A Comparative Study: Vaginal Vs. Sublingual Administration of Misoprostol in the Management of Missed Miscarriages During the First Trimester

Abstract

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.