Obstet Gynecol Sci.  2018 Mar;61(2):220-226. 10.5468/ogs.2018.61.2.220.

Effectiveness and safety of sublingual misoprostol in medical treatment of the 1st trimester miscarriage: experience of off-label use in Korea

• Park JY
• Ahn HJ
• Yoo BR
• Hwang KR
• Lee TS
• Jeon HW
• Kim SM
• Kim BJ

• KMID: 2420175
• DOI: http://doi.org/10.5468/ogs.2018.61.2.220

Abstract

OBJECTIVE
This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea.
METHODS
A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4-6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records.
RESULTS
About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups.
CONCLUSION
Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.

Keyword

Misoprostol; Incomplete abortion; Missed abortion; Spontaneous abortion; Administration, sublingual

MeSH Terms

Abortion, Incomplete
Abortion, Missed
Abortion, Spontaneous*
Administration, Sublingual
Cohort Studies
Diagnosis
Embryonic Structures
Female
Fetus
Gestational Sac
Hematoma
Humans
Insurance, Health
Korea*
Leiomyoma
Medical Records
Metrorrhagia
Misoprostol*
Off-Label Use*
Pregnancy
Retrospective Studies
Ultrasonography
Uterine Hemorrhage
Misoprostol

Figure

• 

  Fig. 1 Six cases of distorted gestational-sac. (A) Cases in group of successful medical abortion: 4 cases. (B) Cases in group of failed medical abortion: 2 cases.

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