Μg Of Misoprostol Research Articles

Umbilical vein injection of 400 versus 800 μg misoprostol for the treatment of retained placenta: A multicenter, randomized double-blind controlled trial.

This trial was conducted to determine the efficacy of umbilical vein injection of 400 versus 800 μg misoprostol to deliver retained placenta and to compare both regimens regarding the time of placental delivery and amount of vaginal blood loss. A double-blind, multicenter randomized clinical trial was undertaken in four teaching hospitals in the North of Iraq and Al-Azhar University Hospital in Egypt, from March 2016 to May 2019. Group I (274 women) received 400 μg misoprostol and group II (249 women) received 800 μg misoprostol. Data regarding the time of placental separation and amount of vaginal blood loss were analyzed and proportions were compared between groups using Chi-squared test. Mean values were compared using the Student's t-test. The Mann-Whitney test was used to determine the median of vaginal blood loss. The proportion of placental separation was 84.3% among women in group I and 86.7% of women in group II. The mean time of placental separation was 18.86 ± 234.2 and 17.86 ± 213.09 min in groups I and II, respectively (P < 0.05).The mean hemoglobin levels on admission and 24 h after placental deliveries were significantly higher in group I than group II. Intra-umbilical injection of 400 and 800 μg misoprostol were both safe and effective methods for delivery of retained placenta.

Treatment of first trimester miscarriage: a prospective cohort study in a large tertiary care center in Northern Italy

Objective To assess acceptability, efficacy, and short- and medium-term complications of vaginal misoprostol therapy for the treatment of first trimester miscarriage. Study design A prospective cohort study including women admitted to the Unit of Obstetrics, MBBM Foundation, San Gerardo Hospital (Monza, Italy) for medical or surgical treatment of first trimester miscarriage between October 2014 and March 2018. As per Institutional protocol, patients in the medical therapy group received 800 µg of misoprostol vaginally. A second dose could be considered 3 days after the first administration if that was ineffective. Surgical treatment consisted of uterine vacuum aspiration. Success of misoprostol treatment was defined as the expulsion of the gestational sac with no need for subsequent surgery. Results During the study period, 967 patients were diagnosed with first trimester miscarriage and were included in the study. Of these, 514 (53.2%) women were eligible for and consented to medical therapy. Surgical treatment was performed in the remaining 453 (46.8%) patients due to either medical contraindication to misoprostol or patient’s choice. Acceptance of misoprostol as first therapeutic choice increased over time, becoming the preferred treatment after approximately 18 months of use in clinical practice. One dose of misoprostol was successful in 69.8% (n = 359) of patients, whereas 20 women required urgent surgery for bleeding (n = 19) or suspected infection (n = 1). Among the remaining 135 patients, 20 (14.8%) refused the second dose of misoprostol and opted for surgery. Expulsion of the gestational sac was obtained in 74 additional cases who completed the medical protocol, for an overall success rate of 87.7% (433/494). The majority of women receiving misoprostol did not experience any short-term complication (92.0%) or side effect (93.8%). Eight (1.6%) cases requiring delayed surgery (hysteroscopy or vacuum aspiration) for retained product of conception were identified at the postmedical treatment follow up, thus leading to an actual success rate of misoprostol of 86.0% (n = 425). Conclusions This is the first study assessing the acceptability, efficacy, and complication rate of medical management of first trimester miscarriage in an Italian tertiary care center. Our results confirm that misoprostol alone is an effective as well as a safe therapeutic option for the treatment of first trimester miscarriage.

Comparison of efficacy of Misoprostol 4 hourly with Misoprostol 6 hour for Medical termination of pregnancy in second trimester.

