الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Medical management of anembryonic pregnancy with misoprostol is often done in hospital on an inpatient basis mainly due to fear of complications like excessive bleeding and pain. However, it can be managed effectively and safely in the outpatient setting with misoprostol. Outpatient management is preferable to termination in hospital setting because it decreases cost and lessen the burden on hospitals. Patient’s convenience and satisfaction level is high and psychologically they feel at ease in the comfort of their home with their dear ones by their side to support them. Aim: The aim of this study was to evaluate the efficacy, safety and acceptability of an outpatient protocol for the medical management of anembryonic pregnancy using sublingual misoprostol as an alternate to surgical termination. Setting: Outpatient clinic of Obstetrics and Gynecology Department, Talkha Central Hospital, Dakahliya , Egypt. Results: Complete medical evacuation occurred in 76% of cases. However, 24% of cases failed to evacuate after 72 h of the suggested regimen. Thus, they underwent surgical evacuation. Frequently encountered adverse effects of misoprostol were nausea &vomiting (20%), diarrhea (12%) ,shivering (24%), pain needing analgesia (16%).Only one case (2%) reported severe bleeding for which she was urgently admitted for surgical evacuation. No reported shock or severe allergic reactions. Conclusions: Outpatient medical treatment with misoprostol is a highly effective and safe method in the management of anembryonic pregnancy. Successful outpatient management would contribute to a further reduction of the suction evacuation rate . Recommendations: Because of the currently existing variety of protocols, it is recommended to implement standard scheme of misoprostol administration and control visits. No need for hospitalization during the procedure. The development and implementation of a national guideline or adoption of an international guideline might prevent women from having an unnecessary surgical evacuation.