EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL FOR    INDUCTION OF LABOR IN MISSED ABORTION                PRESENTED BY         ...
OBJECTIVES   TO DETERMINE THE EFFICACY OF    VAGINAL VS. ORAL MISOPROSTOL AS A    LABOR INDUCING AGENT IN MISSED    ABORT...
INTRODUCTION MISSED ABORTION IS THE FAILURE TO  EXPEL THE PRODUCTS OF CONCEPTION  AFTER DEATH OF EMBRYO. MISSED ABORTION...
4
INTRODUCTION: MISOPROSTOL CAN BE GIVEN ORALLY,  SUBLINGUALLY, VAGINALLY OR  RECTALLY. IT HAS BEEN EXTENSIVELY STUDIED & ...
DESIGN   A QUASI EXPERIMENTAL STUDY.                                  6
SUBJECT &SETTING: THIS STUDY WAS PERFORMED IN  GYNAE/OBS UNIT II IN HOLY FAMILY  HOSPITAL RAWALPINDI [PAKISTAN]. 35 PATI...
METHOD: TOTAL OF 70 PREGNANT WOMEN  ADMITTED WITH MISSED ABORTION OR  BLIGHTED OVUM OF 8wks TO 24wks OF  GESTATION DURING...
METHODS: THE CASES WERE RANDOMIZED IN TWO  GROUPS. ONE FOR ORAL MISOPROSTOL & OTHER  FOR VAGINAL MISOPROSTOL. IN ONE GR...
10
METHODS: THE DOSE OF MISOPROSTOL WAS  REPEATED AFTER EVERY 4hrs TO A MAX.  OF FOUR DOSES IN 24 hrs. IF COMPLETE EXPULSIO...
RESULTS: [PATIENTSDISTRIBUTION IN BOTH GROUP] 35 35       Vaginal Misoprostol   ORAL Misoprostol                        ...
RESULTS [AGE OF PATIENT]8070605040302010 0     <20 years   20-30 years      >35 years      Oral Misoprostol         Vagina...
RESULTS: [PARITY]   60    50    40    30    20                    Oral    10                    Misoprostol     0        ...
RESULTS:            VAGINAL       ORAL            Misoprostol   Misoprostol            GROUP         GROUPMEANINDUCTIONTO ...
RESULTS: [INDUCTION TO       EXPULSION TIME]                                                 16        Oral Misoprostol  ...
RESULTS:OTHER        VAGINAL    ORAL GROUPMEASURE      GROUP             3%         7%ERPC[REQUIRED]   21%        27%COMPL...
RESULTS: [REQUIREMENT FOR       ERPC IN BOTH GROUP]           52           51           50           49           48     ...
RESULTS: [REQUIRMENT OFOXYTOCIN AUGMENTATION]                                                 Vaginal Misoprostol         ...
RESULTS: [COMPARISON OF  ERPC & OXYTOCIN FOR COMPLETE EVACUATION]   100%   80%   60%   40%   20%    0%      Oral Misoprost...
COMPLICATIONS: [IN BOTH           GROUPS]                                                                       Vaginal  ...
DISCUSSION: TERMINATION OF PREGNANCY IS AN  INTEGRAL PART OF ANY  GYNAECOLOGICAL PRACTICE. DIFFERENT METHODS OF CERVICAL...
DISCUSSION: THEY CLAIMED THAT 100% EXPULSION  RATE WHICH IS COMPARABLE TO 94%  EXPULSION RATE OBSERVED IN OUR  STUDY. MU...
DISCUSSION: NOT REQUIRED SURGICAL TREATMENT  COMPARE TO 52% COMPLETE UTERINE  EVACUATION IN OUR STUDY. ELSHEIKH,etal[200...
CONCLUSION: VAGINAL MISOPROSTOL WAS FOUND  MORE EFFECTIVE WITH LESSER SIDE  EFFECTS AS COMPARE TO ORAL FOR  MISSED ABORTI...
KEY POINTS:   MISOPROSTOL HAS BEEN ON MARKET    SINCE 1985 UNDER BRAND NAME OF    CYTOTEC. IT IS AVAILABLE IN OVER 80    ...
KEY POINTS: USEFULNESS OF MISOPROSTOL IN NO.  OF INDICATIONS IN OBS &  GYNAECOLOGY. NO PROPER DOSAGE IS UPTILL          ...
