Induction Of Abortion Research Articles

Utero-placental apoplexy during induction of therapeutic abortion in a 18-week pregnancy.

Utero-Placental Apoplexy, or Couvelaire Uterus, is a third-trimester major obstetrical complication, occurring especially during labor. It consists of placental abruption followed by an acute intradecidual hemorrhage produced by the rupture of the uterus-placental spiral arterioles leading to a retroplacental hematoma. This hemorrhage infiltrates the uterine wall up to intra- and retro-peritoneal areas. We provide a case report, on which no previous literature is available, of a utero-placental apoplexy during induction of therapeutic abortion.

COMPARATIVE STUDY OF SUBLINGUAL AND VAGINAL MISOPROSTOL TABLET IN MISSED ABORTION

Introduction: Management of missed abortion is matter of concern for obstetrician in terms of its methods and complications. Objectives: To compare efficacy, side effects and complications of sublingual and vaginal misoprostol tablet in missed abortion case of less than 20 weeks of gestation. Methods: Total 300 cases were taken, and out of those 300 cases, group A (150cases) included cases who were given sublingual misoprostol tablet, and group B (150 cases) included cases who were given vaginally misoprostol tablet. Observation: Mean gestational age is 7.9 and 8 weeks in Group A and Group B respectively. P value is 0.94. (Not significant). Mean induction abortion interval is 11.6 hours and 12.9 hours in Group A and Group B respectively i.e., the induction abortion interval is slightly short in the Group A. P value is 0.9, means the difference is not statistically significant. Mean dose of misoprostol was 1004.6 microgm and 1080 microgm for group A and group B respectively. P value is 0.029 is significant. Incidence of side effects (nausea, vomiting, unpleasant taste) was higher in group A than group B. P value is <0.05 is significant. Success rate was 86% in group A and 80% in group B. Conclusion: Sublingual and vaginal misoprostol tablet are both equally effective for medical management of missed abortion. Mean dose required for abortion is more in vaginal misoprostol but side-effects are more associated with sublingual misoprostol tablets.

Cervical ripening with laminaria tents prior to second trimester induction of labor

Background Induction abortion in the second trimester may be favored in some instances, such as in women with compounding medical conditions or when skilled providers are not available. Various methods of pre-induction cervical preparation have been used to shorten the length of induction and decrease the risk of complications. The benefits of cervical preparation with laminaria before D&E have been well studied, but the benefits of laminaria before medical induction are less clear. Objective To determine if overnight cervical preparation with laminaria tents shortens delivery interval in women undergoing 2nd trimester induction of labor (IOL) with misoprostol. Study Design This was a retrospective cohort study comparing overnight intracervical laminaria placement followed by misoprostol to misoprostol alone for 2nd trimester IOL between 1/2000 and 12/2010. Women were excluded if the reason for IOL was preterm labor or preterm premature rupture of membranes or if misoprostol was not used as the primary induction agent. The primary outcome was time from misoprostol administration to delivery. Results 126 women were analyzed including 36 (29%) who received laminaria + misoprostol and 90 (71%) who received misoprostol alone. Women in the laminaria + misoprostol group were significantly older (30 yrs [14–44] vs. 27 yrs [17-43], p = .029). Induction for fetal anomaly (92% vs. 34%, p ≤ .001) and the use of feticide (56% vs. 13%, p ≤ .001) were more common in the laminaria + misoprostol group. The mean time to delivery in the laminaria + misoprostol group was 6 h longer compared to the misoprostol only group; 19 ± 8 h compared to 13 ± 12hrs (p = .007). There was no difference in fetal to placental delivery time (p = .329), total misoprostol dose (p = .182), or length of hospitalization (p = .144) however, significantly more women completed abortion at 24 hrs in the misoprostol alone group (90% vs. 61%, p ≤ .001). Conclusions The use of laminaria tents for overnight cervical preparation does not expedite delivery times in patients undergoing 2nd trimester IOL with misoprostol.

