Administration Of Misoprostol Research Articles

Outcomes After Early Pregnancy Loss Management With Mifepristone Plus Misoprostol vs Misoprostol Alone

Medication management of early pregnancy loss (EPL), or miscarriage, typically involves the administration of misoprostol with or without pretreatment with mifepristone. Combination treatment with mifepristone plus misoprostol is more effective than misoprostol alone but is underutilized in the US. To describe differences in clinical outcomes after EPL management with mifepristone plus misoprostol vs misoprostol alone using commercial claims data. This retrospective cohort study used national insurance claims data from the IBM MarketScan Research Database. Participants included pregnant people (aged 15-49 years) with private insurance who presented with an initial EPL diagnosis between October 1, 2015, and December 31, 2022. The primary exposure was the medication used to manage EPL (ie, mifepristone plus misoprostol or misoprostol alone). Other exposures of interest included demographic characteristics and location of service. The primary outcome was subsequent procedural management (eg, uterine aspiration) after EPL diagnosis and medication management. Other outcomes of interest included return visits, hospitalizations, and complications occurring in the subsequent 6 weeks. Descriptive statistics and bivariate analyses were used, and a multivariable logistic regression model was created to examine factors associated with subsequent procedural management. This study included 31 977 patients (mean [SD] age, 32.7 [5.6] years) with claims for EPL who received medication management. Of these patients, 3.0% received mifepristone plus misoprostol and 97.0% received misoprostol alone. Patients who received misoprostol with pretreatment with mifepristone were less likely to have subsequent uterine aspiration (10.5% vs 14.0%; P = .002), and they were also less likely to have subsequent emergency department (ED) visits for EPL (3.5% vs 7.9%; P < .001). In multivariable analysis, use of mifepristone plus misoprostol was associated with decreased odds of subsequent procedural management (adjusted odds ratio, 0.71 [95% CI, 0.57-0.87]). The findings of this study suggest that mifepristone is underutilized for the medication management of EPL, but its use is associated with a lower need for subsequent uterine aspiration and a decrease in the number of subsequent visits to an ED. Increasing access to mifepristone for EPL management may decrease health care utilization and expenditures.

Comparative Efficacy of Different Misoprostol Administration Routes in Medical Abortion: A Randomized Controlled Trial

Comparative Efficacy of Different Misoprostol Administration Routes in Medical Abortion: A Randomized Controlled Trial

Role of Administration of Sublingual Misoprostol Before Open Myomectomy.

Role of Administration of Sublingual Misoprostol Before Open Myomectomy.

Sonographic evaluation of retained products of conception within 48h following delivery: a retrospective cohort study.

Early diagnosis of retained products of conception (RPOC) is critical for directing clinical management and for preventing associated complications. This study aimed to evaluate the utility of post-delivery ultrasound in patients with risk factors for RPOC. A retrospective cohort-study was conducted in asingle tertiary university-affiliated hospital (January 2016-September 2022). Sonographic evaluation, including endometrium thickness measurement and color Doppler, were reviewed of women with risk factors for RPOC: postpartum hemorrhage, a hemoglobin drop > 4g/dl, manual removal of the placenta, and suspicious placenta. Results of early postpartum ultrasound (within 48h), misoprostol administration and hysteroscopies were evaluated. Of the 591 women included, RPOC was suspected in 141 (24%). Endometrial thickness > 5mm was associated with sonographic RPOC diagnosis in 58%. Suspected sonographic RPOC was concluded for 100%, 92% and 7% of the women with marked, moderate, and undetectable vascularity, respectively, p < 0.001. Misoprostol 1000mcg per rectum (PR) was administered to 86% of those with suspected RPOC; only 11% of them needed an operative hysteroscopy for removal of the RPOC. RPOC on a pathology report was confirmed for 71% of those who underwent hysteroscopy. Postpartumtransabdominal ultrasonography within 48h of deliverywas effective for assessing RPOC. For appropriate triage, color Dopplergrading increased the accuracy of RPOC diagnosis. Misoprostol treatment was successful in 88% of women with suspected sonographic RPOC. The combination of sonographic evaluation and misoprostol treatment for suspected RPOC might lower the rate of unnecessary invasive procedures.

