COMPARISON OF MEAN DURATION REQUIRED FOR COMPLETE EXPULSION WITH ISOSORBIDE MONONITRATE VERSUS MISOPROSTOL IN FIRST TRIMESTER MISSED MISCARRIAGE

Background: Medical management of first trimester miscarriage possess significant advantages over surgical management. Misoprostol has been previously tested in the management of miscarriage in different regimens and settings. Isosorbide mononitrate (IMN) is also an effective and safe drugs for early expulsion of conception material. But controversial results have been noticed from literature. So we conducted this study to confirm more effective drug. Objective: To compare the mean duration required for complete expulsion with isosorbide mononitrate versus misoprostol for first trimester missed miscarriage. Material & Methods Study Design: Randomized Controlled Trial. Setting: unit I, Department of Obstetrics & Gynaecology, Lahore General Hospital, PGMI, Lahore. Duration: Six months ( August, 2017 to January,2018) Data Collection Procedure: Females were randomly divided in two groups by using lottery method. Group A was given 800 µg misoprostol in posterior fornix of vagina 3 hourly maximum 2 doses. Group B was given 40mg IMN in posterior fornix of vagina 3 hourly maximum 2 doses. Patients were reassessed if vaginal bleeding or uterine contractions were noted otherwise repeat dose was given after 3 hours. Time till complete expulsion was noted. Complete expulsion was confirmed subsequently by ultrasonography when no products of conception are found in utero. All the data was entered and analyzed through SPSS version 21. Results: The mean age of females was 30.40±5.51years. In this study, 18 (25%) were para 1, 27 (37.5%) were para 2, 15 (20.83%) were para 3 and 12 (16.67%) were para 4. The mean gestational age of females was 9.51±1.11weeks. The mean BMI of females was 24.56±3.76kg/m2. The mean duration required for complete expulsion was 91.69±15.74min in misoprostol group and 122.58±16.55min in IMN group. There was significant difference in both groups (p<0.05). Conclusion: Thus the mean expulsion time was significantly less for misoprostol than IMN. For future, we can recommend misoprostol for complete evacuation of conception material during first trimester missed miscarriage.