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Termination of the missed abortion in the second trimester by vaginal misoprostol (Cytotec)

انهاء موت محصول الحمل في الثلث المتوسط باستخدام الميسوبروستول ( سايتوتيك ) مهبليا

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 Publication date 2000
and research's language is العربية
 Created by Shamra Editor




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In this study , 103 pregnant women with the diagnosis of missed abortion in the second trimester of pregnancy had been accepted to terminate the pregnancy, by one of two methods : In the first group (53 patients ) we used vaginal Misoprostol (cytotec ) ; in the second group (50 patients) we used the classic method by insertion of Foley catheter followed by induction of uterine contractions by oxytocine . (intravenous infusion ) .


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Research summary
تتناول هذه الدراسة مقارنة بين طريقتين لإنهاء الحمل في الثلث الثاني من الحمل بعد موت الجنين. الطريقة الأولى تتضمن استخدام الميسوبروستول (سايتوتيك) عن طريق المهبل، بينما الطريقة الثانية تعتمد على الطريقة التقليدية باستخدام قسطرة فولي والتحريض بالأوكسيتوسين. شملت الدراسة 103 امرأة، حيث تم تقسيمهن إلى مجموعتين: 53 امرأة في المجموعة الأولى و50 امرأة في المجموعة الثانية. أظهرت النتائج أن المجموعة الأولى التي استخدمت الميسوبروستول كانت لديها فترة زمنية أقصر لبدء التقلصات الرحمية (2.28 ± 1.2 ساعة) مقارنة بالمجموعة الثانية (17.46 ± 4.38 ساعة). كما أن فترة طرد الجنين كانت أقصر في المجموعة الأولى (7.22 ± 2.14 ساعة) مقارنة بالمجموعة الثانية (31.49 ± 6.34 ساعة). بالإضافة إلى ذلك، كانت نسبة اللجوء إلى تجريف الرحم أقل في المجموعة الأولى (13.2%) مقارنة بالمجموعة الثانية (30%). وأظهرت الدراسة أيضًا انخفاضًا في معدلات التهاب الملحقات الحاد والتهاب بطانة الرحم الحاد في المجموعة الأولى مقارنة بالمجموعة الثانية. بناءً على هذه النتائج، توصي الدراسة باستخدام الميسوبروستول عن طريق المهبل كطريقة فعالة وآمنة لإنهاء الحمل في الثلث الثاني بعد موت الجنين.
Critical review
دراسة نقدية: تعتبر هذه الدراسة من الدراسات المهمة في مجال طب النساء والتوليد، حيث تقدم بديلاً فعالاً وآمناً للطريقة التقليدية في إنهاء الحمل بعد موت الجنين في الثلث الثاني. ومع ذلك، هناك بعض النقاط التي يمكن تحسينها. أولاً، كان من الأفضل توسيع حجم العينة لتشمل عدد أكبر من النساء لضمان تعميم النتائج بشكل أفضل. ثانياً، لم يتم التطرق بشكل كافٍ إلى الآثار الجانبية المحتملة لاستخدام الميسوبروستول على المدى الطويل. ثالثاً، كان من الممكن تقديم المزيد من التفاصيل حول كيفية مراقبة النساء بعد الإجراء لضمان سلامتهن. على الرغم من هذه النقاط، فإن الدراسة تقدم مساهمة قيمة في هذا المجال وتفتح الباب لمزيد من الأبحاث المستقبلية.
Questions related to the research
  1. ما هي الطرق المستخدمة في الدراسة لإنهاء الحمل بعد موت الجنين في الثلث الثاني؟

    استخدمت الدراسة طريقتين: الأولى باستخدام الميسوبروستول عن طريق المهبل، والثانية باستخدام الطريقة التقليدية التي تتضمن قسطرة فولي والتحريض بالأوكسيتوسين.

  2. ما هي الفروق الزمنية بين الطريقتين في بدء التقلصات الرحمية وطرد الجنين؟

    كانت فترة بدء التقلصات الرحمية في المجموعة الأولى (الميسوبروستول) 2.28 ± 1.2 ساعة، بينما كانت في المجموعة الثانية (الطريقة التقليدية) 17.46 ± 4.38 ساعة. أما فترة طرد الجنين فكانت 7.22 ± 2.14 ساعة في المجموعة الأولى مقارنة بـ 31.49 ± 6.34 ساعة في المجموعة الثانية.

  3. ما هي نسبة اللجوء إلى تجريف الرحم في كل من المجموعتين؟

    كانت نسبة اللجوء إلى تجريف الرحم في المجموعة الأولى (الميسوبروستول) 13.2%، بينما كانت في المجموعة الثانية (الطريقة التقليدية) 30%.

  4. ما هي معدلات التهاب الملحقات الحاد والتهاب بطانة الرحم الحاد في كل من المجموعتين؟

    كانت معدلات التهاب الملحقات الحاد في المجموعة الأولى 3.77% وفي المجموعة الثانية 16%. أما معدلات التهاب بطانة الرحم الحاد فكانت 1.88% في المجموعة الأولى و14% في المجموعة الثانية.


References used
Abramovici D, Goldwasser S, Mabie BC, Mercer BM, Goldwasser R, Sibai BM. A randomized comparison of oral misoprostol versus Foley catheter for induction of labor at term. Am J Obstet Gynecol . 1999 Nov. 181(5 Pt 1): 1108-12
Apgar BS. Current trends in cervical ripening and labor induction Am Fam Physician. 1999 Aug,60(2):418-20
Blanchette HA, Nayak S, Erasmus S. Comparison of the safety and efficacy of intravaginal misoprostol (prosta E1) with those of dinoprostone (prostaglandin E2) for cervical ripening and induction of labor in a community hospital. Am J Obstet Gynecol. 1999 Jun, 180 (6Pt 1) 1551-9
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Objectives: Syria is considered to have the highest fertility rate in the world, some of the reasons are due to women themselves and some are due to the health system and its providers. Methods: Our study is a cross sectional study. It included wome n at fertility age between (15-49 years) they were selected using cluster samples at the six Syrian regions. Results: The study showed that about (24%) of sampled women did not use any form of contraception. Husband refusal was the main reason, followed by health issues and fear of side effects, while religious believes and less frequent intercourse were only responsible for a small percentage. The study also showed that about half of the women who underwent induced abortion was because of social reasons and couples wishing not to keep the pregnancy, followed by failure of contraceptive methods mainly oral contraceptive pills. The majority of induced abortions (96%) were done surgically by dilatation and evacuation while medication was only used in a small percentage. Conclusion: Although (95%) of the induced abortions were done by specialists and (96%) of women were satisfied with the service provided, however this procedure was not devoid of major complications although it was in a small percentage but it was serious enough to affect the woman's life and her future fertility.
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