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Objective: To identify the efficacy of oral misoprostol (600 μg) for the management of missed abortion. Method: A prospective study was conducted at the Gynecology Department of Muhammad Medical College Hospital (MMCH) over a period of two year from January, 2013 till December 2014. Eligible women satisfying the inclusion and exclusion criteria were recruited after written informed consent and given 600 μg of misoprostol orally at six hour interval, with a maximum of 4 doses. Patients were monitored for 24 hours following complete abortion or surgical evacuation and then discharged. The primary outcome of the study was defined as Success (non surgical evacuation of product of conception) or Failure (excessive bleeding with retained product of conception where surgical evacuation was performed). Associated adverse events were also recorded. The data was analysed using SPSS version 21 (IBM, Chicago, IL). Result: Among four hundred and eighty five participants, success in abortion with Misoprostol was observed in 157 (32.4%) of patients with majority (92.4%) success being achieved with two doses. Women where failure was documented, excessive bleeding (61%) was most prevalent followed by incomplete abortion (36%). The most common side effects observed were severe bleeding (41.1%), cramping/ abdominal pain (16.4%), increased bleeding (13.8%) and nausea/ vomiting (8.8%). Conclusion: High failure rate and increased bleeding with the use of 600 μg of oral misoprostol for missed abortion was identified thus should only be a consideration for prescription to patients once admitted in hospital settings.

Use of Misoprostol in Missed Abortion – A Double Edged Sword in Anemia Prevailing Countries