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400 μg Oral and Vaginal Misoprostol Comparison Before Manual Vacuum Aspiration for Voluntary Termination of Pregnancy Before 10 Weeks Gestation

Yıl 2012, Cilt: 4 Sayı: 1, 24 - 30, 01.04.2012

Öz

Aim: The aim of the present study was to compare the effectiveness and tolerability of 400 μg oral and 400 μg vaginal misoprostol administered 3 or 6 hours before surgical evacuation for termination of pregnancy before 10 weeks of gestation Material and Method: A total of 210 patients with mostly used four regimens in our department; oral 400 μg misoprostol 3 hours before evacuation O3 , oral 400 μg misoprostol 6 hours before evacuation O6 , vaginal 400 μg misoprostol 3 hours before evacuation V3 , vaginal 400 μg misoprostol 6 hours before evacuation V6 were retrospectively analyzed. Results: Misoprostol administration regardless to dosage, route and timing had significant effect on cervical dilatation. Dilatation requirement was significantly low in all misoprostol groups compared with control. 5.8% of subjects in control group had abundant blood loss significantly higher than other four groups. Postoperative evaluation showed that hematocrite decrease, endometrial thickness measurement and postoperative analgesic usage were similar in all groups. Preoperative VAS scores were higher in O6 and V6 groups. The most frequent side effect was nausea and it was especialy seen in oral O3,O6 groups. Conclusion: The analyze showed that 400 μg vaginal misoprostol taken 3 hours before vacuum aspiration for voluntary termination of pregnancy before 10weeks gestation seems as an ideal route and dosage.

Kaynakça

  • WHO-World Health Organization. Unsafe abortion- Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th edition. WHO; 2004. 82pp. Available in: http://www. who.int/reproductive-health/publications/unsafe_ abortion_estimates _04/estimates.pdf.
  • Goldberg AB, Dean G, Kang MS, Youssof S, Darney PD. Manual versus electric vacuum aspiration for early first-trimester abortion: a controlled study of complication rates. Obstet Gynecol 2004;103:101–7.
  • Watkinson G, Hopkins A, Akbar FA. The therapeutic efficacy of misoprostol in peptic ulcer disease. Postgrad Med J 1998;64:60–77.
  • Gemzell KD, Marions L, Rodriguez A, Spur BW, Wong PYK, Bygdeman M. Comparison between oral and vaginal administration of misoprostol on uterine contractility. Obstet Gynecol 1999;93:275–280.
  • Cakir L, Dilbaz B , Caliskan E, Dede F. S, Dilbaz S, Haberal A. Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study. Contraception 2005;71:337–342
  • Carbonell JLL,Velazco A, RodriguezY, Tanda R, Sanchez C, Barambio S, et al. Oral versus vaginal misoprostol for cervical priming in first trimester abortion. A randomized trial. Eur J Contracept Reprod Health Care 2001;6:134–40.
  • Oppergaard K, Abdelnoor M, Nesheim BI, Jerve F, Eskild A. The use of oral misoprostol for pre-abortion cervical priming: a randomised controlled trial of 400 versus 200 μg in first trimester pregnancies. BJOG 2004;111:154–159.
  • Hamoda H, Ashok P, Flett GMM, Templeton A. A randomized controlled comparison of sublingual and vaginal administration of misoprostol for cervical priming before first-trimester surgical abortion. Am J Obstet Gynecol 2004;190:55–59.
  • Zieman M, Fong SK, Benowitz NL, Bansketer D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997;90:88–92.
  • Hamoda H, Ashok P, Flett GMM, Templeton A. A randomized controlled comparison of sublingual and vaginal administration of misoprostol for cervical priming before first-trimester surgical abortion. Am J Obstet Gynecol 2004;190:55–59.
  • MacIssac L, Grossman D, Balisteri E, Darney P. A randomized controlled trial of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynecol 1999;93:766–770.
  • Taner ZM, Nas T, Bor P, Güner H, Yıldırım M. Yasal 12.Tahliye Öncesi Servikal Dilatasyonu Sağlamak ve Kolaylaştırmak Amacı ile Misoprostol Kullanımı. Turkiye Klinikleri J Gynecol Obst 1997;7(3):159-162
  • Esteve JL, Marı´ JM, Valero F, Llorente M, Salvador I, Varela I, et al. Sublingual versus vaginal misoprostol (400 Ag) for cervical priming in first-trimester abortion: a randomized trial Contraception 74 (2006) 328–333
  • Ashok PW, Hamoda H, Nathani F, Flett GM, Templeton A.Randomized controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy. Br J Obstet Gynaecol 2003;110:1057–1061.
  • Kaali SG, Szigetvari IA, Bartfai GS. The frequency and management of uterine perforations during first trimester abortions. Am J Obstet Gynecol 1989;161: 406–408.
  • MacIssac L, Grossman D, Balisteri E, Darney P. A randomized controlled trial of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynecol 1999;93:766–770.
  • Aronsson A, Helstrfm L, Gemzell-Danielsson K. Sublingual compared with oral misoprostol for cervical dilation prior to uterine aspiration: a randomized comparison. Contraception 2004;69: 165–169.
  • Salakos N, Iavazzo C, Bakalianou K, Gregoriou O, Paltoglou G, Kalmantis K, et al. Misoprostol use as a method of medical abortion. Clin Exp Obstet Gynecol 2008;35:130–132 .
  • Robledo C, Zhang J, Troendle J, Barnhart K, Creinin MD, Westhoff C, et al. Clinical indicators for success of misoprostol treatment after early pregnancy failure. Int JGynecol Obstet 2007;99:46–51.
  • Reeves MF, Lohr PA, Harwood BJ, Creinin MD.Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure. Obstet Gynecol 2008;111:106–112.
  • Tang SO, Chung HP The pharmacokinetics and different regimens of misoprostol in early first- trimester medical abortion Contraception 2006; 74:26–30.
  • Ashok PW, Hamoda H, Nathani F, Flett GM, Templeton A. Randomized controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy. Br J Obstet Gynaecol 2003;110:1057–1061.
  • Kulier R, Gulmezoglu A, Hofmeyr G, Cheng L, Campana A. Medical methods for first trimester miscarriage. Cochrane Database Syst Rev 2004;2: CD002855.
  • Pang MW, Lee TS, Chung TK. Incomplete miscarriage: a randomized controlled trial comparing oral with vaginal misoprostol for medical evacuation. Hum Reprod 2001;16: 2283–2287.
  • Helena von Hertzen, Gilda Piaggio, Nguyen Thi My Huong, Effi cacy of two intervals and two routes of administration of misoprostol for termination of early pregnancy: a randomised controlled equivalence trial Lancet 2007;369:1938–1946
  • Von Hertzen H, Honkanen H, Piaggio G, Bartfai G,Erdenetungalag R, Gemzell Danielsson K, et al. WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion I: Efficacy. BJOG 2003;110:808–818.
  • Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997;90:88– 92.

