A Study to Compare the Safety And Efficacy of Intravaginal Mifepristone -Misoprostol Combination, with Extra-Amniotic Ethacridine Lactate for Mid Trimester Pregnancy Termination in a Tertiary Care Center of West Bengal
Journal Title: International Journal of Research and Review - Year 2018, Vol 5, Issue 12
Abstract
Background: Termination of second trimester pregnancy has been reported to be associated with 3-5 times higher morbidity and mortality risks than termination in 1st trimester. Aims: To compare the safety and efficacy of intravaginal mifepristone -misoprostol combination, with extra-amniotic ethacridine lactate for mid trimester pregnancy termination. Materials and methods: This study was conducted in Burdwan Medical College in a time span of one year after taking Institutional ethical clearance and informed consent of the subjects. 102 pregnant women who were admitted in the Gynaecology and Obstetrics department for second trimester abortion between 13 – 20 weeks of gestation were divided into two groups. Mifepristone with Misoprostol Group and Ethacridine lactate group and drugs were administered accordingly. All patients were monitored clinically with 2 hourly assessments of maternal temperature, pulse, blood pressure and respiratory rate. Occurrences of fever, chest pain, breathing difficulty, vomiting, diarrhea were recorded. After expulsion of the fetus and placenta cervical injury was looked for and check curettage done in incomplete expulsion cases. Induction abortion interval was decided as the time duration from introduction of drug to the expulsion of products of conception. The induction abortion interval was defined as time from instillation of ethacridine lactate or administration of 1st dose of misoprostol to abortion. Hemorrhage was defined as an estimated blood loss exceeding 500 mL approx. quantified as fall in Hb >2 gm/dl or a need for blood transfusion. Fever was defined as a temperature of 38 0C or more occurring 24 hours or more after pregnancy termination Statistical methods: Data was collected and compiled and software package SPSS version 19 was used for statistical analysis. P value < 0.05* was considered as significant and <0.01** as highly significant. Results: No significant difference was found between any of the demographic characteristics like age, BMI, parity and gestational age between Group A and Group B. The induction delivery interval was 16.09 hours and 36.53 hours in group A and B respectively, which was statistically significant. When considering only primigravida, the induction-delivery time came out to be 16.35 hours and 42.27 hours in group A and group B respectively. The difference is statistically significant. On the other hand, in multigravida, induction-delivery time (P= 0.004), group A= 15.93 hours and 28.2 hours. At the end of 48hours, 100% and 78.43% patients delivered in both groups. Induction - delivery time was found to be less in parous than in nulliparous in both the groups. The most common side-effect was found to be abdominal pain. GI side effects were more in group A but the difference was not statistically significant. Only incidence of fever was found to be more in ethacridine lactate group. Conclusions: We may conclude that mifepristone and misoprostol combination for second trimester termination of pregnancy, is preferable to ethacridine and oxytocin combination, because it works faster, has a higher success rate in a shorter period of time, and fewer complications.
Authors and Affiliations
Dr. Debdut Banerjee, Dr. Priyankar Kanrar, Dr. Barnali Ghosh, Dr. Arunima Chaudhuri, Dr. Bibekananda Das, Dr. Samir Kumar Hazra
Keywords
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