THE STUDY OF EFFICACY OF SUBLINGUAL MISOPROSTOL IN TERMINATION OF EARLY PREGNANCY

Introduction: Nearly 20% of all confirmed pregnancies end in spontaneous abortion. Misoprostol’s use in early pregnancy failure is varied and dose and route are not well established. AIM: To study the efficacy of sublingual misoprostol in causing expulsion of products of conception in early pregnancy failure.
 Methods: Women with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were included in the study. Tablet Misoprostol 600 mcg was given six hourly sublingually for 3 doses. All observations were noted and analyzed. Results: Mean gestational age was 7.946+1.2 weeks. Mean induction abortion interval was 18.241+1.2 hours. Women with gestational age six to eight weeks had least mean induction-abortion interval time of 17.38+2.86. Mean dose required was 1560mcg. Efficacy of protocol was 92.85% in achieving complete abortion.
 Conclusion: The regime had 92.85% efficacy, acceptability (90%) and few side effects. Thus by using a lower dose and appropriate interval between two doses (six hours), the side effects were lessened with high efficacy.
 Keywords: Efficacy, Missed Abortion, Misoprostol.

Medical Induction of First Trimester abortion by Misoprostol or Misoprostol with Letrozole

Background: Managing of abortion is an important subject in gynecology. Millions of patients had sufferedfrom spontaneous abortions that occur per year.Objectives: The aim of this study was to compare the effect of misoprostol alone and misoprostol withletrozole in the induction of abortion in the first trimester of pregnancy.Patients and Methods: In a single –blind clinical trial ,128 female applicants for legal abortion within thefirst trimester of pregnancy that referred to AL-Batool hospital , were divided in to two groups: intervention(misoprostol with letrozole) and control groups (misoprostol alone). The complete abortion, drug-inducedside effects of misoprostol and letazole were noted and evaluated.Results: The complete abortion rate was93.2% in intervention group and in68.7% in the control group(misoprostol) only, which was significantly higher in intervention group (p = 0.001).Abdominal pain in the intervention group is also significantly lower than that of the control group (p =0.013). Intervention group also had significantly lower duration of bleeding rather than control group (p =0.006).Conclusions: Based on our results, pretreatment with letrozole plus Misoprostol was more effective forprompting abortion in the first trimester of pregnancy without increasing side effect compared to misoprostolalone.

Rupture of the unscarred uterus during induced termination of pregnancy in the second trimester: A case report

Introduction. Uterine rupture is a rare complication of induced termination of pregnancy in the second trimester. We report a case of a patient with a rupture of the unscarred uterus during a prostaglandin-induced abortion in the second trimester of pregnancy. Case Report. A 26-year-old pregnant woman was admitted to the Clinic of Gynecology and Obstetrics in the 22nd week of gestation of her fourth pregnancy due to complete absence of amniotic fluid. The patient denied previous surgeries and other diseases. Due to a poor prognosis for the fetus, the Ethics Committee approved the termination of pregnancy. The induction of abortion was started by applying two dinoprostone gels intracervically and continued by using carboprost tromethamine intramuscularly. The patient aborted after 38 hours from the start of induction. During instrumental revision of the uterine cavity, a rupture of the right side of the uterus was suspected. Ultrasound examination showed a parametrial hematoma. Laparotomy was indicated due to suspected uterine rupture. The intraoperative findings showed a hematoma located in the right parametrium and a complete rupture of the posterior wall of the uterus extending from the right vaginal fornix to the right uterine horn. A total abdominal hysterectomy with preservation of both ovaries was performed. Conclusion. Since ruptures of the unscarred uterus are rare, almost at the chance level, it is important to always keep them in mind as a potential complication of induced termination of pregnancy in the second trimester.

USING OF MISOPROSTOL VAGINALLY PRIOR TO INTRAUTERINE CONTRACEPTIVE DEVICE INSERTION FOLLOWING PREVIOUS INSERTION FAILURE: RANDOMIZED CLINICAL TRIAL

Background: Intrauterine devices (IUDs) are good contraceptive method for women as they have a long acting contraceptive effect compared to other hormonal methods. Misoprostol or prostaglandin El (PGE1) analogue is a synthetic prostaglandin that has been used to induce cervical ripening in vaginal delivery and in medical induction of abortion. Objective: To investigate the possible effect of vaginal administration of misoprostol to insertion of IUCDs in women with previous IUCD insertion failure. Subjects and methods: This study was done at Obstetrics and Gynecology Department of at El-Hussien hospital. It is a double blind randomized clinical trial. The study included 100 patients with previous failed attempt of IUD insertion, divided into two equal groups: Group I received misoprostol prior to IUD insertion and group II received placebo to IUD insertion. Results: There was high significant difference between the two groups regarding the degree of cervical softening and its effect on the success rate of IUCD insertion in each group. Conclusion: Vaginal misoprostol before IUD insertion in parous women with previous insertion failure increased the rate of successful insertion, particularly in women with previous cesarean delivery.

