3), for cervical ripening before curettage. Outcome parameters were cervical dilation at the time of operation and maximum dilation reached with Hegar's dilator and the degree of difficulty in mechanical dilation as well as safety and side effects of the preparations.. Sixty-five pregnant women with missed abortion were included and assigned to the three study groups (n=22 for group 1, n=22 for group 2, n=21 for group 3). Misoprostol vaginal gel and Dilapan-S were significantly more effective than ISMN vaginal gel in cervical dilation reached with priming (p<0.005 and p<0.005) and in the degree of difficulty in cervical dilation assessed by the surgeon (p<0.001 and p<0.01). Mild discomfort was indicated by all patients after Dilapan insertion, whereas no patient complained about discomfort after misoprostol or ISMN insertion (p<0001). Three patients suffered from mild hypotension and headache after ISMN treatment, and two had increased vaginal bleeding due to uterine atony during surgery (p<0.05).. A vaginal gel of ISMN is less effective for cervical ripening prior to first trimester curettage compared to misoprostol vaginal gel or Dilapan-S. The latter could be an effective and safe alternative to prostaglandin priming avoiding preoperative contractions caused by prostaglandin preparations.

Topics: Abortion, Missed; Adolescent; Adult; Cervical Ripening; Dilatation and Curettage; Female; Humans; Isosorbide Dinitrate; Misoprostol; Oxytocics; Polymers; Pregnancy; Pregnancy Trimester, First; Vaginal Creams, Foams, and Jellies

We sought to compare endometrial thickness after misoprostol or dilation and curettage (D&C) for early pregnancy failure and to assess the predictive value of endometrial thickness for subsequent D&C after misoprostol treatment.. In a randomized trial of early pregnancy failure management, 491 women were treated with misoprostol vaginally, and 161 were treated with D&C. Transvaginal ultrasonography was planned for 2 and 14 days after misoprostol treatment, and 14 days after D&C.. The mean endometrial thickness 14 days after treatment was 9.0 mm for the misoprostol group and 6.9 mm for the D&C group, (difference 2.1 mm, 95% confidence interval [CI] 1.0-3.2). After the ultrasonograms 2 and 14 days after misoprostol, 13 (3.8%) and 12 (3.2%) women, respectively, subsequently underwent D&C. Women requiring D&C after successful expulsion had significantly greater endometrial thickness than those who did not at 2 days (mean difference 5.2 mm, 95% CI 1.6-8.8) and 14 days (mean difference 5.5 mm, 95% CI 2.3-8.8) after misoprostol. However, endometrial thickness was a poor predictor of subsequent D&C. The areas under the receiver operating characteristic curves for endometrial thickness at 2 and 14 days were 0.71 and 0.73, respectively. Regardless of cutoff values used for predicting subsequent D&C, endometrial thickness had a positive predictive value of 40% or less.. The difference in endometrial thickness between misoprostol treatment and D&C for early pregnancy failure is not clinically significant. Endometrial thickness is not a useful predictor of subsequent surgical intervention after successful expulsion of the gestational sac after misoprostol for early pregnancy failure.. ClinicalTrials.gov,www.clinicaltrials.gov, NCT00177333. I.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Adult; Dilatation and Curettage; Endometrium; Female; Humans; Misoprostol; Predictive Value of Tests; Prospective Studies; Ultrasonography

This prospective study was carried out at a tertiary care hospital on 50 women with missed abortion up to 13 weeks who were given 600 mug misoprostol sublingually every 3 h for a maximum of three doses. Success rate was 86% (up to 72 h), and the acceptability of the method was 69.7%. Sublingual misoprostol is a non-invasive, effective and safe medical method for completion of abortion in missed abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Sublingual; Adult; Female; Gestational Age; Humans; Misoprostol; Patient Satisfaction; Pregnancy; Prospective Studies; Treatment Outcome

We wanted to evaluate the efficacy, safety and acceptability of misoprostol for outpatient management of missed miscarriage. This was a prospective observational study conducted in the early pregnancy unit of a university teaching hospital involving women attending the unit with a diagnosis of missed miscarriage. All women with a missed miscarriage of <12 weeks' gestation and opting to have medical management were eligible for inclusion. Women who consented to take part were given 800 microg of misoprostol in the unit and advised to take two further doses of 400 microg of misoprostol, orally, 3 h apart, the following day at home. Outcome measures included success rates, emergency admission rates, blood transfusion rates, pain scores, satisfaction scores, incidence rates of side-effects and number of women who would choose medical management in future. Of the 268 women diagnosed as having a missed miscarriage during the study period, 75 (28.0%) opted to have medical management. Over three-quarters (n = 58, 77.3%, 95% confidence interval (CI) 66.2 - 86.2) of the women achieved successful complete medical evacuation. Overall, five (6.7%; 95% CI 2.2 - 14.8) women presented for emergency admission. The mean visual analogue scale (VAS) score of all women was 6.7 (SD = 2.8) and the mean satisfaction score was 8.6 (SD = 2.1). Two-thirds of women (n = 50, 66.7%) said that they would choose to have medical evacuation in a future miscarriage, while seven (9.3%) were unsure. A total of 70 (93.3%) women said they preferred to have the treatment at home rather than in the hospital. We conclude that medical evacuation of missed miscarriage is efficacious, safe and acceptable in the outpatient setting.

Topics: Abortifacient Agents; Abortion, Missed; Administration, Oral; Adolescent; Adult; Ambulatory Care; Female; Humans; London; Middle Aged; Misoprostol; Pain Measurement; Patient Satisfaction; Pregnancy; Prospective Studies

To compare the effectiveness and safety of misoprostol and mifepristone, followed when needed by misoprostol, for the treatment of women with early pregnancy failure.. Prospective randomized nonblinded controlled trial.. University-affiliated tertiary medical center.. One hundred fifteen consecutive women diagnosed as having a blighted ovum or missed abortion of <9 weeks of gestation enrolled.. The patients received orally 600 mg mifepristone (group I) or orally 800 microg misoprostol (group II). Most patients in both groups subsequently received 48 hours later orally 800 microg misoprostol.. Failure was defined as surgical intervention due to retained gestational sac 48 hours after completion of the drug protocol, severe symptoms, or suspected retained products of conception after the menstrual period.. The success rate was similar in groups I and II: 38 of 58 patients (65.5%) versus 42 of 57 patients (73.6%), respectively. No cases of severe infection or bleeding necessitating blood transfusion occurred.. Misoprostol is an effective and safe treatment for early pregnancy failure and could replace surgical curettage in over two-thirds of the patients. Mifepristone offers no advantage compared with misoprostol as initial treatment.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Adult; Drug Combinations; Female; Hormone Antagonists; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Outcome; Treatment Outcome

The aim of this study was to evaluate the efficacy and tolerance of a high dose of vaginal misoprostol for outpatient medical management of missed abortion.. Three doses of 400 mug misoprostol were administered intravaginally every 4 h daily, for a maximum period of 3 days, to 108 women with uneventful first trimester pregnancy failure.. A total of 98 women (90.7%) were managed successfully, with 74 (68.5%) of them within the first 24 h. The mean dose of misoprostol administered was 1,113.0 microg (range 400-3,600 microg), and the mean time required was 19.5 h (range 7-65 h). Only 6 out of 108 women (9.3%) required surgical intervention as the result of retained products of conception. The side effect profile was minimal.. This protocol of 400 mug intravaginally misoprostol every 4 h as three daily doses for a maximum of 3 days, may offer an efficacious and safe alternative to the outpatient management of first-trimester missed abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Dose-Response Relationship, Drug; Drug Administration Routes; Female; Humans; Misoprostol; Outpatients; Pregnancy; Pregnancy Trimester, First; Treatment Outcome

