Abstract:
Vaginal misoprostol has shown to be effective and safe in the management of missed
miscarriage. However since the optimum dose for that indication is not established, in this
study our aim was to find out a cost effective dose of misoprostol for the management of
missed miscarriage in our setting. To compare effectiveness and safety of two misoprostol
regimes (400 llg versus 800 ug vaginal misoprostol) for the management of missed
miscarriage :A randomized controlled trial carried out at the Professorial Unit, Colombo
South Teaching Hospital, Kalubowila, Sri Lanka for a period of 8 months commencing 151
July 2007. One hundred and eighty four women with missed miscarriage between 8 to 20
weeks of POA were randomized to receive 40011g or 80011g vaginal misoprostol. The
'principle outcome measures were success of misoprostol treatment, completeness of
medical evacuation, need for surgical evacuation, patient satisfaction and side effects.
Comparison of vaginal misoprostol, 80011g and 40011g doses in management of missed
miscarriage, revealed that there was no statistically significant difference in success ( p
value=O.35), completeness of evacuation( p value=O.38), need for surgical evacuation( p
value=O.38) and also patient satisfaction( p value=0.25). Though there was more success
and completeness of evacuation noted with 800~Lg dose in earlier gestations (S12weeks)
compared with 400flg dose, it did not reach statistical significance( p value=0.06 and 0.05).
Further, the dose of 800llg was more successful in the management of early gestations
(::;12w) as compared with later gestations which was statistically significant (p
value=O.02). The common side effects were compared between the two groups. There was
no statistically significant difference between the two groups regarding the occurrence of
diarrhoea, vomiting fever or abdominal pain. However the percentages of all side effects are
higher in the 800~lg group as compared with 400flg group. Management of missed
miscarriage by uSll1g vaginal misoprostol, both 800llg and 400~lg doses are equally
effective considering success, completeness of evacuation, need for surgical evacuation and
also patient satisfaction. Although there was no statistical proof ,the results of this study is
tempting to favour 800llg over 400~lg dose regarding success and rate of complete
evacuation for early gestations (PO A ::;12w).There is no statistically significant difference
in the common side effects (PY pleading, diarrhoea, vomiting, fever and abdominal pain)
between 2 doses. However the frequency of all observed side effects were less with 400flg
dose. For the management of missed miscarriage when the POA 12weeks 400 ug dose of
vagInal misoprostol can be recommended as a better cost effective and safe regimen
compared with 80 ug dose
