MISSED MISCARRIAGE

COMPARISON OF MEDICAL VERSUS SURGICAL MANAGEMENT

Abstract

Objectives: The aim of this study was to compare the medical treatment with
surgical evacuation of uterus in the management of first trimester missed miscarriage. Study
Design: Randomize controlled trial: Place and Duration of Study: The study was conducted
in the Obstetrics and Gynecology department civil hospital Bahawalpur from 1st January 20114
to 31 December; 2014. Material and Methods: Total 120 patients were included in the study
diagnosed as a case of first trimester missed abortion. Patients were randomly assigned
either medical or surgical group. In the surgical group (controlled group) dilatation and the
evacuation was performed. In the medical group misoprostol was used for medical termination.
The criteria for success was complete expulsion of products of conception. Results: There
was no statistically significant difference regarding demographic and clinical characteristics
between the two groups .Complete expulsion of the conceptus was less in medical group
(83.3%) than the surgical group (88.3%) but the difference was not significant. Almost 16.7%
patients in the medical group had failure of expulsion and underwent surgical evacuation.
Duration of bleeding after the procedure was 9±2.6 days in surgical group and 12±3.4 in
medical group. Conclusion: Medical termination of first trimester missed miscarriage using
Misoprostol (800mcg initial dose followed by 400mcg 4 hourly 3 doses if need) is an efficacious
and safe alternative to the surgery.