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Contraception. 2014 Mar;89(3):187-92. doi: 10.1016/j.contraception.2013.11.014. Epub 2013 Nov 26.

Buccal misoprostol for treatment of fetal death at 14-28 weeks of pregnancy: a double-blind randomized controlled trial.

Author information

1
Gynuity Health Projects, New York, NY 10010, USA. Electronic address: hbracken@gynuity.org.
2
Center for Research and Consultancy in Reproductive Health, 16D Luy Ban Bich. Tan thoi Hoa Tan Phu, Hochiminh City, Vietnam.
3
Albert Einstein College of Medicine, Bronx, NY 10461, USA.
4
Family Planning Services and Research, Stanford University, Stanford, CA 94305-5317, USA.
5
Christiana Care Health System, Department of OB/GYN Research, Newark, DE 19718, USA.
6
Department of Obstetrics and Gynecology, JH Stroger Jr. Hospital of Cook County, Chicago, IL 60622, USA.
7
Gynuity Health Projects, New York, NY 10010, USA.

Abstract

OBJECTIVE:

To assess whether buccal misoprostol is effective for the treatment of intrauterine fetal death.

STUDY DESIGN:

This double-blind randomized trial was conducted at five tertiary-level hospitals in the United States and Vietnam. One hundred fifty-three women with an intrauterine fetal death at 14-28 weeks of pregnancy received either 100 mcg buccal misoprostol or 200 mcg buccal misoprostol every 6 h for a maximum of 8 doses. The main outcome measure was the fetal-placental delivery rate within 48 hours of prostaglandin commencement without any additional intervention.

RESULTS:

Most of the women (140/153) were recruited at the study site in Vietnam. Expulsion of both fetus and placenta within 48 hours of prostaglandin commencement without any additional interventions occurred in 61.8% (47/76) of women receiving misoprostol 100 mcg and 77.9% (60/77) of women receiving misoprostol 200 mcg. The 200 mcg dose was significantly more effective than the 100 mcg dose at expelling the fetus and placenta within 48 h [RR 0.68 (95% CI: 0.50-0.92; p=.03)]. The mean time to expulsion was significantly shorter using the 200 mcg dose (18.5±11.9 h) than the 100 mcg dose (23.9±12.5 h) (p=.02). Most women in both groups found the procedure satisfactory or very satisfactory (100 mcg: 76.7% (56/73); 200 mcg: 89.5% (68/76) [RR 0.86 (95% CI: 0.74-1.00)].

CONCLUSION:

Buccal misoprostol is an effective method for medical induction of labor after intrauterine fetal demise. A 200 mcg dose is significantly more effective than 100 mcg for evacuating the uterus within 48h. The treatment is highly acceptable to women.

IMPLICATIONS:

Administration of 200 mcg buccal misoprostol every six hours is an effective and acceptable method to effect the delivery of a demised fetus at 14-28 weeks that can be feasibly implemented in a wide variety of settings.

KEYWORDS:

Buccal misoprostol; Intrauterine fetal demise

[Indexed for MEDLINE]

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