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On the Origin of Ortho-Gardenhose Heliospheric Flux

Parker-spiral theory predicts that the heliospheric magnetic field (HMF) will have components of opposite polarity radially toward the Sun and tangentially antiparallel to the solar rotation direction (i.e., in Geocentric Solar Ecliptic (GSE) coordinates, with B _{X}/B _{Y} < 0). This theory explains the average orientation of the HMF very well indeed but does not predict the so-called “ortho-gardenhose” (hereafter OGH) flux with B _{X}/B _{Y} > 0 which is frequently observed. We here study the occurrence and structure of OGH flux, as seen in near-Earth space (heliocentric distance r = 1~mbox{AU}) by the Wind and Advanced Composition Explorer (ACE) spacecraft (for 1995 – 2017, inclusive) and by the Helios-1 and -2 spacecraft at 0.29~mbox{AU} < r leq 1~mbox{AU} (for December 1974 to August 1981), in order to evaluate the contributions to OGH flux generation of the various mechanisms and factors that are not accounted for by Parker-spiral theory. We study the loss of OGH flux with increasing averaging timescale [tau ] between 16 seconds and 100 hours and so determine its spectrum of spatial/temporal scale sizes. OGH flux at Earth at sunspot minimum is shown to be more common than at sunspot maximum and caused by smaller-scale structure in the HMF (with a mode temporal scale at a fixed point of tau_{text{mp}} approx 10 hours compared to tau_{text{mp}} approx 40 hours for sunspot maximum, corresponding to about 5.5∘ and 22∘ (respectively) of heliocentric angular width for corotational motion or 21 mathrm{R}_{odot} and 84 mathrm{R}_{odot} for radial solar-wind flow (where mathrm{R}_{odot} is the mean solar radius). OGH field generated by rotating the HMF through the radial direction is also shown to differ in its spectrum of scale sizes from that generated by rotating the HMF through the tangential direction – the former does not contribute to the “excess” open heliospheric flux at a given r but the latter does. We show that roughly half of the HMF deflection from the ideal Parker-spiral needed to give the observed occurrence of OGH flux at Earth occurs at r below 0.3 AU. By comparing the Helios and near-Earth data we highlight some questions that can be addressed by the Parker Solar Probe mission, which will study the HMF down to r = 0.046~mbox{AU}. We suggest that with decreasing heliocentric distance, Probe will detect decreased OGH field due to draping around transient ejecta, such as blobs and coronal mass ejections, but increasing structure in the radial field within traditional HMF sectors that are remnant Alfvénic disturbances in outflow regions from coronal reconnection sites.

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

Comparison of 25 Microgram of Sublingual Misoprostol with 25 Microgram Vaginal Misoprostol for Induction of Labour at Term

Comparison of 25 Microgram of Sublingual Misoprostol with 25 Microgram Vaginal Misoprostol for Induction of Labour at Term

English

BACKGROUND: Abortion is the termination of pregnancy by the removal or expulsion of the foetus or embryo from the uterus before the age of viability. Second trimester pregnancy termination has been reported to be associated with 3-5 times increased morbidity and mortality. Medical methods of induced abortions in the midtrimester has shown development and proven to be safe and accessible. The ideal agent for cervical softening should be clinically effective, it should have a low side effect profile and it should be easy to administer. The cervical ripening effects of nitric oxide donors and of prostaglandin might be additive. So if a small dose of nitric oxide donor is given in combination with a small dose of prostaglandin it will cause effective cervical ripening and reduce the side effects associated with larger doses of either agent used alone. OBJECTIVES: Our aim is to compare the traditional use of vaginal misoprostol versus misoprostol and Isosorbide mononitrate in medical management of second trimester abortions. The comparison involves aspects of efficacy which are evaluated by means of the difference in success rate of inducing abortion, induction to expulsion period, amount of misoprostol used rate of manual/ surgical removal of the placenta and the rate of post abortive haemorrhage and also comparison of safety profile of both drugs. METHODOLOGY: The study was conducted in the labour ward of Institute of Obstetrics and Gynaecology, Egmore (IOG) in the period from October 2014- July 2015. The patients included in the study were 100 pregnant women from 12 to 20 weeks of gestational age undergoing induced abortion. Women were divided into two groups: Group 1 – Combination of 400 mcg of misoprostol and 40 mg of ISMN placed intravaginally. Repeat doses included combination of 400 mcg of misoprostol and 20 mg ISMN every 4 hours for maximum 4 doses..Group 2 - 400 mcg of misoprostol placed intravaginally every 4 hours for maximum 4 doses. RESULTS: It was observed that in Group A. Mean induction abortion interval was significantly less (7 hrs 36 mins ) in Group A, compared with group B(9 hrs 55 min). The mean dose of misoprostol decreased in group A (848 mcg ) when compared with group B (936 mcg) In Group A 76% of the patients aborted with two doses where as in Group B 62 % of the patients aborted with two doses. It is interpreted that on adding ISMN the number of complete abortion rates are higher. There was no failure of abortion.. The side effects such as pain abdomen and fever were less in Group A(38 %) when compared to Group B(78%). Side effects specific to ISMN was very less and reported only in 2 % of study groups. There was no reported evidence of postpartum haemorrhage or increased blood loss. The drug ISMN, was also economical and cost effective. CONCLUSION : Vaginally administered ISMN seems to be safe and well tolerated and provides a merit in some situations, where uterine contractions are unwanted before cervical ripening. Combination therapy of prostaglandins with nitrates might therefore be an ideal method for second trimester termination of pregnancy.