Termination of Pregnancy (TOP), in our country is carried out only when considerable danger to a fetus due to congenital abnormalities, intrauterine fetal loss or when maternal life is under threat. The principle concerns in providing second trimester termination include safety, efficacy, simplicity, low-cost, and fast acting with minimal side effects. Objectives: To compare the efficacy in term of complete abortion within 48 hours between protocol-I (200 µg misoprostol 4 hourly) versus protocol-II (200 µg misoprostol 6 hourly) for second trimester (14-24 weeks) medical termination of pregnancy. Study Design: Randomized controlled trial. Settings: Gynecology &amp; obstetrics unit-II, Bahawal Victoria Hospital (BVH) Bahawalpur. Period: From 1st July 2017 to 30th June 2018. Material &amp; Method: A total of 182 patients meeting the inclusion criteria were included in study. Ninety one patients were included in group-A and 91 patients were included in group-B. Women allocated to group-A was given misoprostol 200µg every 4 hour. Similar drug and dose were administered to women of group-B intra-vaginally, 6 hourly. Patients in both groups were monitored up to 48. If abortion occurred within 48 hours of induction, it was labeled as effective abortion otherwise it was regarded as failed abortion. Results: The mean age in group-A was 26.71 years 25.49 years in Group-B. In group-A, 89 (97.8%) patients showed efficacy (abortion within 48 hours) and in group-B, 74 (81.32%) patients showed efficacy to misoprostol. Conclusion: The regimen of using 200μg of vaginal misoprostol 4 hourly is more efficacious and quick for 2nd trimester TOP with fewer side effects when compared to 200μg of vaginal misoprostol 6 hourly.

TO COMPARE THE EFFICACY OF PGE2 GEL AND 25ΜG OF INTRAVAGINAL MISOPROSTOL FOR INDUCTION OF LABOR IN TERM PROM

Background: Induction of labour is one of the most common obstetric interventions worldwide. The study was conducted to compare the efficacy and safety of 25µg (low dose) vaginal Misoprostol with intracervical Dinoprostone for cervical ripening and induction of labour in term pregnancy.&#x0D; Methods: For the purpose of this study, 100 term pregnancy patients (only primigravidae and second gravidae) were included who had spontaneous rupture of membrane before onset of labor. Data was collected from cases admitted in labor room at Pannadhay Mahila Chikitsalaya associated with RNT Medical College,Udaipur between July 2014 to July 2015.&#x0D; Results: Requirement of Oxytocin for augmentation of labor between group A and group B. It is evident from the table that oxytocin was required in only 16% of patients in group A, while 46% in group B. This indicates that requirement of oxytocin was significantly less in misoprostol group (P&lt;0.001).&#x0D; Conclusion: This study was designed to assess efficacy of a 25 μg misoprostol vaginal tablet, Finding confirms that vaginal misoprostol tablet is as effective as dinoprostone in cervical ripening and labour induction with dinoprostone.&#x0D; Keywords: Cervical ripening, Dinoprostone, Labour induction, Low- dose misoprostol.

Prevention of postpartum Hemorrhage with Sublingual Misoprostol or Oxytocin

Postpartum hemorrhage is a life threatening situation and one of the important causes of maternal mortality and morbidity, worldwide. To evaluate the effectiveness of a low dose (400ug) of misoprostol administrated sublingually compared to 10 IU of intramascular oxytocin for the reduction of postpartum blood loss. A total of 120 patients were randomized to receive either 400μg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included change in pre and 24 hour post-delivery hemoglobin and hematocrit values, side effects of the used drugs, and the need for blood transfusion. Results: Although not statistically significant, mean blood loss mean in misoprostol group (301.92 ±132.95) was lower than in oxytocin group (317.58 ±120.12). Incidence of postpartum hemorrhage was (1.7%) in misoprostol group versus in oxytocin group (3.3%). We observed that 6.7% and 8.3% of women experienced a hemoglobin decline of >10% 24 hours after receiving misoprostol and oxytocin, respectively (p = 1.0), the mean of HCT drop in misoprostol group (3.43 ±2.8) and (3.38 ± 2.92) in oxytocin group ( p = 0.92) . Side effects were significantly greater in the misoprostol group than in the oxytocin group. Conclusion: Although not statistically significant, 400 ug of sublingual misoprostol is more effective than 10 IU of oxytocin administrated via the intramuscular route in reducing post delivery blood loss.

