scholarly journals Medical Termination of Delayed Miscarriage: Four-Year Experience with an Outpatient Protocol

2017 ◽  
Vol 39 (10) ◽  
pp. 529-533 ◽  
Author(s):  
Joana Lyra ◽  
João Cavaco-Gomes ◽  
Marina Moucho ◽  
Nuno Montenegro
Keyword(s):  
Fetal Loss ◽  
First Trimester ◽  
Success Rates ◽  
Missed Abortion ◽  
Medical Termination ◽  
Paper Form ◽  
Inflammatory Bowel ◽  
Gestational Sac ◽  
Vaginal Misoprostol ◽  
Oral Analgesia

Purpose To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Methods Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease or misoprostol allergy; no more than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 µg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later – if the intrauterine gestational sac was still present, the application of 800 µg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol – if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Results Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; p = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac (p = 0.049). Conclusions We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences.

scholarly journals Role of Misoprostol in Missed Abortion

2013 ◽  
Vol 26 (2) ◽  
pp. 92-99
Author(s):  
KN Nahar ◽  
SB Chowdhury ◽  
Shayela Shamim ◽  
Begum Nasrin ◽  
Fawzia Hossain ◽  
...  
Keyword(s):  
Cardiac Activity ◽  
Expectant Management ◽  
First Trimester ◽  
Uterine Perforation ◽  
Missed Abortion ◽  
Gestational Sac ◽  
Vaginal Misoprostol ◽  
Very High

Spontaneous abortion or miscarriage is the spontaneous end of a pregnancy at a stage where  the embryo or fetus is incapable of surviving independently, generally defined in humans at  prior to 20 weeks of gestation, but in our country before 28 weeks of gestation. Nearly 20% of  all confirmed pregnancies end in abortion. The incidence of this type of abortion is very high  during first trimester and decreases with increasing gestational age. Of many types of abortion, missed abortion occurs when the embryo or foetus has died, but a miscarriage has not yet  occurred. The retention of a fetus known to be dead for >4 weeks. The cervix is closed and   there is no or only slight bleeding. Ultrasound examination shows an empty gestational sac or  an embryo/fetus without cardiac activity. Surgical evacuation is the most common method of  treatment of missed abortion.It is considered to be safe but carries some risk of complications  related to anaesthesia and of surgical complications such as uterine perforation, cervical trauma, intrauterine adhesions and infections. Expectant management and medical treatment  are the two other ways of treatment of missed abortion. Based on a review of the published  literature, a single dose of 800?g vaginal misoprostol may be offered as an effective, safe and acceptable alternative to the traditional surgical treatment for this indication in the first trimester. Alternatively, 800?g misoprostol can be administered sublingually. Treatment may be repeated  twice with a 3-4 hour interval for maximum three doses can be given orally or sublingually. Where as, vaginally, dose can be repeated 6-8 hourly for three doses. For the rest, 12-28 weeks of missed abortion,400?g of misoprostol every 4 hours until expulsion. Majority of  cases have the expulsion within 48 hours. After administration of misoprostol, hospitalization  is not necessary and the time of expulsion varies considerably. Bleeding may last for more than 14 days with additional days of light bleeding or spotting. The woman should be advised  to contact a provider in case of heavy bleeding or signs of infection. A follow up is recommended  after 1 to 2 weeks.DOI: http://dx.doi.org/10.3329/bjog.v26i2.13787Bangladesh J Obstet Gynaecol, 2011; Vol. 26(2) : 92-99 

scholarly journals A comparative study of oral, sublingual and vaginal route of misoprostol as cervical ripening agent before surgical method of termination of first-trimester pregnancy

2017 ◽  
Vol 6 (4) ◽  
pp. 1295 ◽  
Author(s):  
Divya Sinha ◽  
Sourabh Shrivastava ◽  
Swati Shrivastava
Keyword(s):  
Blood Loss ◽  
First Trimester ◽  
Cervical Ripening ◽  
Vaginal Route ◽  
Surgical Method ◽  
First Trimester Pregnancy ◽  
Medical Termination ◽  
First Trimester Of Pregnancy ◽  
The Mean ◽  
Vaginal Misoprostol

