Evaluation of the Effectiveness of Intravaginal Misoprostol in Termination of Pregnancy

Year 2020, Volume: 11 Issue: 40, 55 - 59, 30.08.2020

Cem Yener , Sinan Ateş Cenk Sayın Süheyla Görmez Füsun Varol

https://doi.org/10.17944/mkutfd.578284

Abstract

Introduction: The aim of our study was to evaluate the distribution of indications of termination of pregnancies in the 2,5-year period between the period May 2016-December 2018 at the Obstetric Clinic of Trakya University Medical Faculty and to compare the efficacy of 400 μg misoprostol administered intravaginally in every 4 hours to 600 μg misoprostol administered intravaginally in every 24 hours for pregnancy termination.
Methods: In our retrospective cohort study, indications for termination of pregnancies over 10 (ten) weeks and efficiency of misoprostol treatment protocols were investigated. A total of 128 women were included in the study between ages 18 and 45 that were hospitalized for pregnancy termination over 10 (ten) weeks. In 63 patients (Group 1), 400 μg misoprostol was administered intravaginally 4 hours apart. In 65 patients (Group 2), 600 μg misoprostol was administered intravaginally 24 hours apart. The dose was repeated until adequate uterine contraction was achieved in both groups. The method was considered to be unsuccessful in cases where abortion / delivery was not achieved after 48 hours.
Results: The termination indications of 128 patients in our study were determined. Indications for termination of pregnancy were: Missed Abort and IUGR (in utero mort fetus) 32 (%25), central nervous system anomalies 30(%23,4), anhydramnios 28(%21,8), chromosomal anomalies 11(%8,5), cardiac anomalies 7(%5,4), multiple system anomalies 6(%4,6), musculoskeletal anomalies 5(%3,9), gastrointestinal and genitourinary system anomalies 5 (%3,9). Group 1 abortus rate was %90,4 in 48 hours. Group 2 success rate was %92,3 in 48 hours.

Conclusion: Obstetric ultrasonography examination is the most important method in the diagnosis of fetal structural anomalies. When fetal anomalies are evaluated, central nervous system anomalies constitute the largest group in termination cases. In our hospital, the misoprostol protocols were found to be effective and reliable. But no consensus yet on what an effective and reliable route of administration and dosage should be for misoprostol.

Keywords

Fetal anomaly, termination of pregnancy, misoprostol

İntravajinal Mizoprostolün Gebelik Sonlandırılmasında Etkinliğinin Değerlendirilmesi

Abstract

Amaç: Çalışmamızın amacı Trakya Üniversitesi Tıp Fakültesi Doğum Kliniğinde Mayıs 2016 –Aralık  2018 tarihleri arasındaki 2,5 yıllık zaman aralığında terminasyon yapılan gebeliklerin endikasyonlarının dağılımını değerlendirmek ve 10 (on) hafta üzeri gebelik sonlandırmasında dört saatte bir intravajinal ve yirmi dört saatte bir vajinal yolla uygulanan sırasıyla 400 μg ve 600 μg mizoprostolün etkinliğini karşılaştırmak. 

Gereç ve Yöntem:Retrospektif dosya incelemesi şeklinde planlanan çalışmamızda kliniğimizde terminasyon kararı verilen 10 (on) hafta üzeri gebeliklerin sonlandırılma endikasyonları ve uygulanmakta olan mizoprostol tedavi protokollerinin etkinliği incelendi. 18-45 yaş arası, 10 (on) hafta ve üzeri olan gebeliklerin sonlandırılmasının planlandığı toplam 128 kadının dosyası değerlendirildi. 63 hastaya (Grup 1) 4 saat ara ile tekrarlanan 400 μg vajinal yolla mizoprostol uygulandı. 65 hastaya (Grup 2) 24 saat ara ile tekrarlanan 600 μg vajinal yolla mizoprostol uygulandı. Her iki grupta yeterli uterin kontraksiyon elde edilene kadar doz tekrarlanıp 48 saat sonrasında abortus/doğum gerçekleşmemesi halinde yöntem başarısız olarak kabul edildi. 