Rectal misoprostol after cesarean delivery: does it affect recovery of bowel functions? A prospective randomized trial

Aim: To assess the efficacy of rectally administered misoprostol in the improvement of bowel function recovery after cesarean delivery (CD). Methods: This prospective randomized trial was conducted among 171 pregnant women subjected to term elective CD. Patients were divided equally into 3 groups by simple randomization. Participants in group A were given misoprostol 200 μg rectally; those in group B were given misoprostol 400 μg rectally just after CD but before leaving the operating theater, while the participants in group C did not receive any rectal drug. The study outcome measures were: duration before first bowel movement and start of the regular oral diet. Adverse effects, need for additional analgesics, and post-CD hospital stay period were also recorded. Results: The mean times to first audible intestinal sounds and to the first passage of flatus were significantly lower in group B (14.1 ± 1.4 h and 16.7 ± 2.3 h, respectively) when compared to both groups A and C [ 21.9 ± 5.3 h and 24.9 ± 5.7 h (A) vs. 23.6 ± 6.9 h and 27.1 ± 7.9 h (C)] (p = 0.001). It was found that notably, patients in group B resumed diet more quickly, with a mean period of 20.5 h, which was significantly faster than the remaining groups (29.8 h and 33.1 h in groups A and C, respectively Of great interest, patients in group B had a lower post-CD hospital stay (38.5 h vs. 59.2 h in group A and 64. 8 h in group C). Conclusion: For the recovery of bowel functions after CD, rectal administration of 400 μg misoprostol appears to be more effective than 200 μg of rectally administrated misoprostol or traditional feeding regimens.

A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14-28weeks of gestation.

Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established. To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. Research databases from January 2006 to October 2018. Randomized controlled trials with IUFD cases at 14-28weeks of gestation. We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. Sixteen trials from 1695 citations. When misoprostol is used alone, 400μg is more effective than 200μg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low. Misoprostol 400μg every 4hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.

First trimester termination of pregnancy.

First trimester termination of pregnancy (TOP) is a safe and effective procedure. The complete abortion rates of surgical and medical abortion are approximately 97% and 95%, respectively. Vacuum aspiration (VA) either by electrical suction or manual aspiration is the method of choice for surgical TOP. Risk of significant bleeding is≤5% in VA, while major complications occur in <1%. The risk of infection after VA can be reduced significantly by using prophylactic antibiotics or by the screen-and-treat strategy. Pre-operative administration of misoprostol can also reduce the risk of complications. The combination of 200mg mifepristone followed by 800μg misoprostol 24-48h later is recommended for first trimester medical TOP. If mifepristone is not available, misoprostol can also be used alone, but repeated doses may be required and the complete abortion rate may be lower. Due to the reduced efficacy in more advanced gestation, repeated doses of misoprostol may be required for medical TOP over 9 weeks of gestation. The complete abortion rate with this regimen is 95% or more. Gastrointestinal upsets can occur in up to 50% of women, but major complications are rare. There was no lower limit of gestational week for TOP, although extra precaution is required for the confirmation of completion of procedures and exclusion of ectopic pregnancy.

Misoprostol-Induced Modification of the Notch Signaling Pathway in the Human Cervix.

The complex and multifactorial mechanisms that initiate and sustain the early labor process in the human uterus and cervix are still not well defined. Cervical maturation or ripening is likely to play a key role in preparing for birth. Prostaglandins have many different functions, including the regulation of uterine contractility and structure during pregnancy. The prostaglandin E1 analogue misoprostol is frequently used as a uterotonic and cervical ripening agent. Notch is a transmembrane receptor family responsible for basic functions such as cell survival, cell-cell communication, and differentiation and decidualization in pregnancy. However, our understanding of the effect of Notch signaling on the cervical ripening process is limited. This study was conducted in 20 pregnant women aged at 12 to 20 weeks of gestation undergoing medical abortion for fetal or maternal indications. True-Cut needle biopsies were taken from the anterior cervix 4 hours after oral ingestion of 200-μg misoprostol or before the ingestion of misoprostol in the control group. Cervical expression of Notch receptors and ligands changed during the early phase of prostaglandin-induced preterm labor. Four hours after the administration of misoprostol, it was seen that N1 expression increased in muscle, while DLL1 and J2 expression increased in blood vessels, and N4 expression increased in macrophages. Knowing the mechanisms that initiate preterm birth is the most important step in planning the treatments and actions to prevent premature birth. As a signal that affects and perhaps directs preterm labor, Notch is prone to be an important actor in this process.