10 Haftalıktan Önceki İstemli Gebelik Sonlandırılmasında Kullanılan Manuel Vakum Aspirasyonundan Önce 400 μg Oral ve Vaginal Misoprostolün Karşılaştırılması

Yıl 2012, Cilt: 4 Sayı: 1, 24 - 30, 01.04.2012

Öz

Amaç: Bu çalışmanın amacı 10 haftadan küçük gebeliklerin terminasyonu için kullanılan cerrahi evakuasyonun 3 ve 6 saat öncesi kullanılan 400 μg oral ve vaginal misoprostolün etkinliği ve tolerabilitesinin karşılaştırılması Gereç ve Yöntemler: Kliniğimizde en sık kullanılan 4 misoprostol rejiminin kullanıldığı 210 hasta retrospektif olarak değerlendirildi; Evakuasyondan 3 saat önce oral 400 μg O3 , 6 saat önce oral 400 μg O6 , 3 saat önce ovaginal 400 μg V3 , 6 saat önce vaginal 400 μg V6 . Bulgular: Dozajına, kullanım yoluna ve zamanlamasına bakılmaksızın misoprostolün servikal dilatasyon üzerine belirgin etkisi vardır. Dilatasyon ihtiyacı kontrol grubuna kıyasla tüm misoprostol gruplarında belirgin olarak azdır. Diğer dört gruba kıyasla kontrol grubunda %5.8 oranla aşırı miktarda kan kaybı izlenmiştir. Postoperatif inceleme, hematocrit düşüşü, endometrial kalınlık ve analjezik ihtiyacı tüm gruplarda benzer bulunmuştur. Preoperatif VAS skorları O6 ve V6 gruplarında yüksekti. En sık görünen yan etki bulantı olup, özellikle oral O3, O6 gruplarda belirgindi. Sonuç: Analiz 10 haftalık ve öncesi gebeliğin istemli sonlandırılmasından 3 saat önce alınan 400 μg vaginal misoprostolün ideal kullanım yolu ve dozajı olarak göstermektedir.

