COMPARISON OF EFFICACY OF ORAL VERSUS VAGINAL MISOPROSTOL FOR FIRST TRIMESTER MISSED MISCARRIAGES

Abstract

Background: Missed miscarriage is a common early pregnancy complication requiring timely and effective  management. Misoprostol is widely used for medical treatment, but the optimal route of administration remains debated.

Objective: To compare the efficacy of oral versus vaginal misoprostol in the management of first-trimester missed miscarriage.

Methodology: This comparative cross-sectional study was conducted at the Maternity and Child Health Centre, Pakistan Institute of Medical Sciences, from 20-10-2025 to 03-04-2026, including 122 women aged 18–40 years with ultrasound-confirmed missed miscarriage (≤12 weeks gestation), allocated into oral (n=61) and vaginal (n=61) misoprostol groups. Participants received 800 μg misoprostol every 6 hours for a maximum of three doses. Complete expulsion was confirmed by transabdominal ultrasonography 24-hours after passage of pregnancy tissue, defined as endometrial thickness <15 mm with no retained products of conception. Data were analyzed using SPSS version 27. Chi-square test was applied for efficacy comparison, with p ≤ 0.05 considered significant.

Results: Baseline characteristics were comparable between groups (all p>0.05). Vaginal misoprostol achieved a significantly higher complete expulsion rate than oral misoprostol (91.8% vs. 75.4%, p=0.018). More women in the vaginal group achieved complete expulsion after the first dose (52.5% vs. 29.5%, p=0.031). The vaginal route resulted in a shorter mean time to expulsion (8.3±1.9 vs. 10.4±2.2 hours, p=0.001) and required fewer doses (1.8±0.7 vs. 2.5±0.6, p=0.003). Nausea and vomiting were less frequent with vaginal administration (14% vs. 32%, p=0.011), whereas abdominal pain and fever were comparable (p>0.05). Stratified analyses by age and gestational age showed no significant effect modification (all p>0.05).

Conclusion: Vaginal misoprostol is more effective, faster, and better tolerated than oral misoprostol for first-trimester missed miscarriage, though both remain safe options.