MISOPROSTOL VERSUS MANUAL VACUUM ASPIRATION FOR REATMENT OF FIRST-TRIMESTER MISSED MISCARRIAGE

Abstract

Objectives
The objective of this study was to compare the effectiveness, safety, and acceptability of misoprostol and manual vacuum aspiration (MVA) in the management of first-trimester missed miscarriage

Methodology
This comparative observational study included 120 women diagnosed with first-trimester missed miscarriage, allocated into two groups: misoprostol (n=60) and MVA (n=60). Data on demographic characteristics, efficacy, bleeding, pain, need for repeat intervention, hospital stay, and time to resume normal activities were recorded. Qualitative variables, including satisfaction, acceptability, and emotional responses, were assessed through structured interviews. Statistical analysis was performed using t-tests, chi-square tests, and thematic content analysis for qualitative data.

Results
Baseline characteristics were similar between groups. MVA demonstrated significantly superior outcomes, including a higher success rate of complete evacuation (96.7% vs. 81.7%), shorter evacuation time, and reduced need for repeat intervention (3.3% vs. 18.3%). Misoprostol was associated with slightly greater blood loss and longer hospital stay, whereas pain scores were higher in the MVA group. Qualitatively, 90% of MVA participants reported they would choose the method again compared to 68% in the misoprostol group. Women undergoing MVA expressed greater satisfaction and emotional relief, while misoprostol users frequently reported anxiety due to prolonged bleeding.

Conclusion
MVA proved more effective, quicker, and more acceptable than misoprostol, although both methods were safe. Misoprostol remains a valuable option in settings with limited resources, but MVA offers superior clinical and patient-reported outcomes.