USE OF FOLEY’S CATHETER AND PROSTAGLANDIN F-2 ALPHA IN SECOND TRIMESTER TERMINATION OF PREGNANCY
AbstractBackground: Termination of pregnancy (TOP) in the second trimester is associated withthree to five times higher risk of maternal morbidity and mortality than termination duringfirst trimester. The main concern of obstetrician is to provide the most effective and safestregimen which combines the shortest expulsion interval with least side effects. This study wasundertaken to compare the use of Foley’s catheter with extra-amniotic instillation of PGF2alpha for second trimester TOP so that a choice of the safer and cost-effective method couldbe available. Methodology: The study was conducted in Department of Obstetrics andGynecology Unit ‘B’ at Ayub Teaching Hospital Abbottabad between August 2003 and July2004. Sixty patients recommended for TOP (missed abortion or anencephalic fetus confirmedon ultrasonography) were randomly allocated into two groups. In group ‘A’, Foley’s catheteralone was used while in group ‘B’ extra amniotic instillation of Prostaglandin F-2 alpha (PGF2alpha) was done via a Foley’s catheter. After expulsion of catheters in both cases oxytocininfusion containing 30 units were started till the expulsion of fetus, placenta and membranes.The mean induction to expulsion time and the mean induction to delivery time for both groupswere noted as well as total cost of treatment. Results: Difference in time interval with regardto induction to expulsion time of catheter and induction to delivery time between the twogroups was significant being 3 hours and 5 hours respectively less in group ‘B’ (p < 0.001);however only 25% of patients in group ‘B’ had a significant short induction to delivery timeas compared to group ‘A’. The difference in costs of treatment between the groups was alsosignificant (p < 0.001). Conclusion: Use of PGF 2 alpha is preferred, though for poor patientsFoley’s catheter may be used, but only in a tertiary care setting.Key Words: Dinoprost, Abortion, Labor onset, Uterine contraction, Cervical ripening,Balloon dilatation.
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