USING OF MISOPROSTOL VAGINALLY PRIOR TO INTRAUTERINE CONTRACEPTIVE DEVICE INSERTION FOLLOWING PREVIOUS INSERTION FAILURE: RANDOMIZED CLINICAL TRIAL

Background: Intrauterine devices (IUDs) are good contraceptive method for women as they have a long acting contraceptive effect compared to other hormonal methods. Misoprostol or prostaglandin El (PGE1) analogue is a synthetic prostaglandin that has been used to induce cervical ripening in vaginal delivery and in medical induction of abortion. Objective: To investigate the possible effect of vaginal administration of misoprostol to insertion of IUCDs in women with previous IUCD insertion failure. Subjects and methods: This study was done at Obstetrics and Gynecology Department of at El-Hussien hospital. It is a double blind randomized clinical trial. The study included 100 patients with previous failed attempt of IUD insertion, divided into two equal groups: Group I received misoprostol prior to IUD insertion and group II received placebo to IUD insertion. Results: There was high significant difference between the two groups regarding the degree of cervical softening and its effect on the success rate of IUCD insertion in each group. Conclusion: Vaginal misoprostol before IUD insertion in parous women with previous insertion failure increased the rate of successful insertion, particularly in women with previous cesarean delivery.

Misoprostol only or in combination with intra cervical Foley’s catheter for termination of the second trimester demise pregnancy in patient with previous caesarean sections

Objective: Termination of second trimester pregnancy is unique obstetric contest due to its difficulty and risky especially if the condition is associated with prior Caesarean deliveries. Aim of the work: To compare the safety and efficacy of two regimens for termination of the second trimester pregnancy in ladies with scarred uterus by prior Caesarean deliveries either by using sublingual and vaginal misoprostol or sublingual misoprostol in a combination with intra cervical Foley’s catheter. Patients and methods: 163 pregnant ladies with second trimester demise pregnancy at14-24 gestational weeks in scarred uterus (≥ one cesarean sections) participated in this prospective randomized comparative study which was performed in obstetric emergency unit in Zagazig University Hospitals, Egypt from June 2019 to May 2020. 140 patients only far-reached the trial through termination of the pregnancy via induction of abortion by sublingual and vaginal misoprostol Group 1 (GI) or Foley’s catheter with vaginal misoprostol Group 2 G (II). Whichever of those methods sustained for 48 hours else the fetus expulsed formerly .Outcomes was determined by comprehensive expulsion of fetus and placenta, Induction Abortion interval, Incidence of side effects, requirement for surgical intervention and complications" rate. Results: The demographic criteria of both groups revealed no significant difference (P-value>0.05). The mean (SD) of Induction to abortion interval (hours) in GI was significant longer than in G II (51.07±23.84, 45.20±31.28) respectively with (P- value 0.021). Total dose (μg) of misoprostol used in GI (1100.72±23.54) was higher than G II (645.35± 322) with p value 0.001. Admission-termination hospitalization (days) was significant longer in G I (4.11±1.02) than in G II (2.371±1.98) with P value 0.004. No significant difference as regard occurrence of adverse effects between both groups except the incidence of fever (17.1%) in G I and (5.7%) in G II with P value 0.01. Success rate in GI and G II were (80%, 95%) respectively with P-value 0.01. Incomplete expulsion was higher in GI (14.3%) in comparison with G II (4.2%) with P value 0.04. Incidence of haemorrhage was significant higher in G II than in GI P value 0.03. No significant differences between both groups as regard incidence of rupture uterus or occurrence of infection. Conclusion: Practice of inserting Foley’s catheter through cervix with misoprostol sublingually for termination of mid-trimester pregnancy in preceding uterine scar(s) is efficient, inexpensive and safe procedure.