Background: Cervical ripening is a critical step for surgical method of termination of first trimester of pregnancy. Misoprostol, PGE1 analogue have promising role as cervical ripening agent. The present study aimed to compare the efficacy and side effects of oral, sublingual and vaginal misoprostol at dosage of 400mcg for cervical priming before surgical method of termination in first-trimester pregnancy.Methods: It was a prospective hospital based randamosied study. Total 150 patients at 6-12 weeks gestation requesting for medical termination of pregnancy were divided equally in to 3 groups. Every group was advised to have single dose of 400 mcg misoprostol either oral, sublingual or vaginal route respectively 4 hour before suction and evacuation.Results: The sublingual group had highly significant cervical dilatation (P<0.001) and the duration of suction and evacuation was less as compared to the vaginal and oral routes (p<0.000). However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. Loose motions and nausea/vomiting were more with oral routes while blood loss was more in the vaginal route.Conclusions: Thus, it can be concluded from present study that sublingual route of misoprostol is more preferable than oral or vaginal route as pro-abortion cervical ripening agent.

scholarly journals Efficacy of combination of oral mifepristone and vaginal misoprostol in termination of pregnancy up to 63 days of gestation

2019 ◽  
Vol 8 (12) ◽  
pp. 4951
Author(s):  
Shivani Gupta
Keyword(s):  
First Trimester ◽  
Termination Of Pregnancy ◽  
Trimester Abortion ◽  
Safe Alternative ◽  
Patient Counselling ◽  
Women Health ◽  
Medical Termination Of Pregnancy ◽  
Medical Termination ◽  
Vaginal Misoprostol

Background: Unsafe and illegal abortions are one of the major problems in women health in India. Despite legal approval for medical termination of pregnancy in 1971, unsafe abortion still remains the third leading cause of maternal deaths in the country, contributes eight percent of such deaths annually. The objective of this study was to study efficacy of Mifepristone 200 mg orally followed 36-48 hours later by Misoprostol 800 microgms per vaginally in women undergoing medical termination of early pregnancy (up to 63 days of gestational age).Methods: The present study included 60 pregnant women requesting termination of pregnancy in the first trimester. Women who fulfilled the inclusion criteria were included in the study. Women without medical or surgical contraindications to Mifepristone and Misoprostol were included. Patients with previous caesarean sections were also included.Results: In our study 60 women were included, majority were in age group 20-29 years of age and majority of cases were primipara or multipara. The success rate in terms of complete abortion was 97%, 2% needed surgical evacuation and 1% lost to follow up. Side effects were nausea, vomiting, diarrhoea, abdominal cramps, pyrexia etc. The method proved to be safe, effective, cheap, non-invasive and has minimal or no complications.Conclusions: Medical termination of pregnancy with oral mifepristone and vaginal misoprostol is an effective method for first trimester abortion. The prerequisite for the method is patient counselling, patient participation and willingness for regular follow up and to report any complication. Hence this method comes out to be a safe alternative to surgical method which is invasive and costly.

scholarly journals Safety And Efficacy Of Vaginal Misoprostol In Treatment Of First Trimester Miscarriage

2020 ◽  
Vol 7 (3) ◽  
pp. 138-144
Author(s):  
Mohamed S. A. Emarah
Keyword(s):  
Medical Treatment ◽  
Initial Dose ◽  
Uterine Cavity ◽  
Medical Abortion ◽  
First Trimester ◽  
Successful Outcome ◽  
Controlled Study ◽  
Gestational Sac ◽  
Vaginal Misoprostol ◽  
Median Interval

Objective: This study was conducted to determine the outcome of medical treatment with vaginal misoprostol in missed miscarriage.          Methods: A randomized controlled study was performed in Benha Teaching Hospital between April 2016 and June 2017. Eighty patients diagnosed with miscarriage before 13 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 400 microgram (mcg) of misoprostol  vaginal as an initial dose, and repeated the same dose 4-6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). Ultrasonography at least 24 hours later from the initial dose to assess the uterine cavity if gestational products were not expelled, surgical evacuation was performed. Results:  About two-thirds of patients (77.5%) had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. Conclusion: Medical treatment with vaginal misoprostol should be a proper option for the first trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the first trimester miscarriage.

scholarly journals Comparison of efficacy of Misoprostol 4 hourly with Misoprostol 6 hour for Medical termination of pregnancy in second trimester.

