Özlem DURAL, Cenk YAŞA, Deniz K. ACAR, Gökhan YILDIRIM, Melih BESTEL, Sedat TEKELİ, Halil ASLAN

GEÇİRİLMİŞ SEZARYEN ÖYKÜSÜ OLAN VE UTERİN SKARI OLMAYAN GEBELERDE İKİNCİ VE ERKEN ÜÇÜNCÜ TRİMESTER TERMİNASYONLARINDA DÜŞÜK DOZ VAGİNAL MİZOPROSTOL KULLANIMININ KARŞILAŞTIRILMASI

Amaç: Geçirilmiş sezaryen veya uterin cerrahi öyküsü olan ve olmayan hastalarda geç gebelik terminasyonlarında düşük doz vaginal mizoprostol uygulamasının güvenilirliği ve etkinliğinin belirlenmesi amaçlandı. Yöntem ve Gereç: Ocak 2008 ile Haziran 2012 tarihleri arasında ikinci veya erken üçüncü trimesterde gebelik terminasyonu yapılan 209 gebe retrospektif olarak değerlendirildi. Gebelerden 173’ünde uterin skar bulunmazken (Grup 1), 36’sında daha önce sezaryen hikayesi mevcuttu (Grup 2). İndüksiyon ile abortus arasında geçen süre, komplikasyon oranı, başarısızlık oranı ve bu süreçteki ek girişim gereksinimi değerlendirildi. Bulgular: Grup 1’deki hastaların145’inde (%83,8), ilk 48 saatte vaginal doğum olurken, indüksiyonla abortus arasındaki ortalama süre 21±10,3 saat idi. Bu gruptaki hastaların 11’inde (%6,3) bir veya daha fazla ek girişim gerekirken, bir olguda (%0,57) uterin rüptür gözlendi. Grup 2’de ise hastaların 26’sında (%72,2) ilk 48 saatte vaginal doğum olurken (p=0.11) indüksiyonla abortus arasındaki ortalama süre 22,7±10,8 saat idi (p=0.45). Altı hastada (%16,7) ek girişim gerekirken (p=0.05), bir olguda (%2,7) uterin rüptür görüldü (p=0.28). Sonuç: Geç gebelik terminasyonlarında düşük doz vaginal mizoprostol, belirgin yan etki veya komplikasyona sebep olmaksızın uygulanabilir görünmektedir

Anahtar Kelimeler:

Mizoprostol, gebelik terminasyonu, uterin rüptür

COMPARISON OF USE OF LOW DOSE VAGINAL MISOPROSTOL FOR SECOND AND EARLY THIRD TRIMESTER PREGNANCY TERMINATION IN WOMEN WITH PRIOR CAESAREAN AND UNSCARRED UTERI

Objective: The study was aimed to determine the safety and efficacy of the vaginal administration of low dose misoprostol for late pregnancy termination in women with prior caesarean and unscarred uteri.Study design: A retrospective study was carried out from January 2008 to June 2012 on 209 pregnant women who underwent termination of pregnancy in the second and early third trimester. Among the women, 173 did not have a uterine scar (Group 1) while 36 had a history of prior caesarean (Group 2). The induction-to-abortion interval, the rate of complications and failureand the need for a different method during the process were assessed.Results: In group 1, 145 of patients (83.8%) delivered vaginally in 48 hours, the mean duration of the induction-to-abortion interval was 21±10.3 hours. In this group, 11 patients (6.3%) needed one or more different methods and one case of uterine rupture (0.57%) was observed. In group 2, 26 of patients (72.2%) delivered vaginally in 48 hours (p=0.11), the mean induction-abortion interval was 22.7±10.8 hours (p=0.45). Six patients (16.7%) needed a different method (p=0.05) and there was also one case (2.7%) of ruptured uterus (p=0.28).Conclusion: Administration of low-dose vaginal misoprostol appears to be effective without excessive side effects or complications for late pregnancy termination.Key words: Misoprostol, pregnancy termination, uterine rupture,

Keywords:

Misoprostol, pregnancy termination, uterine rupture,

PDF

___

New US food and drug administration labeling on Cytotec (misoprostol) use and pregnancy. ACOG Committee Opinion 283. Washington, DC: American College of Obstetricians and Gynecologists 2003. Int J Gynaecol Obstet. 2003;82:137-8
WHO. Safe abortion: technical and policy guidance for health system. Geneva: WHO; 2003.
Ho PC, Blumenthal PD, Gemzell-Danielsson K, Gomez Ponce de LR, Mittal S, Tang OS. Misoprostol for the termination of pregnancy with a live fetus at 13 to 26 weeks. Int J Gynaecol Obstet 2007;99(2):178–81.
Lehair J, Lemarie P, Helleringer M, Manini P. Expulsion of arrested pregnancy product in the second trimester using a prostaglandin E1 analog administered intravaginally. Apropos of 12 cases. Rev Fr Gynecol Obstect 1989;84:19-23.
Bugalho A, Bique C, Almeida L, Fau´ndes A. The effectiveness of intravaginal misoprostol (Cytotec) in inducing abortion after eleven weeks of pregnancy. Stud Fam Plann 1993;24:319-23.
Elsheikh A, Antsaklis A, Mesogitis S, Papantoniou N, Rodolakis A, Vogas E, Michalas S. Use of misoprostol for the termination of second trimester pregnancies. Arch Gynecol Obstet 2001;265:204-6.
Nigam A, Singh VK, Prakash A. Vaginal vs. oral misoprostol for mid-trimester abortion. Int J Gynaecol Obstet 2006;92:270–1.
Dickinson JE, Evans SF. A comparison of oral misoprostol with vaginal misoprostol administration in second-trimester pregnancy termination for fetal abnormality. Obstet Gynecol 2003;101:1294–9.
Bebbington MW, Kent N, Lim K, Gagnon A, Delisle MF, Tessier F, et al. A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination. Am J Obstet Gynecol 2002;187:853–7.
Borgatta L, Kapp N. Clinical guidelines. Labour induction abortion in the second trimester. Contraception 2011;84(1):4-18.
Hsieh TY, Yu CH, Kuo PL, Chang FM. Prenatal diagnosis of alobar holoprosencephaly with cystic hygroma. Taiwan J Obstet Gynecol 2006;45:146-9.
Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for midtrimester termination of pregnancy. Cochrane Database Syst Rev 2011;19:CD005216.
Grimes DA. The continuing need for late abortions. JAMA 1998;280(8):747-50.
Lin CJ, Chien SC, Chen CP. The use of misoprostol in termination of second-trimester pregnancy. Taiwanese Journal of Obstetrics & Gynecology 2011;50:275-82.
Elati A, Weeks AD. The use of misoprostol in obstetrics and gynaecology. Br J Obstet Gynecol 2009;116:61-9.
Lalitkumar S, Bygdeman M, Gemzell-Danielsson K. Mid-trimester induced abortion: a review. Hum Reprod Update 2007;13:37-52
Dickinson JE, Doherty DA. Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality. Prenatal Diagnosis 2009;29(5):520–4.
Jain JK, Mishell DR. Comparison of intravaginal misoprostol with prostaglandin-E(2) for termination of 2nd-trimester pregnancy. N Engl J Med 1994;331:290–3.
Dickinson JE, Evans SF. The optimization of intravaginal misoprostoldosing schedules in secondtrimester pregnancy termination. Am J Obstet Gynecol 2002;186:470–4.
V Berghella, J Airoldi, AM O’Neill, K Einhorn, M Hoffman. Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review. Br J Obstet Gynecol 2009;116(9):1151-7.
Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol 2009;113(5):1117-23.
Nayki U, Taner CE, Mizrak T, Nayki C, Derin G. Uterine rupture during second trimester abortion with misoprostol. Fetal Diagn Ther 2005;20:469–71.
Atienza MF, Burkman RT, King TM. Midtrimester abortion induced by hyperosmolar urea and prostaglandin F2a in patients with previous cesarean section: clinical course and potential for uterine rupture. Am J Obstet Gynecol 1980;138:55–9.
Aslan H, Unlu E, Agar M, Ceylan Y. Uterine rupture associated with misoprostol labor induction in women with previous cesarean delivery. Eur J Obstet Gynecol Reprod Biol 2004;113:45–8.