Management of recurrent second-trimester missed abortion

Introduction: Termination of missed abortion in the second trimester by suction evacuation is more traumatic than in early pregnancy. Misoprostl is effective in first and second trimester abortions. Vaginal route being superior to oral. Objectives: The study was carried out to evaluate the effectiveness and safety of vaginal Misoprostl in the management of second trimester missed abortion. Methods: This prospective study was carried out in the department of Obstretrics and Gynaecology, Dhaka Medical College Hospital from January 2004 to December 2004. A total 50 missed abortion patients were randomly selected. After required investigations Tab Misoprostol 200 ug was introduced per vagina in the posterior fornix which was repeated every four hours. The incidence of complete expulsion and side effect was examined. The patient who did not respond to Misoprostol, Oxytocin infusion was given to them after 6 hours of the last doses of Misoprostol. If the patient failed to respond, surgical evacuation was attempted. Ultrasonogram was done after 12 hours to confirm complete abortion. Results: Among the 50 cases 38 (76%) had gestation age within the range of 13?24 weeks. Twenty five (50%) cases required only Misoprostol for expulsion of product of conception with range of 1?4 doses. Eight (16%) required misoprostol with oxytocin drip & 17 (34%) required surgery even after misoprostol & oxytocin. The induction-expulsion interval of 25 (50%) cases was 11±4 in 25 women who were given Tab Misoprostol only. Forty three (86%) had no side effects & well-tolerated with the drug. Only Misoprostol is 09 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 required in gestational age group of 21?24 weeks (64.3%) & 25?28 weak (66.7%). Misoprostol was successfully used in most Nulliparous women (64.7%) & Primiparous women (42.9%). Conclusion: The second trimester missed abortion termination by srgical evacuation is traumatic and complications are more. If Tab Misoprostol proves safe and effective a large number of patients will be benefited and will escape from surgical intervention and complications. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22897 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014

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A prospective study of hypothyroidism during pregnant attending tertiary care hospital in south India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205790 ◽

2020 ◽

Vol 10 (1) ◽

pp. 326

Author(s):

G. Sravani ◽

M. Smitha

Keyword(s):

Tertiary Care ◽

Chronic Hypertension ◽

Care Hospital ◽

Pregnancy Induced Hypertension ◽

Second Trimester ◽

Missed Abortion ◽

Incomplete Abortion ◽

Induced Hypertension ◽

Criteria For Diagnosis ◽

A Prospective Study

Background: Disorder of thyroid function is common during pregnancy and hypothyroidism is more common then hyperthyroidism affecting 3–5% of all pregnant women. Maternal hypothyroidism is associated with both maternal adverse effects like preeclampsia, ecclampsia, pregnancy induced hypertension and gestational diabetes mellitus and foetus complication like low birth weight, pre term birth, neurological deformities and abnormal presentation.Methods: In present study 120 patients with overt and subclinical hypothyroidism were included in this study. Detailed histories of patients were taken and clinical examination was done and data was collected in a predesigned Performa. We used standard diagnostic criteria for diagnosis of overt and subclinical hypothyroidism.Results: Pregnancy induced hypertension was found in 10% patient, Chronic hypertension was present in 1.6% patients, abortion in second trimester 1.6% patients, incomplete abortion in 4.18% patients. Missed abortion was present in 2.5% patients.Conclusions: Hypothyroidism during pregnancy is more common in primi. Most common age group was third decade and was commonly detected before 10 weeks of gestation. Pregnancy induced hypertension, oligohydramnios and preterm delivery was more common than abortion in second trimester and missed abortion.

