Vaginal oral misoprostol_lugansk-state-medical-university

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PRESENTED BYPRESENTED BYLugansk State Medical University Lugansk State Medical University

Block 50 years, Of lugansk Block 50 years, Of lugansk defence, 1. Lugansk - 91045, defence, 1. Lugansk - 91045,

Ukraine. Ukraine.

email : [email protected] / email : [email protected] / [email protected] [email protected]

Official website - Official website - http://www.lsmuedu.com http://www.lsmuedu.com

+38-091-9484-428 +38-091-9484-428

EFFICACY OF VAGINAL VS. EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL FOR ORAL MISOPROSTOL FOR INDUCTION OF LABOR IN INDUCTION OF LABOR IN

MISSED ABORTIONMISSED ABORTION

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OBJECTIVES OBJECTIVES

TO DETERMINE THE EFFICACY OF TO DETERMINE THE EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL AS VAGINAL VS. ORAL MISOPROSTOL AS A LABOR INDUCING AGENT IN A LABOR INDUCING AGENT IN MISSED ABORTION.MISSED ABORTION.

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INTRODUCTIONINTRODUCTION

MISSED ABORTION IS THE FAILURE TO MISSED ABORTION IS THE FAILURE TO EXPEL THE PRODUCTS OF CONCEPTION EXPEL THE PRODUCTS OF CONCEPTION AFTER DEATH OF EMBRYO.AFTER DEATH OF EMBRYO.

MISSED ABORTION IS MANAGED EITHER MISSED ABORTION IS MANAGED EITHER BY SURGICAL & NON SURGICAL METHODS.BY SURGICAL & NON SURGICAL METHODS.

IN RECENT YEARS MISOPROSTOL,A IN RECENT YEARS MISOPROSTOL,A SYNTHETIC PGE1, ANALOGUE, IS BEING SYNTHETIC PGE1, ANALOGUE, IS BEING EVALUATED FOR LABOR INDUCTION.EVALUATED FOR LABOR INDUCTION.

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INTRODUCTION:INTRODUCTION:MISOPROSTOL CAN BE GIVEN MISOPROSTOL CAN BE GIVEN

ORALLY, SUBLINGUALLY, VAGINALLY ORALLY, SUBLINGUALLY, VAGINALLY OR RECTALLY.OR RECTALLY.

IT HAS BEEN EXTENSIVELY STUDIED IT HAS BEEN EXTENSIVELY STUDIED & USED FOR OBSTETRICAL & & USED FOR OBSTETRICAL & GYNAECOLOGICAL CAUSES, SUCH AS GYNAECOLOGICAL CAUSES, SUCH AS PRE-INDUCTION CERVICAL RIPENING, PRE-INDUCTION CERVICAL RIPENING, LABOR INDUCTION, EVACUATION OF LABOR INDUCTION, EVACUATION OF UTERUS AFTER PREGNANCY FAILURE UTERUS AFTER PREGNANCY FAILURE OR VARIOUS MEDICAL REASONS.OR VARIOUS MEDICAL REASONS.

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DESIGNDESIGN

A QUASI EXPERIMENTAL STUDY.A QUASI EXPERIMENTAL STUDY.

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SUBJECT &SETTING:SUBJECT &SETTING:

THIS STUDY WAS PERFORMED IN THIS STUDY WAS PERFORMED IN GYNAE/OBS UNIT II IN HOLY FAMILY GYNAE/OBS UNIT II IN HOLY FAMILY HOSPITAL RAWALPINDI [PAKISTAN].HOSPITAL RAWALPINDI [PAKISTAN].

35 PATIENTS IN VAGINAL 35 PATIENTS IN VAGINAL MISOPROSTOL GROUP & 35 MISOPROSTOL GROUP & 35 PATIENTS IN ORAL MISOPROSTOL PATIENTS IN ORAL MISOPROSTOL GROUP WERE STUDIED.GROUP WERE STUDIED.

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METHOD:METHOD:

TOTAL OF 70 PREGNANT WOMEN TOTAL OF 70 PREGNANT WOMEN ADMITTED WITH MISSED ABORTION OR ADMITTED WITH MISSED ABORTION OR BLIGHTED OVUM OF 8wks TO 24wks OF BLIGHTED OVUM OF 8wks TO 24wks OF GESTATION DURING THE PERIOD OF GESTATION DURING THE PERIOD OF JUNE 2005 TO NOV 2005.JUNE 2005 TO NOV 2005.

MISSED ABORTION WAS CONFIRMED MISSED ABORTION WAS CONFIRMED ON ULTRASOUND.ON ULTRASOUND.

INITIAL EVALUATION OF PTS WAS DONE.INITIAL EVALUATION OF PTS WAS DONE.CONSENT OF PATIENT.CONSENT OF PATIENT.

