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Comparison of therapeutic abortion efficacy by suction curettage and
misoprostol vaginally in the first trimester of pregnancy
Mahvash Zargar 1, Roshan Nikbakht 1, Vida Naji givi 1, Masoud Hemadi1*
Abstract
Infertility and Perinatology Research Background: This study compared the health outcomes of abortion
Center, Ahvaz Jundishapur University by vaginal misoprostol tablets and suction curettage in the first of Medical Sciences, Ahvaz, Iran. trimester of pregnancy.
Materials and Methods: In this study, 220 pregnant women
(under 14 week’s gestational age) who candidate for termination of
pregnancy (due to fetal or maternal reasons) were divided into the
treatment and surgery groups. In the medical abortion group, 600
µg vaginal misoprostol was given, then 36 hours later if needed this
dose was repeated. However, if the remains of the pregnancy were
observed by ultrasound 1 week after the initial dose, the curettage
was done. Suction curettage was used in the surgical abortion
group.
Results: In general, 79% of treatment group had a complete abortion
without the need for surgical abortion. In all subjects of surgical
groups, all products of pregnancy with surgical curettage were fully
discharged. The mean satisfaction from amount of bleeding in the
drug and medical abortion groups was 80% and 84%, respectively
with no statistical difference.
Conclusion:The obtained results showed that misoprostol as an
effective alternative to surgical termination of pregnancy can be
used at the first trimester abortions.
٭Corresponding author:Masoud Hemadi; Assistant Professor, Keywords: therapeutic abortion, surgical abortion, misoprostol
Fertility,Infertility and PerinatologyResearch Center, Ahvaz JundishapurUniversity of Medical Sciences, Ahvaz, Zargar M, Nikbakht R, Naji givi V , Hemadi M . Comparison of therapeutic abortion efficacy by suction curettage and misoprostol vaginally in the first trimester of pregnancy. Jentashapir J Health Res 2013; 4(5):355-362 Received: 10.03.2013
Accepted: 31.08.2013
Results abortion by vaginal tablet
Introduction
The decision to perform an abortion is
prostaglandin1) are most famous drug which seems that the misoprostol due to no need to freeze and easy application into the vagina, hypertension, mitral valve sparseness, severe syndrome are face with high probability to In addition,, if the pregnancy is associated epithelial tumors as well as prescribed as a with fetal anencephaly, thalassemia, mole safe and effective agent in the treatment of non-ruptured ectopic pregnancy (10).
Given that , there are also some studies that million abortions per year are performed in compared to the surgery and this study aimed methods exist for termination of pregnancyin the first trimester of pregnancy that the Materials and Methods
A randomized controlled clinical trial study medicine methods (7). Indeed, nearly half of was designed Through the period from July all legal abortions are carried out by induced 2007 to July 2009, healthy subjects between abortion therapy and pregnancy termination carried out only by surgery so that, in 97% of methods were randomly divided equally into procedures is cervical dilatation method and abortion procedure: Group surgical method The patients were selected based on:1- Patient suctioned that is easier and safer method awareness of both surgical and medical of comparison with the previous one. In recent pregnancy termination methods and related years, medical termination of pregnancy is introduced as suitable alternative to surgical termination of pregnancy in the entire world.
measurements, with intrauterine pregnancy metabolite (9-10). In fact, medical abortion Patients with kidney disease, anemia, pelvic Jentashapir J Health Res, 2013; 4(5)
Zargar et al
coagulation disorders 5- Lack of access to 72 hours after administration of misoprostol the patient for follow-up were also excluded.
Subsequent to selecting the patients, initially In the second Patient's visit, the patients were asked about pain and the bleeding. In the surgical groups so that the medical group third Patient's visit (day eight) outcomes was received vaginally misoprostol and the misoprostol and also disposing of the uterine Questionnaire that contains: Gestational age, the dose of misoprostol used for medicinal patients and the time needed for spontaneous expulsion and evacuation was completed for If the remains were equal to or greater than suction curettage, cause of termination of out, and in case, the uterine content remains uterine cramps, duration of the spotting or bleeding after abortion, postoperative pain Suction curettage group:
In surgery group the patients were undergone The data was collected directly from patient answers and observations at several stages performed with appropriate bushey and the Initially, each patient was noticed with pros patients were all discharged after 6 hours of method and with full knowledge and notice The performing suction curettage was also prophylactic antibiotics with doxycycline 100 mg, 2 times a day for 5 days and have been advised to report any vaginal bleeding to the investigator. Un this study the patients contributors were obtained .The safety of Statistical analysis:
material have been approved previously by The data was analyzed by Chi-square using the software SPSS version 16. Significant level of P <0.05 was applied for statistical Misoprostol group
On the first visit of the patient ,if there is noban misoprostol tablets 800 mg was placed into her posterior vaginal fornix and then the methods.The mean age of patients was 28.4 Jentashapir J Health Res, 2013; 4(5)
Results abortion by vaginal tablet
±6.6 years. Age difference between the two However, for the bleeding rate of the two groups was statistically significant. The The treatment satisfaction rate:
mean gestational age was 9.8 ± 2.8 weeks from the outcome of abortion so that in the of 13), respectively. Differences between the medicine group 74 and in the surgical group 76 patients were offered their satisfaction for gestational age of the two groups were not the final treatment outcome. Satisfaction rate fetus that the forensics agreed to terminate The success rate:
the pregnancy to save the mother's life or successfully followed the administration of anomalies. The most reason of the abortion in the two groups was dead fetus that was confirmed by the ultrasound (control group= group= 87). Therefore, the success rate in 50 cases and medical group= 64 cases). The the surgical group was significantly higher medical reason of the abortion was in the than the medicine group. The success rate second step with 70 cases (control group= was also correlated with satisfaction rate.