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Role of adding Isosorbide-5-Mononitrate to misoprostol in Induction of the second trimesteric abortion, a randomized controlled trial

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2020.11.00510 ◽

2020 ◽

Vol 11 (4) ◽

pp. 202-206

Author(s):

Amera Yehia ◽

Hala Alansary

Keyword(s):

Nitric Oxide ◽

Abdominal Pain ◽

Side Effects ◽

Cervical Ripening ◽

Nitric Oxide Donor ◽

Severe Bleeding ◽

Second Trimester ◽

Missed Abortion ◽

No Donor ◽

Vaginal Misoprostol

Objective: To compare the therapeutic efficacy of prostaglandins when they used alone versus a combination therapy of prostaglandins and a nitric oxide (NO) donor as isosorbide-5-mononitrate to induce cervical ripening and effacement for induction of the second trimester missed abortion and occurrence of complete abortion. Methods: A Randomized clinical trial study in which 160 Second trimester (13-26weeks) missed abortion pregnant women admitted for medical induction of abortion, were randomly divided into two group (80 patients in each). One group received only vaginal Misoprostol and the other group received combined vaginal Misoprostol with Isosorbide-5-mononitrate. To determine the efficacy in form of " induction abortion interval ": the duration interval between the beginning of the induction and the complete expulsion of the abortus and also the number of the doses of misoprostol needed to complete expulsion and also the adverse events that increased or newly discovered when prostaglandins and a nitric oxide donor used together such as severe bleeding, headache, abdominal pain, pelvic pain, sever hypotension, backache, fever, nausea and vomiting. Results: It is proved in the study that combination between misoprostol and isosorbide mononitrate gives better results regarding cervical consistency improvement, cervical dilatation, effacement, the whole induction time and the number of misoprostol doses needed to complete expulsion when compared to misoprostol alone and also fewer side effects as abdominal pain. Conclusion: Misoprostol is a good cervical ripening agent when used alone but we can get a benefit from combining both misoprostol and NO donor (isosorbide-5- mononitrate) making a synergistic action with fewer side effects.

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Experience with misoprostol in the management of missed abortion in the second trimester

Journal of Obstetrics and Gynaecology ◽

10.1080/01443610500239354 ◽

2005 ◽

Vol 25 (6) ◽

pp. 583-585 ◽

Cited By ~ 4

Author(s):

U. Menakaya ◽

V. Otoide ◽

L. Omo Agboja ◽

K. Odunsi ◽

F. Okonofua

Keyword(s):

Second Trimester ◽

Missed Abortion

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EFFICACY OF VAGINAL MISOPROSTOL IN FIRST AND SECOND TRIMESTER MISSED ABORTIONS

10.36106/ijsr/5331590 ◽

2020 ◽

pp. 1-4

Author(s):

Hema T ◽

Annapoorani R ◽

Karthiyayini M

Keyword(s):

Failure Rate ◽

First Trimester ◽

P Value ◽

Second Trimester ◽

Missed Abortion ◽

Interval Change ◽

Group I ◽

The Mean ◽

Group Ii ◽

Vaginal Misoprostol

Objectives : Missed abortion is a common problem in obstetrics and gynecology. This study aims to study the efficacy of vaginal misoprostol in termination of first and second trimester missed abortions. Materials and Methods: Fifty women with missed abortions were included in the study, out of which 30 patients were in first trimester comprised of group I, other 20 patients in second trimester were designated as group II. After getting informed consent, 200 mcg misoprostol was kept in posterior fornix, every 4 hours 200 mcg was repeated until the patient expelled. Parameters analyzed were induction abortion interval, change in PCV, success rate. Results : In the present study out of the 70% (21/30) cases belonging to group I – the mean induction abortion interval was between 12-16 hrs. In group II category in (19/20) 95% of women , the mean induction abortion interval was less than 8 hrs. One patient failed to expel even after maximum of 4 dose and hence underwent surgical termination giving a failure rate of 5%, ‘P’ value is also significant. Conclusion : Vaginal Prostoglandin E analogue (misoprostol) is a very safe and effective method to be used in missed abortion. It was more effective and successful in II trimester compared to I trimester. The failure rate was very minimum and complications were almost nil with very few side effects

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