BACKGROUNDUnsafe abortion is a major public health problem. Globally, 20 million unsafe abortions take place each year and account for 13% of all maternal deaths. According to WHO, 56% of abortions in developing countries are still unsafe even though medical abortion methods have been in use for more than a decade.The main objective of the present study is to compare the efficacy, acceptability, side effects and factors affecting outcome of early medical abortion with oral and vaginal misoprostol after oral mifepristone in inducing early medical abortion up to 49 days. MATERIALS AND METHODSIt was an interventional study (non-RCT) conducted on women requesting termination of early pregnancy at the outpatient department of family planning unit with ultrasound confirmed intrauterine gestation of 49 days allocated into two groups. Mifepristone 200 mg was administered on Day 1 followed by 400 mg of oral misoprostol for Group I and 800 mg of vaginal misoprostol for Group II. They were reviewed on Day 14 by ultrasound for completion of abortion and Hb. If abortion was incomplete or bleeding was excessive, curettage was done. RESULTSThe two groups were comparable with respect to age, parity and gestational age, socio-economic status and level of education. There was no significant difference in the complete abortion rates for oral (91.1%) and vaginal (92.0%). Mean induction abortion interval was 4.29 hours for oral and 3.5 hours for vaginal (p= 0.023). History of previous abortion was found to be a strong predictor of failure of early medical abortion (p= 0.007). Nausea (24%), vomiting (13%) and fatigue (50%) were more in the oral group. Mean duration of bleeding was 9.4 days in oral and 8.2 days in vaginal group (p= 0.000). Method satisfaction was more among oral group (92.2%) compared to 85.1% in vaginal, but not statistically significant (p > 0.05). CONCLUSIONMedical abortion with 200 mg of mifepristone in combination with 400 mg misoprostol orally or 800 mg vaginally after 48 hours was found to be safe, simple, effective, non-invasive and acceptable method. BACKGROUND Unsafe abortion is a major public health problem in developing countries. Globally, 20 million unsafe abortions take place each year and account for 13% of all maternal deaths. (1) The incidence of induced abortions is not definitely known, because estimates of illegal abortions are generally unreliable. This has led to the liberalisation of abortion laws and search for newer methods. KEYWORDSMedical abortion offers great potential for improving abortion access and safety. The drugs used were mainly mifepristone (RU 486), a potent antiprogestin in combination with prostaglandin E1 analogue misoprostol.
BACKGROUND Hypertensive disorders of pregnancy complicate 5-10% of all pregnancies. Pre-eclampsia and eclampsia are leading threats to safe motherhood in developing countries. Studies showing the association between hypertensive disorders of pregnancy and diabetes are generally based on data from western settings. The main objective of the present study is to find out as to whether the proportion of hypertensive disorders in diabetic pregnancies is more compered to euglycemic patents in a tertiary care hospital in Kerala. MATERIALS AND METHODS A prospective observational study was conducted among antenatal women diagnosed to have diabetes (GDM/overt) who received antepartum care at Govt. Medical College Kottayam. The controls were matched normoglycemic patients. Information was collected using questionnaires. BP was measured using standard methods with Korotkoff 1 for systolic BP and Korotkoff 5 for diastolic BP. BP more than 140/90 on two occasions six hours apart was taken as hypertension. For detecting diabetes, IADPSG values of fasting 92 mg/dl (>5.2 mmol /l), 1 hr. 150 mg/dl (>10.0 mmol/l) and 2 hrs. 153 mg/dl (8.5 mmol/l) were taken. RESULTS Of the 241 patients, majority belong to the age group 21-30 (83%). 56.5% were primigravidas. Diabetic pregnant ladies are more prone to develop hypertensive disorders of pregnancy (21.4%) as compared to nondiabetics (12.1%). Of the diabetics, majority 94 (87.8%) belongs to GDM group and 13 (12.2%) were overt DM. Out of the 214 (16.8%) developed hypertensive disorders of pregnancy. Among the diabetic patients those with overt DM are at a higher risk of developing hypertensive disorders (38.4% with overt DM and 19.1% of GDM). In the GDM group, 11.7% developed gestational hypertension, 5.3% preeclampsia and 2.1% eclampsia. Among overt diabetics, 38% developed preeclampsia. There were no cases of gestational hypertension or eclampsia among overt DM patients. 60% of diabetics who developed hypertension had poor glycaemic control which shows that glycaemic control had a strict relation with development of hypertension in diabetic patients. CONCLUSION There was increased incidence of hypertensive disorders of pregnancy in diabetic patients compared to nondiabetic controls in our setting also. Those with poor glycaemic control are at increased risk of developing hypertension.
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