Comparison of effectiveness of mifepristone misoprostol combination versus mifepristone Foley EAS (Extra-amniotic instillation of saline) combination in second trimester pregnancy termination

Second trimester medical abortion with mifepristone followed by misoprostol is effective and is associated with considerably shorter induction abortion interval. This study is a comparison of the effectiveness, safety profile and side effects of mifepristone- misoprostol and mifepristone-Foley’s EAS combinations in second trimester termination. The patients were grouped into two, first group received oral mifepristone 200 mg followed by vaginal misoprostol 800 mcg after 48 hours and then 400 mcg misoprostol vaginally 3 hourly up to a maximum of 4 further doses. Second group were induced with oral mifepristone 200 mg followed by extra amniotic saline instillation through a Foley’s catheter after 48 hours. The success rates were comparable between the two groups. But the 6 hour expulsion rates (36.4% Vs 0%) as well as 12 hour expulsion rates (56.36% Vs 3.6%)(p value=0.001) were significantly high in mifepristone – misoprostol group compared to mifepristone-Foley EAS group. Mean induction abortion interval was shorter in the first group (14.64hrs vs 18.4hrs)(p=0.026).But the incidence of complaints after administration of misoprostol was significantly high. 7 patients from Group 1 and 5 patients from Group 2 required surgical evacuation for retained placenta. The study revealed that mifepristone-Foley’s EAS induction can be used as an effective alternative to mifepristone-misoprostol combination with similar success rates and significantly reduced side effects but with significantly increased induction abortion interval. The results of this study can be extrapolated to cases where prostaglandins are contraindicated like in previous cesarean section cases. Keywords: Foley EAS, Misoprostol, Abortion, .

Comparison of successful abortion rate of mifepristone –Misoprostol combination with exrtaamniotic ethacridine lactate – misoprostol for termination of second trimester pregnancy

Abortion procedure is one of the commonly practiced procedure in practice thereby demanding a safe and effective method of abortion. Objective: Objective of study was to compare successful abortion rate and to compare the mean induction-abortion interval. Materials and Methods: The present was undertaken among the patients admitted to hospitals attached to J.J.M. Medical College; Bapuji hospital, women and children hospital and Chigateri general hospital Davangere during the study period from November 2016 - October 2017. Patients are randomized in two groups. Patients coming for second trimester abortion to above mentioned hospitals were assigned serial number from one to eighty and all patients with even number will be allocated to group 1 and all patients with odd number will be allocated in group 2, each group comprising 40 women each. Results: In the present study the mean induction abortion interval for group 1 was 19.56±1.82 hours and group 2 was 14.13±2.72 hours. This was statistically significant. Of the 40 cases in each group, 37 had complete abortion i.e. 92.5% 3 cases (7.5%) from both the groups had incomplete abortion and was supplemented with check curettage in both groups. Conclusion: Ethacridine lactate instilled extra­amniotically then by vaginal misoprostol is safer and acceptable, has short I-A interval than mifepristone – misoprostol for 2nd trimester termination of pregnancy. Keywords: Abortion rate, Induction-abortion interval Extraamniotic; Ethacridine lactate, Mifepristone, Second trimester abortion, Misoprostol.

Therapeutic goals of terminaton and their efficacy in patients

: The purpose of this study is to provide the most safest, effective and cost-effective method with least or no complications in both first and second trimester.Induction abortion can be done either by medical or surgical methods. Medical method of abortion has advantages over surgical methods. The morbidity of the second trimester abortion continues to be more than the morbidity of first trimester termination. Causes for termination in Telangana region include oral contraceptive failure, Fetal anomalies, Lack of knowledge on termination procedure.: A Prospective observational study was conducted for 6 months, a total of 120 women in the first and second trimester of pregnancy who are eligible for termination following inclusion and exclusion criteria were included, the women attending at, Govt. maternity Hospital, Hanamkonda, Warangal. The main outcome in studied were, induction abortion interval, incidence of side-effects, success rates, pain pattern and bleeding pattern. For first trimester abortion mifepristone followed by misoprostol is found to be more effective, has shorter induction abortion interval and lesser side effects compared to misoprostol alone, D&C regimen. For second trimester abortion misoprostol is found to be more effective, has shorter induction abortion interval and lesser side effects compared to D&C, Foley’s catheter, Hysterotomy regimens. All methods used in the department showed efficacy and it does not effect on conceiving rate of women.

