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Abstract
Introduction: According to a review of trials, there is insufficient data regarding the safety and efficacy of misoprostol in termination of pregnancy throughout the second trimester, both with and without uterine scarring. Thus, further study is required in this area. Comparing the effectiveness and safety of misoprostol in scarred versus unscarred uteri for termination of pregnancy in the second trimester was the rationale behind the current investigation. For both scarred and unscarred uteruses, this would assist build trust in a medication that is safe, effective, well-tolerated, and very cost-effective for midtrimester termination of pregnancy.
Materials & Methods: From February 2025 to June 2025, 120 patients who needed to have their pregnancies terminated in the second trimester (13–26 weeks) for maternal reasons, fetal congenital abnormalities, or intrauterine death were gathered for the study via the Allied Hospital's outdoor or emergency department in Faisalabad. Total 50 women with scarred uteruses were assigned to group A, while seventy women with unscarred uteruses were assigned to group B. Participants with a history of three or four cesarean sections, acute asthma, heart conditions, or low-lying placentas were not allowed to participate in the study. Per vaginal dose of 400 micrograms of misoprostol every 3 hourly till expulsion was given to each patient. Patients were monitored for uterine contractions and the discharge of fetal material. In cases when the result of conception failed to eject despite an open cervical OS, a syntocinon infusion was initiated to enhance expulsion. In order to detect scar dehiscence or rupture in individuals with scarred uteruses, the maternal pulse and uterine contractility were tracked. Patients who were unable to terminate with this procedure were switched to a different TOP technique.
Results: According to the current study's findings, misoprostol was effective in ending pregnancies in roughly 77.50% of cases, with no discernible difference between the two groups (68.0% in group A and 84.29% in group B). One patient in group A experienced uterine rupture, but none of the patients in group B did. The two groups' levels of excessive bleeding differed significantly. Group A consisted of 10 patients (20%) and Group B had 4 individuals (5.71%). Eleven patients (22.0%) in group A and five (7.14%) in group B required surgical intervention.
Conclusion: In preschoolers aged 1 to 5, we concluded that open ureteric surgery is safer and more successful than endoscopic double J stents for the reimplantation of primary obstructive megaureters.