COMPARISON OF VAGINAL VERSUS SUBLINGUAL MISOPROSTOL IN THE TREATMENT OF FIRST TRIMESTER MISSED MISCARRIAGE

Abstract

Objectives: To compare vaginal and sublingual misoprostol in the treatment of first trimester missed miscarriage in terms of success of treatment.

Study Design: It was Randomized Controlled Trial. 

Place & Duration of Study:  Department of Obstetrics and Gynecology, WAPDA Teaching Hospital, Lahore for a period of three months w.e.f 14-02-2025 to 13-05-2025.

Methodology: After approval from the Hospital’s Ethical Review Board, patients presenting to the Obstetrics and Gynecology Department of WAPDA Teaching Hospital, Lahore who met the inclusion criteria were enrolled after counseling and written informed consent. Detailed history was taken and participants were randomly assigned by lottery method into Group A (vaginal misoprostol) and Group B (sublingual misoprostol). Each group received misoprostol according to protocol and was monitored in hospital for at least 24 hours until stable. Patients were followed up after one week for assessment of treatment outcome. Data were analyzed using SPSS version 26.

Results: A total of 168 women were enrolled with a mean age of 28.42±5.56 years. Most were 18–30 years (60.1%), with mean gestational age 8.27±1.71 weeks, BMI 26.01±3.45 kg/m², and majority multiparous (63.7%). Group B (sublingual misoprostol) demonstrated significantly higher treatment success compared to Group A (vaginal misoprostol), 75.0% vs 54.8% respectively (p=0.006). Stratified analysis showed consistent superiority of Group B, though not always statistically significant.

Conclusion: Sublingual misoprostol demonstrated superior efficacy compared to the vaginal route in the medical management of first trimester missed miscarriage, with a significantly higher treatment success rate. It provided more consistent clinical outcomes and is therefore considered a more effective and reliable option for routine clinical practice.