Effect of Intravenous Dexamethasone on Induction of Mid-Trimesteric Abortion Randomized Controlled Trial

Background: Medical abortion, the termination of pregnancy through the use of a drug or a combination of drugs, has the potential to reduce complications and to expand access to abortion provided not only by specially trained clinicians but also by other health care providers who may or may not have training in surgical methods of abortion.Aim: This study aimed to elicit the safety and efficacy of intravenous injection of dexamethasone with vaginal misoprostol for shortening the induction abortion interval in the second trimester of pregnancy.Materials and Methods: This study was conducted in Ain-Shams Maternity University Hospital where 140 pregnant females were included for induction of second trimester abortion from June 2018 till December 2019.Results: There was significant statistical difference between the two groups as regard induction-expulsion interval (P >0.001) and length of hospital stay (P > 0.001), mean induction-expulsion interval in dexamethasone group was 10.5 hours; while in the control group was 17.5 hours, the mean length hospital stay was 16 hours in the dexamethasone group while it was 23 hours in the control group. There was significant statistical difference between the two groups as regard dose of misoprostol used (P>0.001), mean dose of misoprostol in the dexamethasone group was 800 mcg while it was 1600 mcg in the control group.Conclusion: It was suggested that use of intravenous injection of dexamethasone with misoprostol was effective in shortening the induction- abortion interval, the length of hospital stay and reducing the misoprostol doses

Safety and efficacy of misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks

Aims: To compare the safety and efficacy of Misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks.
 Methods: This is comparative study where Misoprostol 800 μg was administered sublingually four hourly till expulsion of products or maximum of three doses in one group and 400 μg misoprostol followed by manual vacuum aspiration 4 hours later was done under local anaesthesia in another group from October 2019 to March 2020 at Government Medical College and Hospital, Aurangabad, Maharashtra. Unpaired t-test and Chi squared test were performed with alpha-error set at 0.05.
 Results: The success rate in Misoprostol group was 88 % and in the MVA group, it was 98%. Mean duration of hospital stay in Misoprostol group was 2.46±1.18 days and in MVA group was 1.55 ± 1.52 days (p= 0.3). Mean induction abortion interval in Misoprostol group was 8.125±3.29 and 4.46±0.44 hours in MVA group (p=0.000). One woman from MVA group had perforation of uterus which could be attributed to previous LSCS with tight os.
 Conclusion: Single dose of Misoprostol followed by manual vacuum aspiration is better than the multiple dosage of Misoprostol for the treatment of first trimester missed abortion in terms of duration of treatment but not for the individual success rate. Hospital stay is similar.
 Keywords: manual vaccum aspiration, misoprostol, missed abortion

Effect of misoprostol with and without letrozole on the induction of abortion for women with first-trimester missed abortion.

To determine whether addition of letrozole to a misoprostol-based abortion regimen can increase the rate of complete abortion. The randomized, placebo-controlled, double-blind trial enrolled women with missed abortion in the first trimester of pregnancy attending Sadooghi Hospital, Isfahan, Iran, from 2016 to 2018. The women were randomly assigned to the study group, which received 10mg of letrozole daily for 3days, followed by two doses of 800μg of vaginal misoprostol at a 4-hour interval, or the control group, which received a placebo, followed by the same dose of misoprostol. Sonography was performed to check the abortion status. In total, 120 women completed the study: 60 in the misoprostol plus letrozole group, and 60 in the misoprostol only group. Complete abortion was documented for 93 (77.5%) women: 48 (80.0%) in the misoprostol plus letrozole group and 45 (75.0%) in the misoprostol only group (P=0.80). The mean duration of induction in the misoprostol plus letrozole and misoprostol only groups was 7.35±3.54hours and 8.2±3.8 4hours, respectively (P=0.21). Administration of misoprostol alone was found to be as effective as the administration of misoprostol plus letrozole for first-trimester missed abortion.