To compare the respective effectiveness and safety of 600 microg and 800 microg of intravaginal misoprostol for complete abortion in cases of early pregnancy failure (occurring in the first 12 weeks).. A total of 114 women with a diagnosis of early pregnancy failure made by transvaginal ultrasonography at Rajavithi Hospital between November 25, 2002 and July 31, 2003, were assigned randomly to 2 groups of equal size. In one group the women received 600 microg of misoprostol and in the other 800 microg of misoprostol intravaginally.. The rate of complete abortion within 24 h was significantly higher in the group that received 800 microg of misoprostol (68.4%) than in the other group (45.6%) (P<0.05). There were no significant differences between the 2 groups regarding time interval between misoprostol insertion and complete abortion or side effects.. Intravaginal misoprostol 800 microg is significantly more effective than vaginal misoprostol 600 microg for the termination of an early pregnancy failure, with no significant differences in side effects.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Drug Administration Schedule; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Treatment Outcome; Ultrasonography

The objective of this study was to compare NO-donor isosorbide mononitrate to misoprostol, both applied as vaginal tablets for cervical ripening prior to first trimester curettage in patients with missed abortion.. Thirty women with missed abortion were assigned after a random list to be treated either with 200 microg gemeprost (Cytotec, Pfizer, Germany) or with 40 mg isosorbide mononitrate for cervical priming at least 3 h before curettage. Vaginal bleeding or the intracervical presence of products of conception was documented. The largest number of Hegar's dilator, which could be introduced without difficulty and the largest number of Hegar's dilator at which cervical dilation was performed and the ease of mechanical dilation was assessed.. There were no significant differences in cervical ripeness before procedure nor in ease of dilation. In the misoprostol group, the cervical canal was more dilated before any procedure (median of Hegar's dilator 6 vs. 5) and after dilation (median of Hegar's dilator 11 vs. 10), although this difference was not significant. Vaginal bleeding occurred in two patients in each group. Products of conception were only found in the cervix of one patient of the misoprostol group.. Vaginal application of isosorbidemononitrate in cervical priming prior to curettage abortion is as effective as vaginal application of misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Cervical Ripening; Female; Humans; Isosorbide Dinitrate; Misoprostol; Nitric Oxide Donors; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Treatment Outcome

The aim of this study was to determine the effectiveness and safety of misoprostol (cytotec, Searle) used during labour in women with missed abortion in the second trimester of pregnancy. Labour was induced in 42 women with missed abortion at the Women's Health and Action Research Centre, Benin City, Nigeria with intermittent vaginal administration of 100 microg tablets of misoprostol every 6 h. All women achieved successful vaginal delivery with five women requiring post-delivery uterine evacuation. The gestational ages of the women at the time of induction ranged between 13-24 weeks with a median of 17 weeks. The median dose of misoprostol resulting in successful delivery was 1,100 microgand ranged between 300 microg to 3,100 microg. Side-effects were minimal with five patients experiencing shivering, two women experiencing fever, while three vomited during the period of the induction. These results confirm the efficacy and safety of misoprostol for induction of labour in second trimester missed abortion in Nigerian women. We conclude that misoprostol is effective in the management of missed abortion in the second trimester in Nigeria.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Female; Humans; Misoprostol; Nigeria; Pregnancy; Pregnancy Trimester, Second

The purpose of this study was to estimate whether the efficacy of treatment with intravaginal misoprostol for first-trimester pregnancy failure is enhanced by the addition of saline solution.. Eighty women with embryonic/fetal death or anembryonic pregnancy were assigned randomly to receive either 800 microg of misoprostol with saline solution (group I, 41 women) or without (group II, 39 women). Treatment was repeated on day 3 if the gestational sac remained. Curettage was performed if the gestational sac remained on day 8 or as necessary during at least 30 days of follow-up. Data were analyzed with the Student t test and the chi(2) or Fisher exact test.. By the first follow-up visit, 73% (group I) and 64% (group II) of women passed the gestational sac (P=.38). By the second follow-up visit, expulsion rates were 83% and 87%, respectively (P=.59). Five subjects in each group underwent curettage.. Misoprostol is effective for the treatment of failed first-trimester pregnancy. The expulsion rate is not improved by adding saline solution.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Abortion, Spontaneous; Administration, Intravaginal; Female; Fetal Death; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Sodium Chloride

To compare the efficacy of two routes of misoprostol administration (oral and vaginal) for treatment of missed abortion.. Two hundred women with confirmed missed abortion received 800 mcg misoprostol either orally or vaginally. All women returned for follow-up care 2 days later. If the pregnancy was not completely evacuated at this time, women could wait an additional 5 days or undergo immediate surgical completion. Efficacy was defined as the percent of women discharged from the study without need for surgical intervention.. Efficacy was high in both groups and not statistically different (oral=89.0%, vaginal=92.9%). While the groups did not differ in terms of the completion rate by day 2 (oral=41.6%, vaginal=52.7%), the mean time to expulsion was longer (21.04 h) in the oral group than the vaginal group (13.47 h), p=0.041. Women in both groups were highly satisfied with the method.. Medical management of missed abortion with either oral or vaginal misoprostol is highly effective and highly acceptable.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Administration, Oral; Adult; Female; Humans; Middle Aged; Misoprostol; Pregnancy; Pregnancy Trimester, First; Treatment Outcome

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Dilatation and Curettage; Dinoprostone; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Length of Stay; Misoprostol; Oxytocics; Patient Satisfaction; Pregnancy; Prospective Studies; Tablets; Uterine Hemorrhage

Topics: Abortion, Missed; Administration, Intravaginal; Female; Follow-Up Studies; Humans; Misoprostol; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Risk Assessment; Risk Factors

To compare the efficacy of two different medical treatment regimens: mifepristone 600 mg orally + misoprostol 0.4 mg vaginally (Mf + Ms) or misoprostol 0.4 mg vaginally (Ms) with conventional surgical evacuation (SE) in women with missed abortion.. Prospective crossover study with alternating regimens every 4 months. The three university clinics of Obstetrics and Gynecology in Gentofte, Herlev and Glostrup of Copenhagen County. During the period October 1999 to October 2000, 176 women with missed abortion accepted to participate in the study.. The proportion of women who needed surgical evacuation after medical treatment, number of women who needed re-evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, need of analgesics, and the subjective experiences from the participating women. Fifty-four, 73 and 49 patients were randomized to Mf + Ms, Ms and SE, respectively. Within 1 week, complete expulsion occurred in 40 (74%), 52 (71%), 47 (96%) of the three arms, respectively. Duration of bleeding was 6.9, 7.1 and 2.5 days in the three arms, respectively (p < 0.01). Women with an initial plasma chorionic gonadotrophine (p-hCG) between 2000 and 20 000 IU/l and a gestational age less than 75 days had a significantly better response to the medical treatment than those not fulfilling these two criteria. Initial p-progesterone did not correlate with success of medical treatment.. Proportion of women who needed surgical evacuation after medical treatment, and the number of women who needed re-evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, the need of analgesics, and subjective experiences from participating women.. Vaginal misoprostol 0.4-0.6 mg is effective in most patients with missed abortion. Pre-treatment with the antiprogesterone mifepristone does not increase the success rate. The selection of women with missed abortion for medical treatment based on gestational age and initial p-hCG level may increase the success of medical treatment significantly.

Topics: Abortifacient Agents; Abortion, Missed; Administration, Intravaginal; Administration, Oral; Adolescent; Adult; Chorionic Gonadotropin; Cross-Over Studies; Denmark; Drug Administration Schedule; Female; Gestational Age; Humans; Middle Aged; Mifepristone; Misoprostol; Pregnancy; Prospective Studies; Treatment Outcome

Missed abortions are a common occurrence and represent a heavy gynaecological emergency workload to both medical and nursing staff. The conventional method using vacuum aspiration of uterus is associated with morbidity and mortality. Medical termination of pregnancy is accepted as a safe and effective alternative method. However, medical evacuation of uterus in missed abortions had not been fully investigated. In this study we hope to examine the efficacy of medical methods for terminating missed abortions. Mifepristone and misoprostol prescribed to 100 women with an ultrasonically confirmed missed abortion was compared with 100 women who had surgical evacuation under general anaesthesia for their missed abortion. The disparity in complications between medical and surgical groups was not significantly different (Student's t-test, P=0.5). This study showed medical evacuation of missed abortion to be an effective, safe and cost-effective, alternative to surgical evacuation of the uterus and is particularly suited to women not wanting hospital admission or a surgical procedure under general anaesthesia. It represents an option of management that can be less intrusive and gives the woman some control but is both safe and effective.

