الفهرس 
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Abstract
Miscarriage is common, affecting one in five pregnancies Miscarriage can cause physical harm, such as excessive bleeding and infection, and substantial psychological harm, including anxiety, depression, and post-traumatic stress disorder.
Misoprostol, a prostaglandin analogue, is commonly used for the medical management of miscarriage to induce myometrial contractions to aid the expulsion of pregnancy tissue. However, misoprostol is not always effective, and 15–40% of women require an additional dose of misoprostol, thus prolonging the duration of treatment. Failure of medical management can result in more surgical procedures being done, which can be particularly undesirable to women who have chosen to have medical management.
To augment the effect of misoprostol, a steroidal anti-progesterone like mifepristone is sometimes used in combination. Mifepristone is a competitive progesterone receptor antagonist that primes the myometrium before prostaglandin exposure.
Due to its anti-progestin activity, Ulipristal is highly effective for use in emergency. It’s primary mechanism of action is delay of ovulation, but endometrial effects that may affect implantation may also contribute to efficacy
This study aimed to assess the effectiveness and safety of Ulipristal Acetate in the management of 2nd trimester missed abortion along with misoprostol in pregnant women versus the use of misoprostol only with placebo as regards the time needed for abortion (whether complete or incomplete abortion).
During this study, forty six patients were assessed for eligibility and 24 patients were included in the study (12 in each group). Of all eligible patients, 18 patients were excluded from the study based on the inclusion criteria and 4 patients refused to participate in of the study.
Ultimately, the analysis was based on the data of 12 patients in Ulipristal Acetate group and 12 in the control group.
Our results revealed that all cases in both groups had equal cervical dilatation with non-significantly shorter cervical dilatation time from the start of induction and less complete expulsion and abortion in Ulipristal group.
Our results revealed that induction to abortion and expulsion time was non-significantly shorter in cases had complete expulsion among Ulipristal group than among placebo group.
Regarding the surgical complications and blood loss, one case in each group (8.3%) had rupture uterus with 3 cases in ulipristal group (25%) and 2 cases in placebo group (16.7%) underwent hysterotomy with no statistically significant difference between the both groups with non-significant less blood loss in Ulipristal group.
We concluded that no additional effect for ulipristal acetate in combination with misoprostol in second trimesteric medical abortion.
Considering the small samples of our study, more data are still needed to verify our conclusions.
We rcecommended increased the dosing interval in a multi-centeric further study with increase doses of uripristal acetate.