First dose of misoprostol administration at home or in hospital for medical abortion between 12–22 gestational weeks in Sweden (PRIMA): a multicentre, open-label, randomised controlled trial

Medical abortion after 12 gestational weeks often requires a stay in hospital. We hypothesised that administering the first misoprostol dose at home could increase day-care procedures as compared with overnight care procedures, shorten inpatient stays, and improve patient satisfaction. This multicentre, open-label, randomised controlled trial was done at six hospitals in Sweden. Participants were pregnant people aged 18 years and older who were undergoing medical abortion at 85-153 days of pregnancy. Randomisation was done in blocks 1:1 to mifepristone administered in-clinic followed by home administration or hospital administration of the first dose of misoprostol. Allocation was done by opening of opaque allocation envelopes. Due to the nature of the intervention, masking was not feasible. Between 24-48 h after mifepristone 200 mg, the participants administered 800 μg of misoprostol either at home 2 h before admission to hospital or in hospital. The primary outcome was the proportion of day-care procedures (defined as abortion completed in <9 h). The intention-to-treat analysis included all participants randomly assigned to receive the study drug and who had known results for the primary outcome. Individuals who received any treatment were included in the safety analyses. This trial is registered at ClinicalTrials.gov, NTC03600857, and EudraCT, 2018-000964-27. Between Jan 8, 2019, and Dec 21, 2022, 457 participants were randomly assigned to treatment groups. In the intention-to-treat-population, 220 participants were assigned to the home group and 215 to the hospital group. In the home group, 156 (71%) of 220 participants completed the abortion as day-care patients, compared with 99 (46%) of 215 in the hospital group (difference 24·9%, 95% CI 15·4-34·3; p<0·0001). In total, 97 (22%) of 444 participants in the safety analysis had an adverse event. Seven (2%) of 444 participants aborted after mifepristone only. Two (1%) of 220 in the home group aborted after the first dose of misoprostol, before hospital admission. Home administration of misoprostol significantly increases the proportion of day-care procedures in medical abortion after 12 gestational weeks, offering a safe and effective alternative to in-clinic protocols. Region Västra Götaland, Hjalmar Svensson's Fund, the Gothenburg Society of Medicine, Karolinska Institutet-Region Stockholm, and The Swedish Research Council.

24-Hour Compared With 12-Hour Mifepristone-Misoprostol Interval for Second-Trimester Abortion: A Randomized Controlled Trial.

To compare 24-hour and 12-hour mifepristone-to-misoprostol intervals for second-trimester medication abortion. We conducted a prospective randomized controlled trial. Participants were allocated to receive mifepristone either 24 hours or 12 hours before misoprostol administration. The primary outcome was the time from the first misoprostol administration to abortion (induction time). Secondary outcomes included the time from mifepristone to abortion (total abortion time); fetal expulsion percentages at 12, 24, and 48 hours after the first misoprostol dose; side effects proportion; and pain and satisfaction scores. A sample size of 40 per group (N=80) was planned to compare the 24- and 12-hour regimens. Eighty patients were enrolled between July 2020 and June 2023, with 40 patients per group. Baseline characteristics were comparable between groups. Median induction time was 9.5 hours (95% CI, 10.3-17.8 hours) and 12.5 hours (95% CI, 13.5-20.2 hours) in the 24- and 12-hour interval arms, respectively ( P =.028). Median total abortion time was 33.0 hours (95% CI, 34.2-41.9 hours) and 24.5 hours (95% CI, 25.7-32.4 hours) in the 24- and 12-hour interval groups, respectively ( P <.001). At 12 hours from misoprostol administration, 25 patients (62.5%) in the 24-hour arm and 18 patients (45.0%) in the 12-hour arm completed abortion ( P =.178). At 24 hours from misoprostol administration, 36 patients (90.0%) in the 24-hour arm and 30 patients (75.0%) in the 12-hour arm had complete abortion ( P =.139). The need for additional medication or surgical treatment for uterine evacuation, pain scores, side effects, and satisfaction levels were not different between groups. A 24-hour mifepristone-to-misoprostol regimen for medication abortion in the second trimester provides a median 3-hour shorter induction time compared with the 12-hour interval. However, the median total abortion time was 8.5-hours longer in the 24-hour interval regimen. These findings can aid in shared decision making before medication abortion in the second trimester. ClinicalTrials.gov, NCT04160221.