EFFICACY OF VAGINAL MISOPROSTOL IN FIRST AND SECOND TRIMESTER MISSED ABORTIONS

Objectives : Missed abortion is a common problem in obstetrics and gynecology. This study aims to study the efficacy of vaginal misoprostol in termination of first and second trimester missed abortions. Materials and Methods: Fifty women with missed abortions were included in the study, out of which 30 patients were in first trimester comprised of group I, other 20 patients in second trimester were designated as group II. After getting informed consent, 200 mcg misoprostol was kept in posterior fornix, every 4 hours 200 mcg was repeated until the patient expelled. Parameters analyzed were induction abortion interval, change in PCV, success rate. Results : In the present study out of the 70% (21/30) cases belonging to group I – the mean induction abortion interval was between 12-16 hrs. In group II category in (19/20) 95% of women , the mean induction abortion interval was less than 8 hrs. One patient failed to expel even after maximum of 4 dose and hence underwent surgical termination giving a failure rate of 5%, ‘P’ value is also significant. Conclusion : Vaginal Prostoglandin E analogue (misoprostol) is a very safe and effective method to be used in missed abortion. It was more effective and successful in II trimester compared to I trimester. The failure rate was very minimum and complications were almost nil with very few side effects

Vertical exposition to Luffa operculata extract deregulates behavior and hypothalamus neurotransmitters in juvenile rats

Ethnopharmacological relevanceLuffa operculata (L.) Cogn (Cucurbitaceae) is a traditional plant popularly used in the abortion induction, against sinusitis and is toxic. Aim of the studyTo verify the influence of the aqueous extract obtained from the dry fruit of L. operculata (BNE) on the male rats vertically exposed to a subabortive dose of BNE, by evaluating alterations in behavior and neurochemical features in hypothalamus, striatum and frontal cortex, at a juvenile age, after receiving a stress challenge given by the use of the “New York subway stress” technique (NYS). Materials and methodsPregnant female rats (F0 generation) received 1.0 mg/kg BNE, or distilled water (100 mL/kg), by gavage, between gestation days GD17 and GD21. The pups were weaned at PND21 and were kept up to PND60 (juvenile age) in controlled environmental conditions. Four groups were obtained: control (CG), experimental (EG), stress control (SCG) and stress experimental (SEG) After being stressed, the animals were behavioral screened for in the open field (OF) and in light-dark box (LDB) apparatuses. They were euthanized, and the liver, kidneys and brain were removed for both macroscopic and microscopic analyses, and for quantification of vanillylmandelic acid (VMA), norepinephrine (NE), dopamine (DA) and its metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC) and the serotonin (5-HT) and its metabolite 5-hydroxyindolylacetic acid (5-HIAA) were accessed in the hypothalamus, frontal cortex and striatum. Results and discussionalthough most of the behavior changes were due to the stress challenge, the rats spent more time in the dark side of the LDB and were less likely to explore the light side, indicating that the treatment with BNE induced to fear. Interferences of BNE over behavior were due to impairment of VMA, NE, 5-HT and DA and increasing of DOPAC in the hypothalamus, and an increase of 5-HIAA in the frontal cortex, indicating alterations in the hypothalamic-hypophysis-adrenal axis (HHAA). No macroscopic or histopathological changes were observed in the liver, kidneys, or brain, although GFAP was diminished in the SCG, as expected for stressed rats. Conclusionthe vertical exposition of juvenile rats to BNE led to the manifestation of fear and to a down regulation of the hypothalamic-hypophysis-adrenal axis.

Evaluation of Apoptosis, Proliferation, and Adhesion Molecule Expression in Trophoblastic Tissue of Women With Recurrent Spontaneous Abortion and Infected With Toxoplasma gondii.

Recurrent spontaneous abortion is an obstetric complication with undefined causes. Apoptosis, proliferation, and adhesion are considered important factors in the pathogenesis of abortion. This work aimed to determine Bax and Bcl-2 as a proapoptotic and antiapoptotic protein, Ki67 and P27kip as proliferative and antiproliferative proteins, and E-cadherin and CD44 as adhesion molecules in the trophoblastic tissues in cases with recurrent miscarriage. Immunohistochemistry and quantitative polymerase chain reaction analysis of Bax, Bcl-2, Ki67, P27kip, E-cadherin, and CD44 in paraffin-embedded sections of placental tissues obtained from 108 women were divided into 3 categories: 66 Toxoplasma gondii-positive women with recurrent abortion, 22 T. gondii-negative women with recurrent abortion, and 20 women with no history of abortion as a control group. The mean ratio of the expression of Bax and P27kip proteins was 35.3% and 36.1%, which is significantly higher than that of the second group (19.88 and 20.02%), and the third group (12.3% and 10.98%), while the mean ratio of the expression of Bcl-2, Ki67, E-cadherin, and CD44 proteins was 12.35%, 11.23%, 10.32%, and 9.97%, which is significantly lower than that of the second group (33.75%, 13.18%, 21.88%, and 23.29%) and that of the third group (38.58%, 39.27%, 37.98%, and 35.79%). The presence of proapoptotic protein (Bax) and antiproliferative protein (P27kip) at high levels and the presence of antiapoptotic protein (Bcl-2), proliferative protein (Ki67), and adhesion molecules (E-cadherin and CD44) in lower levels in the T. gondii-positive group clarify the mechanism involved in the induction of abortion and loss of pregnancy.

