Sublingual versus vaginal misoprostol in the management of missed miscarriage

Objective: To compare the efficacy of sublingual and vaginal misoprostol in the medical management of missed miscarriage. Methods: Fifty women diagnosed as having missed miscarriage of gestational age less than 20 weeks were assigned randomly to receive 4008g of either sublingual or vaginal misoprostol every three hours, up to a maximum of five doses. The primary outcome measures were, complete evacuation of products of conception, mean induction to delivery time and the occurrence of side effects. Results: There was no significant difference in complete evacuation rates between the sublingual misoprostol and the vaginal misoprostol groups (52% vs. 48%, p = 0.571) mainly within the first 24 hours. Mean induction to delivery time was also similar for both groups (13.07 ± 6.95 hours for sublingual versus 13.29 ± 5.63 hours for vaginal group) as was the total number of doses required (4.44 ± 1.04 for sublingual versus 4.52 ± 0.96 for vaginal misoprostol). Side effects were seen in 18 women (72%) in the sublingual group compared to 5 women (20%) in the vaginal group (p < 0.001). The incidence of unpleasant taste was significantly higher in the sublingual group than in the vaginal group (60% versus 4%, p = < 0.001). Conclusion: Sublingual misoprostol is as effective as vaginal misoprostol for medical management of missed miscarriage but is associated with an increased risk of side effects especially an unpleasant taste.