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Volume 7, Issue 1 (January & February 2022)                   J Obstet Gynecol Cancer Res 2022, 7(1): 20-24 | Back to browse issues page


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Shirazi M, Torkzaban M, Fallah S, Ghaemi M. Comparing Two Methods of Rectal Diclofenac Administration for Pain Management in Second Trimester Abortion: A Randomized Clinical Trial. J Obstet Gynecol Cancer Res. 2022; 7 (1) :20-24
URL: http://jogcr.com/article-1-403-en.html
1- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
3- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran , marjan_ghaemi@yahoo.com
Abstract:   (212 Views)

Background and Objective: Pain is the most common side effect of induced medical abortion. However, the optimal analgesia method remains as a clinical challenge. This study aimed to compare the efficacy of two methods of administration of diclofenac as a prophylactic or a therapeutic in pain management in induced second-trimester medical abortion. 
Materials and Methods: This randomized clinical trial study was conducted upon pregnant women who were candidates for induced medical abortion and referred to a tertiary educational hospital between October 2019 and December 2020. Participants were divided into two groups based on the mode of diclofenac administration, which was either simultaneously with the first dose of misoprostol or after beginning of the pain. Pain severity, induction-to-abortion time interval, total misoprostol dosage, Hemoglobin concentration, length of hospitalization, and size of retained pregnancy products by ultrasound, and the cumulative dose of opioid usage were compared between the groups.
Results: The severity of pain which was measured by a visual analog scale (VAS), residual of conceived products, hospitalization days, and the total misoprostol dosage were significantly lower (P<0.05) in the prophylaxis compared to the treatment group.
Conclusion: Simultaneous administration of diclofenac with misoprostol as prophylactic method of pain management may be an optimal method in induced medical abortion in the second trimester.

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Systematic Review: Original Research | Subject: Obstetrics and Gynecology
Received: 2021/05/22 | Accepted: 2021/06/28 | Published: 2021/09/9

