Μg Of Misoprostol Research Articles

Efficacy of 10 IU Syntocinon versus 800 µg Misoprostol Sublingual in Active Management of 3rd Stage of Labour

Background: The active management of the third stage of labor is crucial for preventing postpartum hemorrhage (PPH), a leading cause of maternal mortality. Syntocinon (oxytocin) and Misoprostol are prominent pharmacological agents used to manage this stage by inducing uterine contractions and minimizing blood loss. Objective: This study aimed to compare the efficacy of 10 IU intravenous Syntocinon and 800 µg sublingual Misoprostol in the active management of the third stage of labor, focusing on maternal outcomes, blood loss, side effects, and the need for additional interventions. Methods: A randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology at Hayatabad Medical Complex from August 1, 2021, to February 1, 2022. A total of 284 women aged 18-40 years with singleton pregnancies were enrolled and randomized into two groups of 142 each. Group A received 800 µg of sublingual Misoprostol, while Group B received 10 IU intravenous Syntocinon at the delivery of the anterior shoulder of the baby. The third stage of labor was managed with early cord clamping and controlled cord traction. Blood loss was meticulously recorded, and patients were monitored for 24 hours postpartum. Data were analyzed using IBM SPSS Statistics version 25, with continuous variables expressed as mean ± standard deviation and categorical variables as frequencies and percentages. Post-stratification analysis utilized an independent sample t-test, with a p-value of ≤ 0.05 considered statistically significant. Results: The mean age of participants was 29.507±3.24 years in the Misoprostol group and 28.352±3.77 years in the Syntocinon group. Blood loss was slightly lower in the Misoprostol group (242.4 ± 3.72 ml) compared to the Syntocinon group (249.176 ± 4.07 ml). The majority of participants were aged 18-30 years (69.7% in Group A and 71.1% in Group B). No statistically significant differences were observed in blood loss based on age, gestational age, or parity. Conclusion: Misoprostol offers practical advantages in terms of ease of administration and stability at room temperature, making it a viable alternative, especially in low-resource settings. Both Misoprostol and Syntocinon are effective in managing the third stage of labor, with comparable efficacy in reducing blood loss.

Evaluation of the effect of Nigella sativa oil on the outcome of missed abortion in women: A randomized double-blind clinical trial.

Due to the concern about the side effects of chemical drugs and their ineffectiveness, the use of natural compounds as alternatives or complementary therapies has received increasing attention. The purpose of this study was to investigate the effect of Nigella sativa oil on the outcome of missed abortion. In this double-blind clinical trial, 70 nulliparous pregnant women referred to Hajar Hospital and Imam Ali clinics of Shahrekord and had missed abortion before the 12-week gestational age were selected and randomly divided into two interventions and control groups. The intervention group received 5 gof Nigella sativa oil alone daily for up to 3 days and the control group received a placebo. In case of nonresponse, 3 days after the last dose of medication or placebo, 800 μgof misoprostol (vaginal) were used. Data were analyzed by SPSS software. The chi-square test, Fisher's exact test, independent t-test and paired t-test were used for analytical statistics. According to the results, 18 cases (51.4%) in the intervention group and seven cases (20%) in the control group showed complete evacuation of uterine contents which had a significant difference (p < 0.05). The frequency of vagina physical examination and type of hemorrhage did not show any significant difference between the two groups before and after the intervention. After the intervention, human chorionic gonadotropin (HCG) was significantly decreased in the intervention group but did not change in the control group (p < 0.05). The frequency of adverse events in the intervention group was three (8.6%) and in the control group was one (2.9%) which had no significant difference. Nigella sativa improves the outcome of missed abortion by reducing HCG and facilitating cervix dilatation and delivery of uterine contents.

