EFFICACY OF MIFEPRISTONE FOLLOWED BY MISOPROSTOL VERSUSMISOPROSTOL ALONE IN MEDICAL MANAGEMENT OF EARLY PREGNANCY FAILURE

2021 ◽  
pp. 129-131
Author(s):  
Jahnvi Varshney ◽  
Shivani Agarwal ◽  
Sangita N Ajmani
Keyword(s):  
Oral Dose ◽  
Early Pregnancy ◽  
The Other ◽  
Successful Management ◽  
Pregnancy Failure ◽  
Obstetrics And Gynaecology ◽  
Early Pregnancy Failure ◽  
Sequential Combination ◽  
The Difference ◽  
Pre Treatment

Purpose of the study- To study the efcacy of mifepristone followed by misoprostol over misoprostol alone in early pregnancy failure in terms of complete evacuation of uterus. METHODS: In a randomized comparative study at the Department of Obstetrics and Gynaecology of Kasturba Hospital, 100 women with early pregnancy failure and gestational age ≤12 weeks between January 2017 and December 2017 were recruited. Of these, 50 women were given a single oral dose of mifepristone (200 mg) followed by 800 mcg misoprostol vaginally (if required) after 24 hours and the other 50 women were treated with 800 mcg misoprostol vaginally alone. RESULTS: Complete evacuation of uterus was achieved in 96% women treated with a sequential combination of mifepristone and misoprostol versus 84% women treated with misoprostol alone. The difference in the rate of complete expulsion was 12% (p <0.05, 95% CI). Also, pre-treatment with mifepristone resulted in statistically signicant reduction in induction to abortion interval (2.40 ± 1.774 vs 3.30 ± 1.951 hr), amount of bleeding (402.2 ± 111.84 vs 535.0 ± 114.84 ml) and duration of bleeding (10.7 ± 2.30 vs 12.4 ± 3.38 days). CONCLUSION Medical treatment of early pregnancy failure with a sequential combination of mifepristone and misoprostol was more effective than misoprostol alone. Hence, women with early pregnancy failure may be offered mifepristone pretreatment before misoprostol to increase the chance of successful management, while reducing the need for surgery.

scholarly journals Mifepristone and misoprostol versus misoprostol alone for uterine evacuation after early pregnancy failure: study protocol for a randomized double blinded placebo-controlled comparison (Triple M Trial)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joyce van den Berg ◽  
Charlotte C. Hamel ◽  
Marcus P. Snijders ◽  
Sjors F. Coppus ◽  
Frank P. Vandenbussche
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Medical Treatment ◽  
Early Pregnancy ◽  
Expectant Management ◽  
Pregnancy Failure ◽  
Products Of Conception ◽  
Early Pregnancy Failure ◽  
Pre Treatment ◽  
Double Blinded

Abstract Background Early pregnancy failure (EPF) is a common complication of pregnancy. If women do not abort spontaneously, they will undergo medical or surgical treatment in order to remove the products of conception from the uterus. Curettage, although highly effective, is associated with a risk of complications; medical treatment with misoprostol is a safe and less expensive alternative. Unfortunately, after 1 week of expectant management in case of EPF, medical treatment with misoprostol has a complete evacuation rate of approximately 50%. Misoprostol treatment results may be improved by pre-treatment with mifepristone; its effectiveness has already been proven for other indications of pregnancy termination. This study will test the hypothesis that, in EPF, the sequential combination of mifepristone with misoprostol is superior to the use of misoprostol alone in terms of complete evacuation (primary outcome), patient satisfaction, complications, side effects and costs (secondary outcomes). Methods The trial will be performed multi-centred, prospectively, two-armed, randomised, double-blinded and placebo-controlled. Women with confirmed EPF by ultrasonography (6–14 weeks), managed expectantly for at least 1 week, can be included and randomised to pre-treatment with oral mifepristone (600 mg) or oral placebo (identical in appearance). Randomisation will take place after receiving written consent to participate. In both arms pre-treatment will be followed by oral misoprostol, which will start 36–48 h later consisting of two doses 400 μg (4 hrs apart), repeated after 24 h if no tissue is lost. Four hundred sixty-four women will be randomised in a 1:1 ratio, stratified by centre. Ultrasonography 2 weeks after treatment will determine short term treatment effect. When the gestational sac is expulsed, expectant management is advised until 6 weeks after treatment when the definitive primary endpoint, complete or incomplete evacuation, will be determined. A sonographic endometrial thickness < 15 mm using only the allocated therapy by randomisation is considered as successful treatment. Secondary outcome measures (patient satisfaction, complications, side effects and costs) will be registered using a case report form, patient diary and validated questionnaires (Short Form 36, EuroQol-VAS, Client Satisfaction Questionnaire, iMTA Productivity Cost Questionnaire). Discussion This trial will answer the question if, in case of EPF, after at least 1 week of expectant management, sequential treatment with mifepristone and misoprostol is more effective than misoprostol alone to achieve complete evacuation of the products of conception. Trial registration Clinicaltrials.gov (d.d. 02-07-2017): NCT03212352. Trialregister.nl (d.d. 03-07-2017): NTR6550. EudraCT number (d.d. 07-08-2017): 2017–002694-19. File number Commisie Mensgebonden Onderzoek (d.d. 07-08-2017): NL 62449.091.17.

