الفهرس 
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Abstract
Summary : Our randomized controlled trial was conducted on 70 females treated for missed miscarriage in first trimester that were randomly allocated into 2 groups (group A treated with misoprostol and group B treated with MVA) at Mansoura University Maternity Hospital from January 2020 to January 2021. The aim of the study was to compare the effectiveness, patient’s satisfaction and hematocrit DROP of misoprostol versus MVA to understand the potential role of misoprostol as a first line for treatment of first trimester missed miscarriage. A structured questionnaire was used to collect information regarding the demographic details and risk factor exposure among the participants. The study revealed the following findings : Mean age of patients which observed in misoprostol group was 29.83 years, whereas in MVA group was 27.91 years. Median parity was 2 and median gravidity was 3. Only 20% of patients had medical history in both groups like bronchial asthma, DM, hypertension, hypothyroidism and RA. Absence of medical history increase satisfaction score by 3.89. About 65.7% have no previous abortion history in both groups and 91.4% of MVA group have no previous preterm labour versus 97.1% of misoprostol group. History of preterm labour in misoprostol group and MVA group was (2.9% & 8.6%), respectively. Mean gestational age at abortion was 8.57 weeks in misoprostol group versus 9.31 weeks in MVA group without significant difference between them. Fetal poles were detected among 94.3% of misoprostol group and 97.1% of MVA group without significant difference between groups. MVA group has slightly higher efficacy (94.3%) as compared to misoprostol group (82.9%) but the difference is not statistically significant. This finding demonstrated that medical treatment is as effective as surgical treatment of first‑trimester missed miscarriages. MVA group has slightly higher efficacy in terms of time, as all the products of conception removed at one sitting, less bleeding after procedure with short hospital stay, patient can be discharged at same day. Misoprostol group also has good results but in terms of effectiveness it was not always effective with 1st dose but may require repeat dose and bleeding or spotting may remain continues for one to two weeks. Lower gestational age was significantly associated with success rate and every increase one week in gestational age decreased success rate by 0.266. Cesarean rate ≤ 2 or absence of CS increased success rate by 14.4 & 8, respectively. There is no statistically significant difference between studied groups related to success rate and mean patient satisfaction score immediately and after one week. Increased satisfaction rate more than 4 immediately increase success rate by 2.56 and satisfaction after one week increases success rate by 5.84. The mean client satisfaction score at a follow‑up visit was higher among women treated with misoprostol when compared with those treated with MVA. The reasons given for chosen misoprostol were being effective method, quick and easy treatment and to avoid uterine instrumentation. The mean hemoglobin and hematocrit after treatment illustrated statistically significant lower mean value among misoprostol group than MVA group (10.07 &10.91, respectively for Hb) and (30.75 & 33, respectively for hematocrit value). Hemoglobin DROP for both groups illustrated no statistically significant difference between studied groups. There is statistically significant negative correlation between endometrial thickness /mm and satisfaction after one week among both group. The study concluded that the use of medical treatment is as effective as surgical treatment