Intravaginal Misoprostol Research Articles

Intra uterine extra-amniotic versus vaginal misoprostol for termination of second trimester miscarriage: A randomized controlled trial

Termination of pregnancy in the second trimester using prostaglandins has been shown to be safe and effective. Misoprostol has multiple routes of administration; oral, vaginal, buccal, rectal and sublingual. The study aims to compare the efficacy and safety of intrauterine extra-amniotic and vaginal misoprostol in a dose of 200 microgram every 4 hours for the termination of pregnancy in cases of second trimester miscarriage. A prospective randomized open labeled clinical trial included 180 women with missed miscarriage in gestational age between 13 and 24 wks. Patients were randomized to receive subsequent doses of 200 µg misoprostol every 4 hrs either intra uterine extra-amniotic by Foley catheter or vaginally administered. Randomization was completed using a computer-generated random table. The primary outcome of this study was the mean duration from the initial misoprostol dose until complete fetal expulsion (induction-expulsion interval). The mean gestational age was 17.74 wks. The mean time to complete miscarriage in the intra uterine extra-amniotic group was 5.27 hrs, which was significantly lower than the vaginal group (9.92 hrs, p=0.001). Side effects were more common in vaginal group. Intra uterine extra-amniotic misoprostol with a dose of 200 µg every 4 hrs appears to be more effective and safer than vaginal misoprostol in induction of second trimester miscarriage.

“Comparative Study of 'Intravaginal Misoprostol Alone' Versus 'Extra Amniotic Ethacridine Lactate Instillation Followed by Intravaginal Misoprostol' for Mid Trimester (13-20 Weeks) Termination of Pregnancy”

Objective(s): To compare the efficacy, safety and induction-abortion interval of alone versus Ethacridine lactate 0.1% followed by intravaginal Misoprostol for mid-trimester (13-20 weeks) abortion. Method(s): 60 women undergoing mid-trimester abortion were recruited for comperative study.They were devided into 2 groups. Group-A (30 cases) received intravaginal tab 600 g followed by 400 g 8 hourly and Group-B (30 cases) received extra-amniotic Ethacridine lactate 0.1% followed 6 hours later by intravaginal 400 g 3 hourly until abortion occurred or upto 48 hours. Result(s): Mean induction-abortion interval in Group-A was 24.9  10.83 hours whereas 18.3  6.1 hours in Group-B. In Group-A complete abortion occurred in 70% cases and in Group-B 83.33%. Failure rate in GroupA was 6.67% while none in Group-B. Efficacy of abortion in Group-A was 93.33% while 100% in Group-B. Side effects and complications were more common in Group-A than Group-B. Conclusion(s) : Ethacridine-lactate followed by is definitely a better and effective method for midtrimester abortion rather than using alone. Keyword(s): Intravaginal Misoprostol, Extra-amniotic Ethacridine lactate, mid-trimester abortion

Do Obese Women Need Higher Dosages of Misoprostol for Labor Induction? [6A

INTRODUCTION: To determine the association between maternal BMI and time to delivery in women receiving misoprostol for labor induction (IOL). METHODS: This is a retrospective cohort study of women undergoing IOL with intravaginal misoprostol from 1/2013–2/2015. Women admitted for IOL with singleton, term, cephalic gestations were identified through a database. Maternal demographics, obstetrical variables, and admission BMIs were collected. Time to delivery (vaginal and cesarean) from the initial misoprostol dose was primary outcome. Groups were made based on maternal BMI and misoprostol dose (25 mcg vs 50 mcg). Time to delivery was compared among BMI categories stratified for misoprostol dose using two-sample t test, Wilcoxon rank sum test, and exact chi-square test. A P value less than 0.05 was considered significant. Kaplan Meyer survival and time to event curves were created. RESULTS: 483 patients were included. Mean gestational age was 39.2±1.6 wks, median parity was 0 (range 0–1), and maternal age was 30.5±6.1. Misoprostol 25 mcg was most commonly used (n=290, 60%). Vaginal delivery was achieved in 79% (n=382). More than 90% (n=435) of the women had BMIs greater than 30. Time to delivery was significantly longer with BMIs greater than 30 when misoprostol 25 mcg was used compared with 50 mcg. For BMIs greater than or equal to 40, time to delivery was six hours longer regardless of dose. CONCLUSION: There is an association between maternal BMI and initial misoprostol dosage on time to delivery. Admission BMI should be taken into consideration when dosing misoprostol for IOL.

