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What is Most safe and effective evacuation in a patient with missed abortion at 14-16 weeks can be achieved with and explain in detail?
Ans. b (Misoprostol) (Ref. Textbook of Obstetrics D.C. Dutta 6th/pg. 64)MISSED MISCARRIAGE# Definition:- Expulsion of the conceptus does not occur despite a prolonged period after embryonic death.# C/f:- Typically, the patient's symptoms of pregnancy regress, the pregnancy test becomes negative, and no fetal heart motion is detected by ultrasound.- Most patients do eventually abort spontaneously- DIC due to retention of a dead fetus is rare in the first half of pregnancy.# Rx:- During the first trimester, Rx by suction curettage preceded by cervical preparation using misoprostol or insertion of laminaria if the cervix is closed.- Evacuation of the uterus by medical means is also an acceptable approach in the first trimester.# Using 800-mg of misoprostol (four 200-mg tablets) per vagina every four hours.# Most patients responded to the first dose of misoprostol.# Combination regimens that include methotrexate or RU-486 with misoprostol more promising.- In the second trimester, the uterus can be emptied by dilation and evacuation (D and E) or induction of labor with intravaginal PGE2 or misoprostol# D & E is an extension of the traditional D & C and vacuum curettage. It is especially appropriate at 13 to 16 weeks gestation, although many proponents use this procedure through 20 weeks.# If induction of labor is chosen, vaginal PGE2 is used, one 20-mg suppository is placed high in the posterior vaginal vault every 4 hours until the fetus and placenta are expelled.# In this situation, a retained placenta is relatively common and may require manual removal and uterine curettage.# Misoprostol, 200-mg tablets placed high in the vagina every 4 hours, is equally effective. This regimen may cause less nausea, vomiting, diarrhea, and fever than PGE2