Topics: Abortifacient Agents; Abortion, Missed; Abortion, Therapeutic; Adolescent; Adult; Female; Humans; Mifepristone; Misoprostol; Patient Acceptance of Health Care; Pregnancy; Treatment Outcome; Ultrasonography; Vacuum Curettage

To estimate the efficacy of vaginal misoprostol for medical management of missed abortion.. Fifty women with missed abortion were randomized to treatment with up to two 800 microg [DOSAGE ERROR CORRECTED] doses of misoprostol vaginally or a placebo. Participants were reviewed daily for 2 days, then again at 1 week. A blood sample for hemoglobin and serum beta-human chorionic gonadotropin (beta hCG) was obtained on day 1 and the hemoglobin level checked again on day 7. Complete abortion was defined as expulsion of the products of conception without dilation and curettage (D&C) and a negative follow-up urine beta hCG test after 4 weeks, or as no products of conception obtained at D&C in cases of suspected incomplete abortion.. The rate of complete abortion was 80% (20 of 25) in the misoprostol group and 16% (four of 25) in the placebo group, relative risk 0.20 (0.08, 0.50), P <.001. The rate of D&C was 28% (seven of 25) in the misoprostol group and 84% (21 of 25) in the placebo group, relative risk 0.33 (0.17, 0.64), P <.001. One participant in the misoprostol group had an emergency D&C for heavy bleeding. No participants required blood transfusion. The mean reduction in hemoglobin from day 1 to day 7 was 3.2 g/L in the misoprostol group versus 4.3 g/L in the placebo group, P = .72. Patient satisfaction with misoprostol treatment was high with 19 of 21 participants reporting they would try medical management again if they experienced another missed abortion.. Medical management of missed abortion is effective, reduces the need for D&C, and is associated with high levels of patient satisfaction.

Topics: Abortion, Missed; Administration, Intravaginal; Adult; Blood Transfusion; Chorionic Gonadotropin, beta Subunit, Human; Dilatation and Curettage; Female; Gestational Age; Hemoglobins; Humans; Misoprostol; Patient Satisfaction; Pregnancy; Ultrasonography; Uterine Hemorrhage

A prospective randomized control trial was designed to assess the effectiveness of single dose, 800 microg misoprostol administered p.v. compared with surgical evacuation for the treatment of early pregnancy failure. A total of 80 women with a diagnosis of early pregnancy failure were randomized to study (vaginal misoprostol) and control (surgical curettage) groups. Success of treatment, side-effects as assessed during, immediately after and 10 days after treatment, and patient satisfaction were compared. Intravaginal misoprostol was successful in 82.5% (33 out of 40) of the patients. None of the control group patients required a repeat evacuation. The number of patients who experienced significant abdominal pain following treatment did not differ between the groups. The duration of pain was shorter in the control group; however, they required more analgesics during this short period. The number of patients with significant vaginal bleeding, the duration or severity of bleeding did not show any significant difference between the groups. All 33 patients in the study group who had successful treatment expressed satisfaction, whereas only 58% of the control group did so. In conclusion this randomized control study demonstrated the efficacy and safety of the administration of 800 microg of misoprostol p.v. for the management of early pregnancy failure.

Topics: Abortion, Incomplete; Abortion, Missed; Administration, Intravaginal; Dilatation and Curettage; Female; Humans; Misoprostol; Oxytocics; Patient Satisfaction; Pregnancy; Prospective Studies

This was a randomized double-blind placebo-controlled trial to determine the effect of oral contraceptive (OC) pills taken immediately after medical abortion on the duration of bleeding and complete abortion rate. Two hundred women in the first 49 days of pregnancy were given 200 mg mifepristone orally followed by 400 microg misoprostol vaginally 48 h later. One day later, they were randomized to receive either OC pills (30 microg of ethinyl oestradiol and 0.15 mg of levonorgestrel per tablet) or placebo for 21 days. The complete abortion rates were 98% in the OC group and 99% in the placebo group. The median duration of bleeding was similar: 17 (range: 5-57) days in the OC group and 16 (range: 6-55) days in the placebo group. In the OC group there was a small but significant fall in the haemoglobin concentration by 14 days (5.3 g/dl) after administration of mifepristone. The incidence of side-effects was similar in the two groups. We conclude that the use of OC pills does not decrease the duration of bleeding after medical abortion nor does it affect the abortion rate.

Topics: Abortifacient Agents, Steroidal; Abortion, Induced; Abortion, Missed; Adult; Contraceptives, Oral; Double-Blind Method; Female; Hemoglobins; Humans; Mifepristone; Misoprostol; Placebos; Pregnancy; Time Factors; Uterine Hemorrhage

Topics: Abortion, Missed; Administration, Intravaginal; Adult; Female; Humans; Misoprostol; Oxytocics; Pregnancy; Prospective Studies; Treatment Outcome

To compare the effect of vaginal misoprostol with that of placebo when used prior to dilation and aspiration in women with a missed abortion.. Eighty-four pregnant women with a missed abortion were randomized to receive either vaginal misoprostol (200 micrograms) or placebo the day before the planned dilatation and aspiration under inhalation anesthesia.. Thirty-five women (83.33%) in the misoprostol group and 6 women (17.14%) in the placebo group aborted spontaneously prior to the scheduled dilatation and aspiration, P < 0.0001. The mean insertion to spontaneous expulsion time was 11.63 +/- 6.14 h in the misoprostol group compared to 11.95 +/- 5.43 h in placebo. In the misoprostol group two women required intramuscular pethidine for analgesia. In the placebo group there were two cases of blood loss in excess of 500 ml and one woman with a uterine perforation.. Vaginal administration of misoprostol to women with a missed abortion produced spontaneous expulsion of the pregnancy and reduced the need for surgical treatment.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Cervix Uteri; Dilatation; Female; Humans; Misoprostol; Pregnancy

To determine whether misoprostol (a prostaglandin E1 analogue) 400 micrograms orally (group 1) or 800 micrograms vaginally (group 2) will cause complete uterine evacuation in women with early pregnancy failure.. Twenty subjects were recruited for a prospective, non-blinded, randomized clinical trial. Early pregnancy failure was diagnosed by transvaginal ultrasound examination; only women with a closed cervical os and minimal vaginal bleeding were enrolled. Subjects returned 24 hours after misoprostol administration for a transvaginal ultrasound examination. If the gestational sac was still present, the misoprostol dose was repeated and the subject returned again 24 hours later. Subjects who failed to expel the pregnancy were offered a suction curettage.. Twelve and eight women were randomized to groups 1 and 2, respectively. Complete uterine evacuation occurred in three of 12 [25%, 95% confidence interval (CI) 1%, 50%] and seven of eight (88%, 95% CI 65%, 100%, P = .010) subjects in groups 1 and 2, respectively. Vomiting occurred in 30% and 13%, respectively, and diarrhea in 50% and 38%, respectively.. Vaginal misoprostol 800 micrograms is more effective than oral misoprostol 400 micrograms for uterine evacuation of early pregnancy failure and may be an effective alternative to dilation and curettage.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Administration, Oral; Adult; Diarrhea; Female; Humans; Misoprostol; Pilot Projects; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Ultrasonography; Vomiting

