A Comparative Study of Surgical versus Medical Management of Cases of First Trimesteric Missed Abortion

Background Missed abortion is a common obstetric problem constitutes approximately 15% of clinically diagnosed pregnancies and it was reported that about 80% of early pregnancy loss occurs in the first trimester. Missed abortion can be managed expectantly, surgically and medically. Surgical evacuation is the standard treatment for missed abortion with around 95% success rate and it had been widely performed all over the world in the last five decades, there are some complications associated with surgery such as higher cost, infection and bleeding. Medical management might be more suitable instead of surgical evacuation, it may be less costly than surgical treatment and consequently due to its lower complications most patients prefer it. Objective To compare the efficacy, safety and patient satisfaction of medical treatment of 1st trimestric missed abortion using misoprostol versus surgical evacuation. Patients and Methods Types of study: Randomized controlled open labelled clinical trial. Study setting: Maternity hospital, Ain Shams University. Study period: For six months from 1st of March 2019 to 31st of August 2019. Results The study shows no significant differences were found between groups regarding systolic blood pressure, diastolic blood pressure, pulse rate and body temperature before and after treatment. The results also show that occurrence of abdominal pain was frequent in both groups but, with no significant difference between groups but time needed to induce abortion was significantly higher in medical management group compared to surgical management one. Conclusion Medical management is found to be as effective as surgical management in the 1st trimesteric missed abortion, by using Misoprostol.

Modern view of the problem of missed abortion

Non-developing pregnancy is an urgent obstetric problem, which is included in the structure of reproductive losses and. The authors performed a systematic analysis of the data presented in the modern scientifi c literature on the epidemiology, etiology, pathogenesis, and diagnosis of non-developing pregnancy. Th e review includes data from foreign and domestic articles on this topic found in PubMed over the past 7 years.

Clinical Efficacy and Safety Study of Mifepristone with Misoprostol Treatment in Patients with Missed Abortion

Currently, medication abortion is widely used in clinical practice in China. The aim of this study was to investigate the effect of mifepristone with misoprostol treatment on the efficacy of patients with missed abortion (MA) and the safety of this drug regimen. 95 patients with MA treated in our hospital from February 2019 to April 2021 were collected as the subjects of this study, and the patients were divided into the control and the research groups according to different treatment modalities. Among them, 46 cases in the control group were treated by diethylstilbestrol combined with oxytocin and 49 cases in the research group were treated by mifepristone combined with misoprostol, and both groups underwent curettage after medication. The rates of complete abortion, time of embryo expulsion, time of operation, intraoperative bleeding, time of postoperative vaginal bleeding, amount of vaginal bleeding, rate of one-time curettage, the levels of serum estradiol (E2), progesterone (P), β-chorionic gonadotropin (β-hCG), and interleukin-18 (IL-18), and the incidence of adverse effects in the two groups were examined and compared. Alanine transaminase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and serum creatinine (Scr) were used as indicators to evaluate the safety of the drug. The results showed that the rates of complete abortion and one-time curettage were significantly higher in the study group than in the control group, while the time of embryo expulsion, operation time, intraoperative bleeding, postoperative vaginal bleeding time, and vaginal bleeding were significantly lower than in the control group. The serum E2, P, and β-hCG levels before curettage in both groups were significantly higher, and IL-18 levels were significantly lower than those at the time of admission, with E2, P, and β-hCG levels increasing more and IL-18 levels decreasing more in the research group. After drug treatment, no abnormal changes in liver and kidney functions were observed in both groups, and the incidence of adverse reactions was at a similar and lower level in both groups. This shows that mifepristone with misoprostol is a safer and more effective drug regimen for the treatment of MA, which can regulate the levels of serum sex hormones and inflammatory factors in the body, promote the shedding of placental tissue, and create conditions for improving the rate of curettage.

On the question of missed abortion

As you know, according to the proposal of Oldhanf and Mattews Dunean, the terms missed labor and missed abortion are defined as cases where, after the onset and again terminated manifestations of childbirth (resp. Abortion), the fetal egg that has died in the uterine cavity is delayed for a considerable time, sometimes even longer than the normal period pregnancy.