Effectiveness and safety of telehealth medication abortion in the USA

Telehealth abortion has become critical to addressing surges in demand in states where abortion remains legal but evidence on its effectiveness and safety is limited. California Home Abortion by Telehealth (CHAT) is a prospective study that follows pregnant people who obtained medication abortion via telehealth from three virtual clinics operating in 20 states and Washington, DC between April 2021 and January 2022. Individuals were screened using a standardized no-test protocol, primarily relying on their medical history to assess medical eligibility. We assessed effectiveness, defined as complete abortion after 200 mg mifepristone and 1,600 μg misoprostol (or lower) without additional intervention; safety was measured by the absence of serious adverse events. We estimated rates using multivariable logistic regression and multiple imputation to account for missing data. Among 6,034 abortions, 97.7% (95% confidence interval (CI) = 97.2–98.1%) were complete without subsequent known intervention or ongoing pregnancy after the initial treatment. Overall, 99.8% (99.6–99.9%) of abortions were not followed by serious adverse events. In total, 0.25% of patients experienced a serious abortion-related adverse event, 0.16% were treated for an ectopic pregnancy and 1.3% abortions were followed by emergency department visits. There were no differences in effectiveness or safety between synchronous and asynchronous models of care. Telehealth medication abortion is effective, safe and comparable to published rates of in-person medication abortion care.

An integrated newborn care kit (iNCK) to save newborn lives and improve health outcomes in Gilgit Baltistan (GB), Pakistan: study protocol for a cluster randomized controlled trial

BackgroundOngoing high neonatal mortality rates (NMRs) represent a global challenge. In 2021, of the 5 million deaths reported worldwide for children under five years of age, 47% were newborns. Pakistan has one of the five highest national NMRs in the world, with an estimated 39 neonatal deaths per 1,000 live births. Reducing newborn deaths requires sustainable, evidence-based, and cost-effective interventions that can be integrated within existing community healthcare infrastructure across regions with high NMR.MethodsThis pragmatic, community-based, parallel-arm, open-label, cluster randomized controlled trial aims to estimate the effect of Lady Health Workers (LHWs) providing an integrated newborn care kit (iNCK) with educational instructions to pregnant women in their third trimester, compared to the local standard of care in Gilgit-Baltistan, Pakistan, on neonatal mortality and other newborn and maternal health outcomes. The iNCK contains a clean birth kit, 4% chlorhexidine topical gel, sunflower oil emollient, a ThermoSpot™ temperature monitoring sticker, a fleece blanket, a click-to-heat reusable warmer, three 200 μg misoprostol tablets, and a pictorial instruction guide and diary. LHWs are also provided with a handheld scale to weigh the newborn. The primary study outcome is neonatal mortality, defined as a newborn death in the first 28 days of life.DiscussionThis study will generate policy-relevant knowledge on the effectiveness of integrating evidence-based maternal and newborn interventions and delivering them directly to pregnant women via existing community health infrastructure, for reducing neonatal mortality and morbidity, in a remote, mountainous area with a high NMR.Trial registrationNCT04798833, March 15, 2021.

The difference of Bishop score change and labor event between oral and vaginal misoprostol in pregnancy beyond 41 weeks

HIGHLIGHTS Oral misoprostol is more effective than vaginal misoprostol in cervical ripening as a part of induction of labor. Oral misoprostol is as safe as vaginal misoprostol. ABSTRACT Objective: To compare Bishop score changes and labor event between oral and vaginal misoprostol in pregnancy beyond 41 weeks. Materials and Methods: A total of 52 pregnant women with more than 41 weeks of gestation, had a Bishop score less than 5, and were undergoing induction labor were randomly divided into two groups: oral and vaginal misoprostol. In the oral misoprostol group, participants were given 25 mg of misoprostol in a solution with a concentration of 1 ug/ml every 2 hours. In the vaginal misoprostol group, a 25 mg misoprostol tablet was inserted into the posterior fornix every 6 hours. The two groups were compared in terms of Bishop score during the first 6 hours, changes in Bishop score, labor at term events, neonatal outcomes, complications, and side effects after the administration of misoprostol. Results: The oral group showed significantly higher changes in Bishop score compared to the vaginal group (5.5 vs 3.6; p=0.0001). The median interval times for induction of labor at term, induction at stage II, and induction at birth were found to be shorter in the oral misoprostol group compared to the vaginal group (7.3 hours vs 10.6 hours, 14.0 hours vs 16.8 hours, and 14.6 hours vs 17.6 hours; p=0.002, 0.003, 0.002). Labor at term occurred much more frequently in the oral group (53.8% vs 15.4%). Additionally, the oral misoprostol group had a 3.5 times higher likelihood of experiencing labor at term within the first 6 hours after the initial administration compared to the vaginal group (OR 3.5, 95% CI 1.33-9.23). Conclusion: Oral administration of misoprostol for cervical ripening has been demonstrated to be more effective than vaginal administration, greater bishop score changes while maintaining an equivalent level of safety.