Comparison of Misoprostol and Dinoprostone Gel for Induction in Prelabor Rupture of Membranes at Term

Background: The aim of the study was to compare the safety and efficacy of vaginal misoprostol with dinoprostone gel for induction of labor in prelabor rupture of membranes at term pregnancy. Methods: This is a prospective study conducted in the Department of Obstetrics and Gynaecology, at Sri Devraj Urs Medical College from December 2010 to September 2012. One hundred patients were induced with either misoprostol or dinoprostone gel using computer-generated randomized table. The study had two groups. Group I had 50 cases of primigravida, where 25 cases were induced with misoprostol and another 25 were induced with dinoprostone gel. Group II had 50 cases of multigravida, where 25 cases were induced with misoprostol and the rest 25 were induced with dinoprostone gel. Twenty-five microgram misoprostol was inserted vaginally every sixth hourly for maximum of six doses and 0.5 mg dinoprostone gel was used intracervically every sixth hourly for maximum of three doses. The primary outcome measured was induction to delivery interval and the secondary outcomes included mode of delivery, and maternal and neonatal outcome. Results: Among the patients induced, both the groups were comparable with respect to age, parity, booking status, gestational age, and pre-induction Bishop’s score. There was no significant difference in induction to delivery interval between both the groups. The induction to delivery interval in misoprostol group was 6.65 hours and that in dinoprostone group was 6.89 hours. In primigravida, the induction to delivery interval in misoprostol group was 7.74 hours and 7.08 hours in dinoprostone group and in multigravida, the induction to delivery interval in misoprostol group was 5.55 hours and in dinoprostone group was 6.71 hours. In primigravida, dinoprostone has shorter induction to delivery interval compared to misoprostol. In multigravida, misoprostol has shorter induction to delivery interval compared to dinoprostone. There was no difference in mode of delivery in both the groups. There was no significant difference in maternal outcome and neonatal outcome among both the groups. Conclusion: Vaginal misoprostol is equally efficacious in labor induction and demonstrates a similar fetal and maternal safety profile when compared with dinoprostone gel. J Clin Gynecol Obstet. 2015;4(4):302-306 doi: http://dx.doi.org/10.14740/jcgo321w

Efficacy and safety of mifepristone combined with misoprostol for termination of pregnancy between 8 and 16 weeks of gestation

