FIRST TRIMESTER MISCARRIAGE;

Objectives: This study was conducted to access the efficacy of misoprostol andmanual vacuum aspiration for the management of first trimester miscarriage. Study Design:Descriptive case series. Setting: This study was conducted in obstetrics and gynecologydepartment of Nishtar hospital Multan. Duration of Study: This study was conducted fromMay, 2015 to October 2015. Material and Methods: Sample including 652 women havinggestational age less than 12 weeks with open os of cervix were taken in the study. Femaleswith previous cesarean section, multiple gestation or with history of asthma, ischemic heartdisease, hepatitis, glaucoma, or known allergy to prostaglandins were excluded. Total womenwere divided into two groups. i.e. 326 in misoprostol while 326 in manual vacuum aspirationgroup. Misoprostol group received misoprostol tablet 400μg vaginally at intervals of four hoursdepending on the degree of cervical dilatation and frequency of uterine contractions. A total of 3doses of misoprostol were given. Six hours after the first dose of misoprostol syntocinon infusionwas started. Infusion rate was 2mIU/min. Dose was increased after every 30 minutes at the rateof 1mIU/min to maximum of 8mIU/min. Manual vacuum aspiration group did not receive anyuterotonics and directly underwent manual vacuum aspiration. Patients were asked to revisit 7days after the procedure. Transvaginal ultrasound was done to access endometrial thicknessin the longitudinal view of the uterus at the maximal AP diameter. Efficacy was measuredin the form of complete abortion. Results: In the study, misoprostol group mean age was31.79±4.86 years while age range was 18-40 years. In manual vacuum aspiration group meanage was 32.38±4.86 years. Majority of patients were between 31-35 years in both groups. Meangestational age was 9.89±1.38 weeks in misoprostol group and 9.871±1.22 weeks in manualvacuum aspiration group, while mean dose in misoprostol group was 2.358±0.65. Conclusion:Regarding management of first trimester miscarriage both options including manual vacuumaspiration and 400μg intra vaginal misoprostol can be considered. Both methods are affectivetreatment options, decision that which method be opted should be based on, availability of twomethods and wishes of the patient.