Vaginal Oral Misoprostol-rafiq

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EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL FOR INDUCTION OF LABOR IN MISSED ABORTION PRESENTED BY DR NOSHABA RAFIQ M.B.B.S. M.C.P.S.F.C.P.S. GYNAE/OBS UNIT II HOLY FAMILY HOSPITAL RAWALPINDI

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OBJECTIVES  TO

DETERMINE THE EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL AS A LABOR INDUCING AGENT IN MISSED ABORTION.

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INTRODUCTION  MISSED

ABORTION IS THE FAILURE TO EXPEL THE PRODUCTS OF CONCEPTION AFTER DEATH OF EMBRYO.  MISSED ABORTION IS MANAGED EITHER BY SURGICAL & NON SURGICAL METHODS.  IN RECENT YEARS MISOPROSTOL,A SYNTHETIC PGE1, ANALOGUE, IS

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INTRODUCTION:  MISOPROSTOL

CAN BE GIVEN ORALLY, SUBLINGUALLY, VAGINALLY OR RECTALLY.  IT HAS BEEN EXTENSIVELY STUDIED & USED FOR OBSTETRICAL & GYNAECOLOGICAL CAUSES, SUCH AS PRE-INDUCTION CERVICAL RIPENING, LABOR INDUCTION, EVACUATION OF UTERUS AFTER PREGNANCY FAILURE OR VARIOUS MEDICAL REASONS. 6

DESIGN

A

QUASI EXPERIMENTAL STUDY.

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SUBJECT &SETTING:  THIS

STUDY WAS PERFORMED IN GYNAE/OBS UNIT II IN HOLY FAMILY HOSPITAL RAWALPINDI [PAKISTAN].  35 PATIENTS IN VAGINAL MISOPROSTOL GROUP & 35 PATIENTS IN ORAL MISOPROSTOL GROUP WERE STUDIED.

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METHOD:  TOTAL

OF 70 PREGNANT WOMEN ADMITTED WITH MISSED ABORTION OR BLIGHTED OVUM OF 8wks TO 24wks OF GESTATION DURING THE PERIOD OF JUNE 2005 TO NOV 2005.  MISSED ABORTION WAS CONFIRMED ON ULTRASOUND.  INITIAL EVALUATION OF PTS WAS DONE.  CONSENT OF PATIENT.

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METHODS:  THE

CASES WERE RANDOMIZED IN TWO GROUPS.  ONE FOR ORAL MISOPROSTOL & OTHER FOR VAGINAL MISOPROSTOL.  IN ONE GROUP 400ug WAS INSERTED UNDER FULL ASEPTIC CONDITIONS HIGH UP IN POSTERIOR FORNIX OF VAGINA WHILE IN SECOND GROUP PATIENT TAKE IT ORALLY. 10

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METHODS:  THE

DOSE OF MISOPROSTOL WAS REPEATED AFTER EVERY 4hrs TO A MAX. OF FOUR DOSES IN 24 hrs.  IF COMPLETE EXPULSION DID NOT OCCUR WITH IN 48hrs & IF PATIENT BLEED HEAVILY THEN ERPC WAS DONE.  FOLLOW UP. 12

 35

RESULTS: [PATIENTS DISTRIBUTION IN BOTH GROUP]

 35

Vaginal Misoprostol

ORAL Misoprostol 13

RESULTS [AGE OF PATIENT] 80 70 60 50 40 30 20 10 0 <20 years

20-30 years

Oral Misoprostol

>35 years

Vaginal Misoprostol 14

RESULTS: [PARITY] 60 50 40 30 20 10 0

Oral Misoprostol Prim igravida



Vaginal Misoprostol

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RESULTS:

MEAN INDUCTION TO EXPULSION TIME

VAGINAL Misoprostol GROUP

ORAL Misoprostol GROUP

9.16 HRS

12.09HRS

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RESULTS: [INDUCTION TO EXPULSION TIME] 

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Oral Misoprostol

Vaginal Misoprostol

RESULTS: OTHER MEASURE

VAGINAL GROUP 3%

ORAL GROUP

ERPC [REQUIRED]

21%

27%

COMPLETE EXPULTION

52%

28%

7%

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RESULTS: [REQUIREMENT FOR ERPC IN BOTH GROUP]  52 51 50 49 48

.

47 46

Oral misoprostol

ERPC Vaginal Misoprostol

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RESULTS: [REQUIRMENT OF OXYTOCIN AUGMENTATION]

Vaginal Misoprostol

Oral Misoprostol

Oral Misoprostol

Vaginal Misoprostol

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RESULTS: [COMPARISON OF ERPC & OXYTOCIN FOR COMPLETE EVACUATION] 100% 80% 60% 40% 20% 0% Oral Misoprostol

Vaginal Misoprostol 21

COMPLICATIONS: [IN BOTH GROUPS] 

Oral Misoprostol

no complication

faild termination

diarrhoea

vomoting

fever

Vaginal Misoprostol Oral Misoprostol

Vaginal Misoprostol

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DISCUSSION:  TERMINATION

OF PREGNANCY IS AN INTEGRAL PART OF ANY GYNAECOLOGICAL PRACTICE.  DIFFERENT METHODS OF CERVICAL RIPENING HAVE BEEN USED WITH VARIABLE RESULTS.  CHOHAN,etal, HAVE DONE A STUDY USING EXTRA AMNIOTIC PGF2 alpha FOR MID TRIMESTER INDUCTION OF LABOR IN PTS WITH LATE MISSED

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DISCUSSION:  THEY

CLAIMED THAT 100% EXPULSION RATE WHICH IS COMPARABLE TO 94% EXPULSION RATE OBSERVED IN OUR STUDY.  MUFFLEY PE,[2002]CONDUCTED A STUDY ON VAGINAL MISOPROSTOL COMPARED WITH SURGICAL TREATMENT IN MISSED ABORTION & CLAIMED THAT 60% PATIENTS IN MISOPROSTOL GROUP

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DISCUSSION:  NOT

REQUIRED SURGICAL TREATMENT COMPARE TO 52% COMPLETE UTERINE EVACUATION IN OUR STUDY.  ELSHEIKH,etal[2001] USED ORAL & VAGINAL MISOPROSTOL IN SECOND TRIMESTER MISSED ABORTION USING SAME DOSAGE AS IN OUR STUDY, MEAN INDUCTION TO EXPULTION TIME IS SAME &THE EFFICACY OF 25

CONCLUSION:  VAGINAL

MISOPROSTOL WAS FOUND MORE EFFECTIVE WITH LESSER SIDE EFFECTS AS COMPARE TO ORAL FOR MISSED ABORTION.  IT IS OBSERVED IN OUR STUDY THAT MISOPROSTOL IS CHEAPER & EFFICIENT FOR MISSED ABORTION.

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KEY POINTS:  MISOPROSTOL

HAS BEEN ON MARKET SINCE 1985 UNDER BRAND NAME OF CYTOTEC. IT IS AVAILABLE IN OVER 80 COUNTRIES WORLD WIDE FOR TREATMENT OF GASTRIC

ULCERS.  MORE THAN 300 ARTICLES HAVE BEEN 27

KEY POINTS:  USEFULNESS

OF MISOPROSTOL IN NO. OF INDICATIONS IN OBS & GYNAECOLOGY.  NO PROPER DOSAGE IS UPTILL DECIDED &THE COMPANY NEVER APPLIED FOR APPROVAL FOR 28

THANK YOU 29