MISSED ABORTION

MISOPROSTOL VERSUS CERVICAL CATHETER AS CERVICAL PRIMING AGENT

Abstract

Objective: To compare the effectiveness of extra-amniotic cervical catheter and vaginal misoprostol as a cervical priming agent prior to surgical evacuation in first trimester missed abortions. Design: Randomized clinical trial. Setting: At lady Willingdon hospital gynecology unit 1 from 1st March 2008 to 28th February 2009. Methods: 100 patients with diagnosis of missed abortions of up to 12 weeks + 6 days were studied. The primigravida were included. They were divided in two groups. In group. A (50) patients 400 microgram (2 tablet ) misoprostol were placed high up in posterior vaginal fornix while in group B (50) patients extra-amniotic. Foleys catheter was placed aseptically 6 hour before surgical intervention as priming agent. Exclusion criteria: All multigravida, patients sensitive to prostaglandin, and with disturbed coagulation were excluded. Main Outcome Measures: The main out comes are 1, cervical dilatation and effacement 2,
complications like fever, pain lower abdomen, headache and vomiting 3, amount of bleeding in ml after application of agent. Results: Cervical catheter proved to be good cervical priming agent comparable to misoprostol. Cervical dilatation was significantly better in misoprostol (> 10 mm 44%, > 8mm 30%, > 5mm 20%) as compared to Foleys group (>10 mm 24%, > 8mm 38%, > 5mm 20%) while in 3 (6%) dose of misoprostol was repeated and in 10 (20%) patient in Foleys group has no effect. The side effects occurred in both groups but systemic effects were more in misoprostol, pain lower abdomen 42% VS 46%, backache 18% VS 26%, fever 10% VS nil, headache 16% VS nil and no side effect 14% VS28%) as compared to Foleys catheter. Systemic effects were absent in Foleys catheter due to inert nature. Bleeding occurred in all patients
with misoprostol while it was absent in 48% cases in Foleys group (>60ml 42% VS 8%, <40ml 32% VS 14% < 20ml 26% VS 30%). 48% cases had no bleeding in Foleys group. Conclusion: Cervical catheter proved to be good priming agent due to lesser systemic side effects as compared to misoprostol.