24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion: A Randomized Controlled Trial [ID 2683386

INTRODUCTION: We aimed to compare 24- and 12-hour mifepristone to misoprostol intervals for second-trimester medical abortion. METHODS: This was a prospective randomized controlled trial. Women were allocated to receive mifepristone either 24 or 12 hours before misoprostol administration. The primary outcome was time from mifepristone administration to fetal expulsion and from first misoprostol administration to fetal expulsion. RESULTS: Eighty women were enrolled between July 2020 and June 2023, 40 women per group. Baseline characteristics were comparable between groups. Median time from mifepristone to fetal expulsion was 33.0 and 24.5 hours in the 24- and 12-hour interval groups, respectively (P&lt;.001). Median time from first misoprostol dose to fetal expulsion was 9.5 and 12.5 hours in the 24- and 12-hour interval arms, respectively (P=.028). At 12 hours from misoprostol administration, 25 (62.5%) and 18 (45.0%) of women in the 24- and 12-hour arms completed abortion (P=.178). At 24 hours from misoprostol administration, 36 (90.0%) and 30 (75.0%) in the 24- and 12-hour arms had complete abortion (P=.139). Need for additional medical and/or surgical treatment for uterine evacuation were comparable between groups. Pain scores, side effects, and satisfaction levels were similar in both groups. CONCLUSION: A 12-hour mifepristone-to-misoprostol regimen for medical abortion in the second trimester provides an 8.5-hour shorter mifepristone-to-fetal-expulsion rate compared with the 24-hour interval. However, misoprostol-to-fetal-expulsion time is 3 hours longer in the 12-hour interval regimen. Medical regimen success rate, side effects, and satisfaction levels are also similar. These findings can aid in shared decision-making prior to medical abortion in the second trimester.

Timing of Mifepristone Relative to Misoprostol Critical for Reducing Blood Loss and Need for Surgical Procedure for Induction of Labor in the Second Trimester [ID 2683544

INTRODUCTION: Mifepristone is used in combination with misoprostol to facilitate inpatient induction of labor in the second trimester; however, the optimal interval of time between administration of these drugs is not known. Current practice guidelines recommend an interval of 24–48 hours. METHODS: In a single-institution retrospective chart review study, we examined whether mifepristone administration practices at that institution improved loss induction duration or adverse outcomes. This study was determined to be exempt from IRB approval. RESULTS: Among 267 loss inductions from 2018 to 2022, 54% received mifepristone. When misoprostol-alone inductions are compared to those that also received mifepristone, results demonstrate no difference in time to delivery (15.1 versus 15.9 hours; P=.62) or adverse outcomes, including blood loss greater than 1 L (8.2% versus 13.1%; P=.24) and need for operating room (OR) procedure (15.6% versus 16.6%; P=.86). Importantly, the average interval in this study between administration of mifepristone and misoprostol was 1.3 hours (median, 0.1 hours). Further analysis of those patients who received mifepristone demonstrated improved outcomes only if mifepristone was given at least 3 hours prior to misoprostol, including blood loss greater than 1 L (17.4% versus 0%; P=.0037) and need for OR procedure (21.4% versus 2.7%; P=.0088). There remained no difference in time to delivery (16.0 versus 15.8 hours; P=.94). CONCLUSION: These data demonstrate the importance of the timing of mifepristone and misoprostol administration for loss induction and strongly suggest that at least a 3-hour interval is required to improve adverse outcomes. Further prospective study is warranted to broaden the scope of these findings.

Comparative study between misoprostol and lidocaine before intrauterine contraceptive device insertion

Background Intrauterine contraceptive device (IUCD) is a safe, extremely effective and long-acting reversible contraceptive method. Misoprostol has definite to be a very pliable and adequate drug because its composition as a tablet that is stable and may be delivered orally, rectally or vaginally, and through the sublingual route. Lidocaine is a common local anesthetic and antiarrhythmic drug. Aims The objective of the present study was to compare between sublingual administration of misoprostol and lidocaine spray prior to IUCD insertion. Patients and methods This randomized controlled clinical trial was conducted at Department of Family Planning at Tanta University Hospital from February 2021 to March 2022. The study included 150 women into three groups each of them had 50 women. Results The pain scores during IUCD insertion and during uterine sounding were lower in group A, B. There was nonhuge distinction between both groups regarding insertion result (failed, easy or difficult insertion). There was nonhuge distinction between sublingual misoprostol and lidocaine spray regarding Visual Analogue Scale during sounding the uterus and during IUCD insertion. There was nonhuge distinction between studied groups as regard of medication related side effect except misoprostol group significant increase abdominal cramps. Conclusions The study concluded that the use of sublingual misoprostol and lidocaine before IUCD insertion reduces Visual Analogue Scale scores (pain scores) during sounding the uterus and during IUCD insertion.