Oxytocin Versus Oral Misoprostol for Induction of Labor in Pregnant Women with Term Prelabor Rupture of Membranes: a Randomized Clinical Trial

This study compares the effectiveness and safety of oxytocin infusion against oral misoprostol for inducing labour in pregnant women with term prelabor membrane rupture. We randomized 173 pregnant women presenting with term prelabor rupture of membranes (PROM) at Ain Shams University Maternity Hospital into Group A (underwent induction of labor (IOL) by 25μg misoprostol oral tablet every 4 h, for maximum 5 doses) and an identical Group B: (underwent IOL by oxytocin infusion according to the hospital protocol). Our primary outcome was rate of vaginal delivery within 24 h, while the secondary outcomes included the time till active phase, induction to delivery interval, maternal pyrexia, nausea and vomiting, fetal distress, Apgar score, birth weight, and neonatal intensive care unit admission. Both groups showed high rates of vaginal delivery (82.4% & 87.1% for misoprostol group and oxytocin group respectively) with no significant difference between the two groups (p=0.394). However, patients induced by misoprostol took significantly less time to reach active phase with a shorter induction to delivery interval as compared to patients induced with oxytocin. This difference was clear in multiparous women, but not observed in primiparous women when subgroup analysis was done. No significant difference was found as regards other outcomes. Our study showed that both oral misoprostol and oxytocin are effective and safe for IOL in patients with PROM, with shorter induction-delivery interval in patients induced by oral misoprostol, an effect that is clear in multiparous but not primiparous women.Trial registrationNCT05215873, on 31/01/2022, “retrospectively registered”.

Role of Misoprostol in Induction of Labor: Sublingual versus Vaginal in Tikrit City

A successful induction of labor leads to vaginal delivery of a healthy baby, in an acceptable time frame with minimum maternal discomfort or side effects. To compare the efficacy and safety of sublingual and per vaginal 25µg misoprostol for labor induction. Primary outcome measures were the number of cases delivering vaginally, Secondary requirement, the incidence of meconium-stained liquor, number of cesarean deliveries, the incidence of hyperstimulation/tachysystole, maternal adverse effects and neonatal outcomes. A prospective study was conducted in Tikrit Teaching Hospital. Indications were reviewed; 416 women randomly received misoprostol 25 µg vaginally and sublingually every three hourly for maximum three doses. Outcomes were analyzed accordingly. The number of the cases who successfully delivered vaginally was greater in the sublingual group. The induction to vaginal delivery interval was significantly shorter in sublingual group. The incidence of tachysystole and meconium-stained liquor were more in the vaginal than in the sublingual group. The mean doses, mode of delivery, oxytocin augmentation and maternal outcomes were significantly favorable in sublingual group. No significant difference is seen in neonatal outcome. Sublingual misoprostol 25 µg administered three hourly for labor induction has better effficacy as compared to 25 µg of vaginal misoprostol.

A randomised comparative study of induction of labour with sublingual misoprostol 50 μg and oral misoprostol 50 μg in term patients

Background: Current study was conducted to compare the efficacy of tab Misoprostol 50 microgram by oral and sublingual routes for induction of labour. Methods: A randomised comparative study of induction of labour in 200 cases of pregnant women at term and were divided into two groups of 100 each for 50 µg Misoprostol for oral and sublingual route repeated 4 hourly either by sublingual or oral route until an adequate contraction pattern set in (establishment of 3 uterine contractions in a period of 10 minutes) or once the cervical dilatation reaches 4 cm, maximum up to 6 doses. The patients were monitored for maternal vital signs, progress of labour and foetal heart rate. Results: In this study, 86% women delivered vaginally with sublingual misoprostol while 76% were delivered vaginally with oral administration. In the present study, no significant maternal side effects were noted in either group. 4% cases of neonates in sublingual group and 6% cases of neonates in oral group required NICU admission. No still birth or neonatal deaths were seen. Conclusions: Our study shows that sublingual Misoprostol has better efficacy, shorter induction to delivery interval, requirement of fewer doses of misoprostol when compared to oral route.

