Objective: This study aimed to evaluate the efficacy of sublingual administration of misoprostol compared to vaginal administration for the management of missed miscarriages in the first trimester. Study design: randomised controlled trial (RCT) Place and Duration: This study was conducted in Sandeman Provisional Hospital Quetta from April 2022 to April 2023 Methodology: The study included 140 patients. Following the International Federation of Obstetrics and Gynaecology (FIGO) protocol, patients were randomly assigned to two groups based on the route of misoprostol administration: sublingual (600 micrograms every 3 hours) or vaginal (800 micrograms every 3 hours). Each group had 70 patients. After 24 hours, patients were assessed for vaginal bleeding and expulsion; if neither occurred, the dose was repeated. In cases of persistent, significant vaginal bleeding after a maximum of two cycles, surgical evacuation was performed, as confirmed by pelvic ultrasound. Results: Both groups exhibited comparable characteristics in terms of mean age (25.23 ± 5.91 vs. 26.12 ± 5.94), parity (3.54 ± 0.49 vs. 3.53 ± 0.75), gestational age (8.82 ± 1.69 vs. 9.31 ± 1.61), and duration of induction to abortion interval (13.79 ± 3.48 vs. 12.89 ± 3.09), with no statistically significant differences (P-value > 0.05). The vaginal misoprostol group required a higher number of doses for complete miscarriage (4.23 ± 0.94 vs. 3.41 ± 1.14, P-value < 0.05). Sublingual administration provided a higher level of comfort (P-value < 0.05) with an 89.22% satisfaction rate compared to 54% in the vaginal misoprostol group. The sublingual misoprostol group exhibited a significantly higher success rate in 54 (77.14%) compared to the vaginal group in 40 (57.14%) (P-value < 0.05). Side effects such as vaginal bleeding (47 (67.14%) vs. 65 (92.85%)), bleeding exceeding menstruation (21 (30%) vs. 58 (82.85%)), and diarrhoea (22 (31.42%) vs. 42 (60.00)) were significantly associated with sublingual misoprostol use (P-value < 0.05). Conclusions: Sublingual misoprostol is a more effective option compared to vaginal administration for the management of first trimester missed miscarriages. Patients reported higher satisfaction and better outcomes with the sublingual route.
Misoprostol, Sublingual Misoprostol, Vaginal Misoprostol, Miscarriage, First Trimester