Background: misoprostol is prostaglandin E1 analogue that can be given by oral, sublingual, vaginal or rectal route. It is cheap and can be stored at room temperature and because of its utero-tonic action, it become an important drug in obstetric and gynecological practice.Objectives: to evaluate the effectiveness of intravaginal followed by oral misoprostol tablets for medical termination of missed abortion between 8 – 13 weeks.Methods : a prospective study of (60) women with diagnosed missed abortion admitted to AL- Zahraa General hospital – Wassit Governorate Iraq from July 2006 through July 2007 . 800 micrograms (4 tablets) of misoprostol inserted in the posterior fornix of the vagina after moisture with normal saline followed by oral 400 micrograms (2 tablets) 6 hours later. Another 400 micrograms were given orally 6 hours from the last dose for those patients whodid not respond to the previous two doses.Results: (48) patients (80%) had complete expulsion . (21) Patients (35%) after the vaginal dose. (15) Patients (25%) respond after the first oral dose and (12) patients (20%) after the second oral dose. (6) Patients (10%) had incomplete abortion; the remainder (6) patients (10%) failed to respond within 24 hours of starting treatment and require surgical evacuation. The mean time for expulsion was 10 hours. Conclusion: first trimester missed abortion medical termination by misoprostol is effective, save and a practical Methods .

الميزوبرستول هو مثيل البروستوكلاندين- اي 1 ويمكن ان يعطى عن طريق الفم وتحت اللسان و عن طريق المهبل وعن طريق الشرج. يعتبر هذا العقار رخيصا و ممكن خزنه في درجة حرارة الغرفه و بسبب فعاليته في احداث تقلصات رحميه اصبح عقارا مهما في مجال النسائيه و التوليد.الهدف من الدراسة هو لتقييم فعالية الميزوبرستول وذلك بأعطائه عن طريق المهبل يليه اعطائه عن طريق الفم لانهاء الاسقاط المنسي طبيا بين 8 – 13 اسبوع. هذهِ دراسه مستقبليه تضمنت ستون امرأه مشخصه بحالة اسقاط منسي ادخلوا مستشفى الزهراء العام في محافظة واسط / العراق للفتره بين تموز 2006 و تموز 2007 . 800 مايكروكرام ( اربع حبوب) من الميزوبرستول توضع في الجزء الخلفي من المهبل بعد ترطيبها بالنورمال سلاين تليها جرعه عن طريق الفم (400 مايكروكرام) بعد ستة ساعات . وجرعه فمويه اخرى بعد ستة ساعات من الجرعه الاخيره للمرضى الذين لم يستجيبوا للجرعتين الاوليتين.النتائج 48 مريضه (80%) حصل اسقاط كامل. 21 منهن(35%) بعد الجرعه الاولى. 15مريضه (25% ) بعد الجرعه الفمويه الاولى و 12 مريضه (20%) بعد الجرعه الفمويه الثانيه .6مريضات (10%) انتهوا بأسقاط ناقص و 6 مريضات (10%) لم يستجيبوا للعلاج بعد مرور 24 ساعه على بدأ العلاج واحتاجوا الى تداخل جراحي لانهاء الحمل. كان معدل وقت انهاء الاسقاط المنسي هو عشرة ساعات .يستنتج من الدراسة انهاء الحمل الطبي في حالات الاسقاط المنسي في الجزء الاول من الحمل بواسطة الميزوبرستول هي طريقه فعاله و امينه وعمليه.

misoprostol --- first trimester missed abortion --- termination

ABSTRACT:BACKGROUND: diagnosis of early pregnancy failure (ectopic pregnancy and missed abortion) still challenging even by using of serial B-HCG and ultrasound. Serum progesterone hormone level value is regarded as one of the important diagnostic tools in the diagnosis of many obstetrical and gynecological conditions; one of these is early pregnancy failure.OBJECTIVE: To assess the role of serum progesterone level in early diagnosis of ectopic pregnancy and missed abortion.PATIENTS AND METHODS: The study is conducted at Al-Elwiyah Maternity Teaching Hospital throughout the period between (April 2010 –July 2011). Ninety women participated in the study, they are at their early weeks of gestation (6-10) weeks. Their ages were between 18-40 years. thirty of them served as a control group (normal intrauterine pregnancy) and sixty pregnant women included in the study group and subcategorized into 2 groups. thirty women with suspected sub-acute or chronic cases of ectopic pregnancy according to ultrasound and β-HCG results and 30 women served as suspected missed abortion. blood samples were taken from the three groups followed by another blood samples after two-day interval to measure of serum progesterone levels. the results were compared among the three groups at first and second readings. p-value, standard deviation and 95% confidence interval calculated and statistically analyzed.RESULTS: P-value of the serial measurements of serum progesterone levels in two-day interval in the three groups was statistically insignificant. while serum progesterone levels of both ectopic pregnancy and missed abortion were greatly lower than serum progesterone levels of normal intrauterine pregnancy in both first and second readings, with statistically significant deference, P-value is CONCLUSION: Serum progesterone levels has a useful role in diagnosing ectopic pregnancy and missed abortion.

KEY WORDS: progesterone --- ectopic pregnancy --- missed abortion