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Efficacy of Mifepristone and Misoprostol Combination in Termination of Early Pregnancy

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Efficacy of Mifepristone and Misoprostol Combination in Termination of Early Pregnancy P. Yamini Shobha Vani, A. Niranjani Devi. Efficacy of Mifepristone and Misoprostol combination in termination of early pregnancy. IAIM, 2016; 3(12): 48-54. Original Research Article Efficacy of Mifepristone and Misoprostol combination in termination of early pregnancy P. Yamini Shobha Vani1, A. Niranjani Devi2* 1,2Assistant Professor, Department of Obstetrics and Gynecology, Government Maternity Hospital, Kakatiya Medical College, Warangal, Telangana State, India *Corresponding author email: [email protected] International Archives of Integrated Medicine, Vol. 3, Issue 12, December, 2016. Copy right © 2016, IAIM, All Rights Reserved. Available online at http://iaimjournal.com/ ISSN: 2394-0026 (P) ISSN: 2394-0034 (O) Received on: 19-11-2016 Accepted on: 24-11-2016 Source of support: Nil Conflict of interest: None declared. How to cite this article: P. Yamini Shobha Vani, A. Niranjani Devi. Efficacy of Mifepristone and Misoprostol combination in termination of early pregnancy. IAIM, 2016; 3(12): 48-54. Abstract Background: Unplanned and unwanted pregnancies are common occurrences in all societies, regardless of the level of medical, economic, educational or religious development present within them. Despite wider availability of contraceptive methods, the incidence of induced abortion is increasing. Aim: To study the efficacy of Mifepristone 200 mg orally followed 48 hours later by Misoprostol 600 µg per vaginally in women undergoing medical termination of early pregnancy (up to 73 days of gestational age). Materials and methods: The present study included 50 pregnant women requesting termination of pregnancy in first trimester attending the department of Obstetrics and Gynecology. Women with gestational age up to 73 days from the first day of the last menstrual period with previous regular cycles were studied. Patients without medical or surgical contraindications to Mifepristone and Misoprostol were included. Women without prior caesarean section were studied. Results: Majority of the patients were of age group between 21-25 years. 92% of these women were married, 15% were nulliparous and 35% were multiparous. The period of gestation varied from 38-73 days. Majority of women were between 36-50 days of gestational age, constituting 50%. 94% of the patients had complete abortion and 4% had incomplete abortion. Success rate was not affected by the parity or gestational age, 72% of the patients expelled the products of conception within 10 hours, 84% in 15 hours and almost all the patients within 24 hours of prostaglandin administration. Most of the adverse effects reported were of the gastrointestinal system of which nausea was reported by 40%, abdominal pain by 70%, vomiting by 16% and diarrhoea by 4% of the cases. 6% of the patients reported excess bleeding at the time of abortion but none of them required hospitalization or blood Page 48 P. Yamini Shobha Vani, A. Niranjani Devi. Efficacy of Mifepristone and Misoprostol combination in termination of early pregnancy. IAIM, 2016; 3(12): 48-54. transfusion. The mean duration of bleeding was 7.24 days. A significant fall in hemoglobin was not observed in any patient (less than 1 gm/dl). This combination has the advantage of high complete abortion rate with low frequency of side effects. Conclusion: The combination of RU 486 200mg orally and misoprostol 600 µg intravaginally appears to offer safe, efficient, acceptable, out-patient procedure and an alternative to surgical abortion in early termination of pregnancy (up to 73 days of gestation). Key words Mifepristone, Misoprostol, Caesarean section. Introduction the time of fetal viability for the purpose of safe Unplanned and unwanted pregnancies are guarding the health of the mother. common occurrences in all societies, regardless of the level of medical, economic, educational or Voluntary abortion is the termination of religious development present within them. pregnancy before fetal viability at the request of Despite wider availability of contraceptive the women but not for reasons of impaired methods, the incidence of induced abortion is maternal health or fetal disease. Most of the increasing. The surgical nature of abortion abortions done today are elective abortions. procedures is problematic, requiring expense and Induced abortions may be legal (Medical technology that challenge many patients and termination of pregnancy) or illegal. It is their health care systems, particularly in estimated that 40-60 million abortions are undeveloped nations. Although surgical abortion performed in the world each year, of which about has been found to be safe and effective, the 33 million are legal