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EFFICACY OF VAGINAL VS.

ORAL MISOPROSTOL FOR
INDUCTION OF LABOR IN
MISSED ABORTION

PRESENTED BY
DR NOSHABA RAFIQ
M.B.B.S.
M.C.P.S.F.C.P.S.
GYNAE/OBS UNIT II
HOLY FAMILY HOSPITAL
2
RAWALPINDI
 OBJECTIVES
 TODETERMINE THE EFFICACY OF
VAGINAL VS. ORAL MISOPROSTOL AS
A LABOR INDUCING AGENT IN
MISSED ABORTION.

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 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
4

SYNTHETIC PGE1, ANALOGUE, IS

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 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.
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 DESIGN

A QUASI EXPERIMENTAL STUDY.

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 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.

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 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.
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 CONSENT OF PATIENT.
 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.
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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.

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 RESULTS: [PATIENTS
DISTRIBUTION IN BOTH
GROUP]
 35
 35

Vaginal Misoprostol ORAL Misoprostol

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RESULTS [AGE OF PATIENT]
80

70

60

50

40

30

20

10

0
<20 years 20-30 years >35 years

Oral Misoprostol Vaginal Misoprostol

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 RESULTS: [PARITY]

 60
50
40
30
20 Oral
10 Misoprostol
0
Prim igravida

Vaginal
Misoprostol

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

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 RESULTS: [INDUCTION TO
EXPULSION TIME]


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Oral Misoprostol Vaginal Misoprostol

 RESULTS:
OTHER VAGINAL ORAL GROUP
MEASURE GROUP
3% 7%
ERPC
[REQUIRED] 21% 27%

COMPLETE
EXPULTION 52% 28%

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 RESULTS: [REQUIREMENT
FOR ERPC IN BOTH GROUP]

52
51
50
49
48 .
47
46
ERPC

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Oral misoprostol Vaginal Misoprostol

RESULTS: [REQUIRMENT OF
OXYTOCIN AUGMENTATION]

Vaginal Misoprostol

Oral Misoprostol

Oral Misoprostol Vaginal Misoprostol

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RESULTS: [COMPARISON OF
ERPC & OXYTOCIN FOR
COMPLETE EVACUATION]
100%

80%

60%

40%

20%

0%

Oral Misoprostol Vaginal Misoprostol

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 COMPLICATIONS: [IN BOTH
GROUPS]


Vaginal
Misoprostol
Oral Misoprostol

termination

complication
fever

vomoting

diarrhoea

faild

no
Oral Misoprostol Vaginal Misoprostol

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 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
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 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 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 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. 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
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 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
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THANK
YOU
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