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Title: EFFICACY OF ORAL VS VAGINAL MISOPROSTOL IN FIRST TRIMESTER MISSED MISCARRIAGE
Authors: Farah Naz, Safia Ewaz Ali, Shazia Baloch, Gulnar, Bushra, Zahida Dawood
Journal: The Research of Medical Science Review
| Category | From | To |
|---|---|---|
| Y | 2024-10-01 | 2025-12-31 |
Publisher: Innovative Education Research Institute
Country: Pakistan
Year: 2024
Volume: 2
Issue: 3
Language: English
Keywords: 1st trimester miscarriagesvaginal or oral misoprostolcomplete uterine evacuation.
Background: First-trimester missed miscarriage is commonly managed with misoprostol, either orally or vaginally. While vaginal misoprostol is thought to be more effective, controversy exists regarding the comparison of oral versus vaginal forms, with inconsistent findings in the literature. Additionally, data on this issue in local population is scarce. This study was conducted to assess and compare the efficacy of oral and vaginal misoprostol in a local population. Objective: To compare the efficacy of misoprostol by vaginal and oral route, for the management of first trimester missed abortion. Duration: Six months.Methodology: A total of 140 patients with of patients with missed abortion, 18 to 45 years of age were included. Patients with signs of allergy to or C/I to misoprostol use, anemia, active lactation, bleeding disorder, deranged coagulation profile and infection were excluded. In group A, 400μg vaginal misoprostol was given, while in group B patients, 400μg oral misoprostol was done. All patients were monitored for vitals, vaginal bleeding and expulsion of POCs. Over the next 18-30 hours, complete, incomplete or no expulsion was documented. Results: The study sample consisted of 140 participants, with a mean age of 27.71 ± 4.31 years. The mean gestational age at the time of enrollment was 7.63 ± 2.35 weeks. In terms of parity, the mean was 3.29 ± 1.15. Both groups were statistically comparable with each other for all baseline variables, as indicated by the p-values greater than 0.05. In terms of efficacy, Group A demonstrated a higher success rate, with 65 participants (92.86%) achieving a successful outcome, compared to 53 participants. Stratification of efficacy between the groups based on age, gestational age, and parity revealed a consistent superiority of Group A over Group B across all subgroups. However, in certain subgroups, statistical significance could not be achieved due to the small sample sizes. Conclusion: The study demonstrated that vaginal misoprostol (Group A) was more effective than oral misoprostol (Group B) in the management of first-trimester missed miscarriage, with a significantly higher success rate observed in Group A. Stratification by age, gestational age, and parity consistently showed the superiority of vaginal misoprostol across all subgroups. However, statistical significance was not achieved in some subgroups due to small sample sizes. Overall, vaginal misoprostol appears to be a more effective treatment for missed miscarriage in the first trimester. 
To compare the efficacy of misoprostol by vaginal and oral route for the management of first trimester missed abortion.
A randomized controlled trial was conducted on 140 patients aged 18-45 years with first-trimester missed abortion. Patients were excluded if they had signs of allergy to or contraindications for misoprostol, anemia, active lactation, bleeding disorder, deranged coagulation profile, or infection. Participants were randomly assigned to Group A (400g vaginal misoprostol every six hours for up to three doses) or Group B (400g oral misoprostol every six hours for up to three doses). Outcomes were monitored for vital signs, vaginal bleeding, and expulsion of products of conception over 18-30 hours.
graph TD
A[Patient Recruitment 140 patients, 18-45 yrs, missed abortion] --> B[Exclusion Criteria Check];
B -- Excluded --> Z[End];
B -- Included --> C[Random Assignment];
C --> D[Group A: Vaginal Misoprostol];
C --> E[Group B: Oral Misoprostol];
D --> F[Administration & Monitoring Vitals, Bleeding, POC Expulsion];
E --> F;
F --> G[Data Collection 18-30 hours];
G --> H[Data Analysis];
H --> I[Conclusion];
The study supports the notion that vaginal misoprostol is more effective than oral misoprostol for managing first-trimester missed miscarriage, aligning with some previous studies but differing from others. The findings address a scarcity of local data on this topic. The consistent superiority of vaginal misoprostol across subgroups, despite limitations in statistical significance for some, suggests its potential as a more effective treatment.
Group A (vaginal misoprostol) demonstrated a higher success rate (92.86%) compared to Group B (oral misoprostol) (75.71%), with a p-value of 0.005. Stratification of efficacy by age, gestational age, and parity consistently showed the superiority of vaginal misoprostol across all subgroups, although statistical significance was not achieved in some subgroups due to small sample sizes.
Vaginal misoprostol was found to be more effective than oral misoprostol in the management of first-trimester missed miscarriage, with a significantly higher success rate. The findings suggest that vaginal misoprostol is a more effective treatment option for this condition.
1. Sample Size: The study included a total of 140 participants.
2. Success Rate (Vaginal): 65 participants (92.86%) in the vaginal misoprostol group achieved a successful outcome.
3. Success Rate (Oral): 53 participants (75.71%) in the oral misoprostol group achieved a successful outcome.
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