Outpatient labor induction-Exploring future potential by assessing eligibility in a historical cohort.

Labor induction rates have increased over the last decades, and in many high-income countries, more than one in four labors are induced. Outpatient management of labor induction has been suggested in low-risk pregnancies to improve women's birth experiences while also promoting a more efficient use of healthcare resources. The primary aim of this paper was to assess the proportion of women in a historical cohort that would have been eligible for outpatient labor induction with oral misoprostol. Second, we wanted to report safety outcomes and assess efficacy outcomes for mothers and infants in pregnancies that met the criteria for outpatient care. Criteria for outpatient labor induction with oral misoprostol were applied to a historical cohort of women with induction of labor at two Norwegian tertiary hospitals in the period January 1, through July 31, 2021. The criteria included low-risk women with an unscarred uterus expecting a healthy, singleton baby in cephalic position at term. The primary outcome was the proportion of women eligible for outpatient labor induction. Secondary outcomes included reasons for ineligibility and, for eligible women, safety and efficacy outcomes. Overall, 29.7% of the 1320 women who underwent labor induction in a singleton term pregnancy met the criteria for outpatient labor induction. We identified two serious adverse events that potentially could have occurred outside the hospital if the women had received outpatient care. The mean duration from initiation of labor induction to administration of the last misoprostol was 22.4 h. One in 14 multiparous women gave birth within 3 h after the last misoprostol dose. In this historical cohort, three in ten women met the criteria for outpatient management of labor induction with oral misoprostol. Serious adverse events were rare. The average time span from the initiation of labor induction to the last misoprostol was nearly 24 h. This suggests a potential for low-risk women with an induced labor to spend a substantial period of time at home before labor onset. However, larger studies testing or evaluating labor induction with oral misoprostol as an outpatient procedure are needed to draw conclusions.

Role of Medical Treatment in Abortion-An Observational Study

Background: Medical treatment of abortion has been identified as safe and effective Method of evacuation of uterus and is more amenable to provision through primary care facilities, ever where providers may not have the skills to perform a surgical evacuation. Medical treatment of abortion care encompasses the management of various clinical conditions including incomplete abortion missed abortion, blighted ovum, as well as post-abortion contraception. Medical management of abortion generally involves misoprostol. Objective: To assess the role of medical treatment in abortion in pregnant women-an observational study. Methods: This is an observational study done at Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh from July 2021 to July 2023. 101 patients fulfilling the inclusion criteria were enrolled. This is an attempt to study incomplete abortion after medical treatment of abortion and to observe the success read of this method of taking it among patients, with prescriptions or without it. Questionnaires were prepared and women were interviewed. Questions pertaining to women knowledge, attitude, perception and use of medicine for treatment of abortion, use of emergency contraception were asked. Study was carried out by using responses in the preform given. Results: This study was done in duration of two years and 101 patients fulfilling the inclusion criteria were enrolled. Women who had ectopic pregnancy, threatened abortion &amp; excessive P/V bleeding were excluded. In our study, most of the women interviewed, were between 25-34 years of age (51.5%). Out of the 101 women, 99 women (98.01%) were married and 2 (1.99%) were unmarried. 76 women (75.2%) belonged to urban residence. 16 women (15.9%) were working women. 81 women (80.2%) were housewives. 4 (3.9%) interviewed were students. 41 women interviewed were illiterate (40.6%) while only 9 women (8.9%) were graduates. In our study, majority of women 76 (75.2%) had taken abortifacient or spontaneous abortion occur at &lt;12 weeks of gestation. However, 05 (4.9%) women did not know about their gestational age. Main complication after taking medicine for abortion was moderate bleeding mentioned by 60 women (59.4%), incomplete abortion by 10 women (9.90%), Repeat prescription after 1 week 05 women (4.95%), pain by 27 women (26.7%) and need MVA or D&amp;C by 07 women (6.93%). Among the 101 women who used misoprostol with known outcome, 90.09% had complete abortions, 10 (9.90%) had incomplete abortions. The rates of incomplete abortion and surgical intervention were not significantly different among the women with administration of misoprostol. Among blighted ovum after treatment, complete abortion 69.3% and 30.7% incomplete abortion. Conclusion: Medical treatment of abortion is safe and effective but complications can occur if not used in accordance. However, the awareness about medical treatment of abortion is increasing. It is therefore of utmost importance to increase the awareness about medical treatment of abortion not only among doctors but also among general population.

