Efficacy of Vaginal Misoprostol for Missed Abortion Management: A Retrospective Case Series

Abstract

Background: Misoprostol is widely used for the medical management of missed abortion, but response rates vary across settings. We evaluated the efficacy of 800 mcg vaginal misoprostol for first-trimester missed abortion at Rabia Balkhi Hospital, Kabul, Afghanistan.

Methods: This retrospective case series included 492 women diagnosed with first-trimester missed abortion and treated with 800 micrograms of vaginal misoprostol between April 2014 and March 2015. Data were collected on maternal age, gravidity, dosing interval, and treatment outcomes. The primary outcome was treatment success, defined as resolution of the missed abortion without the need for dilation and curettage (D&C), including cases that required evacuation and curettage (E&C) for incomplete expulsion. Treatment failure was defined as requiring D&C.

Results: Of 492 patients, 470 (95.5%) had successful medical management without the need for D&C. Treatment failure occurred in 22 women (4.5%). Among non-responders, most were aged 30–38 years (40.9%) and multigravida (90.9%). In the failure group, 45.5% had received misoprostol every 8 hours and 54.5% every 3 hours. No complications such as hemorrhage, infection, or uterine rupture were recorded. The observed failure rate (4.5%) was lower than those reported in studies from Mumbai (8.7%) and Pakistan (10%).

Conclusion: Vaginal misoprostol demonstrated high efficacy and an excellent safety profile for the management of first-trimester missed abortion at Rabia Balkhi Hospital. The effectiveness observed in this cohort exceeds that reported in regional studies. Further research is warranted to optimize dosing protocols and identify factors associated with treatment failure in similar resource-limited settings.