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Effectiveness of the FIGO protocol for medical management of first-trimester abortion. Objective: To determine the effectiveness of misoprostol using the International Federation of Gynecology and Obstetrics FIGO protocol for medical management of first trimester abortion. Methods: A cross-sectional study was performed between March and September Seventy-six patients diagnosed with first trimester spontaneous abortion were managed following the FIGO protocol for medical management of first trimester abortion.

Results: Main indications for inclusion of the 76 patients were missed abortion Medical induction with misoprostol followed the FIGO protocol for medical management of first trimester abortion. The most frequent side effect reported was abnormal uterine bleeding associated with pelvic pain Complete uterine evacuation was accomplished in Conclusion: Misoprostol use in patients with first trimester abortion following the FIGO protocol was a safe and cost-effective therapeutic option.

Key words : Abortion, spontaneous, Management, medical, Efficacy. Palabras clave. Therapeutic options include expectant, medical and surgical management. The most frequently used drugs are mifepristone, misoprostol and methotrexate 1.

There are different regimens recommended in the literature, as shown in Table 1 Transvaginal ultrasound was performed to confirm early pregnancy loss, and the FIGO protocol for misoprostol was used 4.

A follow-up ultrasound evaluation was scheduled 7 days after treatment and earlier if warning signs appeared. In case a gestational sac was still present, a second dose of the protocol was indicated. Medical management was considered successful when no gestational sac was found. A total of 76 patients with diagnosis of first trimester abortion were included. Of these, 44 Main comorbidities found were uterine myomatosis, diabetes mellitus, human papillomavirus, hypothyroidism, and recurrent pregnancy loss Table 2.

The most frequent clinical manifestations were light vaginal bleeding and pelvic pain in 55 patients Ten patients The efficacy of one misoprostol dose was Only one patient did not respond to treatment and presented vaginal hemorrhage and hypovolemic shock; she underwent surgical management. Overall efficacy was In , Khurshid et al. It is possible that they obtained this low result because ultrasonographic control was performed within 12 hours after the misoprostol administration, while most evaluations take place a week or two after the procedure 5.

In , two reviews by the Cochrane Library and the Society of Obstetricians and Gynaecologists of Canada aimed to evaluate the need of antibiotic prophylaxis.

These reviews did not find any randomized trial of the medical management of abortion nor the antibiotic prophylaxis; only surgical managements were considered 6.

The last update of the American College of Obstetricians and Gynecologists, in November , stated that antibiotic prophylaxis is not indicated in this group of patients 7. In accordance with these recommendations, our patients did not receive antibiotic prophylaxis before the medical management.

In , Grossman et al. Therefore, this would be appropriate in centers without ultrasound equipment 5. At our center, all patients received weekly ultrasound follow-up until absence of gestational sac was confirmed. In case of unsuccessful result, the misoprostol regimen was indicated for a second time.

Finally, the American College of Obstetricians and Gynecologists recommends that ultrasound follow-up is enough; when not available, human chorionic gonadotropin determination is acceptable. ACOG also recommends prophylaxis with at least 50 micrograms anti-D immunoglobulin in candidate patients.

To determine reproductive prognosis, patients should be evaluated after two losses 7. A limitation of our study is the restricted number of patients. A prospective study with a larger sample will yield better results. We observed that creating documents for the institutional care of patients with this condition is an important area of opportunity. These include an informed consent form and a follow-up form, as well as handouts explaining possible side effects and therapeutic options for patients to solve the problem at home, warning signs for patients to go to an emergency room, and a questionnaire evaluating patient satisfaction with the medical management of abortion.

In conclusion, the FIGO protocol for the medical management of first trimester abortion with misoprostol resulted in a safe and effective strategy. This regimen also offers a lower-cost therapeutic option by not including mifepristone.

Conflict of interest : The authors report no conflict of interest. Financing : The authors received no financial support for this article. Previous publication of the article: None. EffectivenessoftheFIGOprotocolformedical management of first trimester abortion. Rev Peru Ginecol Obstet. Medications used in evidence-based regimens for medical abortion: An overview.

J Obstet Gynaecol Can. Practice Bulletin Number , May Early pregnancy loss. Practice Bulletin Number , March Int J Gynaecol Obstet. J Soc Obstet Gynaecol Pak. Antibiotic prophylaxis in gynaecologic procedures.

J Obstet Gynaecol Canada. Committee on Practice Bulletins-Gynecology Number Published online : 22 July Servicios Personalizados Revista. Citado por SciELO. Similares en SciELO. Results A total of 76 patients with diagnosis of first trimester abortion were included. Financing : The authors received no financial support for this article Previous publication of the article: None.

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Effectiveness of the FIGO protocol for medical management of first-trimester abortion. Objective: To determine the effectiveness of misoprostol using the International Federation of Gynecology and Obstetrics FIGO protocol for medical management of first trimester abortion. Methods: A cross-sectional study was performed between March and September Seventy-six patients diagnosed with first trimester spontaneous abortion were managed following the FIGO protocol for medical management of first trimester abortion. Results: Main indications for inclusion of the 76 patients were missed abortion Medical induction with misoprostol followed the FIGO protocol for medical management of first trimester abortion.

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El aborto provocado en condiciones de riesgo emergente sanitario en la mortalidad materna en Uruguay. Facultad de Medicina. E-mail: leobriozzo hotmail. En todo el mundo mueren aproximadamente La mortalidad materna se distribuye de manera muy desigual en el mundo. El aborto puede desarrollarse en condiciones seguras para la paciente, en un contexto institucional y con personal entrenado o, por el contrario, en condiciones de riesgo.

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Guido Parra , Israel Yinez Diaz. Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI:

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