A comparative study of efficacy and safety of intramuscular carboprost and intravaginal misoprostol for cervical priming prior to first trimester surgical abortion

Authors

  • Gayatri Mathuriya Department of Obstetrics and Gynecology, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
  • Neha Verma Department of Obstetrics and Gynecology, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
  • Shivangi Pandey Department of Obstetrics and Gynecology, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20194892

Keywords:

Carboprost, Intravaginal, Misoprostol, Multigravida, Prostaglandin, Primigravida

Abstract

Background: MTP Act no 34 of 1971 has been defined as Legal termination of pregnancy before the age of viability of fetus that is 20 weeks of gestation. There is a need to find a medical agent which can help in the process of abortion by speeding it up, with minimal side effects. The objective of this study was to compare the efficacy of I.M carboprost and intravaginal Misoprostol and to evaluate the safety profile of I.M carboprost and Intravaginal Misoprostol. To compare the cervical dilatation caused by I.M carboprost and intravaginal Misoprostol and to compare the blood loss and adverse effects of I.M carboprost and Intravaginal Misoprostol.

Methods: Prospective randomized experimental study including pregnant women up to 12 weeks of gestation opting for M.T.P. Study conducted on 200 patients selected from patients admitted in MGM Medical College and M.Y. Hospital, Indore and Kalyanmal Hospital, Indore during the period July 2014 to March 2015. They were randomly divided into 2 groups. Group A who received intramuscular injection of 250 mcg of caboprost or Group B,which received 400 mcg of vaginal Misoprostol 4 hours prior to suction evacuation.

Results: Intravaginal misoprostol achieves better cervical dilatation compared I.M carboprost which is statistically significant. Misoprostol is associated with higher blood loss as compared to I.M carboprost which is associated with nausea/vomiting & more likelihood of loose stools and abdominal cramps which is proved statistically.

Conclusions: Intravaginal misoprostol is associated with higher blood loss as compared to I.M carboprost which is significant but intravaginal misoprostol achieves more cervical dilatation and causes less adverse events than I.M carboprost which is statistically more significant and therefore intravaginal misoprostol is the drug of choice for cervical priming prior to surgical abortion in terms of both efficacy and safety.

References

Sedgh G, Singh S, Iqbal H. Induced abortion worldwide in 2008: levels and trends. The Lancet. 2012;379(9816):625-32.

Kulier R, Gulmezoglu AM, Hofmeyr GJ, Cheng LN, Campana A. Medical metods for first trimester abortion. Cochrane Database Syst Rev. 2004;2:CD002855.

Niinimaki M, Jouppila P, Martikainen H, Talvensaari-Mattila A. A randomized study comparing efficacy and patient satisfaction in medical or surgical treatment of miscarriage, Fertil Steril. 2006;86:367-72.

Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90:88-92.

Danielsson KG, Marions L, Rodriguez A, Spur BW, Wong PY, Bygdeman M. Comparison between oral and vaginal administration of misoprostol on uterine contractility. Obstet Gynecol. 1999;93:275-80.

Khan RU, EI-Refacy H, Sharma S, Sooranna D, Stafford M. Oral, rectal, and vaginal pharmacokinetics of misoprostol. Obstet Gynecol. 2004;103:866-70.

John A, Thomas, Edward J. Keenan. Principles of endocrine. Pharmacol. 1986;3:64.

Prabhu S, Aurangabadwalla V, Misri A. Cervical priming prior to first trimester suction evacuation: comparative study. J Evol Med Dent Sci. 2014;3(69):14804-10.

Grimes DA, Kenneth F, Schulz, Cates WJ. Prevention of uterine perforation during curettage abortion. JAMA. 1984;251(16):2108-11.

Moberg PJ. Uterine perforation in connection with vacuum aspiration for legal abortion. Int J Gynaecol Obstet. 1976;14(1):77-80.

McKinley C, Thong KJ, Baird DT. The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol. Hum Reprod.1993;8:1502.

Thong KJ, Baird DT. Induction of abortion with mifepristone and misoprostol in early pregnancy. Br J Obstet Gynaecol. 1992;99:1004-7.

Vimala N, Mittal S, Dadhwal V. Cervical priming with sublingual misoprostol vs. 15-methyl-prostaglandin F2alpha prior to surgical abortion. Int J Gynaecol Obstet. 2005;88(2):134-7.

Jayasheela M, Lakshmi ARV, Aswini K. Comparative studies on pre-operative inj. Carboprost with misoprostol tablets in 12-25 weeks medical termination of pregnancies. Int J Allied Sci Clin Res. 2015;3(2):218-23.

Natrajan PK, Tzingounis VA. Cervical dilatation with prostaglandin F2 alpha for first trimesterabortion. South Med J. 1986;79(7):830.

Bala, Singh & Priyanka, Shrivastava. Cervical Ripening For First Trimester Abortion: A Comparative Study between Misoprostol and Carboprost 125 Micrograms. IOSR J Dental Med Sci.(2017);16:40-2.

Singh PD, Megh MG. Carboprost tromethamine in the active management of third stage of labour. Ind Pract. 1995;48:103-5.

Downloads

Published

2019-10-23

Issue

Section

Original Research Articles