الفهرس 
Anatomy & Histology of the UterusOnly 14 pages are availabe for public view
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Abstract
Summary
E
arly pregnancy failure is a common complication of pregnancy occurring in up to 15% of all clinically recognized pregnancies. The majority of cases are currently treated by dilatation and curettage which has been the conventional method of treatment over 50 years. Recently, medical treatment by misoprostol is used to improve patient satisfaction and to reduce complications and costs generated by surgery.
In this study we compared surgical procedure versus vaginal misoprostol treatment of first trimester miscarriage. The study was done at Kafr El Shiekh central hospital, Manchyt El Bakry Hospital and Banha University Hospital from May 2012 to November 2013.
Our study comprised one hundred patients diagnosed to have first trimester early pregnancy failure after taking an informed consent. A full history taking, general and abdominal examination, abdominal and vaginal ultrasonographic evaluation and complete blood picture were done.
All of those patients were of gestational age from 6 to 13 weeks, hemostatically stable (50 patients for each group). The first group of patients were treated with surgical curettage (D& C).The second group of patients were treated with 4 tablets (800 mcg), misoprostol administrated vaginally in the posterior fornix followed by another 2 tablets (400 mcg), 4 hourly for a maximum of 3 doses.Comparing the complete expulsion rate (success rate in the two groups), it was 90% in misoprostol group compared to 98% in the surgical group.
The five patients (10%), who had incomplete evacuation after 24 hours of the first dose of misoprostol, was considered as a failure of therapy and uterine curettage was performed without cervical dilatation due to favourable cervical changes of misoprostol but the patients were not enrolled in the surgical arm of the study.
There was no statistically significant difference as regard side effects and complications for both types of the treatment as follows:-
a- Fifteen patients (30%), suffered from nausea in misoprostol group compared to three patients (6%), in D&C group.
b- Four patients (8%), suffered from vomiting in misoprostol group compared to two patients (4%), in D&C group.
c- Two patients (4%), suffered from documented pelvic infection in misoprostol group compared to no patients (0%), in D&C group.
d- Four patients (8%), suffered from diarrhea in misoprostol group compared to no patients (0%), in D&C group.
e- Eight patients (16%) suffered from abdominal colics in misoprostol group compared to five patients (10%), in D&C group.
f- Three patients (6%), suffered from breast tenderness compared to two patients (4%), in D&C group.
g- Three patients (6%), suffered from fatigue in misoprostol group compared to three patients (6%), in D&C group.
h- Four patients (8%), suffered from headache in misoprostol group compared to one patient (2%), in D&C group.
i- No patients suffered from perforation in misoprostol group and D&C group.
Acceptance and patient satisfaction of medical management by misoprostol was high (94%) compared to 46% in the surgical (D&C), group and that difference was highly statistically significant. Patients in the medical (misoprostol),group opt to try the treatment if they have another miscarriage. Some would recommend it to a friend or near family member.
Conclusions & Recommendations
Misoprostol is a cheap, easily used, and stable medication at room temperature and does not require special conditions for storage.
Treatment of early pregnancy failure with 800 mcg misoprostol vaginally followed by another 400 mcg vaginally 4 hourly for a maximum 3 doses was effective with a success rate of approximately 90 percent.
Misoprostol proved to be cost effective and a relatively safe medication with a tolerable side effects that gained a high patient satisfaction as well.
Misoprostol could be used to avoid surgical intervention when it is either risky or not accepted by patients especially in areas with under resourced setting.
Misoprostol was also useful in cases who did not show complete evacuation, where the cervical ripening property of misoprostol helped in performing surgical evacuation easily even without dilatation.
The results of this study should be combined with larger controlled trails to provide more precise look on the problem of management of early pregnancy failure.