To Evaluate if Serum β HCG Concentration is a Predictive Factor for Successful Early Medical Abortion with Vaginal Misoprostol Within 24 Hours

INTRODUCTION: Surgical curettage has been performed for abortion care in early pregnancy since the 1960s. Medical methods of abortion have more recently been developed and are now an established alternative method of first trimester pregnancy termination. Among researched drugs for medical abortion, mifepristone combined with misoprostol is known as the most effective regimen with approximately 90% success rate, and this regimen is used most commonly in the United States and Western Europe. Misoprostol monotherapy appears less effective than mifepristone plus misoprostol, but has a relatively high success rate of the 84% to 85% .In parts of the world where mifepristone remains unavailable including Korea, misoprostol-only regimens have become the method of choice.Therefore, further research including on the efficacy, side effects, and factors affecting outcomes are needed for misoprostol-only regimens. AIM: To correlate serum β HCG concentration and successful early medical abortion with vaginal misoprostol within 24hours. OBJECTIVE OF THE STUDY: PRIMARY OBJECTIVE: To ascertain whether Beta HCG concentration helps in predicting successful early medical abortion with vaginal misoprostol within 24hours. SECONDARY OBJECTIVE: To find the association between Beta HCG level and successfullness of early medical abortion. MATERIALS AND METHODS: Study design: Prospective cohort study. Study duration: One year. Study locale: Department of obstetrics and gynaecology, PSGIMSR, Coimbatore. Study size: 60. Study Group: Group A (β HCG < 40,000mIU/ml) - 600mcg misoprostol vaginally followed by 400mcg after 4 hrs. Group B (β HCG > 40,000mIU/ml) - 600mcg misoprostol vaginally followed by 400mcg after 4 hrs. METHODOLOGY: Women with pregnancy upto 12 weeks of gestational age who opted for medical abortion and blood sent for beta hcg along with routine investigations prior to intravaginal misoprostol. All patients given intravaginal misoprostol 600mcg followed by 400mcg after 4hrs. Success of abortion was defined as complete expulsion of the conceptus without the need of surgical intervention. Outcome of interest were success of abortion within 24 hrs following administation of misoprostol.Analysing whether β HCG has a role in predicting successful medical abortion or failure medical abortion. INCLUSION CRITERIA: • Primigravida and multigravida. • Maternal age 18 to 45 years. • Singleton pregnancy. • Pregnancy < 12wks of gestational age. Blood samples are collected before intravaginal misoprostol. EXCLUSION CRITERIA: • Multiple pregnancy. • Missed abortion. • Recurrent pregnancy loss. • Vesicular mole • Pregnancy after 12wks of Gestational age. • Maternal age 45 years. RESULTS: Medical abortion is a widely used procedure nowadays. The regimen used in this study was vaginal misoprostol 600mg followed by 400mg 4 hours apart maximum of 2 doses. The success rate was only 18 percent which is statistically insignificant when the beta hCG cut off was taken as 40,000mIU/mL. In our study, various cut off values of beta hCG was analyzed. At a cut off 12,000, the sensitivity and specificity is better and it is statistically significant with p value of 0.015. Many predictors associated with successful medical abortion have been studied. Medical abortion will be highly successful when there is low Beta hCG values and with history of previous normal delivery. CONCLUSION: The Beta hCG value can be used as a predictor for successful early medical abortion with vaginal misoprostol. Though the cut off used in this study was less 40,000mIU/mL, only 18 percent had success rate and it was insignificant. The cut off of 12,000mIU/mL was found to be statistically significant with good sensitivity and specificity. This study does not include mifepristone, so overcomes the delay of 36 to 48 hours. However, the beta hCG cut off is to be remembered. Regarding the regimens of medical abortion, the cut off of beta hCG values and other variables need further studies