scholarly journals Comparison of different regimes of misoprostol for the termination of early pregnancy failure

2014 ◽  
Vol 70 (4) ◽  
pp. 360-363 ◽  
Author(s):  
Nandaram Seervi ◽  
Nupur Hooja ◽  
Lata Rajoria ◽  
Asha Verma ◽  
Kusum Malviya ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Failure ◽  
Early Pregnancy Failure

Misoprostol treatment for early pregnancy failure does not impair future fertility

2014 ◽  
Vol 30 (4) ◽  
pp. 316-319 ◽  
Author(s):  
Ilia Bord ◽  
Michael Gdalevich ◽  
Ravit Nahum ◽  
Simion Meltcer ◽  
Eyal Y. Anteby ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Failure ◽  
Future Fertility ◽  
Early Pregnancy Failure

Genetic abnormalities seen on CVS in early pregnancy failure

2018 ◽  
Vol 33 (13) ◽  
pp. 2142-2147
Author(s):  
Alexis C. Gimovsky ◽  
Amelie Pham ◽  
Sindy C. Moreno ◽  
Sara Nicholas ◽  
Amanda Roman ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Failure ◽  
Genetic Abnormalities ◽  
Early Pregnancy Failure

scholarly journals THE STUDY OF EFFICACY OF SUBLINGUAL MISOPROSTOL IN TERMINATION OF EARLY PREGNANCY

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Arti Kumari ◽  
Usha Kumari ◽  
Anupama Sinha
Keyword(s):  
Side Effects ◽  
Spontaneous Abortion ◽  
Early Pregnancy ◽  
Gestational Age ◽  
High Efficacy ◽  
Missed Abortion ◽  
Pregnancy Failure ◽  
Products Of Conception ◽  
Early Pregnancy Failure ◽  
Sublingual Misoprostol

Introduction: Nearly 20% of all confirmed pregnancies end in spontaneous abortion. Misoprostol’s use in early pregnancy failure is varied and dose and route are not well established. AIM: To study the efficacy of sublingual misoprostol in causing expulsion of products of conception in early pregnancy failure. Methods: Women with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were included in the study. Tablet Misoprostol 600 mcg was given six hourly sublingually for 3 doses. All observations were noted and analyzed. Results: Mean gestational age was 7.946+1.2 weeks. Mean induction abortion interval was 18.241+1.2 hours. Women with gestational age six to eight weeks had least mean induction-abortion interval time of 17.38+2.86. Mean dose required was 1560mcg. Efficacy of protocol was 92.85% in achieving complete abortion. Conclusion: The regime had 92.85% efficacy, acceptability (90%) and few side effects. Thus by using a lower dose and appropriate interval between two doses (six hours), the side effects were lessened with high efficacy. Keywords: Efficacy, Missed Abortion, Misoprostol.

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