Comparative Study to Evaluate Vaginal Versus Oral Prostaglandin E1 Analogue (Misoprostol) in Management of First Trimester Missed Abortion

Background: Missed abortion of the first trimester is a common obstetric complication, usually needing medical intervention. Misoprostol, the prostaglandin E1 analogue, can be given by different routes, most frequently the oral and vaginal routes. Establishing the more efficacious route can help enhance the result of the treatment and the patient's satisfaction. Objective: To compare vaginal versus oral prostaglandin e1 analogue (misoprostol) in management of first trimester missed abortion in term of efficacy. Study Design: Randomized Controlled Trial. Duration and Place of Study: The study was carried out from September 2024 to February 2025 in the Department of Obstetrics and Gynaecology, Qazi Hussain Ahmad Medical Complex, Nowshera. Methodology: A total of 194 women aged 18–35 years with ultrasound-confirmed first trimester missed abortion were recruited and randomized into two equal groups. Group A received 400 micrograms of vaginal misoprostol every three hours (maximum three doses), while Group B received 400 micrograms of oral misoprostol every six hours (maximum three doses). Treatment was considered successful if complete uterine evacuation occurred without surgical intervention and follow-up ultrasound on day three confirmed absence of intrauterine products ≥15 mm. Results: The mean age was 26.63 ± 3.65 years in Group A and 27.04 ± 4.05 years in Group B. Vaginal misoprostol achieved a significantly higher success rate (87.6%) compared to oral misoprostol (64.9%) (p=0.001). Stratified analyses demonstrated consistently better outcomes with vaginal administration across subgroups including age, residence, educational level, socioeconomic status, gestational age, parity, and gravidity. Conclusion: Vaginal misoprostol demonstrated superior efficacy with fewer adverse effects than oral administration for managing first-trimester missed abortion.