In a prospective clinical trial the effectiveness of a combination of 400 mg of mifepristone (antiprogesterone) and 400 g misoprostol (synthetic prostaglandin E1 analogue), both taken orally, was evaluated for the treatment of missed abortion. Of the 31 patients included, 16 (52%) had an empty uterine cavity at follow up six days after inclusion, 11 (35%) required surgical evacuation for retained intrauterine products of conception found at follow up, and four (13%) required emergency surgical evacuation due to severe pain or bleeding. The results do not support the use of mifepristone and misoprostol for women wishing the miscarriage to be resolved quickly.. A prospective clinical trial involving 31 Swedish women failed to demonstrate the effectiveness of a combination of 400 mg of mifepristone and 400 g of misoprostol for the treatment of missed spontaneous abortion. Transvaginal ultrasound examination showed intrauterine products of conception with an antero-posterior diameter of 15-50 mm in all study participants. 6 days after treatment, only 16 women (52%) had an empty uterine cavity. Surgical evacuation was required in the remaining 15 women, 11 because of retained products of conception (mean diameter, 26.7 mm). An additional 4 women underwent emergency surgical evacuation due to severe pain or bleeding. Women who successfully aborted after treatment had a significantly greater number of prior pregnancies than women who failed to abort. There were no differences between groups, however, in gestational length, size of the pregnancy products, or serum levels of human chorionic gonadotropin and progesterone. These results do not support the use of mifepristone and misoprostol for pharmacologic treatment in women who want their spontaneous abortions to be resolved quickly.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Missed; Administration, Oral; Drug Combinations; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Prospective Studies; Treatment Failure

This prospective, randomized study compared the efficacy of intravaginal misoprostol (Cytotec) and gemeprost (Cervagem) as an abortifacient for intrauterine deaths in second trimester pregnancy. Side-effects, complications and the cost-effectiveness associated with each drug were assessed. 21 out of 25 patients (84%) in the misoprostol group aborted whereas only 17 out of 25 patients (68%) in the gemeprost group aborted within 24 hours after the initiation of therapy. In the misoprostol group, the abortion rate was influenced by the gestational age with 100% abortion rate for those > 17 weeks' gestation compared to 67% for those with a gestational age of 13-16 weeks. Side-effects were rare in either group and no major complications were reported in either group. Misoprostol was definitely more cost-effective compared to gemeprost as the mean cost of inducing an abortion using misoprostol was RM 1.08 whereas that of gemeprost was RM 105. We thus concluded that misoprostol was at least as effective as gemeprost as an abortifacient for intrauterine death in second trimester pregnancy. Moreover, it was less costly, with very few side-effects.. The efficacy of intravaginal misoprostol (Cytotec) and gemeprost (Cervagem) as abortifacients in second-trimester pregnancies was compared in a prospective study of 50 women admitted to Hospital Kuala Lumpur (Malaysia) with an intrauterine death at a gestational age of 13-26 weeks. 25 women were randomly assigned to receive 200 mcg of misoprostol inserted into the posterior fornix of the vagina every 3 hours until abortion occurred; the remaining 25 women received 1 mg of gemeprost every 3 hours until abortion. Within 24 hours of drug administration, 21 women (84%) in the misoprostol group and 17 (68%) in the gemeprost group had aborted. In the misoprostol group, the abortion rate was influenced by gestational age; this rate was 100% in women with pregnancies over 17 weeks' gestation compared with 67% in women in weeks 13-16. No major side effects or complications occurred in either group. The mean cost of abortion induction was RM 1.08 with misoprostol and RM 105 with gemeprost. Misoprostol seems to be the drug of choice for second-trimester pregnancy termination. Not only is intravaginal misoprostol at least as effective as gemeprost, it is less costly, does not require refrigeration for storage, and is associated with few side effects. Additional studies with larger sample sizes are recommended to determine the optimal misoprostol dosage and frequency of administration.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Alprostadil; Cost-Benefit Analysis; Female; Humans; Infant, Newborn; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Treatment Outcome

To evaluate the cost-effectiveness of a strategy based on direct-acting uterine curettage (UC) versus a pre-direct-acting misoprostol (1600 mg) in patients with missed abortion (MA), from the perspective of a National Health System.. An open prospective cohort study was carried out at Reina Sofía University Hospital (Córdoba, Spain) from January 1, 2019 to December 31, 2019 in 180 patients diagnosed with MA. The patients chose medical treatment with intravaginal misoprostol (800 μg/4 h) or UC after receiving complete and detailed information. The effectiveness, clinical characteristics of the patients, costs of treating and managing the disease, and satisfaction with the procedures were recorded.. One hundred and forty-five patients (80.6%) chose misoprostol versus 35 patients (19.4%) who chose UC. The effectiveness of misoprostol has been 42% evaluated at 48 h; UC success rate has been 100%. The incidence of side effects is significantly higher in patients treated with misoprostol (p < 0.05); as well as the number of care received by the patient (p < 0.05). Satisfaction is higher in patients treated with UC (p < 0.05). However, the cost is almost 5-folds higher in patients treated with UC (p < 0.05).. UC has a higher success rate, greater satisfaction, and a lower incidence of side effects, although significantly increases the cost compared to misoprostol in MA.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Administration, Intravaginal; Cost-Benefit Analysis; Curettage; Female; Humans; Misoprostol; Pregnancy; Prospective Studies

To assess the rates of success of the second dose of Misoprostol administration and to evaluate the parameters that affect the success of this approach.. This retrospective cohort study was performed using institutional database of Carmel Medical Center between the dates of 1/11/2012-1/11/2017. Patients with ultrasound proven intrauterine abnormal pregnancy, treated for missed abortion or blighted ovum by two doses of intravaginal Misoprostol were included. The primary outcome was the treatment success rate of repeated Misoprostol treatment, and factors affecting this outcome.. Overall, 97 patients were included in the study. The success of repeated dose of Misoprostol was noted in 46 cases (47.4%). A higher success rate was noted in symptomatic women - 64.3% vs. 35.7% in asymptomatic patients (Odds Ratio 2.6, 95% Confidence Interval 1.1-6.5). In addition, marginal significance was noted for pregnancies with an embryonic pulse previously observed (66.7% in the success group vs. 33.3% in failed treatment, p=0.051).. Efficacy of a repeated Misoprostol course was shown to have a success rate of 47%%. This success rate is slightly increased in women presenting symptoms of bleeding before first administration. This information is highly important in the clinical discussion with each patient prior choosing a possible treatment.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Female; Humans; Misoprostol; Pregnancy; Retrospective Studies

In the Netherlands, medical treatment to women with a non-vital pregnancy is provided in secondary care. In a Dutch pilot study, it has been shown that treatment of a missed miscarriage with misoprostol in primary care is an acceptable alternative. However, there are clear indications that medical treatment in women with a non-vital pregnancy is greatly improved when mifepristone is prescribed in addition to misoprostol. The authors state that this treatment is also justified in primary care.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Legal; Abortion, Missed; Adult; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Netherlands; Pilot Projects; Pregnancy; Primary Health Care

It has been estimated that one out of every four women experience first-trimester miscarriage. Missed miscarriage is a common form of early miscarriage where the products of conception are not expelled from the uterus. It is diagnosed by ultrasound. The primary objective of this study was to evaluate the success rate of a combination treatment with mifepristone and misoprostol for missed miscarriage in clinical practice. The secondary objective was to identify significant factors influencing the rate of success.. A cohort of 941 consecutive women with an ICD-10 diagnosis of missed miscarriage who received treatment with 800 µg vaginal misoprostol and 2 repeat doses of 400 µg oral misoprostol after mifepristone pretreatment between 1 January 2012 and 31 December 2014 was analyzed. Women with a uterine size smaller than 12 weeks who were planned for medical treatment were included in the study. The exclusion criteria were primary surgical management or planned follow up outside the Stockholm County Council area.. The success rate of medical treatment, defined as no need for surgical treatment, was 85.5% (805/941) in women with a uterine size of less than 12 weeks. However, for women with uterine size below 9 weeks the success rate was 88.9% (586/659). Indeed, uterine size of 9 gestational weeks or larger at time of treatment was identified as the only significant risk factor for surgical intervention.. The medical regimen for missed miscarriage offered in this study appears to be safe and with high rates of success. Conclusions about which women to exclude from medical treatment could not be made. Medical treatment may therefore benefit all women with missed miscarriage who wish to avoid primary surgery.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Missed; Adolescent; Adult; Drug Therapy, Combination; Female; Humans; Middle Aged; Mifepristone; Misoprostol; Organ Size; Pregnancy; Pregnancy Trimesters; Treatment Outcome; Ultrasonography; Uterus; Young Adult