2020 ◽  
Vol 27 (01) ◽  
pp. 46-51
Author(s):  
Shamas un Nisa ◽  
Farzana Razaq ◽  
Sadaf un Nisa
Keyword(s):  
Side Effects ◽  
Controlled Trial ◽  
Fetal Loss ◽  
Termination Of Pregnancy ◽  
Second Trimester ◽  
Medical Termination Of Pregnancy ◽  
Medical Termination ◽  
Group A ◽  
Vaginal Misoprostol ◽  
Group B

Termination of Pregnancy (TOP), in our country is carried out only when considerable danger to a fetus due to congenital abnormalities, intrauterine fetal loss or when maternal life is under threat. The principle concerns in providing second trimester termination include safety, efficacy, simplicity, low-cost, and fast acting with minimal side effects. Objectives: To compare the efficacy in term of complete abortion within 48 hours between protocol-I (200 µg misoprostol 4 hourly) versus protocol-II (200 µg misoprostol 6 hourly) for second trimester (14-24 weeks) medical termination of pregnancy. Study Design: Randomized controlled trial. Settings: Gynecology & obstetrics unit-II, Bahawal Victoria Hospital (BVH) Bahawalpur. Period: From 1st July 2017 to 30th June 2018. Material & Method: A total of 182 patients meeting the inclusion criteria were included in study. Ninety one patients were included in group-A and 91 patients were included in group-B.  Women allocated to group-A was given misoprostol 200µg every 4 hour. Similar drug and dose were administered to women of group-B intra-vaginally, 6 hourly. Patients in both groups were monitored up to 48. If abortion occurred within 48 hours of induction, it was labeled as effective abortion otherwise it was regarded as failed abortion. Results: The mean age in group-A was 26.71 years 25.49 years in Group-B. In group-A, 89 (97.8%) patients showed efficacy (abortion within 48 hours) and in group-B, 74 (81.32%) patients showed efficacy to misoprostol. Conclusion: The regimen of using 200μg of vaginal misoprostol 4 hourly is more efficacious and quick for 2nd trimester TOP with fewer side effects when compared to 200μg of vaginal misoprostol 6 hourly.

scholarly journals Mid Trimester Termination of Pregnancy : Role of Combined Mifepristone and Misoprostol

2020 ◽  
Vol 19 (1) ◽  
pp. 63-67
Author(s):  
Farah Naz Mabud ◽  
Tahera Begum ◽  
Alok Nandy ◽  
Serajun Noor
Keyword(s):  
Major Complication ◽  
Termination Of Pregnancy ◽  
Missed Abortion ◽  
Trimester Abortion ◽  
Medical College ◽  
Medical Termination Of Pregnancy ◽  
Medical Termination ◽  
Vaginal Misoprostol ◽  
Scarred Uterus

Background: Mid trimester abortions constitute 10%-15% of all induced abortionsworld wide. Over the last decade this increase is due to better prenatal screening. Itcan be done by surgical and medical methods. Medical methods such as Misoprostolis widely used for mid trimester abortion. Mifepristone has antiprogesteroneproperty,so addition of Mifepristone with Misoprostol can increase its effectiveness.To assess the safety, effectiveness and acceptibility of combined Mifepristone andMisoprostol for mid trimester medical termination of pregnancy (Between 13-24weeks of gestation). Materials and methods: This experimental study was conducted among 40 healthywomen who presented for mid trimester termination of pregnancy between 13-24weeks with missed abortion, gross congenital anomalies with or without previoushistory of one caesarian section. The study was conducted from March October2018 at Chattogram Maa-O-Shishu Hospital Medical College, Chattogram,Bangladesh. Each woman received a single dose of tablet Mifepristone 200mg. After24 hours, 200 mcg vaginal Misoprostol was administered which was repeated at 6hourly interval for maximum of 5 doses (1000 mcg) in 24 hours. Success was takenas complete expulsion of fetus and placenta within 24 hours of first dose ofMisoprostol. Primary and secondary outcomes were measured. Statistical analysiswas done using SPSS version 23. Results: Success rate of complete abortion was 97.5%. Mean Induction AbortionInterval was11.59 hours (SD± 3.34). Mean dose of Misoprostol was 1.85 (SD± 0.77)or 370 mcg. Over all safety of the study was satisfactory with only 1 patientexperienced fever and 1 had nausea .There was no major complication. Conclusion: The Mifepristone/Misoprostol regimen is a highly effective as well assafe option for mid trimester medical termination of pregnancy with a shortinduction abortion interval and it can also be used in scarred uterus with closesupervision. Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 63-67

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