Comparison of Duration Required for Expulsion with Misoprostol versus Misoprostol plus Isosorbide Mononitrate in First Trimester Missed Miscarriage

Abstract

Missed miscarriage is diagnosed when a non-viable pregnancy is identified on an ultrasound scan during the first 14 weeks of gestation. Often, women who have missed miscarriage are asymptomatic or have small amounts of vaginal bleeding or pain before the diagnosis is made (ACOG, 2018). Misoprostol is a synthetic prostaglandin E1 analogue marketed as an oral preparation used to prevent and treat gastro-duodenal damage. However, misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medical management of miscarriage, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. (van den Berg et al., 2019).