Our aim of the study was to evaluate the efficacy and complication rate of our inpatient medical management protocol for missed miscarriages. Three-hundred and ninety women hospitalised at our tertiary centre because of a missed miscarriage/anembryonic pregnancy in 2012-2013 were included in this retrospective study. The women underwent either a low (until 9 + 0 weeks of gestation) or high gestational age (from 9 + 1 until 15 + 6 weeks of gestation) management protocol. The success rate, curettage in the first 48 hours after the procedure, the complication rate and the factors that might influence these outcomes were evaluated. The overall success rate was 83.3%. The curettage in the first 48 hours after the procedure was performed in 7.4% of the patients and was more often in the high gestational age protocol. Complications that required another outpatient visit or hospitalisation occurred in 9% of the patients. Higher beta-hCG values 14 days after the procedure and the absence of evacuation of products of conception during hospitalisation were associated with a higher complication rate. IMPACT STATEMENT What is already known on this subject? As much as 10-20% of clinically recognised pregnancies end in a spontaneous abortion. A missed miscarriage and a blighted ovum represent a form of spontaneous abortion, which has long been treated with surgical evacuation. However, nowadays, medical management represents a well-established alternative with very high success rates and is considered as an equivalent and safe method that is also very well accepted by patients. What do the results of this study add? According to our results, a medical management of a first trimester missed miscarriage and a blighted ovum is very effective with an overall success rate of 83.3% and a very low percentage of curettage in the first 48 hours after the procedure (7.4%). Our study was also able to identify higher beta-hCG values 14 days after procedure and absence of evacuation of products of conception during hospitalisation as risk factors for complication occurrence. What are the implications of these findings for clinical practice and/or further research? Our study helps to identify patients who are at greater risk for developing complications after the medical management of a first trimester missed miscarriage.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Missed; Adolescent; Adult; Chorionic Gonadotropin, beta Subunit, Human; Curettage; Female; Gestational Age; Humans; Middle Aged; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Uterine Hemorrhage; Young Adult

We aimed to determine the importance of uterine position as a predicting factor of success rate in medically treated early pregnancy failure (EPF).. We carried out a retrospective cohort study at the Obstetrics and Gynecology Department of a tertiary medical center between January 2011 and June 2012. We included women diagnosed with EPF, which we defined as women diagnosed with missed abortion up to 13 gestational weeks. Patients were treated with one or two doses of 800 μg of misoprostol vaginally in accordance with the department's protocol. Demographic, clinical, and treatment success data were collected from patient electronic records.. A total of 255 women were included in our study. The success rate after treatment with misoprostol for the anterior uterine group was 78.7% as compared to the non-anterior uterine group, which achieved a success rate of 88.1%. This difference was not statistically significant (P = 0.180). In a multivariate analysis comparing patients for whom treatment with misoprostol was successful as opposed to patients for whom treatment failed, only embryonic sac size showed a statistically significant difference, measuring shorter in the success group.. Uterine position has no effect on success rate of misoprostol treatment for EPF.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Female; Humans; Misoprostol; Pregnancy; Retrospective Studies; Treatment Outcome; Ultrasonography; Uterus; Young Adult

To evaluate the percentage change in total βeta-unit human chorionic gonadotropin (βhCG) levels (%ΔβhCG) in the prediction of treatment outcomes following intravaginal misoprostol for missed miscarriage before 13 weeks.. A secondary analysis of a randomised controlled study of medical management of miscarriage was performed. Total βhCG levels were collected before misoprostol (baseline) and after a planned seven day interval (follow-up), when a transvaginal ultrasound (TVUS) reported a gestational sac as present or not. If no sac at TVUS, surgery was indicated on clinical criteria. %ΔβhCG ((baseline βhCG - follow-up βhCG)/baseline βhCG × 100) was evaluated in the prediction of a sac at TVUS and surgery on clinical criteria.. %ΔβhCG was calculated for cases with βhCG levels within two days of misoprostol and TVUS; calculation interval determined case number. The median %ΔβhCG for 24 cases with a persistent sac (6-9 day interval) was significantly lower than for 145 with no sac (58.75% (interquartile range (IQR): 37.59-76.69; maximum 86.54) vs 97.65% (IQR: 95.44-98.43); P < 0.0001). The median %ΔβhCG for eight cases needing surgery on clinical criteria (5-9 day interval) was significantly lower than for 140 cases with no sac not needing surgery (79.68% (IQR: 64.63-91.15; maximum 94.06) vs 97.68% (IQR: 95.61-98.50); P < 0.0001). The area under the receiver-operator curve was 0.975 for prediction of a persistent sac and 0.944 for prediction of surgery on clinical criteria, respectively. %ΔβhCG > 87% predicted no sac at TVUS. %ΔβhCG > 94.5% predicted no surgery on clinical criteria.. %ΔβhCG calculation over one week reliably predicted treatment outcomes after medical management of missed miscarriage.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Area Under Curve; Chorionic Gonadotropin, beta Subunit, Human; Endosonography; Female; Gestational Sac; Gestational Trophoblastic Disease; Humans; Misoprostol; Predictive Value of Tests; Pregnancy; ROC Curve

Medical management of miscarriage allows women to avoid the risks associated with surgical intervention. In 2011 the early pregnancy assessment service (EPAS) at the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia introduced medical management of miscarriage with single-dose 800 μg vaginal misoprostol.. We sought to investigate the impact of the introduction of medical management had on the proportion of women having surgery and conservative management and to examine the success and complication rates of medical management.. We undertook a retrospective cohort study that included all women diagnosed with a miscarriage from 12 months prior to and 18 months after the introduction of medical management. Successful management was defined as the absence of retained products of conception or endometrial thickness less than 15 mm on ultrasound at two weeks. The change in management choices over time, the success rates and complication rates were measured.. Of 1102 women in the final analysis, 446 were in Group A (before medical management) and 656 in Group B (after medical management). Primary surgical procedures fell significantly for missed miscarriages from 68 to 48% (P < 0.001) and primary conservative management reduced for incomplete miscarriages (63-44%; P = 0.01). Overall 89 of 108 (82.4%) patients managed medically had a resolution within two weeks. One in ten presented with a complication.. The introduction of medical management led to a statistically significant reduction in the proportion of women undergoing primary surgical management of missed miscarriage. Success and complication rates were similar to other studies.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Missed; Administration, Intravaginal; Adult; Conservative Treatment; Dilatation and Curettage; Female; Gestational Age; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Retrospective Studies; Treatment Outcome

Misoprostol management of miscarriage is only now becoming widely used in Australia.. To review the efficacy, safety and the popularity of outpatient sublingual misoprostol in empty sac/missed miscarriage management over its first two years of availability in a metropolitan Australian hospital.. A retrospective cohort review was undertaken of women choosing sublingual misoprostol 600 μg (three tablets) × three doses for miscarriage management. Principal outcomes assessed were miscarriage resolution without the need for curettage and complications. Additionally, the relative popularity of misoprostol versus surgery by place of birth and over time, and the return of pregnancy tissue for histology were analysed.. Between 1 December 2012 and 30 November 2014, 279 women chose sublingual misoprostol for nonurgent miscarriage management, while 420 chose surgery (40 and 60%, respectively). Of the misoprostol cohort, 269 had complete data; 239 of 269 (88.8%) had resolution without curettage, nine (3.3%) had acute curettage, 21 (7.8%) had nonacute curettage, 30 (11.15%) had unplanned emergency department presentation, 11 (4.1%) had unplanned admission, three (1.1%) had blood transfusion and one (0.4%) had an infection requiring admission. Misoprostol was as popular with Australian-born as overseas-born women; 53.5% of patients returned histopathology specimens; one (0.7%) demonstrated partial hydatidiform mole.. Outpatient management of missed/empty gestational sac miscarriage using sublingual misoprostol is associated with a high rate of avoiding curettage and the low rate of complication. It is equally popular with Australian-born and overseas-born women. Just over 50% returned pregnancy tissue for analysis.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Sublingual; Adult; Ambulatory Care; Australia; Hospitals, Urban; Humans; Middle Aged; Misoprostol; Patient Preference; Retrospective Studies; Specimen Handling; Vacuum Curettage; Young Adult

