1. EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL FOR
INDUCTION OF LABOR IN MISSED ABORTION
PRESENTED BY
Lugansk State Medical University Block
50 years, Of lugansk defence, 1.
Lugansk - 91045, Ukraine.
email : info@lsmuedu.com /
kanc@lsmuedu.com
Official website -
http://www.lsmuedu.com
1
+38-091-9484-428
2. OBJECTIVES
TO DETERMINE THE EFFICACY OF
VAGINAL VS. ORAL MISOPROSTOL AS A
LABOR INDUCING AGENT IN MISSED
ABORTION.
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3. INTRODUCTION
MISSED ABORTION IS THE FAILURE TO
EXPEL THE PRODUCTS OF CONCEPTION
AFTER DEATH OF EMBRYO.
MISSED ABORTION IS MANAGED EITHER
BY SURGICAL & NON SURGICAL
METHODS.
IN RECENT YEARS MISOPROSTOL,A
SYNTHETIC PGE1, ANALOGUE, IS BEING 3
EVALUATED FOR LABOR INDUCTION.
5. INTRODUCTION:
MISOPROSTOL CAN BE GIVEN ORALLY,
SUBLINGUALLY, VAGINALLY OR
RECTALLY.
IT HAS BEEN EXTENSIVELY STUDIED &
USED FOR OBSTETRICAL &
GYNAECOLOGICAL CAUSES, SUCH AS
PRE-INDUCTION CERVICAL RIPENING,
LABOR INDUCTION, EVACUATION OF
UTERUS AFTER PREGNANCY FAILURE OR
VARIOUS MEDICAL REASONS.
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7. SUBJECT &SETTING:
THIS STUDY WAS PERFORMED IN
GYNAE/OBS UNIT II IN HOLY FAMILY
HOSPITAL RAWALPINDI [PAKISTAN].
35 PATIENTS IN VAGINAL MISOPROSTOL
GROUP & 35 PATIENTS IN ORAL
MISOPROSTOL GROUP WERE STUDIED.
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8. METHOD:
TOTAL OF 70 PREGNANT WOMEN
ADMITTED WITH MISSED ABORTION OR
BLIGHTED OVUM OF 8wks TO 24wks OF
GESTATION DURING THE PERIOD OF
JUNE 2005 TO NOV 2005.
MISSED ABORTION WAS CONFIRMED ON
ULTRASOUND.
INITIAL EVALUATION OF PTS WAS DONE.
CONSENT OF PATIENT.
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9. METHODS:
THE CASES WERE RANDOMIZED IN TWO
GROUPS.
ONE FOR ORAL MISOPROSTOL & OTHER
FOR VAGINAL MISOPROSTOL.
IN ONE GROUP 400ug WAS INSERTED
UNDER FULL ASEPTIC CONDITIONS HIGH
UP IN POSTERIOR FORNIX OF VAGINA
WHILE IN SECOND GROUP PATIENT TAKE
IT ORALLY.
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11. METHODS:
THE DOSE OF MISOPROSTOL WAS
REPEATED AFTER EVERY 4hrs TO A MAX.
OF FOUR DOSES IN 24 hrs.
IF COMPLETE EXPULSION DID NOT
OCCUR WITH IN 48hrs & IF PATIENT
BLEED HEAVILY THEN ERPC WAS DONE.
FOLLOW UP.
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22. DISCUSSION:
TERMINATION OF PREGNANCY IS AN
INTEGRAL PART OF ANY
GYNAECOLOGICAL PRACTICE.
DIFFERENT METHODS OF CERVICAL
RIPENING HAVE BEEN USED WITH
VARIABLE RESULTS.
CHOHAN,etal, HAVE DONE A STUDY
USING EXTRA AMNIOTIC PGF2 alpha FOR
MID TRIMESTER INDUCTION OF LABOR
IN PTS WITH LATE MISSED ABORTION.
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23. DISCUSSION:
THEY CLAIMED THAT 100% EXPULSION
RATE WHICH IS COMPARABLE TO 94%
EXPULSION RATE OBSERVED IN OUR
STUDY.
MUFFLEY PE,[2002]CONDUCTED A STUDY
ON VAGINAL MISOPROSTOL COMPARED
WITH SURGICAL TREATMENT IN MISSED
ABORTION & CLAIMED THAT 60%
PATIENTS IN MISOPROSTOL GROUP
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24. DISCUSSION:
NOT REQUIRED SURGICAL TREATMENT
COMPARE TO 52% COMPLETE UTERINE
EVACUATION IN OUR STUDY.
ELSHEIKH,etal[2001] USED ORAL &
VAGINAL MISOPROSTOL IN SECOND
TRIMESTER MISSED ABORTION USING
SAME DOSAGE AS IN OUR STUDY, MEAN
INDUCTION TO EXPULTION TIME IS
SAME &THE EFFICACY OF METHOD IS
ALSO SIMILAR. 24
25. CONCLUSION:
VAGINAL MISOPROSTOL WAS FOUND
MORE EFFECTIVE WITH LESSER SIDE
EFFECTS AS COMPARE TO ORAL FOR
MISSED ABORTION.
IT IS OBSERVED IN OUR
STUDY THAT
MISOPROSTOL IS
CHEAPER &
EFFICIENT FOR
MISSED ABORTION. 25
26. KEY POINTS:
MISOPROSTOL HAS BEEN ON MARKET
SINCE 1985 UNDER BRAND NAME OF
CYTOTEC. IT IS AVAILABLE IN OVER 80
COUNTRIES WORLD WIDE FOR
TREATMENT OF GASTRIC
ULCERS.
MORE THAN 300
ARTICLES HAVE BEEN
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27. KEY POINTS:
USEFULNESS OF MISOPROSTOL IN NO.
OF INDICATIONS IN OBS &
GYNAECOLOGY.
NO PROPER DOSAGE IS UPTILL
DECIDED
&THE COMPANY
NEVER APPLIED FOR
APPROVAL FOR
OBSTETRICS. 27
28. THANK YOU
Lugansk State Medical University
Block 50 years, Of lugansk defence, 1.
Lugansk - 91045, Ukraine.
email : info@lsmuedu.com /
kanc@lsmuedu.com
Official website - http://www.lsmuedu.com
+38-091-9484-428
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