Role of mesoprostol in the management of first trimester incomplete abortion
Background and objectives: Surgical treatment has been a traditional way of treatment of incomplete abortion. Expectant management and medical treatment can reduce costs and complications generated by surgery. Current study was designed to determine the success rate of treatment of incomplete abortion by mesoprostol thus avoiding surgical intervention. Moreover, factors which can impair efficacy of the treatment were investigated.
Method: The sample size included 100 patients with first trimester incomplete abortion attending Maternity Teaching Hospital in Erbil city/ Kurdistan Region / North of Iraq between October, 1st 2009 and March, 1st 2010 being assigned to receive 400 µg mesoprostol orally. A week later the patients were specifically examined to verify that complete abortion had been occurred. A second dose was administered if complete abortion was not yet achieved, provided that the patient was hemo-dynamically stable and notably no substantial bleeding or infection been noticed.
Results: The success rate of the treatment was 62% and 93% after first and second dose respectively. The difference in response to the treatment was related to the difference in endometrial thickness and gestational age. No any serious complication was reported.
Conclusion: Mesoprostol administered orally is an effective method in treating first trimester incomplete abortion.
Griebel C.P., Halvorsen J., Golemon TH.B., and Day A.A. Management of Spontaneous Abortion. A peer-review. Journal of the American Academy of Family Physicians 2005; Oct.1.
Petrozza, John C (August 29, 2006). E-Medicine. WebMD. Retrieved July 20, 2007.
Laferla JJ., Spontaneous abortion. Clin. Obstet. Gynaecol 1986; 13: 105–114.
Ash M.,Disorders of early pregnancy, Gynaecology by Ten Teachers,18th edition, Edward Arn- old Ltd, 2006, pp 89-102.
Chung H., Lees S., Cheung L., Spontaneous abortion: A randomized controlled trial comparing surgical evacuation with conservative management using mesoprostol. Fertility and Sterility 1999; 71(6): 1054- 1059.
Ross J.A. and Frankenberg E., Findings from two decades of family planning research. New York, Population Council, 1993. p. 63-74.
Henshaw R.C., Cooper K., el-Refaey H, Smith NC, Templeton AA. Medical management of miscarriage: non-surgical uterine evacuation of incomplete and inevitable spontaneous abortion. Br. Med. J., 1993; 306: 894–95.
Chung T.K.H., Cheung L.P., Leung T.Y. Haines CJ, Chang AM. Mesoprostol in the management of spontaneous abortion. Br. J. Obstet. Gynaecol., 1995; 102: 832–35.
Goldberg A.B., Greenberg M.B. and Darney P.D.. Mesoprostol and pregnancy. N. Engl. J. Med. 2001; 344: 38–47.
WORLD HEALTH ORGANIZATION (WHO). Complications of abortion: Technical and managerial guidelines for prevention and treatment. Geneva, WHO, 1995. p. 147.
Kruse B., Poppema S., Creinin MD., Paul M., Management of side effects and complications in medical abortion. Am J Obstet Gynecol 2000; 183 (Suppl): 65–75.
Topping J. and Farquarson R.G., Spontaneous miscarriage in: Dewhurst's text book of Obstetrics and Gynecology for postgraduates, seventh edition London, Black well science. Ltd.2007. p.94-98.
Farrell RG., Stonington DJ., Ridgeway RA. Incomplete and inevitable abortion: treatment by suction curettage in the emergency department. Ann Emerg Med 1982; 11: 652-8.
Heisterberg L., Hebjorn S., Andersen LF., Petersen H., Sequelae of induced first-trimester abortion. A prospective study assessing the role of postabortal pelvic inflammatory disease and prophylactic antibodies. Am J Obstet Gynecol 1986; 155: 76-80.
De Jonge E.T.M., Makin J.D., Manefeldt E. Randomized clinical trial of medical evacuation and surgical curettage for incomplete miscarriage. Br. Med. J., 1995; 311: 662.
Bique C., Usta M., Debora B., Chong E., Westheimer E., Winikoff B., Comparison of mesoprostol and manual vacuum aspiration for the treatment of incomplete abortion. International Journal of Gynaecology & Obstetrics 2007; 98: 222-6.
Dao B., Blum J., Thieba B. Is mesoprostol a safe, effective and acceptable alternative to manual vacuum aspiration for post abortion care? Results from a randomised trial in Burkina Faso, West Africa. BJOG: An International Journal of Obstetrics & Gynaecology 2007; 114: 1368-75.
Shwekerela B., Kalumuna R., Kipingili R.. Mesoprostol at the regional hospital level: results from Tanzania. Journal of Obstetrics & Gynaeco logy 2007;.114:.1363-7.
Creinin MD., Moyer R. and Guido R., Mesoprostol for medical evacuation of early pregnancy failure. Obstet Gynecol 1997; 89: 768–72.
Tang OS., Schweer H., Seyberth HW., Lee SW. and PC., Pharmacokinetics of different routes of administration of mesoprostol. Hum Reprod. 2002; 17: 332-36.
Vimala N., Mittal S., Kumar S., Dadhwal V., Sharma Y., A randomized comparison of sublingual and vaginal mesoprostol for cervical priming before suction termination of first-trimester pregnancy. Contraception 2004; 70: 117–20.
Vimala N., Mittal S., Kumar S., Dadhwal V., Sharma Y., A randomized comparison of sublingual and vaginal mesoprostol for cervical priming before suction termination of first-trimester pregnancy. Contraception 2004; 70: 117–20
.Nielsen S., Hahlin M., Expectant management of first-trimester spontaneous abortion. Lancet 1995; 345: 84–86. [Pub Med: 7815886]
Ballagh SA., Harris HA., Demasio K., Is curettage needed for uncomplicated incomplete spontaneous abortion? Am J Obstet Gynecol 1998; 179: 1279-82.
Jurkovic D., Ross JA., Nicolaides KH., Expectant management of missed miscarriage. Br J Obstet Gynaecol 199; 105: 670-1.
Luise C., Jermy K., May C. Outcomes of expectant management of spontaneous first trimester miscarriage: observational study. BMJ 2002; 324: 873-5.
Coughlin LB., Roberts D., Haddad NG., Long A., The treatment of incomplete miscarriage with oral mesoprostol. BJOG: An International Journal of Obstetrics & Gynaecology 2004; 108: 213-14
Blohm F., Friden BE., Milsom I., Platz-Christensen JJ., Nielsen S., A randomised study comparing mesoprostol or placebo in the management of early miscarriage. International Journal of Obstetrics & Gynaecology 2005; 112: 1090-5.
Khan- JG., Beaker- BJ., Maclsaa- L. The efficacy of medical abortion: a meta analysis. Contraception. 2000 Jan; 61 (1): 29-40.
Zieman M., Fong S.K., Benowitz N.L. Absorption kinetics of mesoprostol with oral or vaginal administration. Obstet. Gynecol. 1997; 90: 88–92.[Web of Science][Medline].
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