Influence of Covid -19 on the management of Appendicitis

2021 ◽  
Vol 15 (7) ◽  
pp. 1718-1721
Author(s):  
Mahreen Zahra ◽  
Muhammad Kashif ◽  
Shafiq Ahmed ◽  
Saif Rasool ◽  
Ikramullah Khan
Keyword(s):  
Acute Appendicitis ◽  
Conservative Management ◽  
Perforated Appendicitis ◽  
Pelvic Abscess ◽  
Ethical Review ◽  
Generalized Peritonitis ◽  
Group A ◽  
Group B ◽  
Operative Findings ◽  
Appendicular Mass

Objective: Acute Appendicitis encounters as the frequent problem in surgical pediatric patients leading to Appendectomy, being one of the most common procedures performed in surgical Emergency. During COVID-19 pandemic, the trends in the management of acute appendicitis have changed. Conservative management of appendicitis with antibiotics is being proposed as an alternative to conventional appendectomy. So, this study is conducted to compare the presentation and outcome of Appendicitis managed during pre and post pandemic period in our settings. Methodology: After approval of Ethical Review Committee, a total of 267 patients of age 1-12 years were selected for the study. It was a retrospective Cohort Study. Patients were divided into group A (n=145) which was pre pandemic group. Data was collected retrospectively from charts regarding demographics, presentation, duration of stay operative findings and complications from May-Oct 2019 and Group B (n=122) during covid-19 was collected from the patients presented with appendicitis over a period of six months from May-Oct 2020 . Similar months of the year were selected to remove seasonal variation in the presentation of Appendicitis. All information was collected on a predesigned Performa. Data was compared and analyzed on SPSS 20. Results: Out of 267 patients, 151 (56.56%) were male. Group A patients presented during pre-pandemic period (n=145) were undergone appendectomy for appendicitis in 129 patients (88.96%) with 59 patients (40.68%) having acutely inflamed appendix and 70 patients (48.27%) had complicated appendicitis such as gangrenous, perforated with generalized peritonitis. In Group A only 16 patients (11.03%) were managed conservatively for appendicular mass. In contrast to group B (n=122) presented during pandemic, only 43 patients (35.24%) were operated with findings of acutely inflamed appendicitis while gangrenous/perforated appendicitis with pelvic abscess and/or generalized peritonitis was found in most of the patients with a number of 69 (56.55%), only 10 (8.19%) patient presented as Appendicular mass hence managed conservatively. Conclusion: Delay in presentation and early conservative management during pandemic crisis has resulted in an increase in the complications of Appendicitis. Early referral to specialized centers with vigilant selection for conservative treatment can save patients from developing complications. Keywords: Appendicitis, covid-19, Appendectomy, complications, Pandemic

scholarly journals Frequency and outcome of complicated appendicitis in toddlers and pre-schoolers

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Naseem Khan ◽  
Muhammad Ayub Khan ◽  
Jehangir Khan ◽  
Sajjad Ali ◽  
Imran Khattak ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Population ◽  
Perforated Appendicitis ◽  
Cross Sectional Study ◽  
Complicated Appendicitis ◽  
Cross Sectional ◽  
Generalized Peritonitis ◽  
Operative Findings ◽  
Study Participants ◽  
Emergency Abdominal Surgery

Background: Acute appendicitis is a frequent indication of emergency abdominal surgery in the pediatric population. In younger children, especially toddlers, and preschoolers, the presentation is comparatively late resulting in complicated appendicitis. This study was done to determine the frequency and outcome of complicated appendicitis in toddlers and preschoolers. Methods: This is a cross-sectional study done at the Department of Pediatric Surgery, Lady Reading Hospital Peshawar, during August 2018 and February 2019. The medical records of 144 toddlers and preschoolers who presented with acute appendicitis were reviewed for demography, clinical presentation, operative findings, and outcome. Frequency and types of complicated appendicitis were recorded. Results: The mean age of study participants was 3 years (±2.84), including 46(32%) toddlers and 98(68%) preschoolers. Overall 62% of patients were male while 38% of patients were female. Complicated appendicitis was documented in 75% of patients. The common types of complicated appendicitis were perforation of the appendix with a localized abscess in 68 patients, gangrenous appendicitis in 4 patients, generalized peritonitis in 24 patients, and mass formation in 12 patients. All patients did well after surgery, except one who succumbed to complications of leukemia. Conclusion: In our study, a great deal (75%) of toddlers and preschoolers had complicated appendicitis especially perforated appendicitis with localized peritonitis.

