الفهرس 
Mid Trimester MiscarriageOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
S
econd trimester abortions constitute 10–15% of all induced abortions worldwide but are responsible for two-thirds of major abortion-related complications. During the last decade, medical methods for second trimester induced abortion have been considerably improved and become safe and more accessible. Today, in most cases, safe and efficient medical abortion services can be offered or improved by minor changes in existing health care facilities (Choudhary et al., 2011).
Misoprostol is a synthetic prostaglandin E1 analogue which was originally developed to prevent non-steroidal anti-inflammatory drugs related gastric ulcers. However, it has been used for various other indications in obstetrics and gynecology (Wu et al., 2017).
Primrose is a herb from the Oenothera bennie’s family. The seeds of the herb contain two essential fatty acids: linoleic acid (LA) and Gamma linoleic acid (GLA) which facilitate the prostaglandin EI synthesis (Sergeant et al., 2016).
The current study was conducted at Ain Shams University maternity hospital during the period from the 1st of January 2019 to the last of August 2019.
The aim of this study was to assess the efficacy of evening primrose oil in shortening the duration of induction of miscarriage when added to misoprostol in women with 2nd trimester missed miscarriage.
The study included 120 participant attended Ain Shams Maternity Hospital emergency room aged 20-35 years with second trimester missed miscarriage. They were recruited after obtaining an informed consent. They were randomized into two groups.
Study group: 60 women with second trimester missed miscarriage received misoprostol (misotac® sigma pharmaceutical industries) 200 µg vaginally applied every 4 hours + 1 capsule evening primrose oil (primrose plus® EMA pharmaceuticals) 1000 mg vaginally applied every 4 hours till full cervical dilatation and fetal expulsion.
Control group: 60 women with second trimester missed miscarriage received misoprostol 200 µg vaginally applied every 4 hours till full cervical dilatation and fetal expulsion.
In the current study the mean age of the participants in both groups was matched 28.5 ± 5.2 VS 27.8 ± 5.0 years, mean BMI was 30.4 ± 5.9 VS 29.6 ± 6.6 kg/m2 in study group and control group respectively.
Induction to abortion interval was 20.2 h and 22 h in study group and control group respectively with no statistical significant difference.
Total dose of misoprostol used till evacuation was 957.69 ±445.16 mcg in the study group and 1079.25 ±632.8 mcg in control group with no statistical significant difference.
Success rate of abortion within the first 24 hours was 75% in case group and 70% in control group with no statistical significance, however only 3.3% of women in EPO group needed surgical intervention while 13.3% in misoprostol only group with p value = 0.048 .
Regarding blood loss in both groups, there was statistical significant difference between case and control group with p value = 0.000 however the clinical significance was small.
In the present study, hematocrit and hemoglobin after medical termination were nearly comparable between both groups 32.8 VS 33.1 gm/dl and 10.8 VS 11.01 gm/dl in case and control group respectively with non-statistical significant differences.
The current study showed no significant difference between case and control groups regarding pain score and endometrial thickness after medical evacuation with P value = 0.372 and 0.139 respectively.
After adjustment for age, BMI and gestational age, there was no effect of EPO on success of spontaneous evacuation (odds ratio = 1.579, 95% CI = 0.638 to 3.913, P-value = 0.324.
Regarding K.M curves for time to different outcomes, there was no statistical significant differences between the two groups for time to onset of uterine contractions (log-rank test chi-squared = 0.88, df = 1, P-value = 0.34), the time to onset of vaginal bleeding (log-rank test chi-squared = 0.792, df = 1, P-value = 0.373),and the time to fetal expulsion (log-rank test chi-squared = 0.300, df = 1, P-value = 0.58).
Regarding different side effects of misoprostol ,there was statistical significant difference between case and control groups in the occurrence of, nausea, chills and pain requiring analgesics with P value = 0.000, 0.001and 0.015 respectively.
In conclusion, the addition of EPO to misoprostol in medical termination of second trimester missed miscarriage did not significantly shorten the induction to evacuation interval; however it was effective on reducing pain, nausea and need for surgical evacuation.