To evaluate the efficacy of misoprostol in the treatment of missed or incomplete abortion in relation to uterine position.. In a retrospective cohort study, misoprostol was evaluated as first-line treatment for missed and incomplete abortion before 13 gestational weeks. Between 2009 and 2011, women received 600 μg of sublingual misoprostol for missed abortion or 400 μg for incomplete abortion. Follow-up examinations were performed 7-10 days later, with the option of a second administration of misoprostol. Success was defined by the absence of vaginal bleeding or sonographic signs of incomplete abortion, and falling levels of β-human chorionic gonadotropin.. In total, 111 women were included in the study. A single-dose regimen was effective for 73 (65.8%) women. The overall success rate, including repeat doses, was 73.0% (81/111). There were no significant differences in treatment success between women with missed abortion and those with incomplete abortion (56/89 [62.9%] vs 18/22 [81.8%]; P=0.152). Anteverted uterine position was associated with significantly higher success rates compared with diverging position (62/86 [72.1%] vs 4/18 [22.2%]; P=0.001).. Misoprostol is an effective treatment for early pregnancy failure. Uterine position might impact the success of medical treatment for missed abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Missed; Adult; Cohort Studies; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Misoprostol; Pregnancy; Retrospective Studies; Treatment Outcome; Uterus

The study objective was to determine the relationship between serum progesterone level and the outcome of mifepristone-misoprostol regimen for medical management of missed miscarriage up to 12 weeks. A blood sample was collected just before mifepristone administration for serum progesterone assay. After 48 h, misoprostol 800 μg was administered vaginally; further 400 μg was administered 4 h later if necessary. Treatment was classed as a success if retained tissues were expelled within 72 h (Group 1), and a failure if this did not occur (Group 2). Of 52 analysed cases, complete medical evacuation occurred within 72 h in 40 (76.9%) women (serum progesterone ranged 13-90 nmol/l). Serum progesterone between the two groups were statistically significant (p < 0.001), by Mann-Whitney test. Of the 12 patients who did not respond, nine (75%) women had serum progesterone < 10 nmol/l. We found mifepristone-misoprostol regimen is less effective in missed miscarriage when serum progesterone is < 10 nmol/l.

Topics: Abortifacient Agents; Abortion, Missed; Adolescent; Adult; Female; Humans; Mifepristone; Misoprostol; Pilot Projects; Pregnancy; Progesterone; Prospective Studies; Treatment Failure; Young Adult

Many misoprostol regimens have been used to treat early pregnancy loss as an alternative to surgical evacuation, with differing adverse event and success rates.. This study sought to compare the effectiveness and adverse effects of 800 and 600 μg of misoprostol administered vaginally for the treatment of early pregnancy failure in an outpatient setting.. A retrospective, observational study of 946 women with a missed miscarriage <12 weeks' gestation was performed: 487 women received 800 μg (group 1) and 459 women received 600 μg (group 2) of vaginal misoprostol every 24 h for two days. The first follow-up was seven days after treatment. Women were asked about symptoms, and a transvaginal ultrasound was performed. If an incomplete miscarriage or gestational sac was still found, then an additional dose of intravaginal misoprostol was prescribed, and a second follow-up visit was arranged for seven days later. Surgical evacuation was scheduled for women who did not wish to continue medical treatment after the first or second follow-up visit.. The total rate of complete miscarriage was 90.6% after 800 μg and 87.8% after 600 μg of intravaginal misoprostol. The percentage of women who underwent surgical evacuation after medical treatment was 9.4% for group 1 and 12.2% for group 2.. Complete uterine evacuation after a missed miscarriage was effectively induced by both 600 and 800 μg of misoprostol. The overall success of medical treatment with intravaginal misoprostol demonstrates that the treatment is safe in an outpatient setting.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Female; Follow-Up Studies; Humans; Misoprostol; Outpatients; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Treatment Outcome

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Missed; Abortion, Spontaneous; Administration, Intravaginal; Chorionic Gonadotropin; Fallopian Tubes; Female; Humans; Laparoscopy; Misoprostol; Practice Guidelines as Topic; Pregnancy; Pregnancy Tests; Pregnancy, Ectopic; Salpingectomy; Ultrasonography, Prenatal; Vacuum Curettage

We report the case of a 16 years old female patient, with a pregnancy history of 11.4 weeks by ultrasound and intrauterine fetal death. In a private clinic were prescribed methotrexate 500 mg intramuscular single dose, and vaginal misoprostol. She had a clinical feature of five days of evolution characterized by fever of 39 degrees C, nausea, general attack and vomiting. The initial diagnosis was severe sepsis secondary to septic abortion, oral candidiasis and acute poisoning by methotrexate. After that, she was referred to the Instituto Nacional de Perinatologia, where stayed with fever for four days, and was managed with hydration, antibiotics, folinic acid and alkalizing. Her recovery was gradual. She was discharged after 12 days with significant clinical improvement. The literature review describes that the use of methotrexate for abortion purpose with therapeutic-dose presents a similar adverse effects to those found in our patient, however there are no case reports that describe the use of this drug in macrodosis for the same purpose, and their cytotoxic effects. We present this case because the patient used a macrodosis of this antimetabolite and due to the premature and empirical management with folinic acid, joined with alkalinization of urine, is the ideal treatment and as it is illustrated in our case.

Topics: Abortifacient Agents; Abortion, Induced; Abortion, Missed; Abortion, Septic; Administration, Intravaginal; Adolescent; Anti-Bacterial Agents; Antidotes; Candidiasis, Oral; Female; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Injections, Intramuscular; Leucovorin; Methotrexate; Misoprostol; Neutropenia; Poisoning; Pregnancy; Recombinant Proteins; Vomiting

Spontaneous abortion is categorized as threatened, inevitable, incomplete, complete, or missed. Abortion can be further categorized as sporadic or recurrent. By definition, a missed abortion is an in utero death of the embryo or fetus before the 20th week of gestation with retained conception products. Missed abortions may also be referred to as blighted ovum or an anembryonic pregnancy.. A prospective-pathological analysis of 100 missed abortion pregnancies that were diagnosed and treated at the obstetrics-gynecology clinic in Pristina were included. Patients were analyzed based on age, parity, gestational age, method of misoprostol application, effective duration from the moment of application to abortion, and adverse effects from applying misoprostol.. In 25 (25%) pregnancies (15 at the end of week 10 pregnant VIII and IX of the week until the end of the week XII) one tablet of misoprostol was applied to the rear vaginal fornix for 3 h, and the effect was achieved in a mean of 10 h for the first group, while it was achieved in 11 h in the second group. Thus, the average efficiency was 10.5 h. After applying three tablets of misoprostol to the rear vaginal fornix, 11 abortions occurred (44%), with the use of four tablets seven (28%) aborted, and with five tablets three (12%) aborted. There was average bleeding in 60 (67.41%) aborted pregnancies, and bleeding of the package in 15 (16.85%).. Administration of misoprostol to women with a missed abortion produced spontaneous expulsion and reduced the need for surgical treatment.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Adolescent; Adult; Female; Humans; Misoprostol; Pregnancy; Young Adult

All hospital-based gynecologists in The Netherlands were sent a questionnaire on the termination of pregnancy with off-label drugs in the absence of treatment protocols. Response was received from 93.2% of the teaching hospitals and 87.9% of the non-teaching hospitals, thus representing practice of nearly all gynecologists working in The Netherlands. More than 40 different regimens were used for five different indications. Gynecologists embarked on a large number of different regimens of which a distressing number do not have any merits to be found in studies or guidelines illustrating that, without clear protocols or guidelines, the implementation of new medical treatments is potential haphazard and based on personal preference. Suboptimal treatment regimens will frustrate patients and doctors and deprive future patients from the most efficacious and patient friendly treatment regimes available.

