Sains Malaysiana 49(1)(2020): 133-138

http://dx.doi.org/10.17576/jsm-2020-4901-16

Dinoprostone in First Trimester Miscarriages: A Prospective Observational Study in a Malaysian Tertiary Healthcare Institution

Penggunaan Dinoprostone dalam Keguguran Trimester Pertama: Kajian Prospektif di Pusat Rujukan Perubatan di Malaysia

RAHANA ABD RAHMAN, AZARISYAM AHMAD, IXORA KAMISAN ATAN & ZALEHA ABDULLAH MAHDY*

Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

Received: 20 September 2019/Accepted: 11 October 2019

ABSTRACT

The objective of this paper was to evaluate the outcome of medical evacuation of first trimester miscarriages using dinoprostone. A prospective observational study in a tertiary centre between 1^st January and 31^st December 2018 in Obstetrics and Gynaecology unit, UKM Medical Centre. Women diagnosed with incomplete and missed miscarriage (n=41) at or less than 13 weeks of gestation were recruited. Dinoprostone 3 mg was inserted into the posterior fornix, twice within 6 h apart on day-1 followed by similar protocol on day-2. Patients were reassessed clinically and sonographically upon passing out products of conception, at 48 h and day-7. Complete evacuation was defined as closed cervical os and/or endometrial thickness of less than 15 mm sonographically. Treatment failure was defined as failure to achieve complete evacuation by day-7. Overall success rate was 55.3% (n=26) being better in incomplete (n=6, 100%) as compared to missed miscarriage (n=21, 48.8%, p=0.03). Those with successful evacuation required dinosprostone at a mean of 8.4 ± 2.9 mg achieving complete miscarriage within a mean of 27.8 ± 16.6 h. Mean pain score was 5.8 ± 0.8 with mean patient satisfaction score of 8.7 ± 0.8. Mean drop in haemoglobin was 0.7 ± 0.2 g/dL. No major adverse effects were reported. Medical evacuation of miscarriage using intravaginal dinoprostone is safe and promising, with acceptable success rate and high patient satisfaction. This study supported previous studies suggesting presence of prostaglandin E2 receptors in the first trimester.

Keywords: Dinoprostone; first trimester miscarriage; medical evacuation

ABSTRAK

Tujuan kajian ini dijalankan adalah untuk menilai hasil penggunaan ubat untuk rawatan keguguran pada trimester pertama. Ini adalah kajian prospektif yang dijalankan di unit Obstetrik dan Ginekologi, Pusat Perubatan UKM dari 1 Januari hingga 31 Disember 2018. Semua pesakit (n=41) yang dikenal pasti mengalami keguguran pada atau kurang dari 13 minggu kandungan telah dimasukkan ke dalam kajian. Ubat dinoprostone 3 mg telah dimasukkan ke dalam faraj sebanyak 2 kali dalam beza masa selama 6 jam. Ini dilakukan selama 2 hari berturut-turut. Pesakit dinilai secara klinikal dan dengan menggunakan mesin imbasan jika ada perdarahan daripada faraj yang mengandungi tisu kandungan atau selepas 48 jam atau selepas 7 hari dari permulaan rawatan. Keguguran lengkap ditentukan apabila pintu rahim telah tertutup atau imbasan menunjukkan ketebalan dinding rahim kurang daripada 15 mm. Rawatan dianggap gagal jika keguguran lengkap tidak berlaku pada hari ketujuh selepas permulaan rawatan. Kejayaan keseluruhan adalah55.3% (n=26) dan ia adalah lebih baik dalam kes pesakit yang telah keguguran tidak lengkap (n=6, 100%) berbanding dengan mereka yang tiada langsung keguguran (n=21, 48.8%, p=0.03). Mereka yang telah berjaya memerlukan dinosprostone pada min 8.4 ± 2.9 mg dan kejayaan dicapai pada min masa 27.8 ± 16.6 jam. Min skor kesakitan adalah5.8 ± 0.8 dan min kepuasan pesakit8.7 ± 0.8. Min penurunan hemoglobin adalah0.7 ± 0.2 g/dL. Tidak terdapat komplikasi yang teruk semasa kajian. Rawatan untuk keguguran dengan menggunakan ubat adalah selamat dan mempunyai kadar kejayaan yang baik. Kebanyakan pesakit juga berpuas hati. Ini membuktikan teori bahawa terdapat reseptor untuk prostaglandin E₂ pada trimester pertama kandungan.

Kata kunci: Dinoprostone; evakuasi perubatan; keguguran trimester pertama

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*Corresponding author; email: zaleha@ppukm.ukm.edu.my