Introducing misoprostol for treatment of incomplete abortion: A feasibility and acceptability study in secondary-level health facilities in Myanmar

ObjectiveTo assess the feasibility and acceptability of misoprostol as a treatment option for incomplete abortion in secondary hospitals in Yangon and Mandalay, Myanmar. MethodsAn explanatory sequential mixed methods study was conducted. Women seeking treatment for an incomplete abortion with a uterine size <12 weeks were eligible to participate in the prospective cohort including sublingual administration of 400 μg misoprostol, clinical assessment 7–10 days after administration, and patient interview. Treatment efficacy was assessed, defined as proportion of participants with complete uterine evacuation with misoprostol alone. After the cohort, provider interviews were conducted to understand how their experiences with misoprostol may have influenced cohort findings. Study sites included seventeen secondary health facilities in four townships in Yangon and Mandalay, Myanmar. ResultsA total of 110 women were enrolled from July 2018 to January 2019; 96 completed follow-up. In 75 % of cases, incomplete abortion was successfully treated with misoprostol. Treatment efficacy varied significantly by region (Yangon 85 %, Mandalay 67 %; p = 0.048), driven by providers’ variable comfort with misoprostol and proclivity to intervene with additional treatment. With experience, all were willing to incorporate the protocol into practice by study end. Patient acceptability and satisfaction were high. ConclusionMisoprostol is an acceptable and feasible treatment option for women seeking postabortion care at secondary facilities in Myanmar. Extensive health provider training and support systems and continued implementation experience are crucial to effectively translate clinical PAC guidelines into practice in Myanmar.

Factors Influencing the Duration of Termination of Pregnancy for Fetal Anomaly with Mifepristone in Combination with Misoprostol.

This study's aim was to determine relevant factors that influence the time interval between first induction and fetal expulsion in late termination of pregnancy (TOP) and TOP after previous feticide for severe fetal malformation with a mifepristone-misoprostol regime. This retrospective study included 913 TOPs from a single tertiary care referral center. In 197 out of 913 TOPs, a previous feticide had been performed due to advanced gestational age (after 22 + 0 weeks of gestation). Induction was accomplished using 600 mg mifepristone followed by 400 μg misoprostol. The interval between first induction with misoprostol and fetal expulsion was examined. Univariate and multivariate logistic regression analysis were used to predict an induction interval of 12 h or less. The median gestational age at induction of labor was 18.9 weeks of pregnancy. In 487 (53.3%) cases women delivered within 12 h; in 344 (37.7%) cases the induction interval was between 12 h and 36 h. In 82 (9%) cases induction took longer than 36 h. Factors that were significantly associated with a delivery duration of <12 h were a lower gestational age at induction (OR 0.87; 95% CI 0.84-0.89; p < 0.001) and a history of at least one previous vaginal delivery (OR 1.57; 95% CI 1.20-2.05; p < 0.001). Factors that had no impact included previous cesarean section, performing feticide before induction and maternal age. Maternal BMI showed a non-significant trend.

Safety and Efficacy of Misoprostol for the Management of Early Pregnancy Loss: A Non-Randomized Clinical Trial

