Analytical Study of the Medical Management of Pregnancy Loss: Implementation of the FIGO Misoprostol Protocol

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Abstract Medical management of pregnancy loss and termination has evolved considerably over the past decade, with misoprostol-based protocols emerging as a cornerstone of care in many settings. Standardized regimens, such as the FIGO 2017 recommendations, aim to improve outcomes by ensuring effectiveness, safety, and reproducibility across diverse clinical contexts. Evaluating their real-world performance is essential, particularly in resource-constrained environments where protocol adherence can directly influence patient care. Objective To evaluate the effectiveness, safety, and clinical applicability of the FIGO 2017 misoprostol protocol for medical management of first□trimester missed abortions, second□trimester intrauterine fetal demise (IUFD), and medical termination of pregnancy (MTP) in a Tunisian tertiary center. Methods A retrospective descriptive and analytical study was conducted in the Gynecology Department A of Charles Nicole Hospital between January 2022 and December 2023. All patients admitted for first□trimester missed miscarriage, IUFD, or MTP and managed with misoprostol were included. Results A total of 190 patients were included: 65.8% with first□trimester missed abortion, 14.4% with IUFD, and 19.8% with MTP. The global success rate was 89.7%. Median induction□to□expulsion time was 32 h for first□trimester pregnancy loss, 19 h for IUFD, and 21 h for MTP. Multigravida women experienced significantly shorter expulsion intervals. Complications occurred in 8.8% of cases, with no uterine rupture. Conclusion The FIGO 2017 misoprostol protocol is highly effective and safe in the Tunisian context, offering high success rates, shorter hospitalization, and minimal complications. Findings support its continued implementation and highlight the need for further research in women with uterine scars.

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