Medical Termination of Missed Abortion Using Misoprostol: A Review of the Literature

Dr. Nguyen Thi Nhu Ngoc, Hung Vuong Hospital, Ho Chi Minh, Vietnam

Objective: Missed abortion, or failed pregnancy, is diagnosed when a pregnancy ceases to develop but there is a delay in the expulsion of the products of conception. We sought to review the available data on misoprostol to determine its role in the treatment of failed pregnancy.

Methods: Online research via Pub Med identified 46 published studies on missed pregnancy using misoprostol in at least one of the treatment arms. Given that inclusion criterion and successful outcome were determined differently, we selected only those studies stipulating a closed cervical os at the time of treatment and where the authors defined failures as either need for additional medications and/or surgical evacuation of the uterus.

Results: The literature shows that misoprostol, at doses ranging from 400 mcg to 800 mcg, and administered either vaginally or orally, successfully evacuates the uterus without need for surgical evacuation. Published efficacy rates range from 60% to 93%, depending on the dose and route of misoprostol administration and the time of final patient assessment. In general, later assessment increases the efficacy rate. Additionally, the time to completion is shorter with vaginal misoprostol; however there are few differences in terms of experience with side effects, regardless of route of misoprostol administration. Results from all studies will be reviewed during this presentation and recommendations for appropriate treatment regimens will be made.

Conclusions: Medical management of missed abortion is clearly becoming more popular worldwide, as is evidenced by the growing interest in studying its role in treatment of missed abortion. The data in support of misoprostol regimens are quite strong, with a dose of 800 mcg vaginally showing the strongest safety and efficacy profile. Larger studies with detailed inclusion and exclusion criterion are needed to make recommendations on how the drug can be incorporated into healthcare programs worldwide.