References
1. Rodriguez MI, Seuc A, Kapp N, von Hertzen H, Huong NT, Wojdyla D, et al. Acceptability of misoprostol-only medical termination of pregnancy compared with vacuum aspiration: an international, multicentre trial. BJOG. 2012;119(7):817-23. [DOI:10.1111/j.1471-0528.2012.03310.x]
2. Winikoff B, Sivin I, Coyaji KJ, Cabezas E, Bilian X, Sujuan G, et al. Safety, efficacy, and acceptability of medical abortion in China, Cuba, and India: A comparative trial of mifepristone-misoprostol versus surgical abortion. American Journal of Obstetrics & Gynecology. 1997;176(2):431-7. [DOI:10.1016/S0002-9378(97)70511-8]
3. Carlsson T. Management of physical pain during induced second-trimester medical abortions: a cross-sectional study of methodological quality and recommendations in local clinical practice guidelines at Swedish hospitals. Scand J Caring Sci. 2019;33(1):111-8. [DOI:10.1111/scs.12608]
4. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams obstetrics, 24e: Mcgraw-hill New York, NY, USA; 2014.
5. Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for mid-trimester termination of pregnancy. Cochrane Database Syst Rev. 2011(1):Cd005216. [DOI:10.1002/14651858.CD005216.pub2]
6. Rahimi-Sharbaf F, Adabi K, Valadan M, Shirazi M, Nekuie S, Ghaffari P, et al. The combination route versus sublingual and vaginal misoprostol for the termination of 13 to 24 week pregnancies: A randomized clinical trial. Taiwan J Obstet Gynecol. 2015;54(6):660-5. [DOI:10.1016/j.tjog.2014.07.010]
7. Jackson E, Kapp N. Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review. Contraception. 2011;83(2):116-26. [DOI:10.1016/j.contraception.2010.07.014]
8. Mohseni M, Shokouhi N, Feizabad E, Khaghani E. Urinary Incontinence Prevalence and Its Related Factors in Pregnant Women. Journal of Obstetrics, Gynecology and Cancer Research. 2020;5(4):167-71. [DOI:10.30699/jogcr.5.4.167]
9. Raymond EG, Weaver MA, Louie KS, Dean G, Porsch L, Lichtenberg ES, et al. Prophylactic compared with therapeutic ibuprofen analgesia in first-trimester medical abortion: a randomized controlled trial. Obstet Gynecol. 2013;122(3):558-64. [DOI:10.1097/AOG.0b013e31829d5a33]
10. Westhoff C, Dasmahapatra R, Winikoff B, Clarke S. Predictors of analgesia use during supervised medical abortion. Contraception. 2000;61(3):225-9. [DOI:10.1016/S0010-7824(00)00090-1]
11. Hamoda H, Ashok PW, Flett GM, Templeton A. Analgesia requirements and predictors of analgesia use for women undergoing medical abortion up to 22 weeks of gestation. Bjog. 2004;111(9):996-1000. [DOI:10.1111/j.1471-0528.2004.00235.x]
12. Penney G. Treatment of pain during medical abortion. Contraception. 2006;74(1):45-7. [DOI:10.1016/j.contraception.2006.03.002]
13. Friedlander EB, Soon R, Salcedo J, Davis J, Tschann M, Kaneshiro B. Prophylactic Pregabalin to Decrease Pain During Medication Abortion: A Randomized Controlled Trial. Obstet Gynecol. 2018;132(3):612-8. [DOI:10.1097/AOG.0000000000002787]
14. Livshits A, Machtinger R, David LB, Spira M, Moshe-Zahav A, Seidman DS. Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study. Fertil Steril. 2009;91(5):1877-80. [DOI:10.1016/j.fertnstert.2008.01.084]
15. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. PAIN. 1983;16(1):87-101. [DOI:10.1016/0304-3959(83)90088-X]
16. Andersson IM, Christensson K, Gemzell-Danielsson K. Experiences, feelings and thoughts of women undergoing second trimester medical termination of pregnancy. PLoS One. 2014;9(12):e115957. [DOI:10.1371/journal.pone.0115957]
17. Jones K, Baird K, Fenwick J. Women's experiences of labour and birth when having a termination of pregnancy for fetal abnormality in the second trimester of pregnancy: A qualitative meta-synthesis. Midwifery. 2017;50:42-54. [DOI:10.1016/j.midw.2017.03.014]
18. Freeman MD, Porat N, Rojansky N, Elami-Suzin M, Winograd O, Ben-Meir A. Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester. Int J Gynaecol Obstet. 2016;135(2):154-7. [DOI:10.1016/j.ijgo.2016.05.008]
19. Fiala C, Cameron S, Bombas T, Parachini M, Agostini A, Lertxundi R, et al. Pain management for up to 9 weeks medical abortion - An international survey among abortion providers. Eur J Obstet Gynecol Reprod Biol. 2018;225:181-4. [DOI:10.1016/j.ejogrb.2018.04.030]
20. Fiala C, Swahn ML, Stephansson O, Gemzell-Danielsson K. The effect of non-steroidal anti-inflammatory drugs on medical abortion with mifepristone and misoprostol at 13-22 weeks gestation. Hum Reprod. 2005;20(11):3072-7. [DOI:10.1093/humrep/dei216]
21. Li CF, Wong CY, Chan CP, Ho PC. A study of co-treatment of nonsteroidal anti-inflammatory drugs (NSAIDs) with misoprostol for cervical priming before suction termination of first trimester pregnancy. Contraception. 2003;67(2):101-5. [DOI:10.1016/S0010-7824(02)00437-7]
22. Mahboobeh S, Fatemeh A, Mamak S, Reihaneh P, Nafiseh S. Pain Control of Medical Abortion with Misoprostol in the First Trimester of Pregnancy. Gynecol Obstet (Sunnyvale). 2017;7(449):2161-0932.1000449.

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