Purpose: This study aims to evaluate the success rate of misoprostol in managing missed miscarriages, identify factors affecting outcomes (such as gestational age and bleeding), and measure the rate of surgical intervention required after misoprostol use in Saudi Arabia due to the lack of data on this region. Patients and Methods: A retrospective cohort study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia, from 2019 to 2023. Women aged 18– 45 years with a diagnosis of missed miscarriage and uterine size less than 12 weeks were included. Misoprostol was the primary treatment, while those who received primary surgical management were excluded. Data were collected from electronic medical records, including demographics, gestational age, misoprostol dosage, blood loss, and surgical indications. The primary outcome was successful medical management, defined as complete uterine evacuation without surgery. Complications such as heavy bleeding, hemoglobin drop, and transfusion were documented. Statistical analysis involved descriptive statistics and Fischer ’ s exact test, with significance set at p < 0.05. Results: A total 317 women met inclusion criteria. The success rate of misoprostol was 78.5%, with 58.3% achieving complete evacuation confirmed via ultrasound. Most patients had an empty uterus with a mean endometrial thickness of 11.1 mm. Retained products of conception (RPOC) were seen in 14.8% of cases. Complications were rare: 3.2% required transfusion and 21.5% needed surgical evacuation. Previous cesarean sections and misoprostol dose were significantly associated with higher complication rates and longer hospital stays (p < 0.05). Conclusion: Misoprostol is an effective, non-invasive treatment for missed miscarriage, with a high success rate and low complication risk. These findings support its use as a practical first-line treatment, potentially reducing the need for surgical intervention and associated healthcare burdens. Keywords: first-trimester pregnancy loss, medical intervention of missed miscarriage, ultrasound, endometrial thickness, Miscarriage management, failed medical treatment
AlJumah et al. (Sun,) studied this question.