Evaluation of the Role of Misoprostol in Complete Termination of Missed Miscarriage

Background; Missed miscarriage is a common early pregnancy loss in which embryonic or fetal death occurs without expulsion of the products of conception. Medical management with misoprostol offers a non-surgical treatment option, but its effectiveness varies across clinical settings.

Aim of the study; To evaluate the role of misoprostol in achieving complete termination of missed miscarriage without surgical intervention, and to assess its safety profile and treatment outcomes.

Patients and methods; This observational clinical study included 50 patients with first-trimester missed miscarriage managed at Babylon Teaching Hospital for Maternity and Childhood. Participants received variable misoprostol regimens ranging from 200 to 800 micrograms by oral, vaginal, or rectal routes, with intervals of 4 to 24 hours and 2 to 6 doses. Treatment success was defined as complete expulsion without surgical uterine evacuation, confirmed by ultrasonography.

Results; The mean maternal age was 31.4 ± 8.8 years, mean body mass index was 22.2 ± 3.5 kg/m², and mean gestational age was 9.2 ± 2.0 weeks. Complete termination was achieved in 36 patients (72.0%). Gestational age was significantly higher in the failure group than in the success group (10.9 ± 1.1 versus 8.6 ± 1.9 weeks; probability value < 0.001). Success was associated with a higher mean dose (488.9 ± 250.5 versus 328.6 ± 168.4 micrograms; probability value = 0.013), a longer mean interval between doses (11.2 ± 8.1 versus 6.9 ± 5.4 hours; probability value = 0.035), and route of administration (probability value = 0.001). Any side effect was reported in 82.0% of patients.

Conclusion; Misoprostol was a practical non-surgical option for the management of missed miscarriage. Lower gestational age and regimen-related factors, particularly higher dose, longer interval, and vaginal administration, were associated with better treatment success. Protocol standardization may improve outcomes.