Abstract
Özet
Amaç. Bu çalışmanın amacı ilk trimesterde gebelik sonlandırması öncesi servikal olgunlaşma için kullanılan iki farklı misoprostol uygulamasının etkinliğini karşılaştırmaktır. Yöntem. Gebelik sonlandırılması kararı verilen 18-42 yaş grubunda 167 kadın değerlendirmeye alınmıştır. Grup 1 içerisinde yer alan 102 hastaya 4 saat ara ile 100 µg oral ve 100 µg vajinal misoprostol, grup 2 içerisinde yer alan 65 kadın hastaya 6 saat ara ile 200 µg oral ve 200 µg vaginal misoprostol uygulanmıştır. Sistemik hastalığı olanlar, servikal operasyon geçirenler, gebeliğinde kanaması olanlar ve bazal servikal açıklığı 4 mm'den fazla olanlar çalışma dışında bırakılmıştır. Ulaşılan servikal açıklık, düşük süresi, yan etkiler ve diğer başlangıç klinik verileri toplandı. Bulgular. Çalışma grupları yaş, gravida, parite ve gebelik yaşı açısından benzerdi. Multipar kadınlarda grup 1'de bazal dilatasyon grup 2'ye göre anlamlı olarak daha yüksekti (p<0,05). Nullipar hastalarda son servikal açıklık ölçümleri grup 2'de grup 1'e göre anlamlı olarak daha yüksekti (p<0,05). Nullipar hastalarda düşük süresi grup 2'de grup 1'e gore anlamlı olarak daha uzundu (p<0,05). Bulantı, kusma ve ishal her iki grupta toplam 6 hastada gözlendi. Sonuçlar. İlk trimester gebelik sonlandırması yapılan nullipar hastalarda 4 saat ara ile uygulanan 100 µg oral ve 100 µg vaginal misoprostol önemli bir yan etkiye rastlanmaksızın yeterli servikal dilatasyonu sağlayabilir.
Anahtar sözcükler: Misoprostol, ilk trimester abortus, servikal olgunlaşma
Abstract
Aim: The aim of this study was to determine the efficacy of two protocols of misoprostol administration for cervical priming before first-trimester surgical abortion. Methods: A total of 167 women, aged 18-42 years, who decided to terminate their pregnancy were evaluated. One hundred two of them (group 1) were received 100 µg of misoprostol oral and 100 vaginal, doses repeated 4 hours later. Sixty five of them (group 2) were received 200 µg oral and 200 µg vaginal doses repeated 6 hours later. Exclusion criteria were systemic disease, a history of cervical operations, bleeding or spotting during the current pregnancy, basal cervical dilation greater than 4mm. Results. The age, gravidity, parity, and gestational age of study groups were comparable (p>0.05). For women with multiparity, the basal dilatation of group 1 was significantly higher than that of the group 2 (p<0.05). For women with nulliparity, the achieved dilatation of group 2 was significantly higher than that of the group 1 (p<0.05). For women with nulliparity, the abortion time of group 2 was significantly higher than that of the group 1 (p<0.05). Nausea, vomiting, and diarrhea were present only in six patients. Conclusion: Misoprostol administered as 100 µg of misoprostol oral and 100 vaginal, doses repeated 4 hours later provides adequate cervical dilation after an acceptable period in nullipar women undergoing first-trimester pregnancy termination without significant side effect.
Keywords: Misoprostol, first trimester abortion, cervical priming
Keywords
References
- Fong YF, Singh K, Prasad RN. A comparative study using two dose regimens (200 microg or 400 microg) of vaginal misoprostol for pre-operative cervical dilatation in first trimester nulliparae. Br J Obstet Gynaecol 1998; 105: 413-7.
- Ngai SW, Yeung KC, Lao T, Ho PC. Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestation. Contraception 1995; 51: 347-50.
- Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA 1984; 251: 2108-11.
- Bergstrom S, Carlson LA, Weeks JR. The prostaglandins: a family of biologically active lipids. Pharmacol Rev 1968; 20: 1-48.
- Cetin A, Cetin M. Diagnostic and therapeutic decision-making with transvaginal sonography for first trimester spontaneous abortion, clinically thought to be incomplete or complete. Contraception 1998; 57: 393-7.
- Tang OS, Schweer H, Lee SW, Ho PC.. Pharmacokinetics of repeated doses of misoprostol. Hum Reprod 2009; 24: 1862-9.
