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 Cervical Twin Heterotopic Pregnancy: Overview of Ectopic Pregnancies and Scanning Detection Algorithm

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 969
Author(s):  
Antonios Koutras ◽  
Zacharias Fasoulakis ◽  
Michail Diakosavvas ◽  
Athanasios Syllaios ◽  
Athanasios Pagkalos ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Uterine Cavity ◽  
Medical Abortion ◽  
First Trimester ◽  
Detection Algorithm ◽  
Heterotopic Pregnancy ◽  
Cervical Canal ◽  
Mortality And Morbidity ◽  
Gestational Sac ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with mild pain in the lower abdomen and traces of bleeding per vaginum for three days. Transvaginal ultrasonography revealed a balloon-shaped cervical canal with a visible gestational sac measuring 3.5 × 3.9 cm. A second gestational sac was seen in the uterine cavity. The measurements of the gestational sacs corresponded to 7 + 4 weeks’ pregnancy. A decision for medical abortion with mifepristone and misoprostol was made. However, due to an incomplete abortion and continuous bleeding, a curettage was performed. Conclusions: Spontaneous heterotopic pregnancy with the ectopic pregnancy located in the cervix is an extremely rare clinical condition requiring urgent treatment in order to reduce maternal mortality and morbidity and preserve fertility.

scholarly journals Morphological verification of the first missed abortion

2021 ◽  
Vol 12 (1) ◽  
pp. 62-67
Author(s):  
E. Y. Lebedenko ◽  
A. P. Milovanov ◽  
N. V. Sablina ◽  
T. V. Fokina ◽  
O. V. Gaida
Keyword(s):  
Comparison Group ◽  
Inflammatory Diseases ◽  
Recurrent Miscarriage ◽  
Uterine Cavity ◽  
Medical Abortion ◽  
First Trimester ◽  
Male Factor ◽  
Missed Abortion ◽  
Decidual Cells ◽  
First Time

Objective. The study aimed to compare the level of INF a2 immunoexpression in tissues obtained during medical abortion with the corresponding level of IFNa2 expression in a retained fetal egg tissues after the first missed abortion. The authors compared the anamnestic data on previous inflammatory diseases of the genital tract with the results of an extended morphological study of the material obtained during the evacuation of the contents of the uterine cavity during the first non-developing pregnancy in the first trimester.Materials and methods. The study included 15 patients with first-time missed abortions caused by a viral infection (6-8 weeks of pregnancy). All patients demonstrated either recurrent herpes simplex labialis/genitalis or PCR confirmed HSV, HPV, CMV. Exclusion criteria were recurrent miscarriage, blighted ovum, endocrinopathies, male factor infertility, and other causes of miscarriage. The comparison group included 20 women of the same age that chose to undergo a medical abortion.Results. In patients from the comparison group, the main producer of IFN a2 was syncytiotrophoblast as well as maternal decidual cells in the parietal endometrium and uteroplacental area. In the main group, manifested hematogenous infection (microabscesses, vasculitis, lymphocytic and macrophage infiltration) with dystrophy and necrosis of decidual maternal cells and secondary pathological changes in the placental villi were diagnosed, which led to a significant decrease in the IFN a2 immunoexpression in all the studied cells.Conclusion. The lack of anamnestic data on previous urogenital infections does not exclude the etiological role of the inflammatory component in the genesis of non-developing pregnancy. First-time occurred pregnancy loss requires adequate postoperative interferon therapy and a thorough examination of a couple.

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 FIRST TRIMESTER MEDICAL ABORTION PRACTICE IN NORTH EAST INDIA

2021 ◽  
pp. 89-91
Author(s):  
VANREMMAWII ◽  
LALROMAWII ◽  
VANLALHRUAII
Keyword(s):  
Gestational Age ◽  
Medical Abortion ◽  
First Trimester ◽  
Termination Of Pregnancy ◽  
Vaginal Route ◽  
North East India ◽  
North East ◽  
Pre Treatment ◽  
Vaginal Misoprostol ◽  
Group B

