Browsing by Author "Kocer, M"

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Induction of Labor in Toxemia With Misoprostol
(Blackwell Munksgaard, 2002) Sahin, HG; Sahin, HA; Kocer, M
Background To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in toxemia of pregnancy with a modified Bishop score of less than or equal to4. Methods. A hundred preeclamptic women with a modified Bishop score of :54 were randomized into two groups of 50 patients one group receiving 50 mug intravaginal misoprostol 4 times at 4 hour intervals, the second group receiving oxytocin infusion for induction of labor starting from 1 mIU/per minute, increasing it every 30 minutes with 2 mIU/per minute increments up to maximum of 30 mIU/per minute. Modified Bishop scores 12 hours after induction, the time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann Whitney-U, Chi-Square and hypothesis tests about differences for two proportions (t test) to determine differences between the two groups. p less than or equal to 0.05 was considered significant. Results. Misoprostol was significantly superior for induction of labor in toxemia of pregnancy with modified Bishop score of less than or equal to4. After 12 hours median modified Bishop scores of misoprostol administered group and oxytocin administered group were 7 and 4 respectively. Misoprostol administered group I was significantly better than oxytocin administered group 2 (p = 0.027). The rate of patients who were in labor after 12 hours were 94% and 80% in group I and 2 respectively and the difference showed significant difference (p < 0.05). The median time from induction to delivery was 14 hours and 16 hours in the misoprostol and oxytocin administered group respectively with significant difference between the groups (p = 0.003). The rate of vaginal delivery was significantly higher in the misoprostol administered group 1 (82%) when compared with the oxytocin administered group 2 (66%) (p < 0.05). The I and 5 minutes median Apgar scores were 5-7 and 6-7.5 in group 1 and 2, respectively with no significant differences between the groups (p = 0.96, p = 0.64). The rate of admission to neonatal intensive care unit was similar in both groups. The complication rates were similar in all groups and no significant detrimental effects were noted. Conclusion. Intravaginal misoprostol is an efficacious, cheap and safe method of induction of labor in toxemia of pregnancy with modified Bishop score of less than or equal to4.
Randomized Outpatient Clinical Trial of Medical Evacuation and Surgical Curettage in Incomplete Miscarriage
(Parthenon Publishing Group, 2001) Sahin, HG; Sahin, HA; Kocer, M
Objective To compare the efficacy and safety of misoprostol in outpatient medical evacuation with surgical curettage in uncomplicated incomplete spontaneous miscarriage. Methods Eighty women with a history of vaginal bleeding, and passage of some products of the conceptus were randomized into two groups. Forty patients in Group I received 200 mug misoprostol q.i.d. after the application of 200 mug intravaginal misoprostol for 5 days; 40 patients in Group 2 had a surgical curettage performed. All of the patients were re-evaluated after 10 days. The success rates, mean number of days of bleeding, mean decreases in hemoglobin levels, the complications and the rates of patient dissatisfaction in the two groups were compared. Results The success rate in the misoprostol-administered group was 93.33%. Although the mean number of days of bleeding was significantly higher in the misoprostol-administered group, the mean decreases in hemoglobin values in the two groups were not significantly different. The patient dissatisfaction rate was 2.5% in the misoprostol group, compared to 35% in the control group. The difference between the two groups was significant. Conclusions The use of misoprostol in the outpatient treatment of uncomplicated incomplete spontaneous miscarriage is safe and effective and can be an alternative to surgical evacuation and expectant management.