Medical; Abortion, Fetus Clinical Trial
Official title:
Fetal Fibronectin as a Predictor of Successful Induction of Mid-trimester Abortion
Fetal Fibronectin as a Predictor of Successful Induction of Mid-trimester abortion.
The population of the study will comprise 135 pregnant women attending Ain Shams University
Maternity hospital at labor and delivery ward diagnosed with mid-trimester missed
miscarriage confirmed by transabdominal ultrasound who will undergo termination by
misoprostol.
Before entering the study, the purpose of this work will be clearly explained and verbal
consent will be obtained from all patients enrolled in the study along with routine written
informed consent as governed by the hospital rules.
All participants will be subjected to:
1. History taking:
1. Personal history: age and special habits
2. Obstetric history (parity, history of abortions, previous cerculage and preterm
labor). Gestational Age will be assigned by means of a combination of menstrual
dating and ultrasonographic evaluation.
3. Past medical history (hypersensitivity to misoprostol, chronic adrenal
insufficiency and inherited porphyrias).
4. Past history of previous cesarean section or other operations as hysterotomy and
myomectomy.
2. Examination:
1. General examination: blood pressure, pulse, temperature, body weight.
2. Abdominal examination: fundal level, presence of scar of previous operations,
uterine contractions.
3. Investigations:
1. Laboratory: complete blood count, c-reactive protein titre, blood group.
2. Pelvic ultrasound: to assess fetal viability, amount of liquor, gestational age,
position of the placenta.
4. Assessment of vaginal fetal fibronectin:
All Patients will be put in the dorsal lithotomy position.Using a proper light source and
sterile gloves, a sterile speculum free of lubricants will be placed into the vagina before
vaginal examination by senior resident and the special Dacron swab from the fetal
fibronectin kit will be used to collect a sample of secretions from the posterior fornix.
The sample will be obtained prior to collection of any vaginal wet preparations, before any
cervical manipulation or cervical cultures, and if enough amount of fluid (about 2ml) is not
found, vagina will be washed with 2ml of normal saline.The swab will be placed in sterile
plastic containers which will be stored until assayed quantitatively with an Enzyme-Linked
Immuno Sorbant Assay.
According to Ain Shams University Maternity Hospital protocol, termination of pregnancy will
be conducted as an inpatient procedure. Termination of pregnancy will be performed using
misoprostol tablets (Misotac® Sigma 200 mcg per tablet). Misoprostol tablets will be
introduced by vaginal routes initially (total 800 mcg). Following the initial dose, 2
misoprostol tablets (400 mcg) will be inserted into the vagina every 4 hours to a maximum of
four doses. If the woman does not have adequate contractions, within 8 hours following the
last dose, the same regimen will be repeated over the following 24 hours without the loading
dose.
The induction to expulsion period will be defined as the time from commencement of
misoprostol until fetal expulsion without exerting any fetal traction by caregiver. After
expulsion of the fetus, the patients will receive 30 units of oxytocin on 500 cc Ringer
solution slowly by intravenous infusion over 30 minutes for expulsion of the placenta.
Surgical evacuation will be done when indicated.
The kits used to measure level of fetal fibronectin in vaginal sample (ZYMUTEST Fibronectin
kits) were provided from Hyphen BioMed corporation , France. The ZYMUTEST Fibronectin kit is
an one-step enzyme immuno-assay for measuring human Fibronectin in plasma, or in any fluid
where fibronectin can be present.
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Observational Model: Case-Only, Time Perspective: Prospective
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