scholarly journals Management of Complicated Appendicitis in Al-Thawra Modern General Hospital Sana'a -Yemen from November 2019 to November 2020: علاج التهاب الزائدة الدودية المعقد

2021 ◽  
Vol 5 (3) ◽  
pp. 56-42
Author(s):  
Yasser Abdurabu Obadiel, Ibrahim Dahan Hussein Morshed Yasser Abdurabu Obadiel, Ibrahim Dahan Hussein Morshed
Keyword(s):  
Conservative Management ◽  
Prospective Observational Study ◽  
Perforated Appendicitis ◽  
Complicated Appendicitis ◽  
Midline Laparotomy ◽  
Female Ratio ◽  
Generalized Peritonitis ◽  
Male To Female ◽  
Appendicular Mass

Background: Complicated appendicitis causes morbidity and mortality more than simple appendicitis. Complicated appendicitis includes appendicular mass, appendicular abscess, perforated appendicitis. Objective: To study presentation of complicated appendicitis regarding to age, sex and complain duration, also to study management of complicated appendicitis and his response to conservative management. Methods: A prospective, observational study was conducted in the department of general surgery at AL-Thawra hospital during the period from Nov 2019 to Nov2020. The data was collected using clinical examination and follow up, and was analyzed using SPSS 24. Results: A total of 57 patients diagnosed as complicated appendicitis, aged from 6 to 60 years were admitted, mean age was 28 years. Male to female ratio was 1.6:1. The complaint duration was more than 3 days in 34 cases (59%), total leucocytes count was >18 × 103 in 28 cases (49.1%). Twenty patients (35.1%) diagnosed as generalized peritonitis, 18 cases (31.6%) diagnosed as localized peritonitis, 14 patients (24.6%) diagnosed as appendicular mass, and 5 cases (8.8%) diagnosed as appendicular abscess. Forty cases (70.2%) underwent surgical intervention, whereas 17 cases (29.8%) improved with conservative management. Fifteen cases (37.5%) of operated patients underwent simple appendectomy and 13 cases (32.5%) underwent appendectomy with drain, and 12 cases (30%) underwent midline laparotomy. Most appendicular mass cases 12 (85.7%) were managed conservatively and 2 cases (14.3%) were operated. Three cases (60%) of appendicular abscess were aspirated, 2 cases (40%) were drained. Surgical site infection was 27.5% of operated cases. Conclusions: Complicated appendicitis can be suspected through clinical presentation, duration of complains and inflammatory response. Management of complicated appendicitis varies accordingly from conservative conventional to midline laparotomy.

scholarly journals Perforated appendicitis: can it be a bedside diagnosis?

2020 ◽  
Author(s):  
Maham Tariq ◽  
Sara Malik ◽  
Eesha yaqoob ◽  
Mehwish Changez ◽  
Saad Javed ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Iliac Fossa ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Retrospective Case ◽  
Perforated Appendix ◽  
Group A ◽  
Bedside Diagnosis ◽  
Group B ◽  
Operative Findings

ABSTRACTINTRODUCTIONAppendicitis remains one of the most common causes of acute abdomen worldwide. It presents as a spectrum of disease ranging from an acutely inflamed appendix to a perforated one. where acutely inflamed can be managed conservatively, a perforated appendix always needs surgery to prevent complications like pelvic abscesses. Bedside diagnosis remains relevant in our setup.AIMS AND OBJECTIVESTo determine whether history, clinical examination, and basic laboratory investigations can help in confident bedside diagnosis of perforated appendicitis especially in the absence of sophisticated diagnostic modalities.MATERIALS AND METHODSA retrospective case-control study was conducted. Hospital records of patients who underwent open appendectomy in the year 2016 were reviewed. Two groups of 100 patients each were made based on per operative findings. Appendices having macroscopic holes in the base or tip were labeled as perforated. Group A had acutely inflamed appendix and group b had perforated appendix. Patients’ demographic details were taken from hospital admission tickets. Findings of history and examination were retrieved from treating resident and operating surgeon's notes. Data were analyzed through SPSS.RESULTSOut of 200 patients the total number of males was 102 (51%) and females were 98 (49%). Mean age was 24.13+9.73 in males and 18.7+ 6.4 in females of group A and 26.0+10.1 in males and 20.56+7.53 in females of Group B. Group B showed a significant delay in presentation to emergency after the onset of pain (P = 0.022). Upon history and clinical examination, the presence of anorexia, malaise, generalized abdominal pain, guarding, mass in right iliac fossa were significantly associated with perforation. Whereas gender, fever, vomiting, and dysuria showed no association with perforation.CONCLUSIONBedside conventional methods of history taking and examination remain a useful tool in anticipating perforated appendicitis. This helps surgeons in planning incisions and prioritizing patients on heavy operating lists. This remains especially relevant in resource-constrained setups where sophisticated modalities like CT scans are largely unavailable.

