Vaginal misoprostol for medical evacuation of missed abortion

Missed abortion is a cause of worry both for the patient and the gynecologist. The gynecoloist’s concern is deciding the method of terminating pregnancy. The problems are because of closed cervix, bulk of products, and the possibility of adherence of products to the uterine wall. This adherence increases the chance of incomplete evacuation and uterine performation. The commonly practiced method of managing missed abortion is dilatation and evacuation. However medical methods of abortion are now establishing themselves in clinical practice. But the drug schedule is not yet established 1. Nonsurgical methods of terminating pregnancy using prostaglandins by various routes following administration of progesterone antagonists are successful in early gestation. Use of prostaglandin alone in missed abortion, without progesterone antagonists, is logical because death of the conceptus brings about natural fall in progesterone level 2. There are reports of use of vaginal misoprostol alone for abortion and of claims that it is better than oral misoprostol 3. Use of medical methods is expected to bring about gradual nontraumatic dilatation of cervix, separation of products, and their expulsion. Few cases might require surgical evacuation to remove retained products. However this becomes safe and easy because of open cervix, separated products and thick contracted myometrium. We present our experience of using misoprostol alone by vaginal route in 84 women having a missed abortion of 6 to 18 weeks gestation.