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Objectives: This study was designed to evaluate the effect of misoprostol on the blood flow in uterine arteries of 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, each woman received 200 [mu]g misoprostol intravaginally and 200 [mu]g misoprostol orally.
Results and conclusion: All Doppler indices increased significantly after misoprostol administration (p < 0.0001), suggesting an increase in flow resistance.
Key words: MISOPROSTOL; DOPPLER; UTERINE ARTERY; PREGNANCY; EMBRYONIC DEMISE
INTRODUCTION
Although misoprostol is not registered for these indications, a number of studies have shown that it is an effective agent for medical termination of first- and second-trimester pregnancies, cervical ripening and induction of term labor1,9. In Brazil, the misuse of 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 vasodisruption10. In order to test this possibility, Doppler flow velocity waveforms of uterine arteries were investigated prospectively in a group of women with embryonic demise.
METHODS
A cohort of 61 consecutively recruited pregnant women with embryonic demise was evaluated between 1 September 2000 and 30 April 2001 at the Department of Obstetrics and Gynecology, Kartal Education and Research Hospital, Istanbul, Turkey. The study was approved by the ethics 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 maternal cardiac disease, inflammatory disease, known allergy to prostaglandins, hemodynamic instability, more than slight vaginal bleeding, a hemoglobin count of less than 10 mg/dl, an abnormal coagulation profile, a temperature higher than 37.5[degrees]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 (General Electric, Norway) with a 7.5-MHz color...