35 and medical group= 35). Null pregnancy The onset of pain after the first dose and
in 14 cases was observed (control group= 4 number of doses of misoprostol:
The bleeding rate
misoprostol was 5.1 ± 1.5 hours. At least 3 Categories: less than a period, the least menstruation, and the most of the period.
commencement of the pain. the number of 60 received the second dose of medication for Significant link was not observed between the onset of pain after the first dose and the It is worth to note that in the medical group, detected a relationship between the number the bleeding of most cases were higher than of doses of misoprostol and the abortion.
Table 1. Baseline characteristics women who admitted to the department were comparable in the
two groups
Jentashapir J Health Res, 2013; 4(5)
Zargar et al
Table 2. Compare number (percent) Reasons for abortion among medical and surgical abortion
Table3.Compare the bleeding rate after abortion between medical and surgical abortion treatment
Table 4. Compare the satisfaction rate after abortion between medical and surgical abortion
treatment
Table 5. Compare the success and failure rates after abortion between medical and surgical
abortion treatment
Discussion
Medicine abortion procedure is a new
abortion) was the most applied device in the opportunity for women to avoid surgery.
Therefore,the present study investigated the comparison of the two abortion methods , In statistically significant differences between a clinical trial that is currently being carried out around the world. the most pregnant cases in both groups were at 10 weeks gestation.
surgery group. However, in other cases i.g.
The results showed that the age, gestational null pregnancy and inevitable abortion, the age, gravity and parity numbers were similar in both groups. Therefore, in terms of the differed significantly and in the medicine abortion there was a consistent in the two group this rates was higher than other group so that the bleeding rate of more than four- fifths cases of this group were higher than different reasons to perpetrate a abortion and ultrasound exam of the dead fetus (missed Jentashapir J Health Res, 2013; 4(5)
Results abortion by vaginal tablet
postoperative bleeding was low so that the curettage. In this study, the rate of complete bleeding more than a normal period in less In one study by Davis et al.,(11) between 2002 and 2004 as a clinical trial 652 women indicated the fewer side effects and accepting was studied to assess the bleeding patterns In another study that conducted in Greece misoprostol ,in overall, cause to being more and was published in 2008 was reported that severe and last longer bleeding than suction curettage. This study also suggested that hemoglobin levels after taking drug rarely is causing any interference with curettage or blood transfusion. It’s outstanding to note that the results of the present study in terms In another study, for inducing abortion in women with a gestational age of less than 70 mention study and other completed studies.
Patient’s satisfaction in the present study vaginally every 48 hours (up to three doses) was similar in both treatment groups and the was used. The results showed that the rate majority of them expressed satisfaction for completed studies on misoprostol, majority While, in another study that conducted by of patients were satisfied with the medicine Carbonel et al., (16) in women with amenorrhea for a period of 36-63 days, the who they are in a similar situation . In this hours and the rate of pregnancy termination of 89.4 percent was reported that this amount was comparable with results of Bugalho et In the current study, the success rate of al., (91.1%) (17) and Jian et al., (88%) (19).
monotherapy regimens using misoprostol in Bugalho et al., (18) in other studies pregnancy termination at gestational age less treatment nearly was about 80 percent .The than 6 weeks with vaginal misoprostol was success rate of about 84 percent in abortion done by 800 microgram and the success rate of abortion was achieved at 87 percent.
conducted by Zhang et al., (13). In this study, In the present study, the success rate of misoprostol in termination of pregnancy was nearly 79 percent, which was less than the The lower success rate in the current study could indisputably be due to lack of proper Jentashapir J Health Res, 2013; 4(5)
Zargar et al
medicine abortion protocol so that ,in this group, there were cases that after one dose suction curettage provided the both surgical and without take the next dose (in the case and medicine procedure to be accessible for medication instructions should be given to However, the current study also had a high physician and the appropriated methods are also being taught to the related patients.
