DOI: https://doi.org/10.53350/pjmhs2216348 ORIGINAL ARTICLE 48 P J M H S Vol. 16, No. 03, MAR 2022 Efficacy of Single Dose of 800μg Vaginal Misoprostol in the Induction of First Trimester Abortion ARJAMAND MAHMOOD 1 , AMINA SALEEM 2 , SALMA KHALID 3 , SAFOORA ANJUM 4 , UMMAY AMMARA 5 , SHAZIA NOOR 6 1 Senior Registrar, Gynaecology & Obstetrics Unit, University of Lahore Teaching Hospital, Lahore, Pakistan. 2 Senior Registrar, Gynaecology & Obstetrics Unit, University of Lahore Teaching Hospital, Lahore, Pakistan. 3 Senior Registrar, Gynaecology & Obstetrics Unit, University of Lahore Teaching Hospital, Lahore, Pakistan. 4 Assisstant Professor, Gynaecology & Obstetrics Unit, University of Lahore Teaching Hospital, Lahore, Pakistan. 5 Senior Registrar, Gynaecology & Obstetrics Unit, University of Lahore Teaching Hospital, Lahore, Pakistan. 6 Assistant Professor, Gynaecology & Obstetrics Unit, University of Lahore Teaching Hospital, Lahore, Pakistan Correspondence to Dr. Amina Saleem, Email: amna.saleem@ucm.uol.edu.pk, Cell:0333-6965854 ABSTRACT Background: Dissolution of pregnancy in the first trimester for several maternal as well as foetal concerns (therapeutic abortion) is a common obstetrical issue. However, induction of abortion demands thorough and effective care, just as women in labour with childbirth. World Health Organization estimates that 13% of all the maternal deaths in South-Asia are associated with abortion procedures. The current recommended approach is 800 μg misoprostol administered vaginally repeated at 3 hours intervals for a maximum of 3 doses with a reported frequency of 85% for complete expulsion of products of conception within 24 hours after administration. There are studies which claim a single vaginal dose of 800μg misoprostol to be equally effective, but more convenient and safe. However, there was controversy surrounding the efficacy of this single dose regimen. Aim: To determine the efficacy of single dose of 800 μg vaginal misoprostol in the induction of first trimester abortion. Methods: This was a descriptive case series conducted at the Department of Obstetrics and Gynecology, University of Lahore Teaching Hospital, Lahore. A written informed consent was taken from all the patients. Results: The total number of patients admitted in the unit over period of 1 year were 369 women in their first trimester requiring therapeutic abortion. The mean age of the patients was 29.04±4.98 years and the mean gestational age was 7.96±2.24 weeks. Majority of the patients were para 2 48(40.1%) followed by para 3(35.8%) and para 1(24.1%). Complete expulsion of POCs within 24 hours was achieved in 342(92.7%) cases while it failed in 7.3% cases. When cross tabulated, the frequency of successful expulsion was unaffected by age (p=.114), gestational age (p=.250) and parity (p=.238). Conclusion: The frequency of complete expulsion of products of conception with single dose of 800μg vaginal misoprostol in first trimester induced abortion was observed to be 92.7%. Keywords: First-Trimester Abortion, Vaginal Misoprostol, 800μg Single Dose INTRODUCTION Maximum number of pregnancy loss is in the form of first trimester abortion. 28% of World’s population resides South-Asia (Bangladesh, India, Pakistan, Nepal and Sri-lanka) and it contributes to almost one third (30%) of world’s maternal deaths. World Health Organization estimates that 13% of all the maternal deaths in South-Asia are associated with abortion procedures 1 . Dissolution of pregnancy in the first trimester for several maternal as well as foetal concerns (therapeutic abortion) is a common obstetrical issue. Induction of abortion demands thorough and effective care, just as women in labour with childbirth. Misoprostol which is a prostaglandin E1 analogue can be administered orally, sublingually, rectally and vaginally and has emerged as an effective agent for the induction of abortion. The current recommended dosage is 800μg misoprostol administered vaginally repeated at 3 hours intervals for a maximum of 3 doses (depending on cervical dilatation) which has an efficacy (complete expulsion in 24 hours) of 85%. However, there are evidences that a single dose of 800 μg misoprostol administered vaginally is equally effective 2,3 . Subedi in 2012 documented that a single dose of 800μg misoprostol administered vaginally was highly effective (complete expulsion rate of 92.7%). Similar results were achieved previously by Prasad et al. in 2007 (94.2%) 4,5 . Thus a single dose of 800μg misoprostol may be equally effective, yet avoiding repeated unnecessary dosage. Also it gives the advantage of outdoor management where the patients can be sent home after single dose and need not to be kept for repeated evaluation and dosage administration. But before jumping to conclusions, one must not forget that there is great discrepancy among results of different authors. Sedigheh et al. in 2008 documented complete abortion rate of just ----------------------------------------------------------------------------------------- Received on 15-09-2021 Accepted on 25-02-2022 62% with single vaginal dose of 800μg misoprostol. Similar results were achieved previously by Blanchard et al in 2005 (60%) and Kovavisarach & Jamnansiri in 2005 (68.40%) 5,6 . This conflict among different authors may be due to poor control of confounder (didn’t exclude uterine abnormalities, didn’t exclude missed/ incomplete abortion, only included early pregnancy failure). The purpose of the current study is to determine the efficacy of single dose regimen after eliminating bias by carefully excluding the confounders. If found better or at least equally effective, this study will enable avoidance of unnecessary dosages and outdoor management of such cases thus avoiding un-necessary burden over the hospital 4-8 . The purpose of the current study was to resolve this controversy while minimizing bias by selecting a large sample size, carefully excluding confounders and stratifying the data for effect modifiers with a hope that if this single dose regimen is found equally effective, the results of this study will enable more convenient, safe and economical management of first trimester abortions in future practice by avoiding repeated dosage in conventional approach. METHODOLOGY This was a descriptive case series conducted at Department of Obstetrics and Gynecology, University of Lahore Teaching Hospital, Lahore after permission from IRB on patients who got hospitalized in unit over a period of 1 year after the approval of synopsis from 16/08/2021 to 15/02/2022. All the patients with first trimester miscarriage as per dating scan requiring therapeutic abortion were included in the study. A written informed consent was taken from all the patients. Study was conducted after getting approval from hospital ethical and research committee. Non probability consecutive sampling technique was used. Patients hypersensitive to prostaglandins, diagnosed case of bronchial asthma, history of missed/ incomplete abortion, previous cesarean section and patients with severe bleeding per vagina necessitating surgical management were excluded.