مقايسه تاثير ميزوپروستول واژينال با اداره انتظاري در ختم سقط زودرس حاملگي

A comparison between vaginal misoprostol and expectational management in the termination of early pregnancy failure

Background: Pregnancy termination before the 20 week of gestational age is referred to as abortion. There are two common ways to treat early pregnancy failure: expectant management and surgical curettage. Some new methods have been suggested for the termanation of early pregnancy failure. The aim of the present study was to determine whether the medical management of vaginal misoprostol for early pregnancy failure is more effective than the expectant management. Materials and Methods: In this study 80 pregnant women with early pregnancy failure were referred to Fatemieh hospital, Hamadan, Iran. Inclusion criteria for the study were: fetal pole more than 6 mm, accompanied by the absence of fetal heart in the transvaginal ultrasonography; fetal pole more than 10 mm in the absence of fetal heait rate in abdominal ultrasonograpgy; empty gestational sac, (16 mm diameter) and gestational age less than 12 weeks. Exclusion criteria were: ectopic pregnancy (EP), severe vaginal bleeding, dilated cervix and misoprostol medical contraindications. The patients were randomly divided into two equal groups: A and B. Patients in group A received 4 vaginal misoprostol tablets (200fig). Twenty four hours later, ultrasonography was repeated. In the case of the presence of pregnancy product, the first dose of misoprostol was readministered and again ultrasonography was performed. If abortion failed, surgical curettage was done. Patients received expectant management for 2 weeks in group B. Patients in group A were evaluated for adverse drug reactions. Using SPSS-13 statistical package, t-student and x2 were used for the comparison. Without the administration of any drug, patients in group B received expectational management for 2 weeks. Results: There was no significant difference between two groups for both age and the gestational failure age (p>0.05). Abortion rate in misoprostol and expectational treatment groups were 87.5% and 20%, respectively. The percentage of vaginally delivered patients with the first and second dose of misoprostol was 60% (n=24) and 27.5% (n=ll), respectively. Among the 40 patients of expectational management, 24 patients (57.5%) received dilation and curettage while a patients (22.5%) undertook curttage. Misoprostol- induced side effects (e.g. fever>38c, nausea, vomitting, diarrhea and pain) were seen in some patients (12.5%) of the first group.