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Volume 13 Issue 3 (March) 2024

Original Articles

Ease of termination of pregnancy in all trimesters with advent of mifepristone and prostaglandins in patients attending labor room and Gynaecology outpatient department of a tertiary care centre
Dr. Ayushi Kumari Arya, Dr. Kavita, Dr. Bindu Arya, Dr. (Prof) Mamta Singh

Background–The combination of mifepristone (RU 486) and a prostaglandin analogue given either sublingually, orally or intravaginally is effective in terminating pregnancy, but the prostaglandin component of the regimen is cumbersome to administer and has side effects. We conducted this study to determine the efficacy& safety of 200 mg of mifepristone followed by a small dose of misoprostol, an orally active prostaglandin E1 analogue, and Dinoprostone, a Prostaglandin E 2 analogue in gel form, for termination of pregnancy. Mifepristone(RU 486 ) is a potent antiprogesterone, a new class of pharmacological agent which antagonizes the action of progesterone. It is 19 Norsteroid which has greater affinity for progesterone receptors present on the myometrium of uterus than does progesterone itself, thus blocking action of progesterone and also increases the sensitivity of uterus to Prostaglandins .But when administered alone , termination of pregnancy is incomplete in 16 % women due to insufficient increase in prostsaglandin concentration in uterus. Mifepristone (RU-486) 200 mg given orally on day 1 . This is followed in 24 to 48 hours by sublingual, buccal or vaginal administration of 400 microgram of misoprostol(prostaglandin E 1 ) , or Local application of PGE2 gel form - Prepidil – available in 2.5 ml syringe for an intracervical application of 0.5 mg of dinoprostone. These are the effective method for termination of pregnancy in all trimesters as It is safe, effective and convenient method as well as privacy is maintained . Aims– To assess the safety &efficacy of medical termination of pregnancy using RU-486&prostaglandins. Method -This was a prospective observational study, conducted on 500 women attending Obstetrics and Gynaecology Department, Nalanda Medical college and hospital, Patna from Nov. 2022 - feb 2024. Firstly, early weeks pregnancy < 13 wks is confirmed by urine pregnancy test by kit method, measurement of serum concentration of Beta subunit of human chorionic gonadotropin ( beta –HCG ) and Ultrasonography. All women who want termination of pregnancy , 200 mg of RU-486was given on day 1 and then 24 to 48 hrs later 800 microgram of misoprostoloraly or vaginally given in first trimester, 400 microgram of misoprostol either sublingually, orally or vaginally given in second trimester. In third trimester, misoprostol 25 or 50 mcg p/v based on parity of women, primigravida 25 mcg &multigravida 50 mcg was administered for pregnancy termination . Dinoprostone gel 0.5 mg was also administered transcervically either alone or 24 to 48 hrs after miferpristone ,for induction of labor > 40 wks whose Bishop’s score less than 6or termination of pregnancy > 28 wks with Intrauterine death . Results - The final assessment of 500 women was completed.140 women pregnant for <12 wks, 288women 13 wks to 27 wks pregnant, 52women >28 wks pregnancy with intrauterine death, 20 pregnant women was induced with this method who had > 40 wks pregnancy with Bishop’s score less than 6. In present study 92 % women are 20 – 32 year age. Majority of women (80 %) are of 1st & 2ndpara. Complete abortion in 96.4 %, Incomplete abortion in 3.5%. 92.3 % women expelled dead fetus within 48 hrs of induction with combined regimen and 90 % delivered vaginally within 24 – 48 hrs after induction of labor. Conclusion-The present study demonstrated the safety and efficacy of combinedMifepristone and prostaglandin therapy for Medical terminaton of Intrauterine pregnancy in Indian adult women.Mifepristone is an alternative to classic uterotonic agents for inducing labor in an unripe cervix and reduced the incidence operative procedure.

 
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