Revista Chilena de Obstetricia y Ginecología (Jan 2012)
Factores clínicos y demográficos predictores de éxito del misoprostol en el tratamiento médico del aborto espontáneo
Abstract
Objetivos: Determinar posibles predictores de éxito del misoprostol en el tratamiento del aborto espontáneo del primer trimestre. Método: Estudio observacional descriptivo y prospectivo, realizado entre febrero de 2009 y febrero de 2010. Inclusión consecutiva de 248 mujeres con diagnostico ecográfico de aborto espontáneo del primer trimestre con tratamiento médico o quirúrgico, siendo las pacientes las que eligieron la opción terapéutica de acuerdo a los criterios de inclusión para el manejo con misoprostol. En el grupo tratamiento médico se aplicó 800 mcg de misoprostol vaginal/24horas/2 dosis, considerándose como criterio de éxito un endometrio homogéneo con grosor Objectives: To determine possible predictors of success of misoprostol in the treatment of first trimester spontaneous abortion. Methods: Descriptive observational study and prospectively from February 2009 to February 2010. It were included 248 women which were diagnosed by ultrasound of spontaneous abortion in the first trimester and received medical or surgical treatment, depending on the patient's own choice, provided that the established clinical conditions were present. The protocol applied in the medical treatment group was 800 mcg of vaginal misoprostol/24h/2 dose. It was considered as criteria of success, the presence of a homogeneous endometrium with a thickness <15 mm in the ultrasound examination performed on the 8 th day of treatment. Results: The following variables influence the success rate of misoprostol: patient age (the younger the better outcome, p = 0.025), number of pregnancies (primiparous respond better, p = 0.024), presence or absence of abortions ( p = 0.05) or previous curettage (p = 0.028) (the success rate of misoprostol is higher in women who have no previous abortion or curettage), and type of vaginal bleeding that occurs as a side effect of misoprostol (improving prognosis when bleeding is equal to or greater than the rule, p = 0.041). Conclusions: We found predictors of success of misoprostol, which can guide the management knowing that better results can get obtained in younger patients, primigravida, no previous abortions or curettage and with a vaginal bleeding equal to or greater than the rule.
