الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
An increasing proportion (15%-20%) of unsuccessful pregnancies are now diagnosed in routine first trimester ultrasonography and designated as abortions. Pregnancies clinically presenting as abortions have so far been treated by surgical evacuation of the uterus. Although considered quick and effective yet it remains invasive procedure and there is considerable evidence that it is associated with certain risks such as cervical trauma, uterine perforation and intrauterine adhesions. The awareness of risk and need for general anesthesia prompted the search for alternatives such as medical methods. Misoprostol, the new synthetic analogue of PGE1 has radically changed the approach to first trimester abortion. Use of prostaglandin alone in abortion, without progesterone antagonists, is logical because death of the conceptus brings about natural fall in progesterone level. There are reports of use of vaginal misoprostol alone for abortion and of claims that it is better than oral misoprostol. Use of medical methods is expected to bring about gradual non-traumatic dilatation off cervix, separation of products, and their expulsion. Few cases might require surgical evacuation to remove retained products. However this becomes safe and easy because of open cervix, separated products and thick contracted myometrium.
Misoprostol is active and safe both by oral and vaginal routes but oral route has the disadvantage of decreased bioavailability and more gastrointestinal side effects. Uterine contractility increases continuously for 4 hours after vaginal administration. Greater effect on the uterus by vaginal route is probably due to direct access to myometrium via cervical canal and by transfer of drug from the peri-vaginal venous plexus to uterine arterioles. When complete drug induced expulsion does not occur within 12 hours, the cervical priming properties of misoprostol are helpful to perform surgical evacuation. This drug has a lower cost, is stable at room temperature with fewer side effects as compared to PGE2 analogues.
The present study has been designed to compare between ultrasonographic endometrial findings following medical and surgical abortion in the first trimester.
The study is composed of 200 women, admitted to El-Shatby Maternity University Hospital, with picture of first trimester abortion, and a well-informed written consent has been taken from each patient after explanation of the procedure, the medication, benefits and possible complications.
All cases were followed up within one week by transvaginal ultrasound after medical and surgical abortion.
The results of the study were tabulated and statistically analyzed.
from the present work, we can reach the following conclusions:
• Medical methods are an effective alternative in the management of confirmed first-trimester abortion. Medical evacuation is an alternative technique that complements but does not replace surgical evacuation. Its availability has lead to an improvement in choice for women who miscarry.
• Vaginal misoprostol is more effective than oral misoprostol and that it requires fewer dosages with less side effects.
• Side effects such as nausea, vomiting, fever, chills and diarrhea may be more common with oral compared with