Randomized controlled trial between sublingual and vaginal misoprostol for induction of labour at term

spontaneous onset of labor, with or without rupture of membranes. When the cervix is unfavorable, cervical ripening with prostaglandins to soften and open the cervix will often commenced to induce labor.Objective: To compare 50 μg of sublingual misoprostol to 50 μg of vaginal misoprostol for induction of labour at term regarding efficacy and safety.Patients and Methods: This prospective randomized controlled trial included 104 pregnant women who were recruited from Department of Obstetrics and Gynecology, Faculty of Medicine Ain-Shams University and Al-Glaa Teaching Hospital, Delivery Unit.Results: Regarding induction-delivery interval (time from given drug for both groups to vaginal delivery), there was no significant statistical difference between both groups regarding the mean time from initial dose to the delivery. Mean 15.04 ± 4.67 for sublingual group versus 14.16 ± 4.45 for vaginal group (P= 0.331). As regarding fetal and maternal complications in our study, there was significant statistical difference between the vaginal and sublingual groups according to secondary outcome (hyperstimulation). The risk of hyperstimulation was higher in vaginal group (5 cases) compared to the sublingual group (No cases) P= 0.046.Conclusion: Sublingual misoprostol 50 μg administered at 6 hourly intervals is as effective in promoting cervical ripening and inducing labor as vaginal misoprostol 50 μg administered 6 hourly intervals as regarding induction to delivery interval, number of doses, shorter hospitalization and neonatal outcome. Sublingual misoprostol 50 μg has a higher maternal and perinatal safety profile than the vaginal 50 μg misoprostol including cesarean rates due to fetal distress, adverse maternal outcomes as hyperstimulation.Recommendations: We recommend sublingual 50 μg misoprostol administered at 6 hourly intervals as an efficacious and safe option for labor induction, low cost and availability is its added benefits

Effectiveness of misoprostol administration for cervical ripening in women before operative hysteroscopy: a randomized, double-blinded controlled trial

Objective: To compare the effectiveness of misoprostol administration orally or vaginally for cervical ripening in women before operative hysteroscopy surgery.Material and methods: Two hundred seventy-five women eligible for operative hysteroscopy were recruited for a controlled, blinded, randomized trial. Twenty-two women were excluded from the study. Patients were randomly assigned to take 600 µg of misoprostol or 30 mg vitamin B6 orally or vaginally, respectively, 4–12 h before operative hysteroscopy. Main outcome measures: Extent of cervical diameter before the hysteroscopy procedure, need for further cervical dilatation, degree of ease of cervical dilation, duration of additional cervix dilatation and hysteroscopy procedure, abdominal pain prior to surgical procedure, patients’ acceptability, complications and associated side effects during the hysteroscopy procedures.Results: Cervical width in the vaginal and oral misoprostol groups after administration was 7.2 ± 0.9 mm and 7.5 ± 1.4 mm, respectively, a statistically significant difference compared to the control group. The duration required for cervical priming with misoprostol, either vaginally or orally (75 ± 24 s or 82 ± 22 s), was significantly shorter than that of placebo (148 ± 31 s). The effect of cervical dilation with misoprostol was significantly higher in the premenopausal participants. Occurrence of uterine false tract substantially increased in the placebo group. Meanwhile, the risk of side-effects increased in the misoprostol-treated patients compared to the control group.Conclusions: The administration of misoprostol seemed more effective than the control for preoperative cervical priming in menstrual participants. Further large randomized controlled trials are needed to determine whether misoprostol could reduce complications with fewer side-effects and to establish whether misoprostol has a substantial cervical dilation effect on either premenopausal or postmenopausal patients.

The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: A randomized national multicenter trial

Our objective was to compare the efficacy of a 200-μg misoprostol vaginal insert vs oral misoprostol regarding the cesarean section rate and the time interval to vaginal delivery in nulliparous women with unfavorable cervix. In this prospective multicenter trial, 283 nulliparous women at term with Bishop score <6 were randomized to induction of labor with either a misoprostol vaginal insert (n=140) or oral misoprostol (n=143). In the oral misoprostol group, a 50-μg dose of oral misoprostol was administered every 4 hours up to three times during the first day; during the second day, the dose was increased to 100-μg every 4 hours up to three times during the first day, if necessary. Primary outcome was the cesarean section rate. Secondary outcomes were the time from induction of labor to vaginal delivery, the rate of other induction methods needed, labor augmentation with oxytocin and/or amniotomy, use of tocolytics and adverse neonatal and maternal events. In the misoprostol vaginal insert group, median time to vaginal delivery was shorter (24.5hours vs 44.2hours, P<0.001), whereas no difference was found in the cesarean section rate (33.8% vs 29.6%, odds ratio [OR] 1.21, 95% confidence interval [CI] 0.66-1.91, P=0.67). Other induction methods and labor augmentation with oxytocin and/or amniotomy were less frequent in the misoprostol vaginal insert group (OR 0.32, 95% CI 0.18-0.59 and OR 0.56, 95% CI 0.32-0.99, respectively). Need for tocolysis and meconium-stained amniotic fluid were more common in the misoprostol vaginal insert group (OR 3.63, 95% CI 1.12-11.79 and OR 2.38, 95% CI 1.32-4.29, respectively). Maternal and neonatal adverse events did not differ between groups. Misoprostol vaginal insert proved to shorten the time to vaginal delivery and to reduce the use of other methods of labor induction and augmentation, but it did not reduce the cesarean section rate compared with oral misoprostol. The benefit of more rapid delivery associated with misoprostol vaginal insert should be weighed against the greater risks for uterine hyperstimulation and meconium-stained amniotic fluid.

Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants.

To explore the clinical and programmatic feasibility of using 800μg of sublingual misoprostol to prevent and treat postpartum hemorrhage (PPH) during home delivery. The present double-blind randomized controlled trial included women who underwent home deliveries in Chitral district, Khyber Pakhtunkhwa province, Pakistan, after presenting at healthcare facilities during the third trimester of pregnancy between May 28, 2012, and November 27, 2014. Participants were randomized in a 1:1 ratio to receive either 800μg of misoprostol or placebo sublingually if PPH was diagnosed, having previously received a prophylactic oral dose of 600μg misoprostol. The primary outcome, hemoglobin decrease of 20g/L or greater from pre- to post-delivery assessment, was compared on a modified intention-to-treat basis. There were 49 patients allocated to receive misoprostol and 38 allocated to receive placebo; the incidence of a 20g/L decrease in hemoglobin was similar between the groups (20/43 [47%] vs 19/33 [58%], respectively; P=0.335). There was no significant difference in clinical outcomes between the two trial arms. ClinicalTrials.gov:NCT01485562.

Misoprostol versus oxytocin in preventing postpartum hemorrhage: A randomized controlled trial

Objective: To compare low dose sublingual misoprostol with the standard 10 IU of intramuscular oxytocin in active management of third stage of labor. Materials and Methods: A total of 104 women with term pregnancy were randomized to receive either 200 μg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included duration of third stage of labor, side effects of drugs and need for additional oxytocics to treat life‑threatening hemorrhage. Results: A total of 104 women with term pregnancy in two groups of 52 were studied. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58 ± 244.12 vs. 253.27 ± 171.74 ml; P = 0.11. There was no significant differences between the misoprostol and oxytocin groups with regard to the incidence of PPH (19.2% vs. 13.5% respectively; P = 0.43). More women in the misoprostol group experienced side effects compared with those in oxytocin group; however, the difference was not statistically significant ( P = 0.26). The mean duration of third stage of labor was similar and the difference was statistically not significant (6.65 ± 3.47 vs. 6.08 ± 3.07 minutes) ( P = 0.38), as well as need for additional oxytocics (13.5% vs. 5.8% P = 0.18) misoprostol and oxytocin, respectively. Conclusion: Sublingual misoprostol has similar efficacy to standard intramuscular oxytocin in preventing PPH following vaginal birth. Misoprostol at 200 μg with its thermostability may be an effective alternative to intramuscular oxytocin in active management of third stage of labor. Keywords: Primary postpartum hemorrhage; misoprostol; uterotonics

Evaluation of isosorbide-5-mononitrate as a cervical ripening agent prior to induced abortion in contrast to misoprostol- a randomized controlled trial

