Vaginal Misoprostol More Effective Than Oral Route for Managing First-Trimester Missed Abortions: Meta-Analysis
Pakistan: A recent systematic review and meta-analysis comparing the oral and vaginal administration of misoprostol for managing first-trimester missed abortions has highlighted the superiority of the vaginal route in terms of both efficacy and safety. The findings were published online in the European Journal of Obstetrics & Gynecology and Reproductive Biology.
The analysis, which pooled data from multiple randomized controlled trials, found that vaginal misoprostol significantly outperformed the oral route in achieving complete abortion. Women who received the drug vaginally experienced a higher overall success rate of uterine evacuation without requiring surgical intervention. Additionally, the time between drug administration and complete expulsion—referred to as the induction-to-expulsion interval—was notably shorter in the vaginal misoprostol group.
Missed abortion during the first trimester refers to the situation where the embryo or fetus stops developing, but the cervix stays closed, and there is usually little or no bleeding. This condition is typically diagnosed through ultrasound, which may show an empty gestational sac or an embryo/fetus without a heartbeat. Misoprostol is commonly used to manage early pregnancy loss. Kanwal Majeed, Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan, and colleagues aimed to compare how effective misoprostol is when given orally versus vaginally in managing missed abortions in the first trimester.
For this purpose, the researchers conducted a systematic review that included randomized controlled trials involving patients with confirmed first-trimester missed abortion, comparing the outcomes of oral versus vaginal misoprostol in terms of uterine evacuation success, induction-to-expulsion time, patient satisfaction, and adverse events.
A total of ten RCTs with 1,142 patients—578 receiving oral misoprostol and 564 receiving vaginal misoprostol—were analyzed. Independent data extraction and quality assessment helped ensure unbiased results. Risk ratios with 95% confidence intervals were calculated using a random-effects meta-analysis, and the quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 2).
Key Findings:
- Vaginal misoprostol showed a higher success rate in managing first-trimester missed abortion compared to oral misoprostol.
- The time taken from induction to expulsion was shorter with vaginal misoprostol.
- Patients reported greater satisfaction with vaginal administration than with oral use.
- Nausea and vomiting were more common in the oral misoprostol group.
- There was no major difference between the two groups in terms of headache, dizziness, diarrhea, fever, heavy bleeding, or discharge.
- Severe cramp-like pain occurred more frequently in patients who received oral misoprostol.
"This review and meta-analysis suggest that vaginal misoprostol is more effective than oral administration for managing first-trimester missed abortions, offering higher success rates, faster expulsion, better patient satisfaction, and fewer side effects," the authors concluded.
Reference:
Majeed K, Syed H, Murtaza M, Hanif ZM, Ali H. Efficacy and safety of oral versus vaginal misoprostol for medical management of first trimester missed abortion: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2025 Feb;305:92-99. doi: 10.1016/j.ejogrb.2024.12.015. Epub 2024 Dec 10. PMID: 39673916.
