Efficacy of sublingual misoprostol for management of early pregnancy failure

Authors

  • Sarinya Thongpoonphan Department of Obstetrics and Gynecology, Warinchamrab Hospital, Ubon Ratchathani

Keywords:

Misoprostol, Sublingual, Early pregnancy failure

Abstract

The purpose of this research was to evaluate the effectiveness, side effects, and complications of medical treatment with sublingual misoprostol in the termination of early pregnancy failure. A retrospective descriptive study was performed in the 50th Anniversary Mahavajiralongkorn Hospital Ubonratchatani from January 1st, 2019 to February 28th, 2021. There were 53 in-patient pregnant women reviewed with ultrasonographically diagnosed anembryonic pregnancy or intrauterine embryonic death during the first trimester. A 400 microgram of misoprostol was administered sublingually. The treatment was repeated at intervals of 4 hours (no more than 3 times within 24 hours). The main outcome included a success rate of termination, mean induction–to-abortion time, the total dose of misoprostol, and side effects were analyzed. The result showed that the success rate of complete abortion within 48 hours was 71.7%. The mean induction-to-abortion time was 13.49±7.25 hours. The two most common side effects were fever and diarrhea at 83.0% and 30.2%, respectively. There were no serious complications reports. In conclusion, the sublingual route of administration of misoprostol appeared to be safe and effective for the management of early pregnancy failure.

Downloads

Download data is not yet available.

References

World Health Organization. Medical management of abortion. Geneva;2018.

Graziosi GC, Mol BW, Ankum WM, Bruinse HW. Management of early pregnancy loss. Int J Gynaecol Obstet 2004;86(3):337-46.

Sarah Prager, Vanessa K. Dalton, Rebecca H. Allen.Early pregnancy loss. ACOG Practice Bulletin 2018;132:197-203.

Luise C, Jermy K, May C, Costello G, Collins WP, Bourne TH. Outcome of expectant management of spontaneous first trimester miscarriage: observational study. BMJ 2002;324:873-5.

Chung TKH, Cheung LP, Chang AMZ. Spontaneous abortion: a randomized controlled trial comparing surgical evacuation with conservative management using misoprostal. Fertility and sterility 1999;71(6):1054-9.

Abubeker FA, Lavelanet A, Rodriguez MI, Kim C. Medical termination for pregnancy in early first trimester (≤ 63 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review. BMC Womens Health 2020;20:142.

กรมอนามัย. คู่มือมาตรฐานการปฏิบัติงานเพื่อยุติการตั้งครรภ์ที่ปลอดภัยแบบองค์รวม.กรุงเทพมหานคร:บริษัทเฌอมาศจำกัด;2561.

Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM, et al. Williams Obstetrics, 26th Edition: McGraw-Hill Education; 2022:198-214.

Doubilet PM, Benson CB, Bourne T, Blaivas M. Diagnostic criteria for nonviable pregnancy early in the first trimester. N. Engl. J. Med. 2013;369(15):1443-51.

Dogra V, Paspulati RM, Bhatt S. First trimester bleeding evaluation. Ultrasound Q. 2005;21 (2): 69-85.

Park JY, Ahn HJ, Yoo BR, Hwang KR, Lee TS, Jeon HW, Kim SM, Kim BJ. Effectiveness and safety of sublingual misoprostol in medical treatment of the 1st trimester miscarriage: experience of off-label use in Korea. Obstet Gynecol Sci. 2018 ;61(2):220-6.

Deepika N, Krishna M, Inderjeet P, Navnita B. Comparative Study of Misoprostol in First and Second Trimester Abortions by Oral, Sublingual, and Vaginal Routes. J Obstet Gynaecol India. 2015;65(4):246–50.

เปรมฤดี อริยานนท์. การศึกษาเปรียบเทียบประสิทธิผลและผลข้างเคียงของการใช้ยามิโซพรอสตอลเหน็บทางช่องคลอดและอมใต้ลิ้นในการยุติการตั้งครรภ์ล้มเหลวระยะแรก. วารสารแพทย์เขต4-5 2015;34:144-53.

Patamasingh Na-Ayudthaya O, Herabutya Y,Oprasertsawat P. A comparison of the efficacy of sublingual and oral misoprotol 400 microgram in the management of early pregnancy failure : A randomized controlled trial. J Med Assoc Thai 2006;89:5-10.

Rashmi S,Radhika D.Sublingual v/s vaginal misoprostol for second trimester termination of pregnancy:a comparative study.Indian Journal of Obstetrics and Gynecology Research 2020;7(4):522-24

Sharma D, Singhal SR & Rani XX. Sublingual misoprostol in management of missed abortion in India. Trop Doct. 2007;37:39–40.

Hang-lin Wu, Sheeba M, Pei Wang, Qiu-meng Wang, Xiao-wen Chen. Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis. Scientific Reports 2017;7:1-9.

Soghra R, Shahedeh K, Mohamed F, Mina A. Comparison of sublingual versus vaginal misoprostol in the management of missed abortions. Biomedical Research and Therapy 2019;6(10):3391-95.

Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. N Engl J Med 2005;353:761–9.

Areerat S, Teerapat C. Comparison of sublingual and vaginal misoprostol for termination of early pregnancy failure: a randomiized controlled trial. Thai Journal of Obstetrics and Gynecology 2014;22:128-36.

Tang OS, Schweer H, Seyberth HW, Lee SW & Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002; 17:332–6.

Kim JO, Han JY, Choi JS, Ahn HK, Yang JH, Kang IS, Song MJ, Nava-Ocampo AA. Oral misoprostol and uterine rupture in the first trimester of pregnancy: A case report. Reprod. Toxicol. 2005;20:575–7.

Published

2022-09-23

How to Cite

Thongpoonphan, S. (2022). Efficacy of sublingual misoprostol for management of early pregnancy failure. Journal of Medicine and Public Health, Ubon Ratchathani University, 5(3), 202–209. Retrieved from https://he01.tci-thaijo.org/index.php/jmpubu/article/view/256683

Issue

Section

Research Articles