الفهرس 
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Abstract
Early pregnancy failure is a major public health problem throughout the world.
Despite the fact that misoprostol of ETP has become an alternative to surgical management in many countries, in others, early termination of pregnancy is still widely managed with surgery. Misoprostol has proven to be a very convenient and flexible drug because of its formulation as a tablet that is stable and that can be administrated orally, rectally, vaginally and by the sublingual route.
Suction curettage refers to dilatation of the cervix followed by vacuum aspiration of the uterine contents.
The objective of this study is to assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy regarding duration and amount of bleeding, presence of product of conception (RPOC), and endometrial thickness 10 days after the procedure.
It was conducted in the emergency unit of the Obstetrics and Gynecology Department of Egypt Railways Hospital. It included sixty one pregnant women with early pregnancy failure. They were divided into two groups:
1-The study group comprises thirty one patients (one was lost and not included) who were underwent manual vacuum aspiration and received 400 µg sublingual misoprostol after surgery.
2-The control group comprises thirty patients who were underwent manual vacuum aspiration only.
All patients were subjected to taking full history, examination and ultrasound examination for diagnoses and detection of fetal age and viability. All patients were returned for follow up visit 10 days after the procedure and were asked about the duration and amount of bleeding and transvaginal ultrasound was done.
The mean gestational age was (8.08 ± 0.76) weeks and (8.04 ± 0.68) weeks in the study and control groups, respectively.
The amount of post abortive bleeding was significantly lower in the study group than it was in the control group. Severe vaginal bleeding occurred in only 3 patients in the study group(10%), whereas it occurred in 6 patients in the control group(20%)(from these 9 patients of severe vaginal bleeding, only one patient in the control group continued to bleeds 10 days after the procedure); 5 patients in the study(16.67%) and 12 patients in the control group(40%) reported a moderate bleeding pattern; 22 patients in the study group (73.33%) and 12 patients in the control group (40%) reported a mild bleeding pattern(P=0.033).
Self-assessed bleeding days were (2.733 ± 1.230) days and (4.167 ± 2.019) days in the study and control groups (P=0.002). In the control and study groups, maximum duration of bleeding days was reported as 10 versus 6 days, while minimum bleeding days were similar ( 1 day); this difference was statistically significant.
On follow-up evaluation 10 days after management, the mean endometrial thickness measured by transvaginal ultrasonography was thinner in the study group compared to that in the control group (7.053 ± 0.550)mm versus (8.590 ± 1.862)mm; this difference was statistically significant (P<0.001). The maximum endometrial thickness was 8mm and 15mm in the study and control groups, respectively.
The mean endometrial thickness measured by transvaginal ultrasonography 10 days after management was(7.075 ± 0.517)mm, (6.700 ± 0.442)mm, (7.500 ± 0.412)mm and (7.400 ± 0.624)mm in gravida one, two, three and four respectively (P=0.025).
The mean endometrial thickness measured by transvaginal ultrasonography after management was (7.221 ± 0.678)mm, (8.218 ± 1.794)mm and (9.344 ± 2.297)mm in patients with mild, moderate and severe post abortive bleeding respectively(P<0.001).
No RPOC was identified in the patients in the study group, whereas specimens obtained from two patients in the control group showed gestational tissue and a diagnosis of RPOC was proven histopathologically. The endometrial thickness of those patients were noted as 14 and 15 mm 10 days after the procedure. And this was not statistically significant(P=0.150).
Conclusion
Sublingual misoprostol following vacuum aspiration for early pregnancy termination reduces the duration and amount of post-abortive bleeding. However, large controlled trials are required to support these results.