Optimal misoprostol dosing among patients with a body mass index greater than 30: a randomized controlled trial

Patients with obesity experience an increased duration of labor with an increased risk for perinatal morbidity. When compared with parturients without obesity, they also experience fewer uterine contractions after administration of misoprostol. It is unclear if the same dose of misoprostol should be used for induction of labor in patients with obesity compared to non-obese patients. Therefore, we sought to investigate if a higher dose of misoprostol for patients with obesity is more effective. This study aimed to determine if 50 μg compared with 25 μg of vaginal misoprostol reduced the time from induction start to delivery among patients with obesity. We performed a double-blinded, pragmatic randomized controlled trial, between June 1, 2022, and July 17, 2023. Patients with a body mass index ≥30 kg/m2 who underwent labor induction at ≥ 36 weeks' gestation, had a singleton gestation, and a cervical dilation ≤3 cm at admission were included. Patients were excluded if they had a contraindication to vaginal delivery or misoprostol administration. Patients were randomized to 25 or 50 μg of vaginal misoprostol, stratified by parity, body mass index <40 kg/m2 or ≥40 kg/m2, and provider intent to use mechanical dilation at the onset of labor induction. Usual labor management was followed at the discretion of the provider. The primary outcome was time from induction to delivery. A priori, we estimated that 90 subjects per group (N=180) were needed for an 85% power to detect a 3-hour difference between groups with a type I error of 5%. Analysis was by intention-to-treat. A 2-sample t test was used for the primary outcome, Cohen's d was used as a measure of effect, and P values were reported. Of the 180 patients randomized, 88 were assigned to the 25 μg group and 92 were assigned to the 50 μg group. Of those, 96.1% of patients received the designated intervention. The baseline characteristics were similar between groups. No difference was found in the primary outcome of time to delivery (21.6 hours vs 18.6 hours; d=.28; 95% confidence interval,-0.02 to 0.57). In a planned subgroup analysis, multiparous patients delivered faster in the 50 μg group (15.2 hours vs 12.0 hours; d=.51; 95% confidence interval, 0.04-0.97). The risk for tachysystole associated with fetal heart tracing changes was rare overall (2.2%) and not significantly different between groups. No differences in maternal or neonatal adverse effects were observed. Patients with obesity who underwent cervical ripening with 50 μg of vaginal misoprostol experienced a similar time to delivery when compared with those who received 25 μg of misoprostol. However, multiparous patients had a significantly reduced time to delivery when 50 μg was used. A higher dose of misoprostol may be a promising intervention for reducing time in labor, which warrants further study.

Local administration of prostaglandins to accelerate the orthodontic movement. A literature review

The search to optimize tooth movement and reduce treatment time is of great interest to the orthodontist, as it involves innovating new materials and procedures to achieve the treatment objectives in the short term. The administration of prostaglandins has been studied, and their effect on accelerating tooth movement when administered locally has been proven. The objective of this study was to evaluate the latest achievements concerning the effects of local administration of prostaglandins to accelerate tooth movement for orthodontic purposes. A search was conducted in four databases (PubMed, SciELO, Cochrane, Google Scholar) and three specialized journals (AJODO, Angle Orthodontics, Journal of Clinical Orthodontics) until August 2023. The methodological quality of the studies was analyzed using the PRISMA checklist. The study had 14 articles. Local administration of prostaglandins accelerates the speed of tooth movement and increases the number of osteoclasts. Evidence of root resorption has been reported concerning high doses of prostaglandins via the submucosal route and a reduction in root resorption by administering prostaglandins with calcium gluconate. Local administration of prostaglandins via the submucosal route produces mild to moderate pain, and inoculation with a local anesthetic is recommended. However, oral administration of the analogous compound Misoprostol does not produce pain or evidence of root resorption. Sufficient scientific evidence has not been found to support the local administration of prostaglandins as a safe method to accelerate tooth movement in humans.

Efficacy and safety of oral and vaginal administration of misoprostol for induction of labor in high-risk obese pregnant women with hypertension or diabetes mellitus

Objective This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes. Methods A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates. Results Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group. Conclusion Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.

