Arunadevi, T A (2011) Comparative study of mifepristone plus vaginal misoprostol Versus vaginal misoprostol alone for second trimester abortion. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Mid trimester termination of pregnancy is one of the controversial issues in obstetrics and gynecology which has moral, technical, emotional and social issues. Many Indian women opt for MTP (Medical Termination of Pregnancy) in second trimester inspite of increased morbidity like excessive hemorrhage, uterine perforation and infection because of unplanned pregnancies. In addition, there is a continuous need for termination of pregnancy in second trimester as there are advanced antenatal diagnostic tests which enable us to identify lethal fetal anomalies. Termination of pregnancy in second trimester is associated with much more morbidity and mortality than when it is done in the first trimester. The various methods for second trimester termination of pregnancy are still under scrutiny and the search for the ideal method which is the safest, easiest, cheapest and optimally most effective is still going on. Second trimester pregnancy termination can be carried out by both medical and surgical methods. Medical methods are comparatively safer and have superseded the surgical methods because of risks involved in surgical methods. AIMS AND OBJECTIVES: 1. To compare the abortifacient efficacy of vaginal misoprostol with mifepristone and vaginal misoprostol alone in second trimester pregnancy termination. 2. To compare the induction -abortion intervals. 3. To compare side effects and complications. 4. To compare the Cost effectiveness. 5. To identify the suitable method for second trimester MTP by comparing the various parameters. MATERIALS AND METHODS: This study comparing the efficacy of mifepristone – vaginal misoprostol combination with vaginal misoprostol alone as a method of second trimester abortion conduct at Institute of obstetrics and Gynaecology, Chennai – 08 during October 2009 – October 2010. Study design: Prospective randomized comparative study. Study Place : Institute of obstetrics and Gynaecology, Chennai-8. Collaborating Unit : Department of family welfare, IOG. Study Population : Patients requesting abortion in their second trimester at Department of family welfare, IOG and patients requiring abortion at second trimester at IOG, Egmore. Period of Study : OCT2009 – OCT2010. Sample Size: 100 (Randam allocation to either group), 50 – mifepristone + vaginal misoprostol group, 50 – vaginal misoprostol group. Inclusion Criteria: 14 – 20 weeks gestation, Woman full filling the MTP indicators as per the MTP act ,Single live fetus, Present with closed cervical os, No vaginal bleeding and Patients consenting to this procedure only. Exclusion Criteria : History of previous uterine surgery (but not a contraindication), Known allergy / Contraindications to mifepristone (or misoprostol / prostaglandin), Multiple fetus, Intra uterine fetal demise, Presentation in active labour, Low lying placenta. SUMMARY: 1. One hundred Patients opting for second trimester pregnancy termination or diagnosed to have anomalous fetus were considered for the study. Fifty patients received 200mg Mifepristone ,followed by 800mcg vaginal misoprostol 36 hours later, followed by 400mcg vaginal misoprostol every 3 hours interval of maximum 4 doses or until delivery. In another fifty women, 800mcg vaginal misoprostol followed by 400 mcg vaginal misoprostol every 3 hrs interval of maximum 4 doses or until delivery. 2. The two groups were comparable with respect to maternal age, parity and gestational age at the time of induction of abortion. Majority of patients in either group were in the age group of 21- 25 years. The commonest gestational age in both group was between 17-18 weeks. 3. There were more multigravida than primigravida in both the groups. Induction abortion interval in primigravida is more compared to multigravida in both group and it was statistically significant in Mifepristone and misoprostol combination (pvalue.01). 4. The most common indication for pregnancy termination in both group was unwanted pregnancy due to social reasons. 5. Induction abortion interval in Mifepristone and misporstol group was 8.2 hours and that in misoprostol alone group was 12.8 hours.The difference between them was found to be statistically significant (p value 0.000). 6. According to the gestational age, induction abortion interval was not statistically significant in both groups. 7. The percentage of complete abortion in Mifepristone and misoporostol group was 90% and in misoprostol group was 72% but the difference was not statistically significant. The percentage of incomplete abortion was 10% in Mifepristone and misoprostol group and was 24% in misoprostol alone group which did not reach statistical significance. 8. There was no failure in Mifepristone and misoprostol group and 4% in misoprostol alone group, but it was not statistically significant. The complete abortion rate within 12 hours was 76% in Mifepristone and misoprostol group and 36% in misoprostol alone group and in 24 hrs it was 100% and 96% respectively. Additional intervention needed in Mifepristone and misoprostol combination group was 10% and in misoprostol alone group was 28%and most common being instrumental evacuation. 9. The mean dose of misoprostol used was 1376 mcg and that of misoprostol group was 1992 mcg. 10. The average cost in misoprostol alone group was rupees 194.2 and Mifepristone and Misoprostol combination group was rupees 483.1, which is two times higher. 11. There was no statistically significant side effects between two groups and no major maternal complications found in both group. 12. It was observed that no bleeding (or) abdominal pain (or) any adverse reactions were not reported after administration of Mifepristone prior to vaginal Misoprostol administration (36 hrs). so Mifepristone could be administered safely prior to hospital admission for termination. CONCLUSION: Comparing Mifepristone and Vaginal misoprostol combination with vaginal misoprostol alone for second trimester pregnancy termination, it was observed that, Mifepristone with vaginal misoprostol combination group is associated with shorter induction abortion interval and 100% success rate. The complete abortion rate , success rate and side effects were comparable in both group. Vaginal misoprostol alone group also dosen’t have the 36 hours anxiety/unease from the time of mifepristone administration. Vaginal misoprostol alone group is cost effective. Hence vaginal misoprostol alone group can also be considered as an effective alternative for Mifepristone and vaginal misoprostol combination group.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparative study ; mifepristone plus vaginal misoprostol ; vaginal misoprostol ; second trimester abortion. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 10:48 |
| Last Modified: | 10 Dec 2017 01:26 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4081 |
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