Get access

Can we use a lower intravaginal dose of misoprostol in the medical management of miscarriage? A randomised controlled study

Authors

  • Scott G. Petersen,

    Corresponding author
    1. Mater Medical Research Institute, Brisbane, Queensland, Australia
    2. Department of Obstetrics and Gynaecology, Toowoomba Base Hospital, Toowoomba, Queensland, Australia
    • Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Southern Medical School, University of Queensland, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Anneliese Perkins,

    1. Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Southern Medical School, University of Queensland, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Kristen Gibbons,

    1. Mater Medical Research Institute, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Julia Bertolone,

    1. Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Southern Medical School, University of Queensland, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Paul Devenish-Meares,

    1. Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Southern Medical School, University of Queensland, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Donald Cave,

    1. Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Southern Medical School, University of Queensland, Brisbane, Queensland, Australia
    Search for more papers by this author
  • Kassam Mahomed

    1. Mater Medical Research Institute, Brisbane, Queensland, Australia
    2. Department of Obstetrics and Gynaecology, Toowoomba Base Hospital, Toowoomba, Queensland, Australia
    3. Department of Obstetrics and Gynaecology, Ipswich Hospital, Ipswich, Queensland, Australia
    Search for more papers by this author

  • The authors have nothing to declare.

Correspondence: Dr Scott G. Petersen, Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Raymond Tce, South Brisbane, Qld 4101, Australia.Email: scott.petersen@mater.org.au

Abstract

Background

The optimal dose of misoprostol to be used in the medical management of miscarriage before 13 weeks has not been resolved.

Aim

To evaluate the effectiveness and side effect profile of two different dosages of misoprostol.

Methods

A randomised controlled, equivalence study comparing 400 vs 800 μg misoprostol per vaginum (PV) on an outpatient basis. The allocated dose was repeated the next day if clinically the products of conception had not been passed. Complete miscarriage was evaluated using two methods: ultrasound criteria on Day 7 and the need for surgical management (clinical criteria). Equivalence was demonstrated if the 95% confidence interval [CI] of the observed risk difference between the two doses for complete miscarriage lay between −15.0 and 15.0%. Differences in side effects and patient satisfaction were evaluated using patient-completed questionnaires.

Results

One hundred and fifty-eight women were allocated to receive 400 μg and 152 women to 800 μg misoprostol for the management of missed (91.3%) or incomplete (8.7%) miscarriage. The rate of induced complete miscarriage was equivalent using both ultrasound criteria (observed risk difference (ORD) −4.6%, 95% CI −12.8 to 3.7%; = 0.313) and clinical criteria (ORD −5.6%, 95% CI −14.8 to 3.6%; = 0.273). Following the 400 μg dose, the reported rate of fever/rigors was lower (ORD −15.6%, 95% CI −28.1 to −3.0%; = 0.015), and more women reported their decision to undergo medical management as a good decision (ORD 15.2%, 95% CI 2.8 to 27.7%; = 0.018).

Conclusion

Four hundred-microgram misoprostol PV can be recommended for the medical management of miscarriage on an outpatient basis.

Ancillary