We speak of missed miscarriage when the termination of pregnancy occurs, and the product of conception is not expelled outside within a limit of 24 hours. For the management of missed miscarriage there are various treatments, expectant, medical or surgical management. The elaborate is a retrospective cohort study that focuses on medical management with the use of sublingual misoprostol, it aims to identify success rates and in particular the existence of correlations between the efficacy of misoprostol and various factors, such as for example the age of the woman, the gestational age, the number of previous pregnancies, previous deliveries, previous caesarean sections and previous abortions. The investigated population includes 145 women who underwent misoprostol therapy in the years 2019, 2020, 2021 and January and February 2022, the women who did not return to follow-up were excluded, for which it was therefore impossible to decide whether the misoprostol was effective or not. The data collection took place at the Gynecology and Obstetrics Unit of the Santa Croce Hospital in Fano, and the data were collected using Ausilya, the software containing the reports of the Obstetric-Gynecological Emergency Department, they were then processed and analyzed using Microsoft Excel and R. The main results of the study are a high success rate of misoprostol, corresponding to 91.8% and the existence of correlations with the efficacy of misoprostol, even if they are sometimes contradicted by studies reported in the literature. In particular, in the sample there was a lower mean age in the success group and a higher mean age in the failure group (35.95 years versus 37.08 years; p=0.5015), an increased success rate in the gestational weeks between 5 and 9 weeks versus 10 to 12 weeks (92.70% vs 75%, p=0.1514) and an increased success rate in women who had previous pregnancies (95.65% versus 84.91 %; p=0.03). In the literature, only the result relating to gestational age is confirmed, as regards the age of the woman and the number of pregnancies, only one study was found that contradicts what was found in the elaborate, in the study, however, we talk about vaginal rather than sublingual misoprostol. By analyzing the women who have had previous births, previous caesarean sections and previous abortions, it appears that the success rate in nulliparous women is slightly higher than in pluriparous women (96.30% vs 95.38%; p=1), for the cut cesarean sections, on the other hand, it seems that those who have performed at least one previous cesarean section have a higher success rate than those who have never performed one (100% versus 94.37%; p=0.058), for abortions there is instead a slightly higher success rate in those who have never had an abortion than in those who have had one (96.49% vs 94.29%; p=1). These results are confirmed by studies regarding the number of births and abortions, as regards caesarean sections the studies indicate instead that the success rate decreases significantly if the woman has had a history of caesarean section in the past. The major criticalities that emerged from the study, however, are the low sample size and the difficulty in finding specific studies for sublingual misoprostol, due to the existence of different protocols for medical therapy. In fact, misoprostol can be taken by different routes of administration and with different dosages. The study was carried out with the idea of being able to choose the most appropriate and effective treatment in the event of missed miscarriage based on the type of woman in front of you, however, further studies should be carried out, on more numerous samples and with the possibility to analyze further variables.
Si parla di aborto interno quando avviene l’interruzione della gravidanza ed il prodotto del concepimento non viene espulso all’esterno entro un limite di 24 ore. Per la gestione dell’aborto interno sono previsti diversi trattamenti, la gestione in attesa, medica oppure chirurgica. L’elaborato è uno studio di coorte retrospettivo che si sofferma sulla gestione medica con l’utilizzo di misoprostolo sublinguale, e mira ad individuare i tassi di successo e in particolare l’esistenza di correlazioni tra l’efficacia del farmaco e vari fattori, come ad esempio l’età della donna, l’età gestazionale, il numero delle precedenti gravidanze, dei precedenti parti, dei tagli cesarei e degli aborti. La popolazione indagata comprende 145 donne che hanno effettuato la terapia con misoprostolo negli anni 2019, 2020, 2021 e gennaio e febbraio 2022, sono state escluse le donne che non son tornate al follow-up, per le quali quindi è stato impossibile decretare se il farmaco abbia avuto efficacia o meno. La raccolta dati è avvenuta nella UOC di Ginecologia e Ostetricia dell’Ospedale Santa Croce di Fano, e i dati sono stati raccolti tramite Ausilya, il software dove sono contenuti i referti del Pronto Soccorso Ostetrico-Ginecologico, sono stati poi elaborati e analizzati tramite Microsoft Excel e R. I risultati principali dello studio sono: un elevato tasso di successo del misoprostolo, corrispondente al 91,8% e l’esistenza di correlazioni con l’efficacia del farmaco, anche se a volte vengono contraddette da studi riportati in letteratura. In particolare, è risultato nel campione un’età media minore nel gruppo del successo e un’età media maggiore nel gruppo del fallimento (35,95 anni contro 37,08 anni; p=0,5015), un tasso di successo aumentato nelle settimane gestazionali comprese tra 5 e 9 settimane rispetto che tra 10 e 12 settimane (92,70% contro 75%, p=0,1514) e un tasso di successo aumentato nelle plurigravide rispetto alle primigravide (95,65% contro 84,91%; p=0,03). Solo il risultato riguardo all’età