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Use of cervical dilators is not necessary during curettage after combined oral and vaginal administration of misoprostol from five to ten weeks of pregnancy

Year 2010, Volume: 32 Issue: 2, 205 - 208, 16.01.2010

Abstract

Abstract

Aim. The aim of this study was to determine the efficacy of oral and vaginal misoprostol administered for cervical priming in nullipar women before first-trimester surgical abortion. Methods. Medical records of 84 nulliparous women, aged 18-42 years, who admitted for pregnancy termination request were reviewed retrospectively. The pregnancies were between 5 and 10 weeks of gestation. 100 µg misoprostol was administered by oral and vaginal route in 84 patients. The doses repeated 4 hours later. Exclusion criteria were systemic disease, a history of cervical operations, bleeding or spotting during the current pregnancy and basal cervical dilation greater than 4mm. Results. Targeted cervical dilatation for pregnancy termination was determined according to gestational age of every patient (for gestations at 5, 6, 7, 8, 9, and 10 weeks, required cervical dilatations from 5, 6, 7, 8, 9, and 10 mm, respectively). A significant correlation was found between gestational ages and achieved cervical dilatation after misoprostol use. Conclusions. Suggested administration of misoprostol provides adequate cervical dilatation. Use of cervical dilators is not necessary during curettage after administration 100 µg misoprostol oral and vaginal two times four hours apart from five to ten weeks of pregnancy.

Key words: Misoprostol; first trimester abortion; cervical priming

 

Özet

Amaç. Bu çalışmanın amacı birinci trimester cerrahi abortus öncesi nullipar kadınlara servikal olgunlaşma için uygulanan oral ve vajinal misoprostolün etkinliğinin belirlenmesidir. Yöntem. Gebelik sonlandırması istemiyle başvuran, 18-42 yaş arası toplam 84 nullipar kadının medikal kayıtları geriye dönük olarak değerlendirilmiştir. Gebelikler 5-10. gebelik hafaları arasında idi. 84 hastaya oral ve vajinal yolla 100 µg misoprostol uygulanmıştır. Dozlar 4 saat sonra tekrarlanmıştır. Dışlama kriterleri sistemik hastalık, servikal operasyon hikayesi, mevcut gebelik süresince kanama veya lekelenme ve bazal servikal dilatasyon düzeyinin 4 mm’den fazla olmasıydı. Bulgular. Her hastada gebelik terminasyonu için hedeflenen servikal dilatasyon gestasyonel yaşa göre belirlenmiştir (5, 6, 7, 8, 9 ve 10 haftalık gebelikler için gerekli görülen servikal dilatasyon sırasıyla 5, 6, 7, 8, 9 ve 10 mm). Sonuçlar. Misoprostolün önerilen uygulama şekli yeterli servikal dilatasyon sağlar. Beş ile on hafta arasındaki gebeliklerde dört saat ara ile iki kez oral ve vajinal 100 µg misoprostol uygulamasından sonra küretaj esnasında servikal bujiye gerek kalmamaktadır.

 

Anahtar sözcükler: Misoprostol, ilk trimester abortus, servikal olgunlaşma

References

  • Clark S, Blum J, Blanchard K, Galvão L, Fletcher H, Winikoff B. Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States. Int J Gynaecol Obstet 2002; 76: 65-74.
  • Goldberg A, Greenberg M, Darney P. Misoprostol and Pregnancy. Journal of Medicine 2001; 344: 38-47.
  • Blanchard K, Winikoff B, Ellertson C. Misoprostol used alone for the termination of early pregnancy: a review of the evidence. Contraception 1999; 59:209-217.
  • Moore ML. Misoprostol-is more research needed? J Perinat Educ 2002; 11: 43-7.
  • Watkinson G, Hopkins A, Akbar FA. The therapeutic efficacy of misoprostol in peptic ulcer disease. Postgrad Med J 1988; 64: 60-77.
  • Tang OS, Schweer H, Seyberth HW, Lee SWH, Ho PC. Pharmacokinetics of different routes of administration ofmisoprostol. Hum Reprod 2002; 17: 332-6.
  • Meckstroth KR, Whitaker AK, Bertisch S, Goldberg AB, Darney PD. Misoprostol administered by epithelial routes. Obstet Gynaecol 2006; 108: 82-90.
  • Ho PC, Ngai SW, Liu KL, Wong GC, Lee SW. Vaginal misoprostol compared with oral misoprostol in termination of second trimester pregnancy. Obstet Gynecol 1997; 90: 735-8.
  • Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet 2007; 99: 160-7.
  • El-Refaey H, Calder L, Wheatley DN, Templeton A. Cervical priming with prostaglandin E1 analogues, misoprostol and gemeprost. Lancet 1994; 343: 1207- 9.
  • Kotsonis FN, Dodd DC, Regnier B, Kohn FE. Preclinical toxicology profile of misoprostol. Dig Dis Sci 1985; 30: 142-6.
  • Henriques A, Lourenco AV, Ribeirinho A, Ferreira H, Graca LM. Maternal death related to misoprostol overdose. Obstet Gynaecol 2007; 109: 489-90.
  • 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: 143-6.

