Discussion
bleeding, pain, post-term, tissue retention, abortion
EVANS, ADVERSE EFFECTS, BLEEDING, UTERINE RUPTURE
The aim of the present study was to compare the effect of vaginal misoprostol plus EPO capsules and misoprostol alone on the consequences of abortion in women with IUFD. The results indicated that vaginal misoprostol plus EPO capsules decreased induction-to-fetal expulsion interval, pain intensity, mean dose of misoprostol received and the need for curettage in the participants. There was no significant difference between the experimental and control groups in variables of blood transfusion, analgesia and side effects of drugs.We found no studies that examined the effects of EPO alone or plus misoprostol on abortion, so we compared our findings with studies examining the effects of EOP in other gynecological and obstetric settings (procedures).Shah Ali et al. conducted a study to determine the effect of vaginal EPO capsules on the cervical ripening of primiparous women with post-term pregnancies. They reported that the duration of the active phase was not statistically significant in the intervention and control groups. However, the duration of the latent phase in the intervention group decreased, and the Bishop score increased [Regarding the effect of EPO capsules on pain intensity, several studies with different research communities have confirmed the results of our study. In a study to determine the effect of EPO on cervical dilatation and pain intensity before and during hysterosalpingography, the intervention group reported less pain intensity than the control group when using a cervical tenaculum and injecting contrast material [The present study showed that the mean dose of misoprostol received in the experimental group was significantly lower than the control group. Since no study was to compare with our findings, we performed the analysis based on the mechanism of misoprostol and EPO. EPO contains the effects of prostaglandins. Prostaglandins play a vital role in the cervical preparation process [In our study, 4.8% of participants in the control group experienced side effects, while the experimental group reported no side effects. It may be due to the lower average dose of misoprostol received. In agreement with these findings, the results of the study by Khoderdoost et al., who examined the effectiveness of two doses of 200 mcg and 400 mcg of vaginal misoprostol for termination of pregnancy of 16 weeks or less, showed that side effects in the group receiving a higher dose (400 mcg) was further [Consistent with our findings, Dickinson and Evans et al. reported that 200 mcg of vaginal misoprostol for therapeutic abortion has few side effects [Nikoei Qazvini et al. prescribed 200 mcg vaginal misoprostol every 6 h for termination of pregnancy in the second trimester of the pregnancy. 46% of participants reported adverse effects of misoprostol [In two studies that examined the effect of vaginal EPO on the cervical ripening in primiparous women, the intervention and control groups were not significantly different in terms of bleeding [One of the negative consequences of misoprostol is the need for curettage following initial treatment failure and tissue retention [On the other hand, Ghasemi et al.’s study comparing two doses of 400 and 600 mcg of misoprostol for abortion in the second trimester did not show a significant difference in the side effects of these two regimens, although some side effects such as uterine rupture, the duration of fetal expulsion and the need to curettage was lower in the 400 mcg regimen [