‹kinci ve üçüncü trimestr gebelik sonland›rmalar›nda misoprostol etkinli¤i

Objective: Retrospective analysis and evaluating reliability and efficiency of misoprostol in 87 cases having pregnancy termination by using vaginal misoprostol between 12 and 35 weeks’ gestation. Methods: The present study was conducted at Celal Bayar University, Gynecology and Obstetrics Clinic, Perinatology unit between January 2006 and November 2008. A total of 87 cases at more than 12 weeks gestation, including 8 cases having uterine scars due to previous cesarean section and 79 cases having no previous uterine surgery, underwent pregnancy termination and were retrospectively analyzed. In all the cases, the induction agent administered was vaginal misoprostol. In cases having previous cesarean delivery, following the initial dose of 200 μg between 12-24 weeks’ gestation and 100 μg at more than 24 weeks’, misoprostol was administered 200 μg every 4 hours for a period of 24 hours until contractions started. In cases having no uterine scar, following the initial dose of 400 μg between 12-24 weeks’ and 200 μg after 24 weeks’, misoprostol was added 400 μg and 200 μg every 4 hours for a period of 24 hours, respectively. If needed, the same dose scheme was repeated after a 12 hours resting period and, in case of failure, an additional method was used. Results: 53 cases (60.9%) were nulliparous and 34 cases (39.1%) were multiparous. 49 out of 87 (56%) cases were between 12 and 20 weeks’ gestation, while 38 (44%) cases were at more than 20 weeks’gestation. The median induction-to-termination interval which was 28.5 h (1-137 h) for all the cases was 30.8 h in nulliparous cases and 24.8 h in multiparous cases, and no statistically significant difference was detected (p=0.32). In 16 cases duration of pregnancy termination was over 48 h. In 10 cases (11.5%) pregnancy termination was achieved by using an additional method. Compared to the cases having no uterine scar, additional methods were used significantly more in cases having previous cesarean delivery (25% versus 10%; p=0.000). 2 cases developed complications (23%): fever and hemorrhage in one case and hemorrhage in one case. 1 case underwent cesarean section due to hemorrhage. No uterine rupture was observed in the cases. Conclusion: Using vaginal misoprostol is a fairly safe, efficient and non-invasive method in second and third trimester pregnancy termination. However, studies with wider series are needed to assess reliability of using misoprostol in cases with uterine scarring.