Background: Management of early pregnancy loss is very crucial for the safety of women.&#x0D; Objective: The purpose of the present study was to see the safety and efficacy of misoprostol for the management of early pregnancy loss.&#x0D; Methodology: This non-randomized clinical trial was conducted in the Department of Obstetrics and Gynaecology in Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh from January 2007 to December 2007 for a period of 12 months. Women with early pregnancy loss who were fulfilling the selection criteria were selected as the study population during the study period. On admission all women were received a vaginal administration of 800 μg misoprostol by digital insertion into the posterior fornix through a speculum (4 tablets of 200 μg misoprostol). The interval between administration of misoprostol and expulsion of product of conception was recorded. After 7 days (8th day) they were instructed to come to the hospital to see the completeness of expulsion of product of conception by ultrasonography. If sonography shows incomplete expulsion then surgical evacuation was done. Every woman were advised to come for follow-up on 15th day. Results: A total of 200 women with first-trimester pregnancy loss were non-randomly assigned to give treatment with misoprostol. The mean with the SD of the study population was 24.95±4.17 years. In most cases expulsion occurred within 24 hours of application of misoprostol, 142(71.0%) cases completed expulsion within 48 hours, 168(84.0%) cases within 7 days, 170(85.0%) cases out of 200 cases completed expulsion occurred. Complete evacuation after the first dose was in 142(71.0%) cases and remained incomplete was 58(29.0%) cases. After administration of the second dose (85.0%) complete evacuation occurred and 30(15.0%) cases remained complete that needed surgical evacuation. Analysis was reveled statistically significant (P&lt;0.05). Vaginal misoprostol treatment appeared to be well tolerated. Only few percent shows mild side effects. About 190(95.0%) cases required no blood transfusion. Conclusion: In conclusion the efficacy of misoprostol for the management of early pregnancy loss gives a good results with minimum adverse events.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):152-156

A Comparative Study of Sublingual Misoprostol Versus Intramuscular Oxytocin in the Active Management of Third Stage of Labor.

Objective Misoprostol has attracted low-income low-resource countries for the active management of the third stage of labor. The objective of this study was to compare the efficacy of sublingual misoprostol and intramuscular oxytocin in the active management of the third stage of labor. Study design This was a prospective randomized controlled trial in which a total of 407 healthy pregnant women having singleton pregnancy, cephalic presentation, and normal vaginal delivery were divided into two groups. In the first group (n=203), women received 600 µg misoprostol tablet sublingually, and in the second group (n=204), women received 10 IU of intramuscular oxytocin, within 1 minute of the delivery of the baby during the third stage of labor. Three patients from the first group and four patients from the second group were excluded from the analysis due to traumatic postpartum hemorrhage (PPH). The primary outcome was an incidence of PPH. Secondary outcomes were the duration of the third stage of labor, amount of blood loss, fall in hemoglobin concentration after 48 hours of delivery, need for additional uterotonics, and side effects of the drugs. Data were compared using the chi-square and independent samples t-test. Results The incidence of PPH was 6.5% in the misoprostol group as compared to 2% in the oxytocin group (p=0.026). The misoprostol group also had significantly higher blood loss (293.75±125.8 mL) and a greater fall in hemoglobin level (0.58±0.25 g/dL) as compared to that in the oxytocin group (226.13±98.44 mL and 0.45±0.20 g/dL) (p<0.001). The mean duration of the third stage of labor was significantly higher in the misoprostol group (5.31±2.1 min) as compared to that in the oxytocin group (3.65±1.75 min) (p<0.001). The additional need for uterotonics was recorded in 15% of the study participants in the misoprostol group as compared to 8% in the oxytocin group (p=0.028). The incidence of side effects such as shivering and fever was significantly higher in the misoprostol group as compared to the oxytocin group. No significant difference between the two groups was observed concerning the incidence of nausea, vomiting, diarrhea, and headache. Conclusion Intramuscular oxytocin is a safe and useful alternative to sublingual misoprostol in facilitating the third stage of labor with minimal blood loss, fewer incidences of hemorrhage, and fewer adverse effects.