To assess the efficacy and safety of mifepristone combined with oral or vaginal misoprostol for termination of pregnancy between 8 and 16 weeks of gestation. This was a randomized, multi-center, open clinical trial. A total of 625 women at 8-16 weeks of gestation were randomized to receive 200 mg oral mifepristone followed by either oral misoprostol 400 µg every 3 hours or vaginal misoprostol 400 µg every 6 hours for a maximum of 4 doses 36-48 hours later. There were 417 women in oral group with 198 at 8-9 weeks and 219 at 10-16 weeks, while 208 women in vaginal group with 99 at 8-9 weeks and 109 at 10-16 weeks. The outcome measures were the success abortion rate, induction to abortion interval, the amount of bleeding, reoccurrence of menstruation and adverse events. Abortion rate was significantly higher in vaginal group [98.1% (202/206)] than that in oral group [94.0% (390/415), P = 0.023]; concerning termination of pregnancy at 8-9 weeks and 10-16 weeks respectively, there were no significant differences between oral and vaginal groups (P = 0.156, P = 0.073). The induction to abortion interval was no significant difference in oral and vaginal group in different gestational weeks (P = 0.238, P = 0.273). The average induction to abortion interval was (4.1 ± 6.6) hours and (6.0 ± 4.5) hours respectively in terminating 8-9 weeks and 10-16 weeks of gestation. Concerning the amount of bleeding within 2 hours of placenta expulsion, there was significant difference between oral group [(63 ± 46) ml] and vaginal group [(55 ± 45) ml] in terminating 8-9 weeks of gestation (P = 0.047), while there was no significant difference between groups in terminating 10-16 weeks of gestation [oral group (76 ± 52) ml versus vaginal group (76 ± 61) ml, P = 0.507]. The reoccurrence of menstruation was about 37 days in both oral and vaginal groups. Two cases of incomplete abortion were serious adverse events (SAE) relating to treatment. The common adverse events (AE) of nausea and vomiting were significantly higher in oral group [57.2% (239/417), 36.3% (151/417)] than those in vaginal group [45.4% (94/208), 26.1% (54/208); P = 0.005, 0.011]. Oral or vaginal misoprostol combined with mifepristone, is effective and safe for termination of pregnancy between 8 and 16 weeks of gestation.

Randomized Comparison of Glyceryl Trinitrate and Prostaglandin E2 for Cervical Ripening at Term

In Brief Objective To estimate the adverse effects of glyceryl trinitrate compared with prostaglandin (PG) E2 vaginal tablet for cervical ripening in term pregnancy. Methods One hundred ten women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly assigned to receive a 500-μg glyceryl trinitrate tablet vaginally (n = 54) or a 3-mg PGE2 tablet vaginally (n = 56), every 6 hours for maximum of two doses. Subjects were sent to the labor ward for amniotomy or oxytocin if their Bishop scores were more than 6 or their cervices were not ripe 24 hours after treatment. Adverse effects, changes in the Bishop scores, progress, and outcomes of labor were assessed. Results Glyceryl trinitrate was associated with fewer episodes of uterine tachysystole (0% versus 9%; P = .02). The median Bishop score after 12 hours was lower in women given glyceryl trinitrate compared with those given PGE2. Adverse effects, including headache and palpitations, were more frequent with glyceryl trinitrate than with PGE2. The cesarean rate was not significantly different between groups. Conclusion Cervical ripening with glyceryl trinitrate resulted in fewer episodes of tachysystole, but there were significantly more minor side effects. It can be used for cervical ripening at term, but it was not as effective as PGE2. Glyceryl trinitrate for cervical ripening caused fewer tachysystoles but was less effective than prostaglandin E2.

Randomized comparison of glyceryl trinitrate and prostaglandin E2 for cervical ripening at term

Objective: To estimate the adverse effects of glyceryl trinitrate compared with prostaglandin (PG) E2 vaginal tablet for cervical ripening in term pregnancy. Methods: One hundred ten women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly assigned to receive a 500-μg glyceryl trinitrate tablet vaginally ( n = 54) or a 3-mg PGE2 tablet vaginally ( n = 56), every 6 hours for maximum of two doses. Subjects were sent to the labor ward for amniotomy or oxytocin if their Bishop scores were more than 6 or their cervices were not ripe 24 hours after treatment. Adverse effects, changes in the Bishop scores, progress, and outcomes of labor were assessed. Results: Glyceryl trinitrate was associated with fewer episodes of uterine tachysystole (0% versus 9%; P = .02). The median Bishop score after 12 hours was lower in women given glyceryl trinitrate compared with those given PGE2. Adverse effects, including headache and palpitations, were more frequent with glyceryl trinitrate than with PGE2. The cesarean rate was not significantly different between groups. Conclusion: Cervical ripening with glyceryl trinitrate resulted in fewer episodes of tachysystole, but there were significantly more minor side effects. It can be used for cervical ripening at term, but it was not as effective as PGE2.