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• W2894620307 abstract "INTRODUCTION:Mid trimester termination of pregnancy is one of the controversialissues in obstetrics and gynecology which has moral, technical,emotional and social issues. Many Indian women opt for MTP (MedicalTermination of Pregnancy) in second trimester inspite of increasedmorbidity like excessive hemorrhage, uterine perforation and infectionbecause of unplanned pregnancies. In addition, there is a continuousneed for termination of pregnancy in second trimester as there areadvanced antenatal diagnostic tests which enable us to identify lethalfetal anomalies.Termination of pregnancy in second trimester is associated withmuch more morbidity and mortality than when it is done in the firsttrimester. The various methods for second trimester termination ofpregnancy are still under scrutiny and the search for the ideal methodwhich is the safest, easiest, cheapest and optimally most effective is stillgoing on.Second trimester pregnancy termination can be carried out byboth medical and surgical methods. Medical methods are comparativelysafer and have superseded the surgical methods because of risksinvolved in surgical methods.AIMS AND OBJECTIVES: 1. To compare the abortifacient efficacy of vaginal misoprostolwith mifepristone and vaginal misoprostol alone in secondtrimester 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 bycomparing the various parameters.MATERIALS AND METHODS:This study comparing the efficacy of mifepristone – vaginalmisoprostol combination with vaginal misoprostol alone as a method ofsecond trimester abortion conduct at Institute of obstetrics andGynaecology, 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 trimesterat Department of family welfare, IOG and patientsrequiring 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 indicatorsas 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 pregnancytermination or diagnosed to have anomalous fetus wereconsidered for the study. Fifty patients received 200mgMifepristone ,followed by 800mcg vaginal misoprostol 36 hourslater, followed by 400mcg vaginal misoprostol every 3 hoursinterval of maximum 4 doses or until delivery. In another fiftywomen, 800mcg vaginal misoprostol followed by 400 mcgvaginal 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 thegroups. Induction abortion interval in primigravida is morecompared to multigravida in both group and it was statisticallysignificant in Mifepristone and misoprostol combination (pvalue.01).4. The most common indication for pregnancy termination in bothgroup was unwanted pregnancy due to social reasons.5. Induction abortion interval in Mifepristone and misporstol groupwas 8.2 hours and that in misoprostol alone group was 12.8hours.The difference between them was found to be statisticallysignificant (p value 0.000).6. According to the gestational age, induction abortion interval wasnot statistically significant in both groups.7. The percentage of complete abortion in Mifepristone andmisoporostol group was 90% and in misoprostol group was 72%but the difference was not statistically significant. The percentageof incomplete abortion was 10% in Mifepristone and misoprostolgroup and was 24% in misoprostol alone group which did notreach statistical significance.8. There was no failure in Mifepristone and misoprostol group and4% in misoprostol alone group, but it was not statisticallysignificant. The complete abortion rate within 12 hours was 76%in Mifepristone and misoprostol group and 36% in misoprostolalone group and in 24 hrs it was 100% and 96% respectively.Additional intervention needed in Mifepristone and misoprostolcombination group was 10% and in misoprostol alone group was28%and most common being instrumental evacuation.9. The mean dose of misoprostol used was 1376 mcg and that ofmisoprostol group was 1992 mcg.10. The average cost in misoprostol alone group was rupees 194.2and Mifepristone and Misoprostol combination group was rupees483.1, which is two times higher.11. There was no statistically significant side effects between twogroups and no major maternal complications found in both group.12. It was observed that no bleeding (or) abdominal pain (or) anyadverse reactions were not reported after administration ofMifepristone prior to vaginal Misoprostol administration (36hrs). so Mifepristone could be administered safely prior tohospital admission for termination.CONCLUSION:Comparing Mifepristone and Vaginal misoprostol combinationwith vaginal misoprostol alone for second trimester pregnancytermination, it was observed that, Mifepristone with vaginal misoprostol combination groupis associated with shorter induction abortion interval and100% success rate. The complete abortion rate , successrate and side effects were comparable in both group.Vaginal misoprostol alone group also dosen’t have the 36hours anxiety/unease from the time of mifepristoneadministration.Vaginal misoprostol alone group is cost effective.Hence vaginal misoprostol alone group can also beconsidered as an effective alternative for Mifepristone andvaginal misoprostol combination group." @default.
• W2894620307 created "2018-10-12" @default.
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• W2894620307 date "2011-04-01" @default.
• W2894620307 modified "2023-09-27" @default.
• W2894620307 title "Comparative study of mifepristone plus vaginal misoprostol Versus vaginal misoprostol alone for second trimester abortion" @default.
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