Reenu Sindhuja, N (2009) Comparative study of Mifepristone and Vaginal Misoprostol combination over Vaginal misoprostol alone in First Trimester Abortion. Masters thesis, Madras Medical College, Chennai.
|
Text
200200109reenu.pdf Download (287kB) | Preview |
Abstract
INTRODUCTION: MTP act can have an impact on reduction of maternal mortality and morbidity through safe abortion. Where abortion is legal, it is generally reasonably safe, where it is illegal, complications are common, and about 78, 000 women die every year from these complications. "Regardless of personal feelings about the ethics of interrupting pregnancy professionals have a duty to know the medical facts about abortion and share them with their patients". Worldwide, about 46 million Women have abortions each year, and about half of these procedures are illegal and considered "unsafe" by the World Health Organisation. Unsafe abortion is a "Procedure for terminating an unwanted pregnancy either by person lacking the necessary skills or in an environment lacking the minimal medical standards or both." AIMS AND OBJECTIVES: 1. To assess the efficacy of mifepristone & misoprostol combination in first trimester abortion 2. To compare this combination with vaginal misoprostol alone for first trimester MTP 3. To compare the various parameters involved in MTP in both the methods & assess the most suitable method for first trimester MTP. MATERIALS AND METHODS : The present study was carried out at Institute of Obstetrics and Gynaecology, Chennai - 8 during 2007 - 2008. The purpose of study is to compare the efficacy of mifepristone - vaginal misoprostol combination with vaginal misoprostol as a method of first trimester abortion. Study Design : Comparative Study Study Place : Institute of Obstetrics and Gynaecology, Chennai - 600 008. Study Population : Patients requesting MTP who attended family planning Dept. IOG, Chennai. Sample size : 100 (Random Allocation to either of groups). 50 - Mifepristone + Misoprostol Group, 50 - Misoprostol Group. Year of Study : Jan 2007 - July 2008. Inclusion Criteria: 1. Confirmed pregnancy up to 9 weeks, 2. Single intra uterine live gestation, 3. No other medical or surgical contra indication for the procedure, 4. Contraceptive failure, 5. MTP for social & eugenic causes. Exclusion Criteria: 1. Gestation age > 9 weeks, 2. Women smoke > 10 cigarettes / day, 3. Missed / incomplete / inevitable abortion, 4. Suspected ectopic pregnancy, 5. Any previous attempts at terminating the present pregnancy, 6. Pregnancies with IUD in situ. METHODOLOGY: All these women were thoroughly investigated before MTP. The work up included; • Details of patient, • Investigations, • Examination of vital signs, • Abdominal and pelvic examination, • USG only on indication, • Counseling. Such of those women who were willing to adhere to the protocol were included for the study, provided they fulfilled the inclusion criteria. SUMMARY: This is a comparative study of medical methods for first trimester abortion conducted at Institute of obstetrics and Gynaecology, Egmore, Chennai - 600 008. Total no. of patients – 100. No. of women who were given mifepristone & misoprostol combination – 50. No. of misoprostol alone – 50. Following were the observations of this study. 1. Most of the patients were in the age group 21-30 and parous. 2. 4% of patients were unmarried who responded well for medical methods. 3. Almost all patients had various symptoms in both groups. 4. Expulsion was complete in the mifepristone / misoprostol group with only 2 woman needing check curettage for confirmation of complete abortion. However in one women, there was no response and their pregnancy was terminated by MVA. On the other hand 48% of women in the misoprostol alone group had to have curettage for completing the abortion process, and 10% of patients there was no response. 5. Induction abortion time is less in patients with mifepristone / misoprostol than misoprostol alone (4-5 hours vs 20-22 hrs. respectively). 6. None of the patients needed blood transfusion or volume expanders. 7. None of the patients had delayed bleeding after 45 days. On an average Bleeding stopped within 25 days of expelling products. 8. Misoprostol is less expensive and efficacious. However induction abortion interval is prolonged than mifepristone / misoprostol combination. 9. Though mifepristone is more expensive, the high complete abortion rate and expulsion within 4-5 hrs of misoprostol administration makes it a preferred method where cost is not a restraining factor. CONCLUSION: 1. Mifepristone misoprostol combination is an effective out patient procedure for early MTP and is ideal for home management. 2. Complete abortion rate is high with this combination. 3. Similarly the induction abortion interval with this method is also less. 4. Other associated complications are less. The only confounding factor is the cost involved which is about 20 times that of misoprostol alone. This makes the routine use of mifepristone misoprostol combination for first trimester abortion an effective option where cost is not a consideration or in situations where an early abortion is required.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Comparative study of mifepristone and vaginal misoprostol combination over Vaginal misoprostol alone in first trimester abortion |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 13:02 |
| Last Modified: | 09 Dec 2017 10:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4113 |
Actions (login required)
 |
View Item |
