Low-dose vaginal misoprostol in the management of intrauterine fetal death.

Objectives: To assess the effectiveness and side effects of vaginal misoprostol (Vagiprost® tablet) termination of second and third trimester pregnancy complicated with intrauterine fetal death (IUFD).

Design: A prospective observational cohort study.

Setting: Tanta University Hospital. Patients. The study carried out on 324 women with fetal demise in the second and third trimesters, from January 2008 to December 2009.

Intervention: All patients were subjected to history taking, physical examination, and the Bishop Scoring. Application of 25 μg misoprostol in the posterior fornix of the vagina, this was repeated every 4 h over 24 h. We assessed the adverse effects, progress, and outcomes.

Results: The success rate was 90% and 45% in women in the third and second trimesters, respectively. The mean induction-termination interval was 8.95 ± 2.63 and 15.3 ± 5.37 h for women in the third and second trimesters, respectively. The induction termination interval correlated negatively with the duration of gestation. Approximately, 90% of second trimester and 55% of third trimester women required oxytocin augmentation. The mean value of total required dose of misoprostol was 166.3 ± 7.5 and 120 ± 28.79 μg for women in the second and third trimesters, respectively.

Conclusion: Vagiprost appears to be a safe, effective, practical, and inexpensive method for termination of third trimester pregnancy complicated with of IUFD.