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METHODS:METHODS:

THE CASES WERE RANDOMIZED IN THE CASES WERE RANDOMIZED IN TWO GROUPS.TWO GROUPS.

ONE FOR ORAL MISOPROSTOL & ONE FOR ORAL MISOPROSTOL & OTHER FOR VAGINAL MISOPROSTOL.OTHER FOR VAGINAL MISOPROSTOL.

IN ONE GROUP 400ug WAS INSERTED IN ONE GROUP 400ug WAS INSERTED UNDER FULL ASEPTIC CONDITIONS UNDER FULL ASEPTIC CONDITIONS HIGH UP IN POSTERIOR FORNIX OF HIGH UP IN POSTERIOR FORNIX OF VAGINA WHILE IN SECOND GROUP VAGINA WHILE IN SECOND GROUP PATIENT TAKE IT ORALLY.PATIENT TAKE IT ORALLY.

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METHODS:METHODS:

THE DOSE OF MISOPROSTOL WAS THE DOSE OF MISOPROSTOL WAS REPEATED AFTER EVERY 4hrs TO A REPEATED AFTER EVERY 4hrs TO A MAX. OF FOUR DOSES IN 24 hrs.MAX. OF FOUR DOSES IN 24 hrs.

IF COMPLETE EXPULSION DID NOT IF COMPLETE EXPULSION DID NOT OCCUR WITH IN 48hrs & IF PATIENT OCCUR WITH IN 48hrs & IF PATIENT BLEED HEAVILY THEN ERPC WAS BLEED HEAVILY THEN ERPC WAS DONE.DONE.

FOLLOW UP.FOLLOW UP.

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Vaginal Misoprostol ORAL Misoprostol

RESULTS: [PATIENTS RESULTS: [PATIENTS DISTRIBUTION IN BOTH DISTRIBUTION IN BOTH

GROUP]GROUP]35353535

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RESULTS [AGE OF PATIENT]RESULTS [AGE OF PATIENT]

0

10

20

30

40

50

60

70

80

<20 years 20-30 years >35 years

Oral Misoprostol Vaginal Misoprostol

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RESULTS: [PARITY]RESULTS: [PARITY]

0102030405060

Pri

mig

ravi

da

OralMisoprostol

VaginalMisoprostol

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RESULTS:RESULTS:VAGINALMisoprostolGROUP

ORALMisoprostolGROUP

MEANINDUCTIONTOEXPULSIONTIME

9.16 HRS 12.09HRS

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RESULTS: [INDUCTION TO RESULTS: [INDUCTION TO EXPULSION TIME]EXPULSION TIME]


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RESULTS:RESULTS:

OTHERMEASURE

VAGINALGROUP3%

ORAL GROUP

7%ERPC[REQUIRED] 21% 27%

COMPLETEEXPULTION 52% 28%

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RESULTS: [REQUIREMENT RESULTS: [REQUIREMENT FOR ERPC IN BOTH GROUP]FOR ERPC IN BOTH GROUP]

46

47

48

49

50

51

52

ERPC

Oral misoprostol Vaginal Misoprostol

.

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RESULTS: [REQUIRMENT OF RESULTS: [REQUIRMENT OF OXYTOCIN AUGMENTATION]OXYTOCIN AUGMENTATION]

Oral Misoprostol

Vaginal Misoprostol


2020

RESULTS: [COMPARISON OF RESULTS: [COMPARISON OF ERPC & OXYTOCIN FOR ERPC & OXYTOCIN FOR

COMPLETE EVACUATION]COMPLETE EVACUATION]

0%

20%

40%

60%

80%

100%


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COMPLICATIONS: [IN BOTH COMPLICATIONS: [IN BOTH GROUPS]GROUPS]

feve

r

vom

otin

g

dia

rrho

ea

faild

term

ina

tion

noco

mp

lica

tion

Oral Misoprostol

VaginalMisoprostol


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DISCUSSION:DISCUSSION:

TERMINATION OF PREGNANCY IS AN TERMINATION OF PREGNANCY IS AN INTEGRAL PART OF ANY INTEGRAL PART OF ANY GYNAECOLOGICAL PRACTICE.GYNAECOLOGICAL PRACTICE.

DIFFERENT METHODS OF CERVICAL DIFFERENT METHODS OF CERVICAL RIPENING HAVE BEEN USED WITH RIPENING HAVE BEEN USED WITH VARIABLE RESULTS.VARIABLE RESULTS.