Topics: Abortifacient Agents; Abortion, Induced; Abortion, Missed; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Gynecology; Humans; Mifepristone; Misoprostol; Netherlands; Obstetrics; Off-Label Use; Practice Patterns, Physicians'; Pregnancy; Pregnancy Trimesters; Premedication; Surveys and Questionnaires; Vacuum Curettage

The results of medical treatment for early pregnancy failure are conflicting.. To determine whether gestational sac volume measurement as well as other variables can predict the success rate of medical treatment for early pregnancy failure.. The study group comprised 81 women diagnosed with missed abortion or anembryonic pregnancy who consented to medical treatment. Demographic data were collected and beta-human chorionic gonadotropin level was documented. Crown-rump length and the sac volume were measured using transvaginal ultrasound. TVU was performed 12-24 hours after intravaginal administration of 800 micro g misoprostol. If the thickness of the uterine cavity was less than 30 mm, the women were discharged. If the sac was still intact or the thickness of the uterine cavity exceeded 30 mm, they were offered an additional dosage of intravaginal misoprostol or surgical uterine evacuation.. Medical treatment successfully terminated 32 pregnancies (39.5%), 30 after one dose of misoprostol and 2 after two doses (group A); 49 underwent surgical evacuation (group B), 47 following one dose of misoprostol and 2 following two doses. There were no significant differences between the groups in age and gestational week. Gestational sac volume did not differ between groups A and B (10.03 and 11.98 ml respectively, P = 0.283). Parity (0.87 and 1.43, P = 0.015), previous pregnancies (2.38 and 2.88, P = 0.037), and betahCG concentration (6961 and 28,748 mlU, P = 0.013) differed significantly between the groups.. Gestational sac volume is not a predictor of successful medical treatment for early pregnancy failure. Previous pregnancies and deliveries and higher betahCG concentration negatively affect the success rate of medical treatment.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Adolescent; Adult; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Misoprostol; Pregnancy; Ultrasonography, Prenatal; Young Adult

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Female; Humans; Misoprostol; Pregnancy; Ultrasonography, Prenatal

Evaluation of factors influencing the duration of second-trimester pregnancy interruption with vaginal misoprostol for fetal abnormality.. All medical terminations >or=13 weeks of gestation 1/1997 to 12/2007 were prospectively identified. Cases receiving vaginal misoprostol 400 microg 6-hourly were extracted from the database and outcomes reviewed.. This consecutive case series comprised 1066 women. Median maternal age was 31 years [interquartile range (IQR) 26, 36] and 15.4% had at least one prior cesarean delivery. Principal indications for termination were aneuploidy (37.6%), neural tube defects (15.9%) and cardiac anomalies (9.4%). Median gestation at termination was 19.5 weeks (IQR 17.9, 21). Median abortion interval was 16.1 h (IQR 12, 23.5). Lower maternal age (median duration 17.6 vs 15.2 vs 13.6 h, age < 30 vs 30-39 vs > 40 years, p < 0.001), nulliparity (median duration 19 vs 14.3 h, nulliparous vs parous, p < 0.001) and increasing gestation (median duration 13 vs 17.8 h, <16 vs >20 weeks, p < 0.001) were associated with abortion prolongation. Controlling for gestation, age and parity, apart from musculoskeletal abnormalities (associated with abortion prolongation, p = 0.03), the specific fetal anomaly did not influence duration.. Three factors: nulliparity, younger maternal age and increasing gestation, were associated with abortion prolongation. Apart from musculoskeletal abnormalities, the fetal anomaly had no impact on abortion duration.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Eugenic; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Cohort Studies; Congenital Abnormalities; Female; Humans; Middle Aged; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Risk Factors; Time Factors; Treatment Outcome; Young Adult

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Cesarean Section; Dose-Response Relationship, Drug; Female; Gravidity; Humans; Misoprostol; Parity; Pregnancy

To assess the success rate of misoprostol to induce abortion in early pregnancy failure and to define the factors associated with success of treatment.. Prospective study.. University-affiliated tertiary medical center.. Two hundred twenty women with the diagnosis of blighted ovum or missed abortion with a crown-rump length (CRL) up to 25 mm (<9 w).. Treatment protocol included two doses of 800 microg misoprostol given vaginally and orally in intervals of 24 to 72 hours.. Failure was defined as surgical intervention because of retained gestational sac, severe pain or bleeding, or suspected retained products of gestation after menstruation.. The treatment was successful in 77.2% (170/220) of the patients. Success rate was 72.5% (121/167) for pregnancies achieved spontaneously and 92.4% (49/53) among women who conceived after assisted reproductive technology (relative risk = 3.65: 95% confidence interval 1.378 to 9.667). Multivariate analysis showed that the risk of failure of medical abortion increased significantly for patients who had had at least five previous pregnancies (of them, three or more abortions) as compared with patients with one or two previous pregnancies only, and for those who conceived spontaneously as compared with pregnancies after ovulation induction.. Medical treatment in early missed abortion is recommended especially for women with low gravidity and for those who conceived after assisted reproductive technology.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Adult; Female; Humans; Middle Aged; Misoprostol; Pregnancy; Prospective Studies; Reproductive Techniques, Assisted

Missed abortion in the first trimester is characterized by the arrest of embryonic or fetal development. The cervix is closed and there is no or only slight bleeding. Ultrasound examination shows an empty gestational sac or an embryo/fetus without cardiac activity. Based on a review of the published literature a single dose of 800 microg vaginal misoprostol may be offered as an effective, safe, and acceptable alternative to the traditional surgical treatment for this indication. Alternatively, 600 microg misoprostol can be administered sublingually. After administration of misoprostol, hospitalization is not necessary and the time to expulsion varies considerably. Bleeding may last for more than 14 days with additional days of light bleeding or spotting. The woman should be advised to contact a provider in case of heavy bleeding or signs of infection. A follow-up is recommended after 1 to 2 weeks.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Administration, Sublingual; Drug Administration Schedule; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Randomized Controlled Trials as Topic; Treatment Outcome

We aimed to investigate the effectiveness and adverse effects of combined (vaginal + oral) administration of misoprostol in missed abortion cases.. 48 missed abortion cases between 8 and 20 weeks of gestation were enrolled in this study. Misoprostol-induced medical abortion was planned; the first dose (200 microg) was administered intravaginally and subsequent doses (200 microg each) orally every following hour. A maximum of six doses (1200 microg) were used. Revision curettage was performed on all subjects who aborted.. The mean time interval from the first dose of misoprostol until the abortion was 6.27 +/- 3.02 hours. The success rate was 95% for the whole group. We observed misoprostol-related trembling in one patient and fever in two patients.. We believe that our low-dose combined misoprostol protocol is a safe, effective and well-tolerated method with minimal adverse effects for the termination of both first and second trimester pregnancy losses.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Administration, Oral; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second

There is currently no consensus on how success should be defined after medical management of first-trimester missed abortion. The aim of this study was to determine the transvaginal ultrasound criterion associated with highest success rate and, at the same time, lowest long-term complications.. Prospective observational study of consecutively enrolled patients.. A tertiary care university hospital in northern Portugal.. Forty-four women submitted to medical management of first-trimester missed abortion using a regimen of vaginal misoprostol, with histologically confirmed conception products passed vaginally. A transvaginal ultrasound scan was performed by an experienced sonographer in the morning after treatment, to characterise uterine content. Patients were provided with a chart for daily registration of axillary temperature, vaginal bleeding and lower abdominal pain. Transvaginal ultrasound was repeated 2-3 weeks later, and again after the following menses.. Success rates of medical management when post-treatment transvaginal ultrasound criteria for subsequent expectant management were: absence of intra-uterine sac, largest anteroposterior diameter of hyperechogenic content, and maximum area of hyperechogenic intra-uterine content in a sagittal view. Self-reported duration of vaginal bleeding and abdominal pain after medical treatment.. Success rate was 86% (38/44) when absence of gestational sac on the 12 h transvaginal ultrasound was used as the main criterion for subsequent expectant management and there was no need for further intervention. The success rate using the ultrasound criterion anteroposterior diameter < or = 15 mm was 51% (22/43), and with maximum sagittal plane area under 7.5 cm(2), 72% (31/43). Mean duration of vaginal haemorrhage was 9 days (minimum 2 days, maximum 14 days) and of lower abdominal pain 6 days (minimum 0 days, maximum 14 days). No patient recorded an axillary temperature exceeding 37 degrees C. No apparent relationship between the size of ultrasound-estimated intra-uterine content and duration of symptoms was observed.. Absence of gestational sac on transvaginal ultrasound should be the criterion used to document success after medical management of first-trimester missed abortion, as it is associated with the highest short and long-term success rates, as well as mild and self-limited symptoms in the days following treatment.