scholarly journals Perforated appendicitis: Can it be a bedside diagnosis?

2020 ◽  
Vol 27 (11) ◽  
pp. 2289-2294
Author(s):  
Maham Tariq ◽  
Sara Malik ◽  
Mehwish Changeez ◽  
Saad Javed ◽  
Ramlah Ghazanfor ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Iliac Fossa ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Retrospective Case ◽  
Perforated Appendix ◽  
Group A ◽  
Bedside Diagnosis ◽  
Group B ◽  
Operative Findings

Appendicitis remains one of the most common causes of acute abdomen worldwide. It presents as a spectrum of disease ranging from an acutely inflamed appendix to a perforated one. Where acutely inflamed can be managed conservatively, a perforated appendix always needs surgery to prevent complications like pelvic abscesses. Bedside diagnosis remains relevant in our setup. Objectives: To determine whether history, clinical examination, and basic laboratory investigations can help in confident bedside diagnosis of perforated appendicitis especially in the absence of sophisticated diagnostic modalities. Study Design: Retrospective Case-control study. Setting: Surgical Unit-1, Holy Family Hospital. Period: Jan 2016 to Dec 2016. Material & Methods: Conducted at Hospital records of patients who underwent open appendectomy in the year 2016 were reviewed. Two groups of 100 patients each were made based on per operative findings. Appendices having macroscopic holes in the base or tip were labeled as perforated. Group A had acutely inflamed appendix and group b had perforated appendix. Patients’ demographic details were taken from hospital admission tickets. Findings of history and examination were retrieved from treating resident and operating surgeon's notes. Data were analyzed through SPSS. Results: Out of 200 patients the total number of males was 102 (51%) and females were 98 (49%). Mean age was 24.13+9.73 in males and 18.7+ 6.4 in females of group A and 26.0+10.1 in males and 20.56+7.53 in females of Group B. Group B showed a significant delay in presentation to emergency after the onset of pain (P = 0.022). Upon history and clinical examination, the presence of anorexia, malaise, generalized abdominal pain, guarding, mass in right iliac fossa were significantly associated with perforation. Whereas gender, fever, vomiting, and dysuria showed no association with perforation. Conclusion: Bedside conventional methods of history taking and examination remain a useful tool in anticipating perforated appendicitis. This helps surgeons in planning incisions and prioritizing patients on heavy operating lists. This remains especially relevant in resource-constrained setups where sophisticated modalities like CT scans are largely unavailable.

Dual versus Triple Antibiotics Regimen in Children with Perforated Acute Appendicitis

2017 ◽  
Vol 28 (06) ◽  
pp. 491-494 ◽  
Author(s):  
Elad Feigin ◽  
Inbal Samuk ◽  
Dragan Kravarusic ◽  
Artur Baazov ◽  
Itzhak Levy ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Perforated Appendicitis ◽  
Cost Effective ◽  
Dual Therapy ◽  
Wound Infections ◽  
Perforated Appendix ◽  
Group A ◽  
Group B