Combination of Mifepristone and Misoprostol for First-Trimester Medical Abortion: A Comprehensive Review of the Literature.

Several medications have been used to achieve medical abortion in the first trimester of pregnancy. The most commonly used is the combination of mifepristone and misoprostol; however, different doses and routes of administration have been proposed. The aim of this study was to summarize published data on the effectiveness, adverse effects, and acceptability of the various combinations of mifepristone and misoprostol in medical abortion protocols in the first trimester of pregnancy. This was a comprehensive review, synthesizing the findings of the literature on the current use of mifepristone and misoprostol for first-trimester abortion. The combination of mifepristone and misoprostol seems to be more effective than misoprostol alone. Regarding the dosages and routes, mifepristone is administered orally, and the optimal dose is 200 mg. The route of administration of misoprostol varies; the sublingual and buccal routes are more effective; however, the vaginal route (800 μg) is associated with fewer adverse effects. Finally, the acceptability rates did not differ significantly. Different schemes for first-trimester medical abortion have been described so far. Future research needs to focus on identifying the method that offers the best trade-off between efficacy and safety in first-trimester medical abortion.

7 Intravaginal administration of misoprostol before artificial insemination improves the fertility of sheep

7 Intravaginal administration of misoprostol before artificial insemination improves the fertility of sheep

Interaction of endocannabinoid system and cyclooxygenase metabolites with fatty acid amide hydrolase and cyclooxygenase enzyme activities on contractile responses in rat vas deferens tissue.

The endocannabinoid system and prostaglandins are important modulators in the genitourinary system. This study aimed to investigate the possible interactions between the endocannabinoid system and the cyclooxygenase (COX) pathway on rat vas deferens. For this purpose, the concentration responses of the endocannabinoid anandamide, prostaglandin F2α analog latanoprost, and prostaglandin E1 analog misoprostol on the electrical field stimulation (EFS)-induced contractile responses were obtained. The concentration responses to anandamide were obtained again in the presence of nonselective COX inhibitor flurbiprofen and prostaglandin analogs, while the concentration responses of latanoprost and misoprostol were obtained in the presence of cannabinoid receptor antagonists and fatty acid amide hydrolase (FAAH) enzyme inhibitor URB597. FAAH, COX-1, and COX-2 enzyme levels in vas deferens tissue samples were also determined. The cumulative addition of anandamide was not different from the vehicle; however, the EFS-induced contractile responses were significantly increased with the incubation of latanoprost or flurbiprofen in the prostatic portion. Flurbiprofen and misoprostol decreased FAAH enzyme levels in both portions of the vas deferens, while latanoprost induced the inhibition in the prostatic portion. The cumulative administration of latanoprost and misoprostol significantly enhanced the contractile responses in the prostatic portion. This effect of latanoprost was significantly antagonized by URB597 and AM251. The enhancing effect of misoprostol was antagonized by anandamide, URB597, AM251, and AM630. Anandamide, AM251, AM630, and URB597 decreased enzyme levels of COX-1 and COX-2 in both portions of the vas deferens. These results demonstrate an intricate crosstalk between endocannabinoids and prostaglandins in modulation of the vas deferens contractility.

Letrozole plus misoprostol versus misoprostol alone in the induction of anembryonic missed abortion: a randomized controlled trial conducted in Upper Egypt