Variation in levels of acceptance, developmental success, and abortion of Halyomorpha halys eggs by native North American parasitoids

Using native North American parasitoid species (Hymenoptera: Scelionidae) that often unsuccessfully attack the eggs of the invasive brown marmorated stink bug Halyomorpha halys (Hemiptera: Pentatomidae), we assessed variation in traits that may determine the parasitoids’ ability to adapt to the invasive host by either exploiting or avoiding H. halys eggs (acceptance, developmental success). We also assessed variation in the parasitoids’ ability to induce H. halys host egg abortion, which may contribute to biological control of H. halys in invaded areas. The first set of experiments evaluated intra- and interspecific variation using standardized laboratory tests with iso-female lines of Telenomus podisi and Trissolcus euschisti that included matching of detailed behavioural observations of acceptance with developmental outcomes. In a second set of experiments, we assessed how variation in developmental ability and abortion induction may affect levels of biological control by indigenous parasitoid species. We examined a broader sample of parasitoids that emerged from field collections of egg masses of an indigenous north American stink bug Podisus maculiventris in a region newly invaded by H. halys. Results from the first set of experiments showed high levels of acceptance of H. halys eggs among iso-female lines of parasitoids, but offspring development success was almost zero. H. halys egg abortion due to unsuccessful parasitism was often very low and varied among iso-female lines only for T. podisi. In the second set of experiments we never observed increases in abortion levels of Halyomorpha halys eggs above natural levels, even for the two species (T. euschisti and T. podisi) that were observed to oviposit in and abort H. halys eggs in the first set of experiments. We conclude that while there may be some variation in behavioural and physiological parameters mediating acceptance and abortion of H. halys eggs by native North American egg parasitoids, there does not appear to be significant variation in developmental success. Moreover, current biological control impact of H. halys eggs via host egg abortion is likely very low.

Role of adding Isosorbide-5-Mononitrate to misoprostol in Induction of the second trimesteric abortion, a randomized controlled trial

Objective: To compare the therapeutic efficacy of prostaglandins when they used alone versus a combination therapy of prostaglandins and a nitric oxide (NO) donor as isosorbide-5-mononitrate to induce cervical ripening and effacement for induction of the second trimester missed abortion and occurrence of complete abortion. Methods: A Randomized clinical trial study in which 160 Second trimester (13-26weeks) missed abortion pregnant women admitted for medical induction of abortion, were randomly divided into two group (80 patients in each). One group received only vaginal Misoprostol and the other group received combined vaginal Misoprostol with Isosorbide-5-mononitrate. To determine the efficacy in form of " induction abortion interval ": the duration interval between the beginning of the induction and the complete expulsion of the abortus and also the number of the doses of misoprostol needed to complete expulsion and also the adverse events that increased or newly discovered when prostaglandins and a nitric oxide donor used together such as severe bleeding, headache, abdominal pain, pelvic pain, sever hypotension, backache, fever, nausea and vomiting. Results: It is proved in the study that combination between misoprostol and isosorbide mononitrate gives better results regarding cervical consistency improvement, cervical dilatation, effacement, the whole induction time and the number of misoprostol doses needed to complete expulsion when compared to misoprostol alone and also fewer side effects as abdominal pain. Conclusion: Misoprostol is a good cervical ripening agent when used alone but we can get a benefit from combining both misoprostol and NO donor (isosorbide-5- mononitrate) making a synergistic action with fewer side effects.