الفهرس 
SECOND TRIMESTER TERMINATION OF PREGNANCYOnly 14 pages are availabe for public view
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Abstract
W
omen who require induction of abortion often present with unfavorable cervices, which can lead to a prolonged and difficult induction. Preinduction cervical ripening is often done to increase the likelihood of successful induced abortion.
Nonpharmacologic approaches to cervical ripening and induction of abortion have included herbal compounds, castor oil, hot baths, enemas, sexual intercourse, breast stimulation, acupuncture, acupressure, transcutaneous nerve stimulation, and mechanical and surgical modalities. Of these nonpharmacologic methods, only the mechanical and surgical methods have proven efficacy for cervical ripening or induction of abortion. Prostaglandines are pharmacologic agents available for cervical ripening and induction of abortion.
The common clinical practice nowadays in pregnant women undergoing induction of abortion with an unripe cervix; cervical ripening is attempted first mainly by the use of prostaglandins or by mechanical methods such as an intracervical balloon catheter like the Foley’s catheter.
Many controversies have been raised regarding the perfect dose and way of administration of prostaglandins, especially prostaglandin E1 analouge (misoprostol) which is preferred than prostaglandin E2 preparations for its cost, thermo stability and easy to use. Recently, many studies have also raised other controversies regarding the Foley’s catheter optimal use, in means of the optimal balloon capacity used and the duration of its use.
Misoprostol (Mesotac) is synthetic prostaglandin E1, and is currently available as a 200-μg tablet for prevention of peptic ulcers. It has been used ”off label” for cervical ripening and labor induction.
Misoprostol is inexpensive, stable at room temperature, and easily administered orally or by being placed into the vagina, but not the cervix.
Misoprostol use may decrease the need for oxytocin, achieve higher rates of vaginal delivery within 24 hours of induction, and reduce induction to expulsion intervals.
The pharmacokinetics of misoprostol suggest that it is more bioavailable when administered vaginally as compared with orally. Plasma concentrations of its metabolite, misoprostol acid, peak one to two hours after vaginal application as compared with the peak seen 30 minutes following oral administration.
Over the past few decades, many researchers studied and compared the use of the mechanical method (Foley’s catheter balloon) versus the use of the pharmacological methods in terms of their effectiveness and safety, and varying results were concluded; some were in favor of using one method over the other and some concluded that they had equivocal effects, depending on the outcome results of each study.
The present study is a pilot one, that was conducted to compare the efficacy of adding PG E1 (misoprostol) injected extra-amniotically to the intracervical Foley’s in induction of abortion in the 2nd trimester of pregnancy.
Thirty women admitted for induction of abortion for varying indications were enrolled in the present study, which was carried out in Ain-shams University Maternity Hospital between February 2013 and July 2013. The women in the study were randomized in two groups. Group I of pregnant women were assigned for the use of the transcervical Foley’s catheter with PG E1 injected extra-amniotically. Group II of pregnant women were assigned for the use of the transcervical Foley’s catheter with saline injected extra-amniotically as a placebo. Randomization was by using a computer-generated randomization sheet. Allocation was performed using 30 concealed opaque envelopes. Each patient received a closed concealed randomly numbered envelope containing 4 prefilled syringes (10cc) with colorless solution.
All pregnant women who met the inclusion criteria were submitted to full history taking, general, abdominal and vaginal examination to assess the cervix, ultrasound scanning to exclude the presence of any of the exclusion criteria, after obtaining an informed consent. The women’s data were registered in a special form, recording relevant aspects of the history, data relevant to the examination and ultrasound scanning. Record of the time of insertion of each treatment modality was taken, and time of subsequent doses or adjustment together with information about women’s progress, intervention the women received or events happened during the process of induction. Oxytocin was used in both I & II groups after expulsion of the balloon to achieve and maintain efficient uterine contractions.
Statistical analysis of the obtained results showed the two groups to form a cohort, being statistically insignificant as regards mean age, parity, gestational age. The indications for labor induction varied between IUFD, CFMF, hydrocephalus and hydrops fetalis.
The mean interval from induction to balloon expulsion for each group is nearly equal and of no statistical significance, (1.41±0.388 hrs) in group 1 and (1.722±0.55 hrs) in group 2.
The mean interval from induction to uterine content expulsion for each group shows big different with high statistically significance, (9.533±3.925 hrs) in group 1 and (22.866±8.227 hrs) in group 2.
Based on the previous findings, it was concluded that all treatment modalities used were effective in achieving uterine content expulsion, but addition of misoprostol to the Foley’s catheter is capable of achieving abortion in less time than Foley’s catheter alone.