The Journol of Molernol-fetol ond Neonotol Medicine 2OO3tl4l.226-228 Misoprostol administratioq in first.trimester pregnancies with embryonic demise reduces uterine arterial blood flow C. Turon, N. Koc, R. Donsuk, B. Cengizoglu,D. S. Mericeli ond O. Unol Depofiment of Obsletrics and Gynecology, KoftolEducation ond Resesrch Hospitol, lstonbul, Tufuey Obiectives: This study was designed to evaluate the effect of misoprostol on the blood flow in uterine arteriesof pregnant women with first-trimester embryonic demise, Methods: Transvaginal ultrasonographic Doppler examinations (resistance index, pulsatility index, systolic/diastolic ratio) of the uterine arteries in 61 pregnant women were performed before misoprostol administration and 90 min later. Following baseline Doppler measurements, eacn woman recelveo zv} ytg misoprostoi inuavaginally and 200 pg misoprostolorally. Resuhs ond conclusion: All Doppler indices increased significantly after misoprostol adminis- tration (p < 0.0001),suggesting an increase in flow resutance. lfty wdr: MISOPROSTOL; DOPPLER; UTERINE ARTERY; PREGNANCY; EM BRYONIC DEMISE INTRODUCTION Although misoprostol is not registered for these indica- tions, a number of studies have shown that it is an effective agent for medical termination of first- and second-rrimester pregnancies, cervical ripening and induction of term laborl-e. In Brazil, the misuseof misoprostol for inducing abortion without the management of a physician is common. Infants reportedly exposed to misoprostol during the first 3 months of gestation for an unsuccessful termination of pregnancy have shown major limb deformities attributed to uterine arterial vasoconstriction and vasodisruptionl0. In order to test this possibility, Doppler flow velociry waveforms of uttrine arteries were investigated prospectively in a group of women with embryonic demise. H=T,IIODS A cohort of 61 consecutively recruited pregnant women with ernbryonic demise was evaluated between 1 September 2000 and 30 April 2001 at the Department of Obstetrics and Gynecology, (ar1al Eduqation and Research Hospital, Istanbul, Turkey. The study was approved by the e*rics committee of the hospital, and informed consent was obtained in advance from each woman, Inclusion criteria consisted of an intrauterine gestational sac with a maximum diameter of 30 mm and either no embryonic pole or an embryonic pole of > 6 mm and no cardiac activity. Exclusion criteria consisted of matemal cardiac disease, inflammatory disease, known allergy to prostaglandins, hemodynamic instability, more than slight vaginal bleeding, a hemoglobin counf of less than 10 mg/dl, an abnormal coagulation profile, a temperature higher than 37.5'C and renal or hepatic dysfunction. Transvaginal ultrasonographic Doppler examinations were performed by the same author before misoprostol administration and 90 min later, using a Diasonics Synergy machine (Geheral Electric, Norway) with a 7.5-MHz color Dopplet probe. All Doppler measurements (resistance index (RI), pulsatility index (PI), systolic/diastolic (S/D) ratio) were obtained within the main branch of the uterine arteries.After the first Doppler measurements, each woman received 200 pg misoprostol intravaginally (posterior fomix) and 200 pg misoprostol orally (Cytotec, Ali Raif' Istanbul, Turkey). Measurements were calculated using three or more optimal waveforms. The instat V3 program was used in the statistical analysis' The differences before and after misoprostol administration were analyzed using the t test. Correspondence: Dr C. Turon, Yesilkosk Sokok, Leylo Buklu Apr,No.1 5 / E,Toprolcyol, Korfol, lslonbul, Turkey @ 2003 The PorlhenonPublishing Group 226 Received 04-03-03 Revised 03-06-03 Accepled 20-06-03