Most safe and effective evacuation in a patient with missed abortion at 14-16 weeks can be achieved with
Correct Answer: Misoprostol
Description: 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
Category:
Gynaecology & Obstetrics
Get More
Subject Mock Tests
Practice with over 200,000 questions from various medical subjects and improve your knowledge.
Attempt a mock test nowMock Exam
Take an exam with 100 random questions selected from all subjects to test your knowledge.
Coming SoonGet More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now