Introduction Acute appendicitis is the most common emergency condition in pediatric surgery. Historically, a triple-antibiotic therapy consisted of ampicillin, gentamicin, and clindamycin has been used postoperatively for perforated appendicitis. According to recently published trials, dual therapy consists of ceftriaxone and metronidazole only, offers a more efficient and cost-effective antibiotic management compared with triple therapy. Based on these results, our department applied dual antibiotic therapy for children with perforated appendicitis that underwent appendectomy from 2009 and forth. Aim The aim of our study was to compare postoperative outcomes between patients treated with triple therapy (ampicillin, gentamicin, and metronidazole) (group A) versus dual therapy (ceftriaxone and metronidazole) (group B). Methods Clinical and laboratory data were retrospectively collected by review of the medical records for all children who underwent appendectomy for the perforated appendix at the Schneider Children's Medical Center of Israel, a tertiary pediatric care center between 2007 and 2011. Children with perforated appendicitis received antibiotic therapy in accordance with the hospital's guidelines that were valid at the time the surgery took place. In the first period (years 2007–2009) (group A) a triad of ampicillin, gentamicin, and metronidazole and the second period (2009–2011) (group B) dual therapy consists of ceftriaxone and metronidazole. The two groups were compared for outcome and complications, such as wound infections, changing of antibiotic therapy, and length of stay. Results During the study period 1,203 patients underwent an appendectomy. Of these, 175 patients were diagnosed with perforated appendix and were treated with postoperative antibiotic's regimen. Group A and group B consisted of 89 and 86 patients, respectively. The two groups were not different significantly in terms of demographic data, length of stay, or readmission rates. However, more rates of wound infection and changing of antibiotic therapy were seen in group B, although not statistically significant (p = 0.064). Conclusion Dual antibiotic therapy for perforated appendicitis is a cost-effective and efficient mode of therapy compared with triple-antibiotic's regimen. However, prospective studies are required to determine whether this policy is associated with higher rates of wound infections and change in antibiotic therapy.

scholarly journals What are the responsible risk factors for delay in diagnosis of acute appendicitis in children? Eleven-year research from a single institution

Folia Medica ◽  
2019 ◽  
Vol 61 (3) ◽  
pp. 389-396
Author(s):  
Katerina Kambouri ◽  
Maria Aggelidou ◽  
Savvas Deftereos ◽  
Aggelos Tsalkidis ◽  
George Vaos ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Imaging Techniques ◽  
Diagnostic Delay ◽  
Initial Examination ◽  
Delay In Diagnosis ◽  
Paediatric Surgeon ◽  
Main Effect ◽  
Logistic Regression Method ◽  
Group A ◽  
Group B

Introduction: We conducted a retrospective analysis of 602 children operated on for acute appendicitis (AA) in our department between 1/2007 and 12/2017. Aim: The aim of this study was to identify factors that are related to a delay in diagnosing AA in children. Furthermore, we’d like to strengthen our previous preliminary results by a) adding gender as a new factor and b) studying a much larger population. Materials and methods: The time that elapsed from the onset of symptoms to the surgical intervention was associated with gender, age, obesity, use of antibiotics prior to diagnosis, and the initial examination by a paediatric surgeon or another physician. Univariate and multivariate logistic regression method (backward method) was applied. Results: The diagnosis of AA was delayed by at least 48 hours in 287 patients (group A, 47.7%) and was made within 48 hours in 315 patients (group B, 52.3%). In multivariate model we noticed that boys who were examined by a paediatric surgeon and didn’t take antibiotics had decreased odds of having length of diagnostic period >48 hours, girls who received antibiotics compared to girls who do not use antibiotics are almost 12 times more likely to have length of diagnostic period >48 hours, the very young age has а main effect оn the diagnostic delay and girls who have been examined by other physician compared to females who have been examined by paediatric surgeon have decreased odds of having length of diagnostic period >48 hours. Conclusions: Therefore, physicians examining children with abdominal pain must keep in mind the multiple causes of diagnostic delay that may exist alone or in combination, and which can lead to serious complications and lengthen the hospital stay. Performing repeated examinations and asking for advice from a specialist specifically for children who are a special category of patients, in areas where it is rather impossible to use imaging techniques, could be the key to correctly diagnosing and treating AA.

scholarly journals WOUND DEHISCENCE;

2018 ◽  
Vol 25 (08) ◽  
pp. 1143-1146
Author(s):  
Ammrah Tahir ◽  
Muhammad Sajid Hameed Ansari ◽  
Abdul Waheed Khan
Keyword(s):  
Controlled Trial ◽  
Wound Dehiscence ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Generalized Peritonitis ◽  
Study Results ◽  
Group A ◽  
Continuous Mass ◽  
Group B ◽  
Laparotomy Incision