Kaynakça

  • WHO-World Health Organization. Unsafe abortion- Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th edition. WHO; 2004. 82pp. Available in: http://www. who.int/reproductive-health/publications/unsafe_ abortion_estimates _04/estimates.pdf.
  • Goldberg AB, Dean G, Kang MS, Youssof S, Darney PD. Manual versus electric vacuum aspiration for early first-trimester abortion: a controlled study of complication rates. Obstet Gynecol 2004;103:101–7.
  • Watkinson G, Hopkins A, Akbar FA. The therapeutic efficacy of misoprostol in peptic ulcer disease. Postgrad Med J 1998;64:60–77.
  • Gemzell KD, Marions L, Rodriguez A, Spur BW, Wong PYK, Bygdeman M. Comparison between oral and vaginal administration of misoprostol on uterine contractility. Obstet Gynecol 1999;93:275–280.
  • Cakir L, Dilbaz B , Caliskan E, Dede F. S, Dilbaz S, Haberal A. Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study. Contraception 2005;71:337–342
  • Carbonell JLL,Velazco A, RodriguezY, Tanda R, Sanchez C, Barambio S, et al. Oral versus vaginal misoprostol for cervical priming in first trimester abortion. A randomized trial. Eur J Contracept Reprod Health Care 2001;6:134–40.
  • Oppergaard K, Abdelnoor M, Nesheim BI, Jerve F, Eskild A. The use of oral misoprostol for pre-abortion cervical priming: a randomised controlled trial of 400 versus 200 μg in first trimester pregnancies. BJOG 2004;111:154–159.
  • Hamoda H, Ashok P, Flett GMM, Templeton A. A randomized controlled comparison of sublingual and vaginal administration of misoprostol for cervical priming before first-trimester surgical abortion. Am J Obstet Gynecol 2004;190:55–59.
  • Zieman M, Fong SK, Benowitz NL, Bansketer D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997;90:88–92.
  • Hamoda H, Ashok P, Flett GMM, Templeton A. A randomized controlled comparison of sublingual and vaginal administration of misoprostol for cervical priming before first-trimester surgical abortion. Am J Obstet Gynecol 2004;190:55–59.
  • MacIssac L, Grossman D, Balisteri E, Darney P. A randomized controlled trial of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynecol 1999;93:766–770.
  • Taner ZM, Nas T, Bor P, Güner H, Yıldırım M. Yasal 12.Tahliye Öncesi Servikal Dilatasyonu Sağlamak ve Kolaylaştırmak Amacı ile Misoprostol Kullanımı. Turkiye Klinikleri J Gynecol Obst 1997;7(3):159-162
  • Esteve JL, Marı´ JM, Valero F, Llorente M, Salvador I, Varela I, et al. Sublingual versus vaginal misoprostol (400 Ag) for cervical priming in first-trimester abortion: a randomized trial Contraception 74 (2006) 328–333
  • Ashok PW, Hamoda H, Nathani F, Flett GM, Templeton A.Randomized controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy. Br J Obstet Gynaecol 2003;110:1057–1061.
  • Kaali SG, Szigetvari IA, Bartfai GS. The frequency and management of uterine perforations during first trimester abortions. Am J Obstet Gynecol 1989;161: 406–408.
  • MacIssac L, Grossman D, Balisteri E, Darney P. A randomized controlled trial of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynecol 1999;93:766–770.
  • Aronsson A, Helstrfm L, Gemzell-Danielsson K. Sublingual compared with oral misoprostol for cervical dilation prior to uterine aspiration: a randomized comparison. Contraception 2004;69: 165–169.
  • Salakos N, Iavazzo C, Bakalianou K, Gregoriou O, Paltoglou G, Kalmantis K, et al. Misoprostol use as a method of medical abortion. Clin Exp Obstet Gynecol 2008;35:130–132 .
  • Robledo C, Zhang J, Troendle J, Barnhart K, Creinin MD, Westhoff C, et al. Clinical indicators for success of misoprostol treatment after early pregnancy failure. Int JGynecol Obstet 2007;99:46–51.
  • Reeves MF, Lohr PA, Harwood BJ, Creinin MD.Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure. Obstet Gynecol 2008;111:106–112.
  • Tang SO, Chung HP The pharmacokinetics and different regimens of misoprostol in early first- trimester medical abortion Contraception 2006; 74:26–30.
  • Ashok PW, Hamoda H, Nathani F, Flett GM, Templeton A. Randomized controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy. Br J Obstet Gynaecol 2003;110:1057–1061.
  • Kulier R, Gulmezoglu A, Hofmeyr G, Cheng L, Campana A. Medical methods for first trimester miscarriage. Cochrane Database Syst Rev 2004;2: CD002855.
  • Pang MW, Lee TS, Chung TK. Incomplete miscarriage: a randomized controlled trial comparing oral with vaginal misoprostol for medical evacuation. Hum Reprod 2001;16: 2283–2287.
  • Helena von Hertzen, Gilda Piaggio, Nguyen Thi My Huong, Effi cacy of two intervals and two routes of administration of misoprostol for termination of early pregnancy: a randomised controlled equivalence trial Lancet 2007;369:1938–1946
  • Von Hertzen H, Honkanen H, Piaggio G, Bartfai G,Erdenetungalag R, Gemzell Danielsson K, et al. WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion I: Efficacy. BJOG 2003;110:808–818.
  • Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997;90:88– 92.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Araştırma Makalesi
Yazarlar

Erdin İlter Bu kişi benim

Aygen Çelik Bu kişi benim

Tonguç Gündüz Bu kişi benim

Berna Haliloğlu Bu kişi benim

Meryem Küçükaşçı Bu kişi benim

Moşe Benhabib Bu kişi benim

Serpil Bozkurt Bu kişi benim

Ümit Özekici Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 4 Sayı: 1

Kaynak Göster

Vancouver İlter E, Çelik A, Gündüz T, Haliloğlu B, Küçükaşçı M, Benhabib M, Bozkurt S, Özekici Ü. 400 μg Oral and Vaginal Misoprostol Comparison Before Manual Vacuum Aspiration for Voluntary Termination of Pregnancy Before 10 Weeks Gestation. Maltepe tıp derg. 2012;4(1):24-30.