ObjectiveTo determine whether vaginal application of 40 mg isosorbide-5-mononitrate (ISMN) has a comparable cervical ripening efficacy to and lesser side effects than 400 µg misoprostol in women scheduled for the first trimester induced abortion using a manual vacuum aspirator (MVA).MethodsWe conducted a prospective randomized open-label study in 70 women at 6–12 weeks of pregnancy at the R G Kar Medical College and Hospital, Kolkata, India, over a period of two years from 2015 to 2017. Forty milligrams of ISMN and 400 µg misoprostol were vaginally applied for cervical priming. The primary outcome measure was the cervical response assessed by the passage of the appropriate and largest sized MVA cannula through the internal os without resistance, at the beginning of the procedure.ResultsThe base line cervical dilatation was found to be significantly higher in the misoprostol group than in the ISMN group (7.65±1.38 vs. 6.9±1.26 mm; P=0.025, 95% confidence interval, −1.4046 to −0.953). However, when the women were sub-analyzed based on parity, there was no statistically significant difference in the same parameters among the multigravid women. The need for further cervical dilatation was significantly higher in the ISMN group when the primigravid women were compared, although the multigravid women responded favorably to ISMN.ConclusionIn the primigravid women, misoprostol appears to exert a higher efficacy as a cervical ripening agent in contrast to ISMN. However, ISMN can be used in multigravid women for the same purpose as in this group, misoprostol did not show any significant improvement in efficacy over ISMN.

Induction of Labor at 39 Weeks versus Expecting Labour till 41 Weeks: Randomized Controlled Trial on Class I Obese Egyptian Women, with Mode of Delivery Being a Study Endpoint

Background: Maternal obesity is reported to be associated with increased incidence of gestational diabetes mellitus and hypertension. These cause failure of labour induction, leading to higher incidence of cesarean section (CS). The aim of this study was to assess which reduces CS rate, labor induction at 39 weeks or leaving women for spontaneous labor onset till 41 weeks. Methodology: A randomized controlled trial was conducted in Ain Shams Maternity Hospital in Egypt from 2016 to 2018. Study population consisted of 200 term primigravida pregnant obese women delivered in Ain Shams Maternity Hospital. They were divided into two groups: Group A: induction of labor at 39 + 0 weeks (n = 100) by vaginal administration of 25 μg misoprostol (PGE1) every 6 hours for 5 doses; Group B: waiting spontaneous labor onset till 41 + 0 weeks (n = 100), and if no spontaneous labor occurred at 41 weeks, induction was performed in the same way. Results: Induction (Group A) vs. waiting spontaneous labor (Group B) showed the followings, which were significant: CS: 22% vs 39%, p = 0.009; maternal birth injury: 4% vs 12%, p = 0.037; non-assisted vaginal deliveries: 93.6% vs 78.7%, p = 0.034; APGAR scores at 1 & 5 min: 7.6 ± 0.8 vs 7.3 ± 1.1 p = 0.038, 8.4 ± 1.0 vs 8.1 ± 1.3 p = 0.040, respectively; birth weight; 3.3 ± 0.1 vs 3.5 ± 0.2 kg, p Conclusion: CS rate was significantly lower in women with induction of labor at 39 weeks than those waiting for spontaneous labor onset till 41 weeks in obese Egyptian pregnant women.

Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

(N Engl J Med. 2018;378:2161–2170) First-trimester miscarriage, or early pregnancy loss, is the most common complication in pregnancy. It can frequently be identified before onset of symptoms, and many women prefer active management, which provides the ability to have some control over the situation. Current guidelines recommend the use of prostaglandin analogues to expedite the expulsion of nonviable pregnancy tissue, with a standard dose of 800 μg misoprostol administered vaginally. However, misoprostol has low efficacy among women with a closed cervical os. Although mifepristone, a 19-nor steroid, can help to prepare the myometrium and cervix for prostaglandin activity, its reported effectiveness ranges from 52% to 95%. The authors of the present study thus compared the efficacy of pretreatment with mifepristone followed by treatment with misoprostol with misoprostol use alone, for the management of early pregnancy loss in women with a closed cervical os.

COMPARISON OF MANUAL VACUUM ASPIRATION UNDER LOCAL ANESTHESIA AND SUBLINGUAL MISOPROSTOL IN MANAGEMENT OF INCOMPLETE MISCARRIAGE IN GMC TEACHING HOSPITAL, NEPAL

Introduction: To compare the efficacy of using sublingual misoprostol and manual vacuum aspiration under local anesthesia in the treatment of spontaneous incomplete miscarriage (of up to 6 to 12 weeks of pregnancy).MATERIALS AND METHODS: This is a prospective study performed in Gandaki Medical College (GMC) Teaching Hospital, Pokhara on 150 patients with spontaneous incomplete miscarriage between 6 to 12 weeks of pregnancy. Patients were divided into two groups: group (I) patient who took 400 μg misoprostol every four hourly for maximum of three doses, group (II) patient who underwent manual vacuum aspiration (MVA) under local anesthesia. Only 68 patients in group I and 64 patients in group II completed their follow up and were included in this study.RESULTS: The success rate of MVA under local anesthesia was 100% and misoprostol was 67.7% (p-value &lt;0.05). Both misoprostol and MVA under local anesthesia are effective for treatment of incomplete miscarriage.CONCLUSION: Although success rate of MVA under local anesthesia is more than misoprostol, both MVA and misoprostol can be used, as an effective method of uterine evacuation in incomplete abortion of &lt;12 weeks.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 52-55

Rectal vs. sublingual misoprostol before cesarean section: double-blind, three-arm, randomized clinical trial.