BackgroundA missed abortion is a spontaneous abortion in which the embryo or fetus has already died but has remained in the uterus for days or weeks with a closed cervical ostium. Termination of pregnancy could be achieved either by surgical evacuation or medical or expectant management. Letrozole is a third-generation aromatase inhibitor. According to many recent studies, letrozole given for three days before the administration of misoprostol was more effective than misoprostol alone at inducing abortion. Our study compared the efficacy of various letrozole regimens (10 mg/d for three days and a single dose of 20 mg) combined with misoprostol vs. misoprostol alone in inducing abortion. To find the most efficient regimen of letrozole administered before misoprostol to induce an abortion.MethodologyThis prospective, parallel, three-arm, single-blinded, allocation-concealed randomized controlled trial was conducted in Sohag Teaching Hospital in Upper Egypt. We randomly divided 105 patients with anembryonic missed abortion (up to 63 days gestation) with no history of medical disorders or a history of allergies to misoprostol or letrozole into three equal groups (a single-dose letrozole group, a multiple-dose letrozole group, and a misoprostol-only group). The complete abortion rate, incomplete abortion rate, failure to abort rate, and induction-to-abortion interval were all collected. All statistical calculations were performed using the computer program SPSS (Statistical Package for the Social Science, SPSS Inc., Chicago, IL, USA).ResultsThe complete abortion rate was significantly higher in the single-dose letrozole and multiple-dose letrozole groups than in the misoprostol group (p values = 0.0455 and 0.001, respectively). On the other hand, there was no significant difference in the complete abortion rate between the single-dose group and the multiple-dose letrozole group (p-value = 0.1713). The time to complete abortion was significantly shorter in the single-dose and multiple-dose letrozole groups than in the misoprostol group (p values = 0.0036 and 0.0049, respectively). On the other hand, there was no significant difference in the time to complete abortion between the single-dose letrozole group and the multiple-dose letrozole group (P = 0.532).ConclusionSingle- and multiple-dose letrozole regimens followed by misoprostol had a higher rate and a shorter time to complete abortion than misoprostol alone.Trial registrationThe trial is registered at gov with the name “letrozole and abortion” and the identifier “NCT05198050”. The date of registration was April 1, 2022, registered prospectively. URL: https://register.clinicaltrials.gov/prs/app/action/ViewOrUnrelease?uid=U0004GED&ts=25&sid=S000BPDQ&cx=43mobl.

Comparison of Intracervical Foley's Catheter With Vaginal Misoprostol Versus Intravaginal Misoprostol Alone for Cervical Ripening and Induction of Labor.

Introduction Induction of labor implies stimulation of contractions before the spontaneous onset of labor, with or without membranes. Augmentation refers to the enhancement of spontaneous contractions that are considered inadequate because of failed cervical and fetal descent. This study compared the effectiveness of intracervical Foley catheter insertion and vaginal misoprostol versus only vaginal misoprostol in the induction of labor and other outcomes relted to it. Methods The present study was a randomized controlled trial that included 148 women divided into two groups: (i) Group A, which received intracervical Foley catheter insertion and vaginal misoprostol (25 µg), and (ii) Group B, which received intravaginal administration of tablet misoprostol (25 µg) alone. We compared the median time from the time of induction to vaginal delivery, incidence of cesarean delivery, chorioamnionitis, puerperal infection, uterine tachysystole, neonatal information at delivery, and discharge status (i.e., birth weight, neonatal intensive care unit (NICU) admission, and neonatal death) between groups. Results We found that the rates of puerperal infection (n=36; 48.6%) and meconium-stained amniotic fluid (n=45; 60.8%) were higher in Group B than in Group A (n=20; 27.0% and n=25; 33.8%, respectively), which were statistically significant differences (p=0.0066 and p=0.0009, respectively). In addition, NICU admission was higher in Group B (n=47; 63.5%) than in Group A (n=30; 40.5%), which was a statistically significant difference (p=0.0051). Conclusion An intracervical Foley catheter with 25 µg of misoprostol was more effective for induction of labor than 25 µg of intravaginal misoprostol alone every six hours for a maximum of four doses in terms of induction to delivery interval, meconium-stained amniotic fluid, mode of delivery, intrapartum complications, and puerperal infection.

Misoprostol-Induced Fever and Unnecessary Antibiotic Prescribing: A Retrospective Study.

Misoprostol is widely used for medication abortion and postpartum hemorrhage. However, it has been associated with the adverse effect of fever, which can pose challenges in management and potentially contribute to unnecessary antibiotic use. The incidence of misoprostol-induced fever in the context of medical abortion has not been extensively studied. This retrospective cohort study aimed to determine the incidence of fever following misoprostol administration at a tertiary care hospital in Saudi Arabia. The study included female patients who received misoprostol for pregnancy termination or management of missed or incomplete abortion between January 2017 and December 2019. Data on demographics, misoprostol dosage and route, fever characteristics, outcome of abortion, and antibiotic use were collected. Statistical analysis was preformed using appropriate tests. A total of 213 patients were included in the study. The incidence of fever post-misoprostol administration was 8%. Patients who developed fever had a higher gestational age and received higher doses of misoprostol. However, no significant associations were found between other patient variables and fever incidence. Antibiotic therapy was administered to a almost half of the patients who developed fever post-misoprostol but was determined to be unnecessary in all cases. This study contributes to the understanding of misoprostol-induced fever in the context of medical abortion. Further research is needed to explore strategies for reducing unnecessary antibiotic use in this population.