Discussion
bleeding, fetus abortion, pain, RPOC, abortion, RPOC expulsion
BLEEDING, POSTPARTUM HEMORRHAGE, UTERINE CERVIX, CONTRACTION, UTERUS, FETAL DEATH, INCOMPLETE ABORTION, COMPLICATIONS
The result of this study confirms an improved efficacy of the medical therapy of misoprostol, either combined with oxytocin or with methylergonovine, in successful expulsion of the RPOC. Although treatment by misoprostol alone (83.3%) has not resulted in remarkable statistical significance, greater therapeutic efficacy was reported in the groups (93.33%) treated by a combination of misoprostol plus oxytocin or misoprostol plus methylergonovine. Moreover, by designating the degree of persistent residual tissues in the patients, it was concluded that those treated with misoprostol plus oxytocin had the best outcome compared to the other groups. Likewise, all the patients treated with other medications showed a sufficient successful rate of RPOC expulsion.Kaviani et al. concluded that ‘the efficacy of methylergonovine in the successful expulsion of retained pregnancy tissues in patients with incomplete abortion showed 94.6%’ [Misoprostol is a prostaglandin E1 analog, a uterotonic pharmacological agent that functions either by contracting the uterine smooth muscles or by dilating the uterine cervix [Although the mean age of all the patients in this study was 29.76 ± 5.53 with no statistical significance in the three different groups, the age-related physiological factors could alter the outcomes. Niroumanesh et al. concluded that older multiparous patients with several previous pregnancies had more tendencies for surgical and curettage approaches than the other patients [Another conclusive point about the patient’s mean age is that younger patients experiencing abortion need to be educated thoroughly about contraceptives and preventive methods, unlike the other age groups. However, this perspective might appear irrelevant to the current study’s aim.Abnormal weight in mothers has a crucial impact on fertility and sanitizations during a healthy pregnancy; that is why determining factors like Body mass index (BMI) like weight and height can play a substantial role in abortion physiology. All the patients were examined for weight and blood pressure, but no statistical significance in these variables was noted that might have altered the outcomes. These findings were compatible with a study conducted by Ghasemi et al. [After the prescription of drugs in the different groups, bleeding, pain, and spots, considered pregnancy tissue expulsion-associated complications, were carefully evaluated. A persistent postpartum hemorrhage after fetus abortion signifies small fragments of trophoblast and decidua still retained in the uterus after fetal death or RPOC expulsion [A study was conducted by Whitehouse et al. to compare the efficacy of medical management for bleeding prevention after surgical abortion in over 336 patients with a history of recent abortion. Their study discovered that 72% of the patients used contraceptive drugs to prevent bleeding and 83% preferred vasopressin over other medications. Likewise, they declared that these patients were willing to intake methylergonovine during the second trimester to control severe bleeding and then preferred misoprostol [Methylergonovine and oxytocin are stimulators of uterine contraction that act directly on uterine smooth muscle and peripheral vasculature, especially uterine vessels, and thus reduce bleeding [Similarly, regarding spotting manifestation after abortion and medication intake, the analysis proved no significant difference between different study groups. This fact confirms the results obtained from the degree of bleeding reported by the participants.Considering medication intake and postpartum pain followed by fetal abortion, our study has discovered that the combination of misoprostol plus methylergonovine showed the best efficacy in pain management. A varied number of guidelines published for pain management by various medical associations have recommended only a normal dosage of common analgesics [Although they strongly recommend controlling, monitoring, and measuring the pain [A study by Kemppainen et al. [