CHOHAN,etal, HAVE DONE A STUDY CHOHAN,etal, HAVE DONE A STUDY USING EXTRA AMNIOTIC PGF2 alpha FOR USING EXTRA AMNIOTIC PGF2 alpha FOR MID TRIMESTER INDUCTION OF LABOR IN MID TRIMESTER INDUCTION OF LABOR IN PTS WITH LATE MISSED ABORTION.PTS WITH LATE MISSED ABORTION.

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THEY CLAIMED THAT 100% EXPULSION THEY CLAIMED THAT 100% EXPULSION RATE WHICH IS COMPARABLE TO 94% RATE WHICH IS COMPARABLE TO 94% EXPULSION RATE OBSERVED IN OUR EXPULSION RATE OBSERVED IN OUR STUDY. STUDY.

MUFFLEY PE,[2002]CONDUCTED A MUFFLEY PE,[2002]CONDUCTED A STUDY ON VAGINAL MISOPROSTOL STUDY ON VAGINAL MISOPROSTOL COMPARED WITH SURGICAL TREATMENT COMPARED WITH SURGICAL TREATMENT IN MISSED ABORTION & CLAIMED THAT IN MISSED ABORTION & CLAIMED THAT 60% PATIENTS IN MISOPROSTOL GROUP60% PATIENTS IN MISOPROSTOL GROUP

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NOT REQUIRED SURGICAL TREATMENT NOT REQUIRED SURGICAL TREATMENT COMPARE TO 52% COMPLETE UTERINE COMPARE TO 52% COMPLETE UTERINE EVACUATION IN OUR STUDY.EVACUATION IN OUR STUDY.

ELSHEIKH,etal[2001] USED ORAL & ELSHEIKH,etal[2001] USED ORAL & VAGINAL MISOPROSTOL IN SECOND VAGINAL MISOPROSTOL IN SECOND TRIMESTER MISSED ABORTION USING TRIMESTER MISSED ABORTION USING SAME DOSAGE AS IN OUR STUDY, MEAN SAME DOSAGE AS IN OUR STUDY, MEAN INDUCTION TO EXPULTION TIME IS SAME INDUCTION TO EXPULTION TIME IS SAME &THE EFFICACY OF METHOD IS ALSO &THE EFFICACY OF METHOD IS ALSO SIMILAR.SIMILAR.

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CONCLUSION:CONCLUSION:

VAGINAL MISOPROSTOL WAS FOUND VAGINAL MISOPROSTOL WAS FOUND MORE EFFECTIVE WITH LESSER SIDE MORE EFFECTIVE WITH LESSER SIDE EFFECTS AS COMPARE TO ORAL FOR EFFECTS AS COMPARE TO ORAL FOR MISSED ABORTION.MISSED ABORTION.

IT IS OBSERVED IN OUR IT IS OBSERVED IN OUR STUDY THAT MISOPROSTOL STUDY THAT MISOPROSTOL IS CHEAPER & IS CHEAPER & EFFICIENT FOR EFFICIENT FOR MISSED ABORTION. MISSED ABORTION.

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KEY POINTS:KEY POINTS:

MISOPROSTOL HAS BEEN ON MARKET SINCE MISOPROSTOL HAS BEEN ON MARKET SINCE 1985 UNDER BRAND NAME OF CYTOTEC. IT 1985 UNDER BRAND NAME OF CYTOTEC. IT IS AVAILABLE IN OVER 80 COUNTRIES IS AVAILABLE IN OVER 80 COUNTRIES WORLD WIDE FOR TREATMENT OF GASTRIC WORLD WIDE FOR TREATMENT OF GASTRIC ULCERS. ULCERS.

MORE THAN 300 MORE THAN 300 ARTICLES HAVE BEEN ARTICLES HAVE BEEN PUBLISHED SHOWING PUBLISHED SHOWING

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KEY POINTS:KEY POINTS:

USEFULNESS OF MISOPROSTOL IN NO. OF USEFULNESS OF MISOPROSTOL IN NO. OF INDICATIONS IN OBS & GYNAECOLOGY.INDICATIONS IN OBS & GYNAECOLOGY.

NO PROPER DOSAGE IS UPTILL NO PROPER DOSAGE IS UPTILL DECIDED DECIDED &THE COMPANY &THE COMPANY NEVER APPLIED FOR NEVER APPLIED FOR APPROVAL FOR APPROVAL FOR OBSTETRICS. OBSTETRICS.

THANK YOUTHANK YOU

Lugansk State Medical University Lugansk State Medical University

Block 50 years, Of lugansk defence, 1. Block 50 years, Of lugansk defence, 1. Lugansk - 91045, Ukraine.Lugansk - 91045, Ukraine.

email : [email protected] / email : [email protected] / [email protected]@lsmuedu.com

Official website - http://www.lsmuedu.comOfficial website - http://www.lsmuedu.com

+38-091-9484-428+38-091-9484-4282828

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