Objectives: This study is to compare the efficacy of Mifepristone combined with Misoprostol (Prostaglandin) administered through vaginal and sublingual route in termination of pregnancy of ≤63 days. Methods: Randomized comparative study comprised of 140 pregnant women of ≤63 days gestational age was conducted at Zoram Medical College, Mizoram. Women in group A received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol sublingually 36–48 h later, whereas women in group B received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol vaginally 36–48 h later. A 2nd dose of 400 μg Misoprostol was given through the same route if abortion process does not start within 4 h. All women who aborted were seen at follow-up and ultrasound pelvis done to confirm complete expulsion of products of conceptions. Results: The total number of primigravida was 34 (24.3%) and multigravida was 106 (75.7%). Complete abortion was seen in 91.4% and 94.28% of per sublingual and per vaginal route group, respectively (p = 0.51). Failure of abortion was 8.57% and 5.71%, respectively, in per oral and per vaginal route (p = 0.51). Conclusion: Sublingual and per vaginal misoprostol after pre-treatment with mifepristone are both an effective method for termination of pregnancy for gestational age of 63 days or less, but the tolerance for sublingual misoprostol was poorer.

scholarly journals Prospective study to compare the efficacy of vaginal misoprostol for first trimester MTP before six weeks and up to 9 weeks

2021 ◽  
Vol 10 (3) ◽  
pp. 1116
Author(s):  
Paresh N. Sheth
Keyword(s):  
Prospective Study ◽  
Gestational Age ◽  
Pregnancy Termination ◽  
Tertiary Care ◽  
Medical Abortion ◽  
First Trimester ◽  
Care Hospital ◽  
Surgical Interventions ◽  
Vaginal Misoprostol ◽  
Group B

Background: Misoprostol is prostaglandin E1 analogue that has been used for medical abortion. MTP has been legalized in India since 1971. Medical abortion refers for early pregnancy termination performed without any primary surgical interventions, usually before 9 weeks (63 days) gestational age. This prospective study was conducted to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <6 weeks (42 days) and in woman up to 9 weeks (63 days) gestational age.Methods: This is a prospective study of total 130 women seeking medical termination of pregnancy up to 9 weeks (63 days) gestational age at obstetrics and gynecology department, at a tertiary care hospital Gujarat, India, from May 2018 to May 2019.Results: In result study the overall complete abortion rate was 91.54% In Group A (<6 weeks) complete abortion occurred in 93.3% women. Whereas in Group B (6 to 9 weeks) complete abortion occurred in 90% of women. The two groups did not differ significantly with respect to side effects. Overall, 91.3% women were satisfied with this method and will choose it again if required.Conclusions: This study shows that vaginal misoprostol alone regimen is highly effective and well tolerated method in Indian women requiring MTP up to 63 days gestational age. However better efficacy maybe achieved at gestational age < 6 weeks (42 days). 

Successful management of three cases of interstitial pregnancies with local instillation of potassium chloride: avoiding a potential cornuostomy

2021 ◽  
Vol 14 (3) ◽  
pp. e239918
Author(s):  
Vineetha Shetty ◽  
Roopa Padavagodu Shivananda ◽  
Akhila Vasudeva ◽  
Jyothi Shetty
Keyword(s):  
Potassium Chloride ◽  
Stable Condition ◽  
Uterine Cavity ◽  
Successful Outcome ◽  
Transvaginal Sonography ◽  
Technical Expertise ◽  
Successful Management ◽  
Interstitial Pregnancy ◽  
History Of ◽  
Gestational Sac

Here, we present three cases of women with interstitial pregnancy who were managed with local instillation of potassium chloride. These women were in their 20s–30s and presented in stable condition. Of them, two had a history of previous ectopic pregnancy. Interstitial pregnancy was diagnosed by transvaginal sonography which showed an empty uterine cavity with a gestational sac 1 cm away from the lateral edge of the uterine cavity, with <5 mm myometrium surrounding it in all planes. Two of the three cases failed to respond to methotrexate injection. Due to the presence of high-end ultrasound machine and technical expertise, local instillation of potassium chloride was offered as an alternative to surgical treatment, which is definitive, and all three patients had a successful outcome. One patient returned with pain in the abdomen, which required inpatient monitoring and was later diagnosed with urinary tract infection and was given appropriate antibiotics.

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.

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