Objectives: To compare the continuous and interrupted closure in term offrequency of wound dehiscence in emergency midline laparotomy incision. Study Design:Randomized controlled trial. Setting: Surgical Unit-I, Allied Hospital Faisalabad. Period: From15th March 2014 to 15th November 2014. Material and Methods: Two hundred patients werediagnosed clinically by taking thorough history and examinations were included. Fascial layerof wound of the patients sampled for group A was closed with interrupted mass closure withprolene no.1 whereas in group B was closed by continuous mass closure with prolene no1. All included patients were kept nothing by mouth. Resuscitation was done with, ringerslactate and blood transfusion if needed until adequate urine output (0.5 ml/kg/hr). Base lineinvestigations were done. After resuscitation and giving preoperative antibiotics, patients wereexplored through mid-line incision. Obvious source of contamination was dealt with accordingly.Variables wound were examined daily for any sign of dehiscence. Temperature pulse wasmeasured daily along with surgical site examination for any kind of discharge, stitches cutthrough and gut visibility through wound. In case of no complication patient was discharged ontenth postoperative day, which was the end point of study. Results: There were 61 (61%) malesand 39 (39%) females in group A, while in group B, 63 (63%) males and 37 (37%) females withmean ages of patients were 39.77+10.16 and 38.61+9.75 respectively. The wound dehiscencewere found 7 (7%) in Group-A and 18(18%) in Group-B while remaining 93 (93%) in Group-Aand 82 (82%) in Group-B had no morbidity statistically (p<0.01). Conclusion: It is concludedthat wound dehiscence is significantly higher in continuous closure as compare to interruptedclosure for emergency midline laparotomy incision for generalized peritonitis.

Abstract W P414: Midterm Clinical Outcomes After Intervention versus Conservative Management for Brain Arteriovenous Malformation

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ichiro Yuki ◽  
Tomoaki Suzuki ◽  
Hideaki Arakawa ◽  
Toshihiro Ishibashi ◽  
Shougo Kaku ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Clinical Outcomes ◽  
Conservative Management ◽  
Neurological Deterioration ◽  
Initial Presentation ◽  
Neurological Sequela ◽  
Brain Arteriovenous Malformation ◽  
Group A ◽  
Group B ◽  
Observation Period

Purpose: Brain arteriovenous malformation (AVM) patients presented in our institution were divided into two groups based on the initial treatment strategy, “intervention” vs. “conservative management”, and the mid-term clinical outcomes of the two groups were compared. Methods: A total of 149 AVM patients were enrolled in this study. After thorough discussions with each patient on the risk and benefit of the treatment, 83 patients underwent either endovascular, surgical intervention, radiosurgery or combination of these different modalities (Group A). 66 patients chose conservative management until hemorrhage or clinical worsening from the AVM occurred (Group B). In each group, 1) the type of the initial presentation, 2) Spetzler-Martin (S-M) Grade, 3) modified Rankin Scale (mRS) and 4) symptomatic bleeding or neurological deterioration during the follow-ups were recorded. The clinical outcomes of each group was compared. Results: Group A; The type of initial presentation was, bleeding 45%, epilepsy 21%, incidental 18%, headache 8%, focal neurological deficit 5% and others 2%. During the average observation period of 1569 days, 42 patients (51%) showed angiographical obliteration. Overall complications were seen in 15 patients (18%). Complications with neurological deterioration (mRS≧3) was seen in 2 patients (2.4%). Group B; The type of initial presentation was, incidental 33%, epilepsy 23%, bleeding 18%, headache 17%, focal neurological symptoms 3% and others 6%. During the follow-ups (778 days), 7 patients (10%) had hemorrhage or neurological deterioration, and all of them underwent treatment. One patient died immediately before the surgery due to substantial re-bleeding. Rupture rate was 4.5% / year, and neurological sequela (mRS≧3) was seen in 2.7% in this group. Conclusion: The risk of neurological deterioration during the observation period was similar in both groups. Considering the “treatment group” has higher risk of bleeding, the intervention (s) might have contributed to the prevention of the neurological deterioration. However, given the limited magnitude of neurological sequela induced by the bleeding, caution should be exercised in determining the treatment indications especially for the asymptomatic patients.

