Comparison of the Efficacy of Oral Versus Vaginal Misoprostol in the Management of First-Trimester Incomplete Miscarriage
DOI:
https://doi.org/10.65761/pjcr.2026.286Keywords:
Miscarriage, Incomplete, Misoprostol, Administration, Treatment OutcomeAbstract
Background: To compare the efficacy of oral and vaginal misoprostol in achieving complete uterine evacuation among women presenting with first-trimester incomplete miscarriage.
Methods: This cross-sectional observational study was conducted from July to December 2025 at the Gynecology and Obstetrics Department, Sandeman Provincial Hospital/Bolan Medical College and Hospital, Quetta. It included 627 women diagnosed with first-trimester incomplete miscarriage. Of these, 314 received oral misoprostol and 313 received vaginal misoprostol. Clinical assessment and ultrasonography evaluated uterine evacuation. The primary outcome was complete evacuation without surgery. Secondary outcomes included treatment failure, surgical evacuation, bleeding duration, pain, nausea, vomiting, fever, and other adverse effects.
Results: The mean age was 28.7±5.1 years in the oral group and 29.1±5.3 years in the vaginal group (p=0.347). Complete uterine evacuation occurred in 262 (83.4%) and 285 (91.1%) patients, respectively (p=0.006). Surgical evacuation was required in 52 (16.6%) oral-group patients versus 28 (8.9%) vaginal-group patients (p=0.006). Bleeding duration was comparable. Nausea and vomiting were more frequent with oral administration. No major complications were observed in either group.
Conclusion: Vaginal misoprostol was significantly more effective than oral misoprostol for the medical management of first-trimester incomplete miscarriage. It achieved a higher rate of complete uterine evacuation and reduced the requirement for surgical intervention. Vaginal administration was also well tolerated, supporting its use as an effective non-surgical treatment option.
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Copyright (c) 2026 Noreen Mir, Shazia Khanum, Iqra Sana, Naebeela Jallat, Nazneen Yousuf
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