An Open Label, Prospective Study to Evaluate the Efficacy of Misoprostol Versus Dinoprostone Gel For Induction of Labour

Objective: This prospective study was conducted to compare the effect, efficacy & safety of intra-vaginal misoprostol (PGE1) & intra-cervical dinoprostone gel (PGE 2) for induction of labour. Methods: 60 women aged 18-35 years with single live fetus, cephalic presentation & term pregnancy, who were admitted for induction of labour were included in this study.30 women received intrvaginal 25 microgram Misoprostol (study group) & 30 women received 0.5mg of intracervical dinoprostone gel(control group). Comparison was done between the mean time taken for onset of labour, time taken for induction to delivery, mean duration of labour, requirement of Oxytocin augmentation, mode of delivery, side effects & the neonatal outcome in either of the groups. Results: The mean time taken for onset of labour was less in the misoprostol group than in the dinoprostone group (58.22 min and 1 hr 55 min). Similarly duration from induction to active phase (1hr 57 min and 4hrs 25 min) and active phase to delivery ( 3 hrs 21 min and 5 hrs 9min) was less for misoprostol group and thus the induction to delivery interval (5 hrs 18 min and 9 hrs 34 min). Cesarean section rate was less in misoprostol group (10% v/s 24%). Maternal side effects were minimal in either group & the neonatal outcome was good in both the groups. The induction cost was much less in the misoprostol group. Conclusion: Misoprostol is safe, efficacious, cheap and mother and fetus friendly drug for the induction of labour.

Second Trimester Medical Termination of Pregnancy with Combined Intracervical and Intravaginal Misoprostol: Comparative Analysis with Intravaginal Misoprostol—A Pilot Study

Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. In this IRB approved prospective study, twenty-two women (mean age 25.4±3.2 years, range 23-32 years; mean BMI 22.3±3.4kg/m(2); mean parity 2.1±1.4, average gestational age 17.9±2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. Mean induction-abortion interval for intravaginal group and combination group was comparable (t=7.9±1.8 and 6.5±3.5h, respectively). Three patients required surgical evacuation for incomplete abortion (n=2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6h was more in the intracervical-intravaginal group (36.3%). Patients with intracervical misoprostol complained of abdominal pain more often than those in other groups. Excessive bleeding and uterine rupture was not seen in any patient. Intracervical misoprostol is an effective method of medical treatment of second trimester pregnancy failure. Its short induction to abortion interval and acceptable safety profile makes induction via the cervical route acceptable for second trimester abortion.

Induction to delivery interval using transcervical Foley catheter plus oxytocin and vaginal misoprostol: A comparative study at Aminu Kano Teaching Hospital, Kano, Nigeria.

Background:Induction of labor (IOL) is an artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Many factors are associated with its success in postdatism.Objective:To compare the induction delivery intervals using transcervical Foley catheter plus oxytocin and vaginal misoprostol, and to identify the factors associated with successful induction among postdate singleton multiparae.Materials and Methods:The study was a prospective randomized controlled trial of singleton multiparous pregnant women. They were randomized into two groups, one group for intravaginal misoprostol and the other group for transcervical Foley catheter insertion as a method of cervical ripening and IOL. The data were analyzed using SPSS version 17 computer software (SPSS Inc., IL, Chicago, USA). Comparisons of categorical variables were done using Chi-squared test, with P < 0.05 considered as significant. Student's t-test was used for continuous variables.Results:The incidence of postdatism was found to be 136 (13.1%). The mean induction delivery time interval was shorter in the misoprostol group 70 (5.54 ± 1.8 h) than in the Foley catheter oxytocin infusion group 66 (6.65 ± 1.7 h) (P = 0.035). There was, however, no statistically significant difference in the maternal and neonatal outcomes when these two agents were used for cervical ripening and IOL. Higher parity and higher Bishop's score were the factors found to be associated with high success rate of IOL (P < 0.001).Conclusion:Vaginal misoprostol resulted in shorter induction delivery time interval as compared to transcervical Foley catheter. High parity and high Bishop's scores were the factors found to be associated with the success of IOL.

