الفهرس 
Missed miscarriageOnly 14 pages are availabe for public view
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Abstract
Objective: To compare the effectiveness of sublingual and vaginal misoprostol in the medical treatment of first trimester missed miscarriage.
Methods: Two hundred women diagnosed as having missed miscarriage of gestational age less than 12 weeks were assigned randomly into two groups to receive 800μg of either sublingual or vaginal misoprostol every four hours for three doses. The primary outcome was visual inspection of product of conception. The secondary outcomes were measurement of endometrial thickness on day7, day14, and day 30 from first dose of misoprostol administration, administration-expulsion interval, duration of bleeding, and occurrence of adverse effects.
Results: During the follow up of our cases we found that sublingual route is more effective than vaginal route in the management of first trimester missed miscarriage. The difference between the sublingual and vaginal groups was statistically significant being increased with increase follow up duration (70% Vs. 50% at day 7, 83% Vs. 69% at day 14, and 87% Vs. 78% at day 30). The mean induction to delivery time was statistically shorter among sublingual group compared to vaginal group (Mean= 12 hours ±3.1 vs. 16.4 hours ±4.2, P<0.001). Duration of bleeding was significantly shorter among sublingual group than among vaginal group (Mean= 14.6 days ±2.5 Vs. 15.2±2.9). Side effects were more common in the sublingual group compared to vaginal group. The most common side effects were unpleasant taste which present in 62% in sublingual group and in 5% in vaginal group (P<0.001). Then low-grade fever presents in 34% in sublingual group and in 16% in vaginal group (P=0.003) and diarrhea presents in 34% in sublingual group and in 16% in vaginal group (P=0.003). Then shivering presents in 32% in sublingual group and in 14% in vaginal group (P=0.002). Then nausea presents in 32% in sublingual group and in 17% in vaginal group (P<0.001). Then vomiting presents in 15% in sublingual group and 6% in vaginal group (P=0.038).
Conclusion: Sublingual administration of misoprostol is more effective than its vaginal administration in missed abortion management. While side effects were more common in sublingual group compared with the vaginal group.