procedures; these numbers surgery entails some risks, and is frequently felt imply a worldwide abortion rate of 37-55 per by patients to be invasive and "unnatural". The 1000 women, aged 15-44 years and an abortion development of safe, effective, inexpensive, ratio of 24-32 abortions per 100 known nonsurgical methods to induce abortion is thus pregnancies. Induced abortions are the third highly desirable. The use of mifepristone and common means of fertility control next to misoprostol combination in termination of early sterilization and oral contraceptives. The pregnancy appears to meet the above criteria [1, abortion rate and ratios are very much under 2]. Hence this medical method of abortion has estimated in some countries. For instance, in been taken up to study the efficacy of this India the legal abortion rate is 3.3 and abortion combination. Abortion is defined as the ratio is 2.1 but illegal induced abortions are termination of pregnancy by any means before estimated to have numbered 4-6 million, giving the fetus is sufficiently developed to survive. In an abortion rate of 36-55 and abortion ratio of United States this definition is confined to the 13-20 per 100 estimated pregnancies per year. termination of pregnancy before 20 weeks of gestation or delivery of a fetus that weighs less Materials and methods than 500 gm. Abortions can be spontaneous The present study included 50 pregnant women abortions and induced abortions. Induced requesting termination of pregnancy in first abortions: Induced abortions signify voluntary trimester (up to 73 days of gestation) attending and wilful termination of pregnancy whether the department of Obstetrics and Gynecology at permitted by law or not (Legal or Illegal) before Govt. Maternity Hospital/ Kakatiya Medical the viability of fetus. Induced abortions are college Warangal, Telangana during March 2012 further classified into therapeutic abortions and to March 2013. elective (Voluntary) abortions. Therapeutic abortion is the termination of pregnancy before Inclusion criteria Page 49 P. Yamini Shobha Vani, A. Niranjani Devi. Efficacy of Mifepristone and Misoprostol combination in termination of early pregnancy. IAIM, 2016; 3(12): 48-54. Women with gestational age up to 73 following mifepristone. After 48 hours Tab days from the first day of the last Misoprostol 600ug was kept in the posterior menstrual period with previous regular fornix of vagina under strict aseptic precautions. cycles. Vitals were monitored half an hourly before and Patients without medical or surgical after the insertion of tablet. Patients were contraindications to mifepristone and discharged 4 hours later on the same day, and misoprostol. were advised to report if there was excessive Women without prior caesarean section. bleeding, fever, foul smelling discharge, vomiting or any other complications were Exclusion criteria experienced. All the patients were kept on Tab Confirmed or suspected ectopic Doxycycline 100 mg bid for 5 days. Patients th pregnancy or undiagnosed adnexal mass. were instructed to report on the 14 day if no Intrauterine device in place. complications occurred in between. Ultra sound th Patients with cardiac, pulmonary was repeated on 14 day to confirm the diseases, epilepsy, asthma, renal failure. completeness of abortion. Success was defined as the complete expulsion of the products of Concurrent long term corticosteroid conception without the need for surgical therapy. intervention. Women who have not responded to Hemorrhagic disorders or concurrent medical treatment within 24 hours of misoprostol anticoagulant therapy. administration, were offered surgical methods to Inherited porphyrias. terminate the pregnancy. Patients on antifungal drugs and antiepileptic drugs. Results 50 patients who fulfilled the inclusion criteria Results were analysed according to age, marital requesting medical termination of pregnancy status, parity, gestational age, induction abortion were taken up for the study. A complete case interval, completeness of abortion, need for record was prepared and detailed history of all surgical intervention, failure of procedure and the patients was taken. A thorough clinical complications. examination including general, per abdominal and per vaginal examination was done. All the In the present study youngest patient was 18 patients were subjected to investigations like years old while the oldest was 35 years old, complete urine examination, hemoglobin around 42% belonged to 21-25 years. In the estimation (Hb%), blood grouping and Rh typing present study, 30% were prirnigravida, 34% were nd rd and random blood sugar were done prior to the 2 gravida, 18% were 3 gravida and 18% were th administration of the regimen. Ultrasonogram 4 gravida and above. Most of the patients were nd was done to confirm the gestational age. All the 2 gravida. Most of the patients
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