THANK YOU     Lugansk State Medical University  Block 50 years, Of lugansk defence, 1.          Lugansk - 91045, Ukraine. ...
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Vaginal oral misoprostol_lugansk-state-medical-university

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Vaginal oral misoprostol_lugansk-state-medical-university

  1. 1. EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL FOR INDUCTION OF LABOR IN MISSED ABORTION PRESENTED BY Lugansk State Medical University Block 50 years, Of lugansk defence, 1. Lugansk - 91045, Ukraine. email : info@lsmuedu.com / kanc@lsmuedu.com Official website - http://www.lsmuedu.com 1 +38-091-9484-428
  2. 2. OBJECTIVES TO DETERMINE THE EFFICACY OF VAGINAL VS. ORAL MISOPROSTOL AS A LABOR INDUCING AGENT IN MISSED ABORTION. 2
  3. 3. INTRODUCTION MISSED ABORTION IS THE FAILURE TO EXPEL THE PRODUCTS OF CONCEPTION AFTER DEATH OF EMBRYO. MISSED ABORTION IS MANAGED EITHER BY SURGICAL & NON SURGICAL METHODS. IN RECENT YEARS MISOPROSTOL,A SYNTHETIC PGE1, ANALOGUE, IS BEING 3 EVALUATED FOR LABOR INDUCTION.
  4. 4. 4
  5. 5. INTRODUCTION: MISOPROSTOL CAN BE GIVEN ORALLY, SUBLINGUALLY, VAGINALLY OR RECTALLY. IT HAS BEEN EXTENSIVELY STUDIED & USED FOR OBSTETRICAL & GYNAECOLOGICAL CAUSES, SUCH AS PRE-INDUCTION CERVICAL RIPENING, LABOR INDUCTION, EVACUATION OF UTERUS AFTER PREGNANCY FAILURE OR VARIOUS MEDICAL REASONS. 5
  6. 6. DESIGN A QUASI EXPERIMENTAL STUDY. 6
  7. 7. SUBJECT &SETTING: THIS STUDY WAS PERFORMED IN GYNAE/OBS UNIT II IN HOLY FAMILY HOSPITAL RAWALPINDI [PAKISTAN]. 35 PATIENTS IN VAGINAL MISOPROSTOL GROUP & 35 PATIENTS IN ORAL MISOPROSTOL GROUP WERE STUDIED. 7
  8. 8. METHOD: TOTAL OF 70 PREGNANT WOMEN ADMITTED WITH MISSED ABORTION OR BLIGHTED OVUM OF 8wks TO 24wks OF GESTATION DURING THE PERIOD OF JUNE 2005 TO NOV 2005. MISSED ABORTION WAS CONFIRMED ON ULTRASOUND. INITIAL EVALUATION OF PTS WAS DONE. CONSENT OF PATIENT. 8
  9. 9. METHODS: THE CASES WERE RANDOMIZED IN TWO GROUPS. ONE FOR ORAL MISOPROSTOL & OTHER FOR VAGINAL MISOPROSTOL. IN ONE GROUP 400ug WAS INSERTED UNDER FULL ASEPTIC CONDITIONS HIGH UP IN POSTERIOR FORNIX OF VAGINA WHILE IN SECOND GROUP PATIENT TAKE IT ORALLY. 9
  10. 10. 10
  11. 11. METHODS: THE DOSE OF MISOPROSTOL WAS REPEATED AFTER EVERY 4hrs TO A MAX. OF FOUR DOSES IN 24 hrs. IF COMPLETE EXPULSION DID NOT OCCUR WITH IN 48hrs & IF PATIENT BLEED HEAVILY THEN ERPC WAS DONE. FOLLOW UP. 11
  12. 12. RESULTS: [PATIENTSDISTRIBUTION IN BOTH GROUP] 35 35 Vaginal Misoprostol ORAL Misoprostol 12
  13. 13. RESULTS [AGE OF PATIENT]8070605040302010 0 <20 years 20-30 years >35 years Oral Misoprostol Vaginal Misoprostol 13
  14. 14. RESULTS: [PARITY] 60 50 40 30 20 Oral 10 Misoprostol 0 Prim igravida Vaginal Misoprostol 14