Reactions to Misoprostol: A Case Report

Background: Most of abortions occur before the 13th week of pregnancy. Nowadays, non-surgical approaches for evacuation of uterine have been replaced with surgical ones due to the reduction in bleeding, fewer complications, ease of management, and cost-effectiveness. Misoprostol is a prostaglandin E1 analog that is used for labor induction. It is known as a safe drug with very few side effects. Case Presentation: A 29-year-old woman with the gestational age of 11 weeks and 6 days with a diagnosis of cystic hygroma introduced herself to the labor ward. At the time of hospitalization, the patient was conscious. The heart sounds were normal. A vaginal exam indicated no pathological findings. Totally, she received 1000 mg of Misoprostol. Approximately, 2 hours after the last placement of Misoprostol, the patient developed bending and mild cyanosis of fingers and showed tachycardia with a pulse rate of 140 beats/min. Her O2 saturation decreased to 78%. At this time, the patient had a successful miscarriage. Echocardiography showed an ejection fraction of 55% and normal right ventricular size. The electrocardiogram showed sinus tachycardia. Therefore, she was sent to CCU with a possible diagnosis of embolism. The cardiologist administered a heparin drip of 5000-unit IV stat, and 1000 unit/h heparin and asked for a D-Dimer test. However, the laboratory reported that the patient’s blood sample was hemolyzed and they could only check her hemoglobin which was 4 g/dl. Immediately, the heparin drip was held and the patient received 3 packed cells. Her Hb was 6.5 g/dl. 12 hours later she showed tachycardia, and her O2 saturation reduced to 70%. She lost her consciousness. Nearly 40 minutes later, she had cardiorespiratory arrest and CPR wasn’t successful and she died. Conclusions: In Conclusion, even a frequently used drug such as Misoprostol can cause life-threatening side effects, leading to emergent situations.

Comparative Study of the Effect of Vaginal use of Primrose Oil with Misoprostol on Cervical Preparation of Prim Gravid Women: A Double-blind Clinical Trial.

This study compares the effect of vaginal administration of evening primrose oil with misoprostol on cervical preparation in prim gravid women at ≥40 weeks gestation. This was a double-blind randomized clinical trial conducted in Isfahan, Iran during 2019-2020 on 110 prim gravid pregnant women with a gestational age of 40 weeks and more and cephalic presentation of the fetus with the obstetrical indication for pregnancy termination. After obstetric examinations to rule out cephalo pelvic disproportion and calculation of the Bishop score by the researcher, patients were randomized to receive 25 μg misoprostol tablets (n = 55) or 1000 mg evening primrose oil Pearls (n = 55) administrated vaginally by a midwife. We compared Bishop's score before and after the intervention, time of cervical ripening, a dose of intervention for cervical ripening, need to induce labor, the interval between cervical preparation and induction of labor, duration of oxytocin use, need for cesarean section, and its cause, Apgar score at 5 and 10 minutes, neonatal birth weight. Mean baseline Bishop Score was not significant between the groups (P = 0.45); after the intervention, it was significantly higher in the primrose oil group (P < .001). Significantly fewer patients required cesarean sections in the primrose oil group (P = 0.03). The other outcomes were. not significant between the groups (P > 0.05). Misoprostol and primrose oil administration appear to positively affect cervical readiness. Primrose oil resulted in significantly better Bishop Scores and fewer cesarean sections compared to misoprostol in pregnancy 40 weeks and more.

COMPARISON OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN FOR REDUCING MEAN BLOOD LOSS AFTER VAGINAL DELIVERY

Postpartum hemorrhage (PPH) is significantly associated with maternal morbidity and mortality, and many maternal deaths are preventable. Uterine atony is managed through uterotonic agents like prostaglandin F2 alpha (PGF2a), misoprostol, ergometrine and oxytocin and uterine rubbing. This prospective study was designed to compare the role of sublingual misoprostol and IV oxytocin in preventing blood loss after vaginal deliveries. This study was conducted at the Department of Obstetrics &amp; Gynecology, Nishtar Hospital Multan, from 15 February 2021 to 14 August 2021. The study was conducted on 60 patients, 30 in both groups, who were selected through consecutive nonprobability sampling. Subjects were divided into Group A and Group B. 600 µg misoprostol (3 doses of 200 µg) was administered to Group A. 5 IU oxytocin was administered to Group B, with 3.3 IU/min at the beginning with the interval of 20 minutes until regular contractions are achieved. A maximum of 30mU/min oxytocin was infused. Mean blood loss was measured and recorded in proforma. The mean age of the subjects was 29.21 ± 6.07 years. The mean age of Group A was 29.40 ± 5.85 years, while that of Group B was 29.21 ± 6.32 years. Mean PPH blood loss in Group A, and B was 118.97 ± 20.26 ml and 154.13 ± 15.21 ml (P = 0.0001). The mean postpartum blood loss was higher by intravenous oxytocin than by sublingual misoprostol.