The commonest surgical procedure for women is cesarean delivery. Postpartum hemorrhage and intra-operative blood during cesarean delivery is a major concern to all obstetricians. This study was conducted to assess the efficacy of the adjuvant use of misoprostol and oxytocin in decreasing intra-operative blood loss in cesarean delivery. This was a double-blinded randomized clinical trial including 636 term pregnant woman scheduled for cesarean section at Ain Shams University Maternity Hospital, Cairo, Egypt, between February 2013 and February 2014. Participants received either 400-μg misoprostol rectally or sublingually or placebo before cesarean section together with 5-IU oxytocin IV. The main outcome measure was intra-operative blood loss. Difference between the three groups was analyzed using one-way ANOVA test (for numeric variables) and Chi-square test (for categorical variables). P < 0.05 was considered statistically significant. Intra-operative blood loss was higher in patients who did not receive misoprostol (Placebo Group) (295-1075ml, 641.7 ± 135.7) than those who received it, regardless the route of administration, rectal (135-830ml, 457.5 ± 140.7; P < 0.001), and sublingual (135-680ml, 357.8 ± 129.7; P < 0.001). In addition, sublingual route was associated with significantly lower estimated intra-operative blood loss compared to rectal administration (P < 0.001). Misoprostol with oxytocin is an effective drug-combination for decreasing intra-operative blood loss during cesarian section with clinical superiority to sublingual over rectal route.

COMPARISON OF MEAN DURATION REQUIRED FOR COMPLETE EXPULSION WITH ISOSORBIDE MONONITRATE VERSUS MISOPROSTOL IN FIRST TRIMESTER MISSED MISCARRIAGE

Background: Medical management of first trimester miscarriage possess significant advantages over surgical management. Misoprostol has been previously tested in the management of miscarriage in different regimens and settings. Isosorbide mononitrate (IMN) is also an effective and safe drugs for early expulsion of conception material. But controversial results have been noticed from literature. So we conducted this study to confirm more effective drug.&#x0D; Objective: To compare the mean duration required for complete expulsion with isosorbide mononitrate versus misoprostol for first trimester missed miscarriage.&#x0D; Material &amp; Methods&#x0D; Study Design: Randomized Controlled Trial.&#x0D; Setting: unit I, Department of Obstetrics &amp; Gynaecology, Lahore General Hospital, PGMI, Lahore.&#x0D; Duration: Six months ( August, 2017 to January,2018)&#x0D; Data Collection Procedure: Females were randomly divided in two groups by using lottery method. Group A was given 800 µg misoprostol in posterior fornix of vagina 3 hourly maximum 2 doses. Group B was given 40mg IMN in posterior fornix of vagina 3 hourly maximum 2 doses. Patients were reassessed if vaginal bleeding or uterine contractions were noted otherwise repeat dose was given after 3 hours. Time till complete expulsion was noted. Complete expulsion was confirmed subsequently by ultrasonography when no products of conception are found in utero. All the data was entered and analyzed through SPSS version 21.&#x0D; Results: The mean age of females was 30.40±5.51years. In this study, 18 (25%) were para 1, 27 (37.5%) were para 2, 15 (20.83%) were para 3 and 12 (16.67%) were para 4. The mean gestational age of females was 9.51±1.11weeks. The mean BMI of females was 24.56±3.76kg/m2. The mean duration required for complete expulsion was 91.69±15.74min in misoprostol group and 122.58±16.55min in IMN group. There was significant difference in both groups (p&lt;0.05).&#x0D; Conclusion: Thus the mean expulsion time was significantly less for misoprostol than IMN. For future, we can recommend misoprostol for complete evacuation of conception material during first trimester missed miscarriage.