Nevertheless, the results showed that the oneof the main advantages of medicine abortion Acknowledgments
is that it can get rid of women from the risk The authors wish to acknowledge the efforts of Fertility, Infertility and Perinatology In Conclusion The results of this clinical trial study showed that the drug abortiontechnique for pregnancy termination was References
1-Scott JR , DiSaia PJ , Hammond CB , Spellacy WN editor. Danforth's Obstetrics and Gynecology . nineth edition.
Philadelphia: JB Lippincott Company; 2003. p. 561.
2-Stubblefield PG, Carr-Ellis S, Borgatta L. Methods for induced abortion. Obstet Gynecol 2004;104(1):174-85.
3-Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, et al. Risk factors for legal induced
abortion-related mortality in the United States. Obstet Gynecol 2004;103(4):729-37.
4-Lamakov K, Pekhlivanov B, Amaliev I. Medical abor tion using methotrexate and misoprostol. Efficacy and
.tolerability Akush Ginekol (Sofiia). 2005;44(3): 8-16
5-Borgatta L, French A, Vragovic O, Burnhill MS. Early medical abortion with methotrexate and misoprostol:
outcomes and satisfaction among women aged 15-21 years. J Pediatr Adolesc Gynecol 2001;14(1):9-16.
6-Borgatta L, Burnhill MS, Tyson J, Leonhardt KH, Hausknect RU, Haskell S. Early medical abortion with
methotrexate and misoprostol. Obstet Gynecol. 2001; 97(1):6-11.
7-Dahiya K, Madan S, Hooda R, Sangwan K, Khosla AH. Evaluation of the efficacy of mifepriston/ misoprostol and
methotrexate/misoprostol for medical abortion. Indian J Med Sci 2005;59(7):301-6.
8-Creinin MD, Wiebe E, Gold M. Methotrexate and misoprostol for early abortion in adolescent women. J Pediatr
Adolesc Gynecol 1999;12(2):71-7.
9-Creinin MD, Fox MC, Teal S, Chen A, Schaff EA, Meyn LA. A randomized comparison of misoprostol 6 to 8
hours versus 24 hours after mifepristone for abortion. Obstet Gynecol 2004;103(5 Pt 1):851-9.
10-Mufftey PE, Stitely ML, Gherman RB. Early intrauterine pregnancy failure: a randomized trial of medical versus
surgical treatment. Am J Obstet Gynecol 2002;187(2):321-5.
11-Davis AR, Hendlish SK, Westhoff C, Frederick MM, Zhang J, Gilles JM, et al. Bleeding patterns after
misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial. Am J Obstet Gynecol
2007;196(1):31.e1-7.
12-Cates W, Grimes DA, Schulz KF. Abortion surveillance at CDC: creating public health light out of political heat.
Am J Prev Med 2000;19(1 Suppl):12-7.
13-Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM. A comparison of medical management
with misoprostol and surgical management for early pregnancy failure. N Engl J Med 2005;353(8):761-9.
14-Prasad S, Kumar A, Divya A. Early termination of pregnancy by single-dose 800 microg misoprostol compared
with surgical evacuation. Fertil Steril 2009;91(1):28-31.
15-Salakos N, Iavazzo C, Bakalianou K, Gregoriou O, Paltoglou G, Kalmantis K, et al. Misoprostol use as a method
of medical abortion. Clin Exp Obstet Gynecol 2008;35(2):130-2.
16-Carbonell Esteve J, Varela L, Velazco A., Tanda R, Cabezas E, Sánchez C. Early abortion with 800 µg of
misoprostol by the vaginal route. Contraception. 1999; 59; 219-225
17-Bugalho A, Mocumbi S, Faúndes A, David E. Termination of pregnancies of <6 weeks gestation with a single
dose of 800 microg of vaginal misoprostol. Contraception 2000;61(1):47-50.
Jentashapir J Health Res, 2013; 4(5)
Results abortion by vaginal tablet
18-Bugalho A, Bique C, Almeida L, Faúndes A. The effectiveness of intravaginal misoprostol (Cytotec) in inducingabortion after eleven weeks of pregnancy. Stud Fam Plann 1993;24(5):319-23.
19-Jain JK, Dutton C, Harwood B, Meckstroth KR, Mishell DR Jr. A prospective randomized, double-blinded,placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for electivetermination of early pregnancy. Hum Reprod 2002;17(6):1477-82.
20-Creinin MD, Huang X, Westhoff C, Barnhart K, Gilles JM, Zhang J. Factors related to successful misoprostoltreatment for early pregnancy failure. Obstet Gynecol 2006;107(4):901-7.
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