Effect of obesity on the time to a successful medical abortion with misoprostol in first-trimester missed abortion.

To evaluate the efficacy of misoprostol used in first-trimester abortion in obese women and to determine whether obesity is associated with time to a successful medical abortion. The records of patients diagnosed with missed abortion at our clinic between 2018 and 2021 were retrospectively reviewed. All women aged 18 to 45years who were diagnosed with missed abortion in the first trimester and treated with misoprostol were included in the study. The cases were divided into two groups: obese (body mass index [BMI] ≥ 30kg/m2) and non-obese (BMI < 30kg/m2). First, they were simultaneously administered 200μg misoprostol orally and 400μg vaginally. After the first misoprostol administration, the dose was repeated vaginally at 400μg every three hours if necessary. The effect of obesity on the time taken to achieve a medical abortion was evaluated. A successful medical abortion occurred in 45.2% of the women in the obese group and 69.0% of those in the non-obese group. The time to uterine evacuation was 8.24 ± 4.03h in the obese group and 6.35 ± 3.54h in the non-obese group. The relationship between obesity and time to a successful medical abortion was evaluated using the Kaplan-Meier curve, which showed a significant difference between the two groups (p = 0.028). Our findings show that obesity affects time to a successful medical abortion. In addition, the rate of successful medical abortion after misoprostol administration was lower in the obese women.

Effects of Misoprostol and Evening Primrose Extracts on Cervix Preparation for Labor Induction in Term Pregnancies

Background: Ripening is the process of preparing the cervix for induction of labor and is crucial to identify a low-complication, low-cost, and safe method of inducing labor before spontaneous labor begins. Therefore, this study aimed to demonstrate the impact of the evening primrose capsule on inducing labor, as well as to compare its effect to that of misoprostol. Methods: This prospective clinical trial study was performed on 200 low-risk pregnant women candidate for delivery in an academic hospital in Tehran from 2018 to 2020. Patients were randomly divided into two groups to receive 25 µg misoprostol vaginally or 500 mg evening primrose vaginal capsule to induce labor and repeated every three hours until reaching the bishop score &gt; 4 in case of no effective up to three doses. The total drug dose, as well as maternal and neonatal outcomes evaluated and compared between groups. Results: Although misoprostol was significantly more effective than evening primrose in increasing cervical bishop score in the inactive phase of labor, the active phase and delivery time were not different between the groups. Also, there was no significant difference between the two groups in the cesarean section rate. Maternal complications, including uterine hyperstimulation, headache, or gastrointestinal complications in the group receiving misoprostol were significantly higher in misoprostol group, but fetal complications, including Apgar score, pH, hospitalization, and meconium excretion, were not significantly different between the two groups. Conclusions: Evening primrose capsules are safe and can be used to induce labor because of the lower risk of hyperstimulation of the uterus and the higher tolerance. There should be more research done to see if this medicine can be used alone or in conjunction with misoprostol or mechanical dilators or if it can be administered at home rather than in the hospital.

A telemedicine model for abortion in South Africa: a randomised, controlled, non-inferiority trial

