FREQUENCY OF COMPLETE ABORTION WITH INTRAVAGINAL MISOPROSTOL VERSUS EXTRA AMNIOTIC CATHETER IN TERMINATION OF SECOND TRIMESTER PREGNANCY

Abstract

Termination of pregnancy in Mid-trimester is one of the most controversial areas in gynecological practice. As a cause of maternal mortality, it is one of the major neglected health issues in Pakistan and it is the third major cause of maternal mortality in our country. The study aim was to establish safe and effective method for abortion in second trimester.

Objectives: The objectives of this study was to compare the frequency of complete abortion with intravaginal misoprostol versus extra amniotic catheter in termination of second trimester pregnancy.

Main outcome measure: It was the frequency of complete abortion in second trimester.

Study design: Randomized Controlled Trial

Setting: Obstetrics & Gynaecology Department, PGMI / AIMC/LGH, Lahore.

Subjects: Female patients of age range 18-35years with gestational age 13-20 weeks calculated through last menstrual period (LMP).

Duration: 6 months (1st November 2015 to 30th April 2016)

Methods: Two hundred ten patients were admitted from OPD of LGH. Informed consent. We randomly divided patients in equally two groups by lottery method. In group A, females were given misoprostol 600g vaginally followed by 400g eight hourly till expulsion of products or up to 48 hours(n=105). Group II, had Foley’s catheter traction and 1ml PGF2 alpha diluted in 19cc normal saline and 1cc/hr injected extra amniotically in control group (n=105), which was removed after expulsion of products of conception or after 24 hours. Women were observed for 48 hours for spontaneous expulsion of products.

Results: 210 patients were included in the study. The mean age of patients was 27.50 years with standard deviation of 2.82 years with most of the patients in the age range 25-30 years. Most of women in the study group were multiparous (54.8%) with 52.9% of sample in gestational age range 17-20 weeks with mean gestational age 17.5 weeks. A total of 173 patients (82.4%) out the 210 patients included in the study had complete abortion as per the operational definition. No statistically significant difference was found when comparison was done with respect to age, gestational age and parity (p>0.05). Frequency of complete abortion was then compared in the study groups (misoprostol versus extra amniotic catheter). It was found that patients in the misoprostol group had significantly higher complete abortion rate as compared to those who were in the extra amniotic catheter group with a p value of 0.007.

Conclusion: This study showed that misoprostol results in significantly higher frequency of complete abortion in second trimester compared to extra amniotic catheter. So Misoprostol is a very effective, easily useable, safe and cheap drug for second trimester termination of pregnancy.