الفهرس 
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Abstract
In medical abortion using prostaglandins, analgesic treatment is important for the acceptability of the method. However, the best treatment schedule remains to be established. The pain is most pronounced following the administration of the prostaglandin (misoprostol or gemeprost). It has not yet been evaluated in a prospective study whether co-administration of a NSAID with misoprostol has an influence on the efficacy of the procedure.
Nonsteroidal anti-inflammatory drugs (NSAIDs) often were avoided in protocols studied for induction of abortion because of concern over their potential inhibition of prostaglandin-induced uterine contractions. However, a previous study had shown that the use of NSAIDs did not interfere with the action of misoprostol in inducing uterine contractions and pregnancy expulsion.
The aim of this study was to assess the effect of nonsteroidal anti-inflammatory drugs on misoprostol efficacy in induction of mid-trimesteric abortion.
Ninty healthy women seeking termination of second trimester pregnancy for medical indications were progressively enrolled in the study. All subjects gave informed consent to participation in the study.
Before the start of therapy, vital signs of the patients were measured and a blood sample was taken to determine haemoglobin, blood group and Rh factor.
The women were randomly allocated to receive either oral ibuprofen 400 mg (Brufen 400 mg tablets) in group A or oral tablet of placebo in group B which were administered with each misoprostol dose. Misoprostol (Mesotec 200 μg tablet) was given in a dose of 800 μg vaginally then 400 μg ∕ 4 h for a maximum of 5 doses within 24h. The same regimen was repeated over the following 24h if no response was achieved. Pain level was determined using 0 – 10 visual analogue scale.
The distribution of patients’ age, weight, height, parity and gestational age was similar in both groups. Likewise, indications for termination of pregnancy and baseline Haemoglobin values were not different between the 2 groups.
None of the patients required further interventions to effect abortion since all of them in both groups aborted within 48 h (100% success rate) with the mean induction to abortion intervals in group A and B were 9.9±5.9 and 11.1±5.7, respectively. 95.6% (43∕45) aborted within 24 h in group A and 93.3% (42∕45) in group B. Moreover, more than half of the subjects had complete abortion within 12 hours after start of misoprostol therapy being 73.3% (33∕45) in group A and 66.7% (30∕45) in group B. Furthermore, the total number of misoprostol doses was lower in group A than in group B (2.6 versus 3.1). A significant difference between both groups in the mean pain score reported on the VAS was observed to be 6.2±1.3 in group A and 7.3±1.4 in group B. also; there is a significant difference between the groups in the acceptability of the pain control method and the need for further analgesia.
Nonetheless, the two groups revealed similar results with regard to surgical evacuation of retained placenta, side effects, haemodynamics of patients and mean decrease in haemoglobin.