gestazionale viene confermato in letteratura, per quanto riguarda l’età della donna, e il numero di gravidanze, è stato ritrovato solo uno studio che contraddice ciò che è stato trovato nell’elaborato, nello studio però si parla di misoprostolo vaginale invece che sublinguale. Analizzando invece nelle donne che hanno avuto gravidanze, i precedenti parti, tagli cesarei e aborti risulta che il tasso di successo nelle nullipare è leggermente più alto che nelle pluripare (96,30% contro 95,38%; p=1), per i tagli cesarei invece risulta che chi ha effettuato almeno un taglio cesareo in precedenza, abbia un tasso di successo aumentato rispetto a chi non ne ha mai effettuati (100% contro 94,37%; p=0,058), per gli aborti si rileva invece una percentuale di successo leggermente maggiore in chi non ha mai avuto aborti rispetto a chi ne ha avuti (96,49% contro 94,29%; p=1). Gli studi confermano i risultati riguardo al tasso di successo correlato al numero dei parti e degli aborti, per il tasso di successo correlato ai tagli cesarei invece gli studi indicano che il tasso diminuisce significativamente se la donna in passato ha avuto una storia di taglio cesareo. Le maggiori criticità emerse dallo studio sono: la bassa numerosità campionaria e la difficoltà nella ricerca di studi specifici per il misoprostolo sublinguale, a causa dell’esistenza di protocolli diversi per la terapia medica. Infatti, il misoprostolo può essere assunto per vie di somministrazioni differenti e con dosaggi diversi. Lo studio è stato attuato con l’idea di poter scegliere in caso di aborto interno il trattamento più appropriato ed efficace in base alla tipologia di donna che si ha di fronte, dovrebbero essere compiuti però ulteriori studi, su campioni più numerosi e con la possibilità di analizzare ulteriori variabili.
L'aborto interno e l’uso della terapia farmacologica con misoprostolo: studio dei fattori correlati con l’efficacia del farmaco
QUADRELLI, ERICA
2020/2021
Abstract
We speak of missed miscarriage when the termination of pregnancy occurs, and the product of conception is not expelled outside within a limit of 24 hours. For the management of missed miscarriage there are various treatments, expectant, medical or surgical management. The elaborate is a retrospective cohort study that focuses on medical management with the use of sublingual misoprostol, it aims to identify success rates and in particular the existence of correlations between the efficacy of misoprostol and various factors, such as for example the age of the woman, the gestational age, the number of previous pregnancies, previous deliveries, previous caesarean sections and previous abortions. The investigated population includes 145 women who underwent misoprostol therapy in the years 2019, 2020, 2021 and January and February 2022, the women who did not return to follow-up were excluded, for which it was therefore impossible to decide whether the misoprostol was effective or not. The data collection took place at the Gynecology and Obstetrics Unit of the Santa Croce Hospital in Fano, and the data were collected using Ausilya, the software containing the reports of the Obstetric-Gynecological Emergency Department, they were then processed and analyzed using Microsoft Excel and R. The main results of the study are a high success rate of misoprostol, corresponding to 91.8% and the existence of correlations with the efficacy of misoprostol, even if they are sometimes contradicted by studies reported in the literature. In particular, in the sample there was a lower mean age in the success group and a higher mean age in the failure group (35.95 years versus 37.08 years; p=0.5015), an increased success rate in the gestational weeks between 5 and 9 weeks versus 10 to 12 weeks (92.70% vs 75%, p=0.1514) and an increased success rate in women who had previous pregnancies (95.65% versus 84.91 %; p=0.03). In the literature, only the result relating to gestational age is confirmed, as regards the age of the woman and the number of pregnancies, only one study was found that contradicts what was found in the elaborate, in the study, however, we talk about vaginal rather than sublingual misoprostol. By analyzing the women who have had previous births, previous caesarean sections and previous abortions, it appears that the success rate in nulliparous women is slightly higher than in pluriparous women (96.30% vs 95.38%; p=1), for the cut cesarean sections, on the other hand, it seems that those who have performed at least one previous cesarean section have a higher success rate than those who have never performed one (100% versus 94.37%; p=0.058), for abortions there is instead a slightly higher success rate in those who have never had an abortion than in those who have had one (96.49% vs 94.29%; p=1). These results are confirmed by studies regarding the number of births and abortions, as regards caesarean sections the studies indicate instead that the success rate decreases significantly if the woman has had a history of caesarean section in the past. The major criticalities that emerged from the study, however, are the low sample size and the difficulty in finding specific studies for sublingual misoprostol, due to the existence of different protocols for medical therapy. In fact, misoprostol can be taken by different routes of administration and with different dosages. The study was carried out with the idea of being able to choose the most appropriate and effective treatment in the event of missed miscarriage based on the type of woman in front of you, however, further studies should be carried out, on more numerous samples and with the possibility to analyze further variables.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/8521