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. OBJECTIVES
 TO DETERMINE THE EFFICACY OF
VAGINAL VS. ORAL MISOPROSTOL AS A
LABOR INDUCING AGENT IN MISSED
ABORTION.
2

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

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. DESIGN
 A QUASI EXPERIMENTAL STUDY.
6

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. 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. 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

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. RESULTS: [PATIENTS
DISTRIBUTION IN BOTH GROUP]
 35
 35
Vaginal Misoprostol ORAL Misoprostol
12

13. RESULTS [AGE OF PATIENT]
80
70
60
50
40
30
20
10
0
<20 years 20-30 years >35 years
Oral Misoprostol Vaginal Misoprostol
13

14. RESULTS: [PARITY]
 60
50
40
30
20 Oral
10 Misoprostol
0
Prim igravida
Vaginal
Misoprostol
14

15. RESULTS:
VAGINAL ORAL
Misoprostol Misoprostol
GROUP GROUP
MEAN
INDUCTION
TO 9.16 HRS 12.09HRS
EXPULSION
TIME
15

16. RESULTS: [INDUCTION TO
EXPULSION TIME]

16
Oral Misoprostol Vaginal Misoprostol

17. RESULTS:
OTHER VAGINAL ORAL GROUP
MEASURE GROUP
3% 7%
ERPC
[REQUIRED] 21% 27%
COMPLETE
EXPULTION 52% 28%
17

18. RESULTS: [REQUIREMENT FOR
ERPC IN BOTH GROUP]

52
51
50
49
48 .
47
46
ERPC
18
Oral misoprostol Vaginal Misoprostol

19. RESULTS: [REQUIRMENT OF
OXYTOCIN AUGMENTATION]
Vaginal Misoprostol
Oral Misoprostol
Oral Misoprostol Vaginal Misoprostol
19

20. RESULTS: [COMPARISON OF
ERPC & OXYTOCIN FOR
COMPLETE EVACUATION]
100%
80%
60%
40%
20%
0%
Oral Misoprostol Vaginal Misoprostol
20

21. COMPLICATIONS: [IN BOTH
GROUPS]

Vaginal
Misoprostol
Oral Misoprostol
termination
complication
fever
vomoting
diarrhoea
faild
no
Oral Misoprostol Vaginal Misoprostol
21

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. 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. 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. 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. 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. 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. THANK YOU
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
+38-091-9484-428
28