Abstract

EFFICACY AND SAFETY OF SUBLINGUAL AND BUCCAL ROUTE MISOPROSTOL FOR FIRST AND SECOND TRIMESTER MISCARRIAGES USING THE INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS (FIGO) 2017 PROTOCOL

Tahira Ramzan*, Shahina Ishtiaq, Shagufta Gulzar, Habiba Sharaf Ali, Haleema Yasmin

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Abstract

Background: Miscarriage affects about 10% of pregnancies and causes significant physical and emotional distress. Medical management with misoprostol is a safe and effective alternative to surgery, especially in low-resource settings where mifepristone may not be available. Traditionally, misoprostol is given vaginally, but this can be uncomfortable for women. FIGO‘s 2017 guidelines introduced sublingual and buccal routes as effective and more acceptable alternatives. Evaluating these routes helps improve patient care and treatment outcomes. Objectives: To evaluate the safety and efficacy of sublingual and buccal route administration of misoprostol according to the latest 2017 International Federation of Gynecology and Obstetricians (FIGO) protocol in the management of first and secondtrimester miscarriages. Methodology: This study was carried out at Ziauddin University Hospital, Karachi, Pakistan, between January and December 2022. A total of 110 patients presenting with first or second trimester miscarriage, or requiring termination of pregnancy before 24 weeks, were treated with misoprostol administered exclusively via the sublingual or buccal route, following the latest FIGO 2017 protocol. Treatment success was defined as complete expulsion within 12 hours of completing the medication course, confirmed by pelvic ultrasound during inpatient monitoring. Results: A total of 84 (76.4%) patients received misoprostol for first-trimester miscarriage, whereas 26 (23.6%) were treated during the second trimester. In the first trimester group, the primary indications for medical termination were missed miscarriage in 74 cases (67.5%) and anembryonic pregnancy in 10 cases (9.1%). Among second-trimester patients, 16 (14.5%) had missed miscarriages, and 10 (9.1%) were diagnosed with lethal fetal anomalies. Treatment success, defined as complete uterine evacuation confirmed by pelvic ultrasound, was achieved in 98% of cases without any significant adverse effects. Conclusion: Misoprostol, when administered through non-vaginal routes, is safe, effective, and more acceptable to patients for the management of miscarriages.

Keywords: Misoprostol, miscarriage, medical termination of pregnancy, sublingual administration, buccal administration.