- Jabir M, Smeet RI. Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage. Saudi Med J 2009; 30: 82-7.
- Ayudhaya OP, Herabutya Y, Chanrachakul B, Ayuthaya NI, O-Prasertsawat P. A comparison of the efficacy of sublingual and oral misoprostol 400 microgram in the management of early pregnancy failure: a randomized controlled trial. J Med Assoc Thai 2006; 89: 5-10.
- Singh K, Fong YF, Dong F. A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks. BJOG 2003; 110: 175-80.
- Ngai SW, Chan YM, Tang OS, Ho PC. The use of misoprostol for pre-operative cervical dilatation prior to vacuum aspiration: a randomized trial. Hum Reprod 1999; 14: 2139-42.
- Taşçı Y, Dilbaz S, Dilbaz B, Haberal A. The Complete Evacuation Rate of Two Different Single Dose Misoprostol Regimens for Termination of Missed Abortion Gynecol Obstet Reprod Med 2007; 13: 143-146.
Abstract
Aim: The aim of this study was to determine the efficacy of two protocol of misoprostol administration for cervical priming before first-trimester surgical abortion. Methods: A total of 167 women, aged 18-42 years, who decided to terminate their pregnancy were evaluated. One hundred two of them (group 1) were received 100 µg of misoprostol oral and 100 vaginal, doses repeated 4 hours later. Sixty five of them (group 2) were received 200 µg oral and 200 µg vaginal doses repeated 6 hours later. Exclusion criteria were systemic disease, a history of cervical operations, bleeding or spotting during the current pregnancy, basal cervical dilation greater than 4mm. Results. The age, gravidity, parity, and gestational age of study groups were comparable (p>0.05). For women with multiparity, the basal dilatation of group 1 was significantly higher than that of the group 2 (p<0.05). For women with nulliparity, the achieved dilatation of group 2 was significantly higher than that of the group 1 (p<0.05). For women with nulliparity, the abortion time of group 2 was significantly higher than that of the group 1 (p<0.05). Nausea, vomiting, and diarrhea were present only in six patients. Conclusion: Misoprostol administered as 100 µg of misoprostol oral and 100 vaginal, doses repeated 4 hours later provides adequate cervical dilation after an acceptable period in nullipar women undergoing first-trimester pregnancy termination without significant side effect.
References
- Fong YF, Singh K, Prasad RN. A comparative study using two dose regimens (200 microg or 400 microg) of vaginal misoprostol for pre-operative cervical dilatation in first trimester nulliparae. Br J Obstet Gynaecol 1998; 105: 413-7.
- Ngai SW, Yeung KC, Lao T, Ho PC. Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestation. Contraception 1995; 51: 347-50.
- Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA 1984; 251: 2108-11.
- Bergstrom S, Carlson LA, Weeks JR. The prostaglandins: a family of biologically active lipids. Pharmacol Rev 1968; 20: 1-48.
- Cetin A, Cetin M. Diagnostic and therapeutic decision-making with transvaginal sonography for first trimester spontaneous abortion, clinically thought to be incomplete or complete. Contraception 1998; 57: 393-7.
- Tang OS, Schweer H, Lee SW, Ho PC.. Pharmacokinetics of repeated doses of misoprostol. Hum Reprod 2009; 24: 1862-9.
- Jabir M, Smeet RI. Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage. Saudi Med J 2009; 30: 82-7.
- Ayudhaya OP, Herabutya Y, Chanrachakul B, Ayuthaya NI, O-Prasertsawat P. A comparison of the efficacy of sublingual and oral misoprostol 400 microgram in the management of early pregnancy failure: a randomized controlled trial. J Med Assoc Thai 2006; 89: 5-10.
- Singh K, Fong YF, Dong F. A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks. BJOG 2003; 110: 175-80.
- Ngai SW, Chan YM, Tang OS, Ho PC. The use of misoprostol for pre-operative cervical dilatation prior to vacuum aspiration: a randomized trial. Hum Reprod 1999; 14: 2139-42.
- Taşçı Y, Dilbaz S, Dilbaz B, Haberal A. The Complete Evacuation Rate of Two Different Single Dose Misoprostol Regimens for Termination of Missed Abortion Gynecol Obstet Reprod Med 2007; 13: 143-146.
Details
| Primary Language | English |
|---|---|
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | November 3, 2009 |
| Published in Issue | Year 2009Volume: 31 Issue: 4 |