Topics: Abdominal Pain; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Extraction, Obstetrical; Female; Gestational Age; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Treatment Outcome; Ultrasonography; Uterine Hemorrhage

The aim of the study was to assess the use, efficacy and factors influencing the outcome of medical abortion at 9-13 weeks' gestation.. Retrospective chart review of consecutive women undergoing medical abortion at 9-13 weeks' gestation was done.. A total of 1927 abortions were carried out at 9-13 weeks' gestation, of which 1076 (55.8%) were undertaken medically. Efficacy decreased with increasing gestation (p=.02). Surgical evacuation was carried out in 45 (4.2%) women including 10 (2.7%) at 64-70 days, 11 (3.3%) at 71-77 days, 10 (5.1%) at 78-84 days and 14 (8.0%) at 85-91 days of gestation (p=.02). Indications for surgery included continuing pregnancy [16 (1.5%) women], retained sac [5 (0.5%)], incomplete abortion [20 (1.9%)] and emergency curettage for bleeding [4 (0.4%)]. The number of misoprostol doses used and the induction-to-abortion interval both significantly increased with gestation (p<.001), while analgesia requirements did not vary with increasing gestation (p=.18).. Medical abortion at 9-13 weeks' gestation is an effective alternative to surgery. Medical methods should be offered routinely at these gestations, thus increasing women's choice.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Abortion, Missed; Administration, Intravaginal; Adult; Drug Administration Schedule; Drug Combinations; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Retrospective Studies

This prospective study of 104 women investigated the dose-related efficacy of mifepristone combined with oral misoprostol in the management of first trimester miscarriage (missed abortion and blighted ovum). Forty-four women (group A) received 600 mg of oral mifepristone and 60 women (group B) received 200 mg of mifepristone, followed after 48 hours by oral misoprostol. Successful treatment was an empty uterus on scan and no bleeding after 10 days. This was achieved in 70.5% of group A and 66.7% of group B. Also studied were amount and time to cessation of bleeding, pain scores, analgesic requirements, adverse effects and infections. Of group A, 54.5% had heavy bleeding and bleeding stopped on average by 8 days. Median pain scores were 5.5 on a linear scale and 18% of women received intramuscular opiate analgesia. Adverse effects were nausea in 25% of women and diarrhoea in 16%. Of group B, 38.3% had heavy bleeding and bleeding stopped on average by 7 days. Median pain scores were 4.5 with 25% of women receiving intramuscular opiates. Nausea occurred in 7% of women and diarrhoea in 7%. We concluded that 200 mg of mifepristone and oral misoprostol is as effective and better tolerated than 600 mg mifepristone with oral misoprostol. Medical management of miscarriage is a valid option for those women seeking an alternative to traditional surgical management.

Topics: Abortion, Missed; Abortion, Spontaneous; Administration, Oral; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Endosonography; Female; Follow-Up Studies; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Risk Assessment; Treatment Outcome

This study was designed to evaluate the effect of misoprostol on the blood flow in uterine arteries of pregnant women with first-trimester embryonic demise.. Transvaginal ultrasonographic Doppler examinations (resistance index, pulsatility index, systolic/diastolic ratio) of the uterine arteries in 61 pregnant women were performed before misoprostol administration and 90 min later. Following baseline Doppler measurements, each woman received 200 microg misoprostol intravaginally and 200 microg misoprostol orally.. All Doppler indices increased significantly after misoprostol administration (p < 0.0001), suggesting an increase in flow resistance.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Arteries; Cohort Studies; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Pulsatile Flow; Regional Blood Flow; Ultrasonography, Doppler; Uterus

Topics: Abortion, Missed; Administration, Intravaginal; Administration, Oral; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Misoprostol; Pilot Projects; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Risk Assessment

To evaluate the efficacy of a regimen of vaginal misoprostol in causing the complete expulsion of first-trimester missed abortions, or alternatively dilating the cervix for surgical evacuation.. Seventy-four women with a transvaginal ultrasound diagnosis of a first-trimester missed abortion and no more than slight vaginal bleeding were consecutively enrolled. Misoprostol (600 microg) was administered vaginally and repeated 4 h later if necessary. Surgical evacuation was performed when complete expulsion was not documented on the ultrasound 10-12 h after treatment.. Complete medical evacuation occurred in 42 women (56.8%), 11 (14.9%) of which required only one dose. Seventy women (94.6%) experienced abdominal pain, 73 (98.6%) vaginal bleeding, 10 (13.5%) nausea, 4 (5.4%) vomiting, 5 (6.8%) diarrhea, and 4 (5.4%) transient hyperthermia. There was one case of heavy vaginal bleeding requiring emergency surgical evacuation, and one re-admission for incomplete abortion at 30 days. All but 4 (5.4%) women had permeable cervices at the time of surgery.. The described regimen of vaginal misoprostol is safe and reasonably effective in inducing complete evacuation in missed abortions. When this does not occur, it almost always provides adequate cervical dilatation for surgery.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Diarrhea; Drug Administration Schedule; Female; Fever; Humans; Misoprostol; Nausea; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Ultrasonography; Uterine Hemorrhage; Vomiting

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Missed; Female; Humans; Mifepristone; Misoprostol; Pain; Pregnancy; Uterine Hemorrhage

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Missed; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocics; Pregnancy

In the fall of 1992, an abortifacient, mifepristone (Mifegyne), was introduced in Sweden. Mifepristone is an antiprogesterone that binds with progesterone receptors without releasing the biological effect of progesterone. The result is a local progesterone burst that causes damage in the blood vessels in the capillaries of the decidua, bleeding, necrosis of the decidua, the detachment of the pregnancy, increased sensitivity of the myometrium to prostaglandin, uterine contractions, and expulsion of the conceptus. Treatment with a combination of mifepristone and a prostaglandin analog, usually gemeprost (Cervagem), is a very effective method of abortion and an alternative to vacuum aspiration during the first weeks of pregnancy. At the present, time this is the only well-known indication for antiprogesterone. However, the range of use of antiprogesterone will most likely rise in the coming years. In a 1992 study, 60 patients with pregnancy up to the 13th week were treated with 600 mg of mifepristone and 36-48 hours later with 600 mcg of misoprostol (Cytotec) for missed abortion and anembryonic pregnancy. 57 aborted, and the rest underwent vacuum aspiration. The average time of abortion was 4 hours, and the period of bleeding averaged 10 days. Uterine pain required analgesics in 20 cases. In a 1993 analysis, 44 women were given prostaglandin for abortion: either in the form of an intramuscular injection of 0.5 mg of sulprostone or in two tablets of misoprostol (400 mcg). The treatment failed in two cases, but 50% of women could return to work immediately, while the rest waited an average of 3 days. Often after the 12th and always after 14th week of pregnancy, a 2-step method is used that consists of prostaglandin analogs such as gemeprost given vaginally. However, it takes up to 24-28 hours to abort. Cervical ripening with intracervical PGE2 or laminaria can shorten the time to 10-15 hours equivalent to one day of hospitalization instead of 2-3 days.

Topics: Abortion, Missed; Abortion, Spontaneous; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Receptors, Progesterone