A Comparison of Vaginal Misoprostol 800 µg Versus 400 µg for Anembryonic Pregnancy: A Randomized Comparative Trial
Najnapa Srikhao MD*, Yuen Tannirandorn MD**
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University ** Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University
Objective : To compare the efficacy, side effects and patient satisfaction between 800 µg versus 400 µg intrav-
aginal misoprostol for anembryonic pregnancy.
Materials and Methods : Women who had diagnosed as anembryonic pregnancy were treated as IPD case and
randomly assigned to receive either 800 µg or 400 µg intravaginal misoprostol. The second dose was adminis-
tered in the equal dose if there was no evidence of abortion in 24 hr. The treatment failure was determined by
no complete abortion within 48 hr. If spontaneous abortion had not occurred, or had heavy vaginal bleeding
or evidence of incomplete abortion either by clinical manifestation or sonographic finding then dilatation
and curettage was performed.
Results : Fifty patients were enrolled into the study, 25 patients were randomized to receive 800 mg and 25
patients were received 400 mg intravaginal misoprostol. Complete abortion within 48 hr was not different
between the 2 groups (72%). However complete abortion within 12 hr was significantly higher in the 800 mg
group than in the 400 mg group (64% versus 20 %, respectively, p = 0.016). The median time to abortion in the
800 mg group was significantly shorter than in the 400mg group (9.0 hr versus 16.0 hr, respectively, p= 0.01).
There was no significant difference in the side effects and patients’ satisfaction between both groups.
Conclusion : Vaginal misoprostol can be used for termination of pregnancy in case of anembryonic pregnancy
with high successful rate of complete abortion and no serious adverse effects. We recommend the 800 µg
vaginal misoprostol regimen because within 12 hr the complete abortion rate was higher and the median time
to abortion was shorter than the 400 µg regimen with no difference in side effects. This may decrease the
suffering time of both physical and psychological trauma to the patient before complete abortion has occurred.
Keywords : Anembryonic pregnancy, Misoprostol, Pregnancy termination.