Telemedicine for medical abortion increases access to safe abortion but its use has not been described in a controlled trial. We aimed to investigate the effectiveness, adherence, safety, and acceptability of a modified telemedicine protocol for abortion compared with standard care in a low-resource setting. In this randomised, controlled, non-inferiority trial we recruited women seeking medical abortion at or before 9 gestational weeks at four public health clinics in South Africa. Participants were randomly allocated (1:1) by computer-generated blocks of varying sizes to telemedicine or standard care. The telemedicine group received asynchronous online abortion consultation and instruction, self-assessed gestational duration, and had a uterine palpation as a safety measure. Participants in this group took 200 mg mifepristone and 800 μg misoprostol at home. The standard care group received in-person consultation and instruction together with an ultrasound, took 200 mg mifepristone in clinic and 800 μg misoprostol at home. Our primary outcome was complete abortion after initial treatment, assessed at a 6-week interview. Our non-inferiority margin was 4%. Group differences were assessed by modified intention-to-treat (mITT) analysis and per protocol. The trial is registered at ClinicalTrials.gov, NCT04336358, and the Pan African Clinical Trials Registry, PACTR202004661941593. Between Feb 28, 2020, and Oct 5, 2021, we enrolled 900 women, 153 (17·0%) of whom were discontinued before the abortion and were not included in the analysis. By mITT analysis, 355 (95·4%) of 372 women in the telemedicine group had a complete abortion compared with 338 (96·6%) of 350 in the standard care group (odds ratio 0·74 [95% CI 0·35 to 1·57]). The risk difference was -1·1% (-4·0 to 1·7). Among women who completed treatment as allocated (per protocol), 327 (95·6%) of 342 women in telemedicine group had complete abortion, compared with 338 (96·6%) of 350 in the standard care group (0·77 [0·36 to 1·68]), with a risk difference of -1·0% (-3·8 to 1·9). One participant (in the telemedicine group) had a ruptured ectopic pregnancy, and a further four participants were admitted to hospital (two in each group), of whom two had blood transfusions (one in each group). Asynchronous online consultation and instruction for medical abortion and home self-medication, with uterine palpation as the only in-person component, was non-inferior to standard care with respect to rates of complete abortion, and did not affect safety, adherence, or satisfaction. Grand Challenges Canada and the Swedish Research Council.

Randomised trials of medical abortion provide some but not all the answers

A medical abortion is the termination of pregnancy by medications without surgery. The most recommended regimen up to 10 weeks’ gestation uses 200 mg oral mifepristone followed 1–2 days later by 800 μg misoprostol.1,2 Mifepristone was initially registered for use under the supervision of a doctor up to 7 weeks of gestation. Since then, hundreds of studies have been carried out to extend availability of the method, including flexible regimens, higher gestational age thresholds, and self-management of medical abortion at home.

Comparing Vaginal and Oral Administration of Misoprostol for Cervical Ripening and Induction of Labour in Prolonged Pregnancies

Background: Dinoprostone (prostaglandin E2), is presently used as the approved standard protocol for cervical ripening and labour induction. In search for a cheaper alternative, misoprostol (prostaglandin E1) has been found to be a good substitute. The ideal dose, route and frequency of administration of misoprostol are, however, still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable means of induction, there is patient resistance to digital vaginal examination and there is a risk of ascending infection. For these reasons, oral administration of misoprostol for cervical ripening and labour induction has been tried.Objective: The efficacy and safety of oral and vaginal misoprostol for the elective induction of labour with prolonged pregnancy and unfavourable cervix was compared through a prospective study over a period of one year at the Military Hospital, Accra. Methods: A prospective, non-blinded randomised study of 148 women with prolonged pregnancy. Data was collected using a prepared structured case record form (data profoma). The study population was randomized into two groups and given 50 μg misoprostol orally in one group and 50 μg vaginally in the other. The main outcomes were measured as induction to delivery time,vaginal delivery achieved within 24 hours and the incidence of uterine hyperstimulation with fetal heart rate (FHR) changes. Results: The mean induction to delivery interval was shorter in vaginal group than oral group but the differences did not reach statistical significance (12.9hrs vs 14.3hrs; mean difference -1.42, P value = 0.24). The shorter duration of vaginal misoprostol, however, was significant for nulliparous women (13.4hrs vs 17.9hrs; mean difference 4.53, p&lt;0.05). There was less failure to achieve vaginal delivery within 24 hours of induction in the vaginal route group, but the differences did not reach statistical significance (6.1% vs. 6.8%; p = 0.81). Fewer women needed oxytocin augmentation in the vaginal group (24.2% vs.17.4%, p = 0.11). There was a higher incidence of uterine hyperstimulation in the vaginal group but not significant (14.7% vs 6.1%, p = 0.10). APGAR scores at 5 minutes showed no difference between the two groups (1.49% vs. 2.99%, p =0.42).Conclusions: Compared with oral misoprostol, vaginal misoprostol for induction of labour at term resulted in a shorter induction-to-delivery time and a lesser need of oxytocin for women to deliver within 24 hours of induction. Both maternal and neonatal safety outcome were comparable in both groups. However, the more frequent occurrence of hyperstimulation in the vaginal group could lessen its preference to the oral route. More trials are needed to determine the right oral dosage that combines efficacy with safety.