EVALUATION OF THE EFFICACY OF THE THREE REGIMENS OF VAGINAL MISOPROSTOL IN THE TERMINATION OF FIRST TRIMESTER PREGNANCY- A RANDOMISED CONTROLLED STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 26
Abstract
BACKGROUND An abortion is the removal or expulsion of an embryo or foetus from the uterus, resulting in or caused by its death. Abortion in the first trimester is safe compared to the second trimester and medical methods are still safer than surgical techniques. Medical methods are safe, efficient and simple and result usually in complete abortion. Both Misoprostol and Mifepristone have been used singly in various doses and also in combination dosage schedule. There are many studies for both and each study claims its schedule to be superior and safer than others. Aim: This study is done to compare the efficacy, complications and complete abortion rate of three different doses of vaginal misoprostol alone in first trimester MTP. MATERIALS AND METHODS This is a randomised controlled study. During the period 2004 - 2006, three hundred patients who attended the family planning clinic requesting for first trimester termination of pregnancy were selected at random based on the inclusion and exclusion criteria. Out of the three hundred patients, hundred each were assigned randomly to 200 micrograms, 400 micrograms and 600 micrograms group respectively. Patient was asked to empty the bladder and asked to lie down in the dorsal position with hips abducted and knees semiflexed. After cleaning and draping, a Sim’s speculum was introduced into the vagina and posterior lip of cervix was caught with vulsellum. 200 micrograms of misoprostol were kept in the posterior fornix every 6 hourly for a maximum of four doses. 400 micrograms of misoprostol were kept every 8 hourly for a maximum of three doses. 600 micrograms were kept every 12 hourly for a maximum of two doses. Three drops of distilled water were added to the tablet before keeping in the posterior fornix of vagina to facilitate the mucosal abortion. Patient was kept in the ward till the expulsion was complete- whenever necessary, check curettage was done. Complete abortion was confirmed with ultrasound. If no expulsion occurred after 24 hours, it was considered as a failure and other interventions were offered. RESULTS This study conducted at Government Kasturba Gandhi Hospital for Women and Children during the period 2004 – 2006, compares the efficacy of three different regimens of vaginal misoprostol in the first trimester termination of pregnancy. The results were subjected to statistical analysis using ANOVA with post-hoc test. 78% of the patients were in the age group of 21 - 30 years. 82% of cases were parous women, whereas only 18% of cases were nulliparous. Above 85% of the women in this study belonged to class IV/V socio-economic status. Though patients were selected at random, 73% of patients were 10 - 12 weeks pregnant. In this study induction, abortion interval was less with 600 micrograms of misoprostol. The I-A interval was least when the GA was 10 - 12 weeks. In this study complete abortion occurred in 41%, 52% and 74% of cases in 200 micrograms, 400 micrograms and 600 micrograms groups respectively. There is no significant difference in I-A interval between and within the parity by statistical analysis. There is statistically significant difference in complete and incomplete abortion between the three regimens, (p= 0.01 and 0.05). Statistically, there is significant difference in the incidence of side effects with the three regimens. CONCLUSION In this study, Induction-Abortion interval is less with 600 ug when compared to 400 ug and 200 ug. Induction-Abortion interval in 10 to 12 weeks of gestation observed in this is less. Complete abortion rate was more with 600 g regimen when compared to other two regimens. Incidence of side effects was less with 200 ug. There was almost similar incidence of abdominal/ uterine cramps and excessive bleeding. Medical management of MTP is a boon to low resource countries like India where infrastructural facilities and trained personnel are at a premium. However, there is scope for misuse of this drug which needs to be curtailed and watched. This is a comparatively inexpensive, easy to administer technique which when used by properly trained persons in a setup with facilities for further management as and when required will go a long way in reducing the unwanted interferences by unscrupulous persons.
Authors and Affiliations
Kavitha Paranthaman, Suchindra Ramamoorthy
Keywords
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- EP ID EP466479
- DOI 10.14260/jemds/2018/682
- Views 72
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