  15. 15. RESULTS: VAGINAL ORAL Misoprostol Misoprostol GROUP GROUPMEANINDUCTIONTO 9.16 HRS 12.09HRSEXPULSIONTIME 15
  16. 16. RESULTS: [INDUCTION TO EXPULSION TIME] 16 Oral Misoprostol Vaginal Misoprostol
  17. 17. RESULTS:OTHER VAGINAL ORAL GROUPMEASURE GROUP 3% 7%ERPC[REQUIRED] 21% 27%COMPLETEEXPULTION 52% 28% 17
  18. 18. RESULTS: [REQUIREMENT FOR ERPC IN BOTH GROUP] 52 51 50 49 48 . 47 46 ERPC 18 Oral misoprostol Vaginal Misoprostol
  19. 19. RESULTS: [REQUIRMENT OFOXYTOCIN AUGMENTATION] Vaginal Misoprostol Oral Misoprostol Oral Misoprostol Vaginal Misoprostol 19
  20. 20. RESULTS: [COMPARISON OF ERPC & OXYTOCIN FOR COMPLETE EVACUATION] 100% 80% 60% 40% 20% 0% Oral Misoprostol Vaginal Misoprostol 20
  21. 21. COMPLICATIONS: [IN BOTH GROUPS] Vaginal Misoprostol Oral Misoprostol termination complication fever vomoting diarrhoea faild no Oral Misoprostol Vaginal Misoprostol 21
  22. 22. DISCUSSION: TERMINATION OF PREGNANCY IS AN INTEGRAL PART OF ANY GYNAECOLOGICAL PRACTICE. DIFFERENT METHODS OF CERVICAL RIPENING HAVE BEEN USED WITH VARIABLE RESULTS. CHOHAN,etal, HAVE DONE A STUDY USING EXTRA AMNIOTIC PGF2 alpha FOR MID TRIMESTER INDUCTION OF LABOR IN PTS WITH LATE MISSED ABORTION. 22
  23. 23. DISCUSSION: THEY CLAIMED THAT 100% EXPULSION RATE WHICH IS COMPARABLE TO 94% EXPULSION RATE OBSERVED IN OUR STUDY. MUFFLEY PE,[2002]CONDUCTED A STUDY ON VAGINAL MISOPROSTOL COMPARED WITH SURGICAL TREATMENT IN MISSED ABORTION & CLAIMED THAT 60% PATIENTS IN MISOPROSTOL GROUP 23
  24. 24. DISCUSSION: NOT REQUIRED SURGICAL TREATMENT COMPARE TO 52% COMPLETE UTERINE EVACUATION IN OUR STUDY. ELSHEIKH,etal[2001] USED ORAL & VAGINAL MISOPROSTOL IN SECOND TRIMESTER MISSED ABORTION USING SAME DOSAGE AS IN OUR STUDY, MEAN INDUCTION TO EXPULTION TIME IS SAME &THE EFFICACY OF METHOD IS ALSO SIMILAR. 24
  25. 25. CONCLUSION: VAGINAL MISOPROSTOL WAS FOUND MORE EFFECTIVE WITH LESSER SIDE EFFECTS AS COMPARE TO ORAL FOR MISSED ABORTION. IT IS OBSERVED IN OUR STUDY THAT MISOPROSTOL IS CHEAPER & EFFICIENT FOR MISSED ABORTION. 25
  26. 26. KEY POINTS: MISOPROSTOL HAS BEEN ON MARKET SINCE 1985 UNDER BRAND NAME OF CYTOTEC. IT IS AVAILABLE IN OVER 80 COUNTRIES WORLD WIDE FOR TREATMENT OF GASTRIC ULCERS. MORE THAN 300 ARTICLES HAVE BEEN 26
  27. 27. KEY POINTS: USEFULNESS OF MISOPROSTOL IN NO. OF INDICATIONS IN OBS & GYNAECOLOGY. NO PROPER DOSAGE IS UPTILL DECIDED &THE COMPANY NEVER APPLIED FOR APPROVAL FOR OBSTETRICS. 27
  28. 28. THANK YOU Lugansk State Medical University Block 50 years, Of lugansk defence, 1. Lugansk - 91045, Ukraine. email : info@lsmuedu.com / kanc@lsmuedu.comOfficial website - http://www.lsmuedu.com +38-091-9484-428 28

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