Experiences in the use of misoprostol in the management of first trimester missed abortion in a low resource setting

Abstract

Background: The use of misoprostol in the management of first trimester abortion is an evolving clinical practice in most parts of sub‑Saharan Africa.

Objective: To determine the effectiveness and acceptability of misoprostol in the evacuation of the uterus in first trimester missed abortion.

Study Design: This was a non‑randomized trial.

Setting: This study was conducted in the Gynecologic Unit, Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Nigeria.

Materials and Methods: Consented consecutive patients with first trimester missed abortion were recruited in the study. Each patient was given sublingual misoprostol 600 μg to be repeated after 6 hours if abortion process was not initiated. They were followed‑up after two weeks and offered contraceptive counseling. However, if active vaginal bleeding persisted, patients were reviewed after 1 week, scanned and offered surgical evacuation (manual vacuum aspiration) on confirmation of residual products of conception. Telephone review was conducted for patients who defaulted follow‑up. Data were analyzed using the Statistical Package for the Social Sciences version 16. P value was considered significant at α < 0.05 at 95% CI.

Results: Sixty‑one patients with missed abortion were managed between 1^st January and December 2013 with a mean age, parity and gestational age of 27.6 ± 5.6 years, 3.6 ± 2.3 and 7.6 ± 2.0 weeks, respectively. Fifty‑six patients (92%) achieved complete evacuation. Mean interval between the first dose of misoprostol and abortion was 5.1 ± 2.2 hours and mean duration of vaginal bleeding was 5.9 ± 1.6 days (range: 3–14 days). Side effects were minor mainly nausea/vomiting, and all the patients with complete evacuation showed satisfaction with the method and preferred it to surgical evacuation.

Conclusion: Misoprostol is very effective in the management of first trimester missed abortion in our setting and should be the treatment method of first choice.

Keywords: Evacuation; first trimester; misoprostol; missed abortion; pregnancy; products of conception