scholarly journals Randomized Controlled Clinical Trial Comparing Transurethral Eneucleation and Resection of Prostate and Trans-urethral Resection of Prostate in the Management of Benign Prostatic Hyperplasia

2017 ◽  
Vol 7 (3) ◽  
pp. 216-220
Author(s):  
Md Mehedi Hasan ◽  
Samira Rahat Afroze ◽  
Muhammad Abdur Rahim ◽  
Muhammad Abdus Salam
Keyword(s):  
Controlled Trial ◽  
Ethical Review ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Transurethral Resection Of Prostate ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Transurethral resection of prostate (TURP) is the predominant surgical procedure for benign prostatic hypertension (BPH) but is not devoid of complications like capsular perforation, drop in Hb%, drop in Na+, residual adenoma; hence endeavors are evolving to combat such complications. A newer technique transurethral enucleation and resection of prostate (TUERP) has been devised to solve these problems. This study was designed to compare the safety and the efficacy of newer technique, TUERP with widely practiced TURP Methods: This randomized controlled trial was done at BSMMU, after getting ethical approval from the ethical review committee of the institute, from January to October, 2009. A total of 60 BPH patients were purposively enrolled in this study, after obtaining informed written consent and they were randomized as control, Group A (30 patients, underwent TURP) and experimental group, Group B (30 patients, underwent TEURP).Results: The mean preoperative Hb% level of Group A was 15.1 gm% (SD ± 0.5) and perioperative Hb% level was 13.04 gm% (SD ± 6.06). There was significant difference (P <0.05). The mean preoperative Hb% of Group B was 15.2 gm% (SD ± 0.5) and perioperative Hb% was 15.2 gm% (SD ± 0.48). There was no difference (P >0.05). The mean preoperative Na + of Group A was 140 mmol/l (SD ± 4.1) and perioperative Na+ was 126 mmol/l (SD ± 6.8). There was significant difference (P<0.01). The mean preoperative Na+ of Group B was 136 mmol/l (SD ± 4) and perioperative Na+ was 136 mmol/l (SD ± 2.70). There was no difference (P >0.05).Conclusion: TUERP eliminates drop in Hb% and Na+which are usual consequences following TURP. Thus TUERP can be advocated in the treatment of BPH as it also allows completeresection down to surgical capsule.Birdem Med J 2017; 7(3): 216-220

scholarly journals Role of misoprostol 4 hourly versus 6 hourly in medical termination of pregnancy in 2nd trimester.

2021 ◽  
Vol 28 (11) ◽  
pp. 1645-1649
Author(s):  
Komal Devi ◽  
Shazia Aftab ◽  
Reena ◽  
Huma Baloch ◽  
Devi Kumari ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Termination Of Pregnancy ◽  
Ethical Review ◽  
Second Trimester ◽  
Cross Sectional ◽  
Medical Termination Of Pregnancy ◽  
Medical Termination ◽  
Ethical Approval ◽  
Group A ◽  
Group B

Objective: To determine efficacy of misoprostol given in 4 hourly versus 6 hourly intervals in second trimester for termination of pregnancy. Study Design: Cross sectional study. Setting: Study was conducted at the department of Obstetrics and Gynecology of Jinnah Medical and Dental College Karachi Allied Hospital. Period: March to August 2020. Material & Methods: Pregnant ladies in second trimester, requiring abortion due to medical reasons, were planned for termination of pregnancy. Two groups were made. Patients in Group-A were given misoprostol 4 hourly and those in Group-B were given misoprostol 6 hourly. Similar dose of drug (200ug) was given in both groups and monitoring was done. If abortion done in 48 hours, it was considered effective abortion and if not happened in 48 hours, it was considered a failed abortion. Consent was taken from all ladies in study group. Ethical approval was taken from ethical review committee. Results: Total 140 cases were studied, 70 cases in each group, A & B. Age range of cases was 16-40 years with mean age of 26.4±3.5 years. Most of the cases were having age between 20-30 years (63.5%). Group-A (N=70) was given misoprostol 4 hourly, where abortion was done in 94.3% cases while abortion failed in 5.7% cases. In Group-B (N=70) misoprostol was given 6 hourly, induced abortion in 82.8% and failed in 17.1% cases. Conclusion: Misoprostol dose of 20ug given via vaginal route is much effective drug for medical termination of pregnancy when given 4 hourly instead 6 hourly, with low failure rate.

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