English

English

Intravaginal Misoprostol for Cervical Ripening and Labor Induction in Nulliparous Women

Background:In China, no multicenter double-blinded prospective randomized controlled study on labor induction has been conducted till now. This study is to evaluate the efficacy and safety of intravaginal accurate 25-μg misoprostol tablets for cervical ripening and labor induction in term pregnancy in nulliparous women.Methods:This was a double-blinded, prospective randomized controlled study including nulliparous women from 6 university hospitals across China. Subjects were randomized into misoprostol or placebo group with the sample size ratio set to 7:2. Intravaginal 25-μg misoprostol or placebo was applied at an interval of 4 h (repeated up to 3 times) for labor induction. Primary outcome measures were the incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h. Safety assessments included the incidences of maternal morbidity and adverse fetal/neonatal outcomes.Results:A total of 173 women for misoprostol group and 49 women for placebo were analyzed. The incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h was higher in the misoprostol group than in the placebo (64.2% vs. 22.5%, relative risk [RR]: 2.9, 95% confidence interval [CI]: 1.4–6.0). The incidence of onset of labor within 24 h was significantly higher in the misoprostol group than in the placebo group (48.0% vs. 18.4%, RR: 2.6, 95% CI: 1.2–5.7); and the induction-onset of labor interval was significantly shorter in the misoprostol group (P = 0.0003). However, there were no significant differences in the median process time of vaginal labor (6.4 vs. 6.8 h; P = 0.695), incidence (39.3% vs. 49.0%, RR: 0.8, 95% CI: 0.4–1.5) and indications (P = 0.683) of cesarean section deliveries, and frequencies of maternal, fetal/neonatal adverse events between the groups.Conclusion:Intravaginal misoprostol 25 μg every 4 h is efficacious and safe in labor induction and cervical ripening.

A randomized controlled trial comparing different doses of intravaginal misoprostol for early pregnancy failure

A randomized controlled trial comparing different doses of intravaginal misoprostol for early pregnancy failure

Comparison of Effectiveness of Laminaria versus Vaginal Misoprostol for Cervical Preparation Before Operative Hysteroscopy in Women of Reproductive Age: A Prospective Randomized Trial

Study ObjectiveTo compare the effectiveness and safety of intracervical laminaria dilator versus intravaginal misoprostol administered before surgery to facilitate cervical dilation before operative hysteroscopy. DesignA prospective randomized study (Canadian Task Force classification 1). SettingA university hospital. PatientsA total of 150 women were assigned at random to the following groups: laminaria dilation (n = 50), misoprostol dilation (n = 50), and mechanical dilation (n = 50). InterventionsHysteroscopic surgery of intrauterine lesions. Measurements and Main ResultsIn this study, 150 women were assigned at random to receive cervical priming with an intracervical laminaria dilator, 200 μg of intravaginal misoprostol, or a mechanical dilator before operative hysteroscopy. Cervical response, surgical outcome, and complications of operative hysteroscopy were assessed. Visual analog scale (VAS) pain scores were recorded in the misoprostol and laminaria dilation groups. Demographic variables of the study groups were comparable (p = .278–.988). The duration of cervical pretreatment was similar with the intracervical laminaria dilator and intravaginal misoprostol (p = .803); however, intravaginal misoprostol was associated with more adverse effects (p = .031). Compared with the misoprostol dilation group, in which all patients required additional cervical dilation, notably fewer patients in the laminaria dilation group required additional cervical dilation after cervical preparation (p = .001). VAS pain scores were significantly higher in the laminaria dilation group, however (p = .001). ConclusionCervical priming with an intracervical laminaria dilator before operative hysteroscopy reduces the need for cervical dilation and better facilitates hysteroscopic surgery compared with intravaginal misoprostol. Oral analgesic use may be required before the use of this device.

