Eficacia y seguridad del misoprostol intravaginal, dosis total 1600 / 2400 microgramos para manejo del aborto retenido
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2019
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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En Ecuador se dispuso un esquema como primera línea para el manejo farmacológico vía vaginal del aborto retenido, recientemente existe una nueva propuesta de la Federación Internacional de Ginecología y Obstetricia como opción terapéutica. Se tenía poca evidencia de si su utilización representaba una mejora sustancial en eficacia y seguridad. El presente trabajo tiene como objetivo determinar la eficacia y seguridad del Misoprostol vía vaginal de 800 µg cada 3 horas por 2 dosis es similar a una dosis de 800 µg cada 4 horas por 3 dosis para la evacuación del aborto retenido. La metodología de la investigación con la que se realizó fue un estudio de cohorte que incluyó de manera no aleatoria 100 mujeres consecutivas que fueron atendidas en el servicio de Emergencia del Hospital Teodoro Maldonado Carbo entre el 1 de noviembre de 2017 al 30 de junio de 2018 por aborto retenido menor de 13 semanas a las cuales se administró 2 esquemas de misoprostol vía vaginal: 800 µg cada 3 horas x 2 dosis (n= 64) y 800 µg cada 4 horas x 3 dosis (n= 36). Los resultados fueron que misoprostol 800 µg cada 3 horas x 2 dosis produjo un número similar de casos de evacuación completa (58,3 % vs. 67,2%; P 0,251), necesidad de repetición del esquema (36.1% vs. 25%; P 0,172), necesidad de legrado (41,7% vs 32,8%; P 0,251), pérdida sanguínea (0,703 ± 0,76 vs. 0,608 ± 0,66; P ,0148) y eventos adversos (58,3% vs 54,7%; P 0,444) que la utilización de 800 µg cada 4 horas por 3 dosis. Misoprostol 800 µg cada 3 horas x 2 dosis se asoció con uso de menos dosis (3000 ± 1071,1 vs 1975 ± 697,8; P 0,001) y menor costo ($7,50 ± 2,6 y de $ 4,94 ± 1,7; P 0,001). Se concluye entonces que la eficacia y seguridad del Misoprostol vía vaginal de 800 µg cada 3 horas por 2 dosis es similar al esquema de 800 µg cada 4 horas por 3 dosis para la evacuación del aborto retenido, pero reduce el número de dosis y el costo.
In Ecuador, a scheme was set up as the first line for the vaginal pharmacological management of aborted abortion, recently there is a new proposal from the International Federation of Gynecology and Obstetrics as a therapeutic option. There was little evidence of whether its use represented a substantial improvement in efficacy and safety. The objective of this study is to determine the effectiveness and safety of misoprostol vaginal route of 800 μg every 3 hours for 2 doses is similar to a dose of 800 μg every 4 hours for 3 doses for the evacuation of retained abortion. The research methodology used was a cohort study that included, in a nonrandomized manner, 100 consecutive women who were treated in the emergency service of Teodoro Maldonado Carbo Hospital between November 1, 2017 and June 30, 2018 for abortion withheld for less than 13 weeks at which 2 vaginal misoprostol regimens were administered: 800 μg every 3 hours x 2 doses (n = 64) and 800 μg every 4 hours x 3 doses (n = 36). The results were that misoprostol 800 μg every 3 hours x 2 doses produced a similar number of cases of complete evacuation (58.3% vs. 67.2%, P 0.251), need for repetition of the scheme (36.1% vs. 25% ; P 0.172), need for curettage (41.7% vs. 32.8%, P 0.251), blood loss (0.703 ± 0.76 vs. 0.608 ± 0.66, P, 0148) and adverse events (58.3 % vs 54.7%; P 0.444) than the use of 800 μg every 4 hours for 3 doses. Misoprostol 800 μg every 3 hours x 2 doses were associated with use of fewer doses (3000 ± 1071.1 vs 1975 ± 697.8, P 0.001) and lower cost ($ 7.50 ± 2.6 and $ 4.94 ± 1.7; P 0.001). It is then concluded that the efficacy and safety of Misoprostol vaginal route of 800 μg every 3 hours for 2 doses is similar to the scheme of 800 μg every 4 hours for 3 doses for the evacuation of retained abortion, but reduces the number of doses and the cost
In Ecuador, a scheme was set up as the first line for the vaginal pharmacological management of aborted abortion, recently there is a new proposal from the International Federation of Gynecology and Obstetrics as a therapeutic option. There was little evidence of whether its use represented a substantial improvement in efficacy and safety. The objective of this study is to determine the effectiveness and safety of misoprostol vaginal route of 800 μg every 3 hours for 2 doses is similar to a dose of 800 μg every 4 hours for 3 doses for the evacuation of retained abortion. The research methodology used was a cohort study that included, in a nonrandomized manner, 100 consecutive women who were treated in the emergency service of Teodoro Maldonado Carbo Hospital between November 1, 2017 and June 30, 2018 for abortion withheld for less than 13 weeks at which 2 vaginal misoprostol regimens were administered: 800 μg every 3 hours x 2 doses (n = 64) and 800 μg every 4 hours x 3 doses (n = 36). The results were that misoprostol 800 μg every 3 hours x 2 doses produced a similar number of cases of complete evacuation (58.3% vs. 67.2%, P 0.251), need for repetition of the scheme (36.1% vs. 25% ; P 0.172), need for curettage (41.7% vs. 32.8%, P 0.251), blood loss (0.703 ± 0.76 vs. 0.608 ± 0.66, P, 0148) and adverse events (58.3 % vs 54.7%; P 0.444) than the use of 800 μg every 4 hours for 3 doses. Misoprostol 800 μg every 3 hours x 2 doses were associated with use of fewer doses (3000 ± 1071.1 vs 1975 ± 697.8, P 0.001) and lower cost ($ 7.50 ± 2.6 and $ 4.94 ± 1.7; P 0.001). It is then concluded that the efficacy and safety of Misoprostol vaginal route of 800 μg every 3 hours for 2 doses is similar to the scheme of 800 μg every 4 hours for 3 doses for the evacuation of retained abortion, but reduces the number of doses and the cost
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Aborto retenido, Misoprostol, Tratamiento farmacológico, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Resultado del tratamiento, Administración intravaginal