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Evaluation of intravaginal misoprostol for medical management of pregnancies less than 20 weeks of gestation with absent cardiac activity
Author(s) -
Kochhar Puneet K.,
Gandhi Gauri,
Batra Swaraj,
Zutshi Vijay
Publication year - 2010
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/j.1447-0756.2010.01230.x
Subject(s) - medicine , misoprostol , chills , gestation , vomiting , gestational age , nausea , anesthesia , obstetrics , abortion , vaginal bleeding , pregnancy , surgery , genetics , biology
Aim: To assess the efficacy and side‐effects of misoprostol (800 µg used intravaginally) for terminating non‐viable pregnancies up to 20 weeks of gestation. Methods: Sixty five patients with non‐viable pregnancies up to 20 weeks of gestation were given 800 µg misoprostol intravaginally on day 1. A second dose of 800 µg was repeated after 24 h if complete abortion was not attained with one dose. Primary outcome measure was success (defined as complete abortion in 48 h without surgical intervention). Duration and amount of blood loss, fall in hemoglobin, and other side‐effects (pain, vomiting, diarrhea, fever and chills) were studied as secondary outcome measures. Results: 73.8% of our patients had a gestational age ≤12 weeks (group A) and 26.2% had a gestational age between 12 and 20 weeks (group B). Success rate after one dose was 66.1% and rose to 84.6% after the second dose. Success rate was higher with increasing gestation (81.2% in group A vs 94.1% in group B). Mean induction abortion interval was 18.8 ± 11.6 h in group A and 10.8 ± 6.2 h in group B. Mean duration of bleeding was 9.4 ± 2.3 days. Average blood loss was 134.9 ± 113.2 mL. No patient required blood transfusion. Mean fall in hemoglobin was 0.56 ± 0.48 g/dL. Most patients had mild pain. Only 6.2% had severe pain requiring injectable narcotic analgesics. Other side‐effects were minimal. Patients who failed to abort completely with misoprostol underwent surgical evacuation. Conclusion: 800 µg vaginal misoprostol is an effective regimen for termination of non‐viable pregnancies <20 weeks of gestation. It has minimal side‐effects and avoids surgical intervention.