 

Bulgular: Çalışmamızda termine edilen 128 hastanın terminasyon endikasyonları belirlendi. Gebelik terminasyon endikasyonları: Missed Abort ve IUGR (in utero mort fetus) 32(%25), santral sinir sistemi anomalileri 30(%23,4), anhidramniyoz 28(%21,8), kromozal anomaliler 11(%8,5), kardiyak anomaliler 7(%5,4), çoklu sistem anomalileri 6(%4,6), kas iskelet anomalileri 5 (%3,9), gastrointestinal ve genitoüriner sistem anomalileri 5(%3,9), teratojen ilaç kullanımı ve radyasyona maruz kalma 4(%3,1) bulundu.  Grup 1 olgularda 48 saatte abortus oranı (%90.4) idi. Grup 2 olgularda 48 saatte başarı oranı ise (%92,3) bulundu.

Sonuç: İlk trimester ve ikinci trimesterde yapılan obstetrik ultrasonografi fetal yapısal anomalilerin tanısında tek yöntemdir. Santral sinir sistemi anomalileri fetal anomaliler içerisinde en büyük grubu oluşturmaktadır. Hastanemizde 10 (on) hafta ve üzeri gebelik sonlandırılmasında kullanılan mizoprostolün etkili ve güvenilir olduğu düşünülmektedir. 

Keywords

Fetal anomali, gebelik terminasyonu, mizoprostol

References

• Agtibay PM, Ramin KD, Harris DY, Ramsey PS, Ogburn PL Jr. Misoprostol as a labor induction agent. J Matern Fetal Med. 1998; 7: 15-8.
• F. Gary Cunningham, Norman F. Gant, Kenneth J. Leveno, Larry C. Gilstrap III, John C.Hayth, Katharine D. Wenstrom. İnduction and Augmentation of Labor. Williams Obstetrics 2001 page 469-481.
• Pongsatha S, Tongsong T, Suwanawut O. Therapeutic termination of second trimester pregnancy with vaginal misoprostol. J Med Assoc Thai 2001; 84: 515-9.
• De Ruiter j. Prostaglandines and Eicosanoids. Principles of Drug Action, Fall 2002;1- 28.
• ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114( 2 Pt1): 386-97.
• Souka AP, Pilalis A, Kavalakis Y. Assessment of fetal anatomy at the 11–13-week ultrasound examination. Ultrasound Obstet Gynecol 24:730–34.
• Wright D, Spencer K, Kagan KO. First-trimester combined screening for trisomy 21 at 7–14 weeks gestation. Ultrasound Obstet Gynecol 36: 404–11.
• Kypros H. Nicolaides. Screening for fetal aneuploidies at 11 to 13 weeks. Prenat Diagn 2011; 31: 7–15.
• Singh S, Chukwunyere DN, Omembelede J, Onankpa B. Niger Postgrad Med J. 2015 Jul-Sep;22(3):174-8.
• Jacobs M, Cooper SA, McGowan R, Nelson SM, Pell JP. Pregnancy Outcome following Prenatal Diagnosis of Chromosomal Anomaly:A Record Linkage Study of 26,261 Pregnancies. PLoS One. 2016 Dec 1;11(12):e0166909.
• El-Refaey H, Hinshaw K, Templeton A. The abortifacient effect of misoprostol in the second trimester. Hum Reprod 1993; 8: 1744-6.
• Wu HL, Marwah S, Wang P, Wang QM, Chen XW. Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis. Sci Rep. 2017 May 10;7(1):1664.
• Danielsson KG, Marions L, Rodriguez A, Spur BW, Wong PY, Bygdeman M. Comparison between oral and vaginal administration of misoprostol on uterine contractility. Obstet Gynecol 1999; 93: 275-80.
• Mohammadi E, Jayaprakash G, Shiva A, Motallebzadeh N. Comparison of Effectivenes and Patient Satisfaction of Vaginal Versus Oral Misoprostol in Treatment of Missed Miscarriage. Open Access Maced J Med Sci. 2019 Mar 26;7(6):955-958.
• Bugalho A , Bique C , Pereira1 C , Granja C and Bergstrom S. Uterine evacuation by vaginal misoprostol after second trimester pregnancy interruption. Acta Obstetricia et Gynecologica Scandinavica, 75: 270-273.
• Goh SE, Thong KJ. Induction of second trimester abortion (12-20weeks) with mifepristone and misoprostol: a review of 386 consecutive cases. Contraception 2006;73(5):516-9.
• Morris JL, Winikoff B, Dabash R, Weeks A, Faundes A, Gemzell-Danielsson K, et al. FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynaecol Obstet. 2017 Sep;138(3):363-366.