Comparison of oral versus vaginal misoprostol for medical management of early fetal demise at Akhtar Saeed Trust Hospital, Lahore.

Objective: To compare the efficacy, safety, and clinical outcomes of oral versus vaginal misoprostol for medical management of first-trimester missed abortion at Akhtar Saeed Trust Hospital, Lahore. Study Design: Randomized Controlled Trial. Setting: Akhtar Saeed Trust Hospital, Lahore. Period: 15 November 2024 to 15 February 2025. Methods: A total of 110 female patients aged 18–45 years with a confirmed diagnosis of first-trimester missed abortion (gestational age <14 weeks) were enrolled. Participants were randomly assigned into two groups: Group A received oral misoprostol (400μg every six hours, up to three doses), and Group B received vaginal misoprostol (400μg soaked in normal saline, every six hours, up to three doses). Primary outcomes included treatment efficacy (complete uterine evacuation within 24 hours) and the need for surgical evacuation. Secondary outcomes included the mean time to expulsion and adverse effects such as bleeding, pain, vomiting, fever, and diarrhea. Data were analyzed using SPSS version 25.0, with a chi-square test used to compare efficacy between groups. Results: The efficacy of vaginal misoprostol (93.1%) was significantly higher than oral misoprostol (75.0%) (p=0.009). The mean time to expulsion was shorter in the vaginal group (10.87±2.0 hours) compared to the oral group (13.24±2.0 hours). The need for surgical evacuation was significantly higher in the oral group (25.0%) than in the vaginal group (6.9%) (p=0.009). Adverse effects, including bleeding, abdominal pain, vomiting, fever, and diarrhea, were comparable between groups, with no statistically significant differences. Conclusion: Vaginal misoprostol is more effective, results in faster expulsion, and significantly reduces the need for surgical evacuation compared to oral misoprostol. Given its superior clinical outcomes, vaginal misoprostol should be considered the preferred method for the medical management of first-trimester missed abortion.