A comparison between two different doses of sublingual misoprostol in the management of first trimester incomplete miscarriage


  • Ishraq M. Shakir Department of Obstetrics & Gynecology, College of medicine, Hawler Medical University, Erbil, Iraq
  • Mina J. Mustafa Erbil directory of health, Erbil, Iraq.




Misoprostol, Incomplete miscarriage, Erbi City


Background and objective: Various methods have been described for management of first trimester incomplete miscarriage. The active methods include surgical methods that are highly effective but are associated with anesthetics and surgical risks. Medical methods by Misoprostol had been shown to be effective, acceptable and widely used treatment for incomplete miscarriage. The aim of this study was to compare the efficacy, patients' acceptability and the side effects of sublingual administration of single dose of 400mcg with single dose of 600mcg of misoprostol in the treatment of first trimester incomplete miscarriage. Methods: This study was conducted from April 1st, 2011 to February 1st, 2012 in the Maternity Teaching Hospital in Erbil city, Kurdistan region, Iraq. The study included 120 patients with incomplete miscarriage at a gestational age ≤12 weeks. They randomly received either single dose of 400mcg or 600mcg of misoprostol sublingually. Patients returned for follow-up and re-evaluation of abortion status after 7 days. Patients with a continuous incomplete miscarriage underwent surgical evacuation. Results: The success rate in the first and second group was 90% and 91.7%, respectively, while patients' acceptability in the first and second group was 96.7% and 95%, respectively with no difference between both groups. Gastrointestinal side effects like nausea and diarrhea were more in the second group. Conclusion: Single dose of 400 mcg of sublingual misoprostol is preferred on 600mcg of sublingual misoprostol regarding the development of side effects.


Metrics Loading ...


Griebel CP, Halvorsen J, Goleman TB. Management of spontaneous abortion. J Am Acad Fam Physician 2005; 72(7): 1243-50.

Grudzinskas JG. Miscarriage, ectopic pregnancy and Trophoblastic disease. In: Dewhurst's Textbook of Obstetrics and Gynecology for post- graduates. 6th edition. London: Blackwell science. Ltd. 1999:61-64.

Everett C. Incidence and outcome of bleeding before 20th weeks of pregnancy. Br Med J 1997; 315:32-4.

Topping J, Farquarson R.G. Spontaneous miscarriage. In: D. Keith Edmonds. Dewhurst's Textbook of Obstetrics and Gynecology. 7th edition. London: Blackwell; 2007.

Warriner I K Shah I H Preventing unsafe abortion and its consequences: Priorities for research and action. New York: Guttmacher Institute; 2006.

Dao B, Blum J Is misoprostol a safe, effective and acceptable alternative to manual vacuum aspiration for post abortion care? Result from a randomized trial in Burkina Faso, West Africa. BJOG 2007; 114: 1368-75.

World health Organization. Global and regional estimates of the incidence of unsafe abortion and associated mortality. Unsafe abortion. Geneva: WHO; 2003.

World health Organization (WHO). Technical and Managerial guide lines for prevention and treatment. Complications of abortion. Geneva: WHO; 2000.

Clark W, Shannon C, Winikoff B Misoprostol for uterine evacuation in induced abortion and pregnancy failure. Expert Review of Obstetrics & Gynecology. 2007; 2(1): 67-108.

Topping J and Farquarson RG Spontaneous miscarriage. In: Rulin MC, Bornstein SG & Campbell JD. Dewhurst's Textbook of Obstetrics and Gynecology. 7th edition. London: Blackwell; 2007.

Jurkovic D, Ross JA, Nicolaides KH. Expectant management of missed abortion. Br.J.Obstet Gynaecol. 2000; 105: 670-1.

Luise C, Jermy K, May C, Costello G, Collins WP Bourne TH. Outcome of expectant management of spontaneous first trimester miscarriage. BMJ 2002; 324: 873-5.

Chia Kv. Oqbo VI. Medical termination of missed abortion. J Obst Gynecol 2002; 19: 266-71.

Sahin HG, Sahin HA, Kocer M Randomized outpatient clinical trial of medical evacuation and surgical curettage in incomplete miscarriage. European Journal of Contraception and Reproductive Health Care 2001; 6(3): 141-4.

Sigma Pharmaceuticals industries. Stability Study. Cairo: Sigma; 2003.

Goldberg AB, Greenberg M, Darney PD Misoprostol and pregnancy. N Engl JM 2001; 344 (1): 38-47.

Shwekerela B, Kalumuna R, Kipingili R, Mashaka N, Westheimer. Misoprostol for treatment of incomplete abortion at the regional hospital level: results from Tanzania. BJOG. Int J Obst Gynecol 2007; 114:1363-7.

Zhang J, Gilles JM, Barnhart K. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. NEnglJM 2005; 353: 761-9.

Tang OS. Schweer H, Seyberth HW. Lee SWH. HO PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod 2002; 17: 332-6.

Diop A, Raghavan S, Rakotovao J, Comendant R, Blumenthal PD, Winikoff B. Two routes of administration for misoprostol in the treatment of incomplete abortion: a randomized clinical trial. Contraception 2009; 79(6):456-62.

Tang OS, HO PC. Pilot study on the use of sublingual misoprostol for medical abortion. Contraception 2001; 64: 315-17.

Tang OS. Miao BY, Lee SWH. Ho PC. Pilot study on the use of repeated doses of sublingual misoprostol in termination of pregnancy up to 12 weeks gestation: efficacy and acceptability. Hum Reproduction 2002; 17: 654-8.

Aronson A, Helstrom L, Gemzell-Danielson K. Sublingual compared with oral misoprostol for cervical dilatation prior to vacuum aspiration: A randomized comparison. Contraception 2004: 69 (2):165-9.

Von Hertzen H, piaggio G, Huong NTM Misoprostol for termination of early pregnancy a randomized multicentre equivalence trial on two routes and two intervals. Human Reproductive Health 2007 May.

Paritakul P, Phupong V Comparative study between oral and sublingual 600 mcg misoprostol for the treatment of incomplete abortion. J Obstet Gynaecol Res 2010; 36(5): 978-83.




How to Cite

Shakir, I. M., & Mustafa, M. J. (2016). A comparison between two different doses of sublingual misoprostol in the management of first trimester incomplete miscarriage. Zanco Journal of Medical Sciences (Zanco J Med Sci), 20(1), 1260_1266. https://doi.org/10.15218/zjms.2016.0018



Original Articles