- Shirin Niroomanesh
 - - Department of Obstet . and Gynecol Mirza Koochak Khan Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Mojgan Sadat Hashemi Fesharaki
- - Department of Obstet . and Gynecol Mirza Koochak Khan Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Received: 4/1/2004 Accepted: 4/1/2004 - Publisher : Avicenna Research Institute |
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Abstract
Introduction: In a number of complications including intrauterine fetal death, premature rupture of membrane, chorioamniotitis and preeclampsia, gynecologists have to terminate the pregnancy in the 2nd trimester to save the mother’s life. The methods of pregnancy termination in a uterus larger than 14 weeks in size, include spontaneous contractions, PGE1 and PGE2 vaginal suppositories, intravenous oxytocin injection, intra amniotic injection of PGF2α, Ethacrynic Acid, and hypertonic saline. Misoprostol, a synthetic PGE1 analogue, which was developed for the prevention of peptic ulcer disease with potent uterotonic and cervical ripening activity, is nowadays applied in the management of obstetric problems like termination of pregnancy. The goal of the present clinical trial is to compare the effectiveness, side effects, hospitalization period and the need for surgical evacuation, when 400 μg and 600 μg Misoprostol is applied to terminate a second trimester pregnancy. Materials and Methods: One hundred women with medical indications for termination of pregnancy in the second trimester were recruited in Mirza Koochak Khan Hospital in 2002- 2003. They were randomly divided into two groups (each group with 50 cases). One group received 400 μg vaginal Misoprostol suppositories (Group A) and the other group 600 μg (Group B) every 12 hours in posterior fornix, upto a maximum total of 4 doses. For Comparison of the results in the two groups 2 and t- test were used. Results: In the group A, 84%, as compared to 80% in the group B, had a complete expulsion of the product of conception. Fourteen percent in group A and 20% in group B needed curettage. The success rate of treatment (complete expulsion of pregnancy products) after 48 hours was 98% and 100% in Group A and group B, respectively. The interval between induction and expulsion of fetus was shorter in the group B (9.26.7 hours) than in the group A (12.27.7 hrs, p=0.003) and in patients with intrauterine fetal death (7.42.8 hrs) compared with premature rupture of membrane (11.9 9.6 hrs, p=0.005). The placenta was expelled after the fetus with shorter interval in group A (p=0.02). There was no statistically significant difference between the two groups concerning the duration of hospitalization and maternal complications such as nausea, vomiting, diarrhoea, fever, unrelenting abdominal pain and hemoglobin drop. Conclusion: Vaginal administration of Misoprostol is a quite safe, efficient and cost effective method for termination of pregnancy in the second trimester. In emergency situations such as chorioamniotitis and preeclampsia, 600 μg dose might be recommended for rapid expulsion of products of conception, otherwise 400 μg dose is a less costly alternative.
Keywords:
Misoprastol, Second trimester, Premature rupture of membrane, Intrauterine fetal death To cite this article:References
- Rivlin M.E., Martin r.N. Manual of Clinical Problems in Obstetrics and Gynecology. 5th Edi-tion.1997;pp:117-122.
- Cunningham F.C., Gant N.F., Leveno, Gilstrap L.C., Hauth J.C., Wenstrom D.D. Williams Obst-etrics. 21st Edition. Mc graw- hlll, Medical Publi-shing Division.2001;pp:874-877.
- Suthutvoravut S., Supacharapongkul V., Bhi-rom Swasdi S. Mid trimester abortion by hyperto-nic saline instillation experience in Ramathibodi Hospital. J Med Assoc Thai.1983;66 (3):176-82.
- Herabutya Y., O- Prasertsawat P. Mid-trimester abortion using hypertonic saline or prostaglandin E2 gel: an analysis of efficacy and complications.J Med Assoc Thai.1994;77(3):148-152.
- Herabutya Y., O- Prasertswat P. Second trimes-ter abortion using intra vaginal misoprostol. Int J Gynaecol Obstet.1998;60(2):161-5.
- Owen J., Hauth J.C., Winkler C.L., Gray S.E. Mid trimester pregnancy termination: a randomiz-ed trial of prostaglandin E2 versus concentrated oxytocin. Am J Obstet Gynecol.1992;167(4Pt1): 1112-6.
- Herabutya Y., Israngura Na., Ayudthaya N. Mid trimester abortion using prostaglandin E2 gel. Int J Gynaecol Obstet.1991;34(2):169-73.
- Cameron I.T., Michie A.F., Baird D. Prostagla-ndine induced pregnancy termination: Further stu- dies using gemeprost (16,16,dimetlyl-trans-2-PGE metlyl ester) vaginal pessaries in the early second trimester prostaglandin. Int J Gynecol & Obs. 1987; 24:111-117.
- Rodger M.W., Baird D.T. Pretreatment with Mifepristone (Ru 486) reduces interval between prostaglandine administration and expulsion in second trimester abortion. Br J Obstest Gynacol.1990;91:41-45.
- Bugalho A., Bique E., Almeidu L., Faundes A. The effectiveness of intra vaginal misoprostol (cytotec) in inducing abortion after 11weeks of pregnancy. Stud Fam Plan.1993;24:319-323.
- Bugalho A., Bique C., Pereira C., Graju A.C., Bergestrom S. Uterine evacuation by vaginal mis- oprostol after second trimester pregnancy inter ruption. Acta Obstet Gynecol Second.1996;75: 270-273.
- Hill N.C., Selinger M., Ferguson J., MacKen-zie I.Z. Mid-trimester termination of pregnancy with 16,16-dimethyl-trans-delta 2 PGE1 vaginal pessaries: a comparison with intra- and extra-amniotic prostaglandin E2 administration. Int J Gynaecol Obstet.1991; 35(4)337-340.
- Thong R.J., Baird D.T. Induction of second trimester abortion with mifepristone and gemeprost. Br J Obstet Gynecol.1993;100:758-761.
- Srisom boon J., Tongsong T., pongpisuttinan S. Mid trimester abortion using intra vaginal misoprostol. J-Med Assoc Thui.1997;80(4):242-6.
- Carbonell J.L., Valera L., Velazco A., Tanda R., Sanchez C. Vaginal misoprostol for early second-trimester abortion. Eur J Contracept Reprod Health Care.1998;3(2):93-8.
- Nutila M., Toironen J., Ylikorkala O. Mid trimester abortion using intra vaginal misoprostol and gemeprost. Obstet Gynecol.1997;90(6):896-9.
- Bebbington M. A randomized controlled trial compairing two protocols for the use of misoprostol in midtimester pregnancy termination. Am J Obstet & Gynecol.2002;187(4) :853.
- Chittacharoen A. A Randomized trial of oral and vaginal Misoprostol to manage delivery in cases of fetal death. Obstet & Gynecol.2003;101 (1):70-73.