Intravaginal misoprostol effective in evacuation. (Failed First-Trimester Gestations).

SEATTLE -- Misoprostol administered intravaginally is "highly effective" for uterine evacuation in women with failed first-trimester gestations, Dr. Jerry M. Gilles said at the annual meeting of the American Society for Reproductive Medicine.

In a randomized clinical trial conducted by the National Institute of Child Health and Human Development, an overall success rate of 80% was seen with the administration of one or two doses of the synthetic prostaglandin analogue.

Medical management following miscarriage can avoid the cost and complications of surgery as well as the uncertainties of expectant management, he said.

But reported evacuation rates with intravaginal misoprostol have ranged from 13% to 96%. "This wide range in evacuation rates may be due in part to variability in absorption of the drug, particularly when given intravaginally," said Dr. Gilles of the department of obstetrics and gynecology at the University of Miami.

The researchers also sought to determine if absorption of the drug could be improved by the addition of saline. Results of observational studies have suggested that when the vagina is cleansed and saline added to the vaginal tablet, absorption may be improved, leading to higher rates of evacuation success, Dr. Gilles said.

Eighty women with embryonic or fetal demise or anembryonic pregnancies with a crown-rump length less than 41 mm or a mean sac diameter less than 46 mm were randomized to receive 800 [micro]g of misoprostol alone or with 2 mL of saline added. There were 39 patients in the dry misoprostol group and 41 in the saline group, he said. Transvaginal pelvic ultrasounds were performed on days 3, 8, and 15. If the gestational sac was still present at day 3, a second dose of misoprostol was given, and if it remained by day 8, a D&C was performed.

By day 3, the sac had ...