Original research - Orijinal araştırma

Year 2010, Volume: 32 Issue: 2, 205 - 208, 16.01.2010

Abstract

Amaç. Bu çalışmanın amacı birinci trimester cerrahi abortus öncesi nullipar kadınlara servikal olgunlaşma için uygulanan oral ve vajinal misoprostolün etkinliğinin belirlenmesidir. Yöntem. Gebelik sonlandırması istemiyle başvuran, 18-42 yaş arası toplam 84 nullipar kadının medikal kayıtları geriye dönük olarak değerlendirilmiştir. Gebelikler 5-10. gebelik hafaları arasında idi. 84 hastaya oral ve vajinal yolla 100 µg misoprostol uygulanmıştır. Dozlar 4 saat sonra tekrarlanmıştır. Dışlama kriterleri sistemik hastalık, servikal operasyon hikayesi, mevcut gebelik süresince kanama veya lekelenme ve bazal servikal dilatasyon düzeyinin 4 mm’den fazla olmasıydı. Bulgular. Her hastada gebelik terminasyonu için hedeflenen servikal dilatasyon gestasyonel yaşa göre belirlenmiştir (5, 6, 7, 8, 9 ve 10 haftalık gebelikler için gerekli görülen servikal dilatasyon sırasıyla 5, 6, 7, 8, 9 ve 10 mm). Sonuçlar. Misoprostolün önerilen uygulama şekli yeterli servikal dilatasyon sağlar. Beş ile on hafta arasındaki gebeliklerde dört saat ara ile iki kez oral ve vajinal 100 µg misoprostol uygulamasından sonra küretaj esnasında servikal bujiye gerek kalmamaktadır

References

  • Clark S, Blum J, Blanchard K, Galvão L, Fletcher H, Winikoff B. Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States. Int J Gynaecol Obstet 2002; 76: 65-74.
  • Goldberg A, Greenberg M, Darney P. Misoprostol and Pregnancy. Journal of Medicine 2001; 344: 38-47.
  • Blanchard K, Winikoff B, Ellertson C. Misoprostol used alone for the termination of early pregnancy: a review of the evidence. Contraception 1999; 59:209-217.
  • Moore ML. Misoprostol-is more research needed? J Perinat Educ 2002; 11: 43-7.
  • Watkinson G, Hopkins A, Akbar FA. The therapeutic efficacy of misoprostol in peptic ulcer disease. Postgrad Med J 1988; 64: 60-77.
  • Tang OS, Schweer H, Seyberth HW, Lee SWH, Ho PC. Pharmacokinetics of different routes of administration ofmisoprostol. Hum Reprod 2002; 17: 332-6.
  • Meckstroth KR, Whitaker AK, Bertisch S, Goldberg AB, Darney PD. Misoprostol administered by epithelial routes. Obstet Gynaecol 2006; 108: 82-90.
  • Ho PC, Ngai SW, Liu KL, Wong GC, Lee SW. Vaginal misoprostol compared with oral misoprostol in termination of second trimester pregnancy. Obstet Gynecol 1997; 90: 735-8.
  • Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet 2007; 99: 160-7.
  • El-Refaey H, Calder L, Wheatley DN, Templeton A. Cervical priming with prostaglandin E1 analogues, misoprostol and gemeprost. Lancet 1994; 343: 1207- 9.
  • Kotsonis FN, Dodd DC, Regnier B, Kohn FE. Preclinical toxicology profile of misoprostol. Dig Dis Sci 1985; 30: 142-6.
  • Henriques A, Lourenco AV, Ribeirinho A, Ferreira H, Graca LM. Maternal death related to misoprostol overdose. Obstet Gynaecol 2007; 109: 489-90.
  • 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: 143-6.
There are 13 citations in total.

Details

Primary Language English
Journal Section Surgical Science Research Articles
Authors

Meral Çetin

Çağlar Yıldız

Publication Date January 16, 2010
Published in Issue Year 2010Volume: 32 Issue: 2

Cite

AMA Çetin M, Yıldız Ç. Use of cervical dilators is not necessary during curettage after combined oral and vaginal administration of misoprostol from five to ten weeks of pregnancy. CMJ. June 2010;32(2):205-208.