Misoprostol for Termination of Second Trimester Pregnancy

Introductions: The termination of second trimester pregnancy is challenging due unfavorable cervix. This study evaluate the efficacy and maternal side effects of intravaginal misoprostol for termination of second trimester pregnancy. Methods: During one year period from 15th June 2011 to 14th June 2012, Department of Obstetrics and Gynaecology of Patan Hospital, women admitted for second trimester termination of pregnancy for fetal congenital anomalies and intrauterine fetal demise were studied using the International Federation of Gynaecology and Obstetrics recommended doses of vaginal misoprostol. For congenital anomalies, 400 mcg 3 hourly to a maximum of 5 doses were used. For fetal demise, gestational age of 13-17 weeks received 200 mcg every 6 hourly to a maximum of 4 doses, and 18-26 weeks dose was adjusted to 100 mcg. Main outcome measures included success rate of abortion within 48 hours, induction to delivery interval and maternal side effects. Results: There were 40 patients during study period. Success rate for termination of 2nd trimester pregnancy within 48 hours was 88.8% for congenital anomalies. For fetal demise, success of termination was 90.9% at 13-17 weeks and 100% at 18-26 weeks. Median time from induction to delivery was 26.8 hours for congenital anomalies. For fetal demise, it was 18 hours for 13-17 weeks was and 24 hours at 18 to 26 weeks respectively. Abdominal pain was seen in all doses of misoprostol. Conclusions: Vaginal misoprostol is an effective method for termination of second trimester pregnancy. Plain Language Summary: The study was conducted to see the effectiveness of vaginal misoprostol for termination of second trimester pregnancy. The success rate of termination for congenital abnormality and fetal demise was high. Vaginal misoprostol was an effective method for termination of second trimester pregnancy. DOI: http://dx.doi.org/10.3126/jpahs.v1i1.13010 Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):16-19

Effect of vaginal administration of misoprostol before intrauterine contraceptive insertion following previous insertion failure: a double blind RCT.

Is pretreatment with misoprostol useful in insertion of intrauterine contraceptives (IUCs) after insertion failure at the first attempt? Pretreatment with intravaginal administration of 200 mcg of misoprostol after IUC insertion failure 10 and 4 h before the second attempt of IUC placement was significantly better than placebo at facilitating the insertion of an IUC. One of the reasons for low use of IUCs is the concept that insertion is difficult. Misoprostol was used in several randomized clinical trials (RCT) before IUC insertion to facilitate the insertion. In general, the results showed no significant differences when compared with placebo. However, most previous studies have been carried out among unselected women whereas the present study is among women with previous insertion failure. This was a double blind RCT conducted between February 2013 and October 2014. Participants were 104 women who requested an insertion of an IUC and the insertion failed at the first attempt. After insertion failure, the women received a sealed envelope with misoprostol or placebo. The randomization system (1: 1) in one block size was computer-generated. The study was conducted at a tertiary care centre. The women were instructed to insert vaginally one tablet of misoprostol 200 µg (Prostokos, Hebron, Cariacica, PE, Brazil) or placebo 10 and 4 h before the woman returned to the clinic for a new insertion attempt. The outcomes were successful IUC insertion and the use of a cervical dilator immediately prior to the insertion procedure. A total of 2639 women requested the insertion of an IUC during the study period. The IUC was inserted at the first attempt in 2535 women (96%) and 104 women in whom we were unable to insert the device were eligible to participate in the RCT. Four women declined and 100 women were randomized (55 for the misoprostol group and 45 for the placebo group). From the 100 participating women, the levonorgestrel-releasing intrauterine system (LNG-IUS) was chosen by 55 and 37 women and the TCu380A intrauterine device (Cu-IUD) was chosen by none and 8 women in the misoprostol and placebo group, respectively. Seven and three women allocated to misoprostol and placebo, respectively, never returned to the clinic after randomization. We placed the IUC in 42 (87.5%) out of the 48 women and in 26 (61.9%) out of the 42 women randomized to misoprostol and placebo, respectively (P = 0.0066). Regarding the Evaluable Population the relative risk (RR) of successful insertions was 1.41 (95% confidence interval (CI) for absolute difference (8.2, 43.0), P = 0.0066); in the Intent-to-Treat Population the RR (95% CI) was 1.32 (0.3, 36.9). Multiple regression analysis showed that the significant variables associated with the insertion failure were the number of Caesarean section ≥1 (P = 0.020) and the use of placebo (P = 0.026). Dilators were used in 21 (43.7%) out of the 48 and 21 (50%) out of the 42 women randomized to misoprostol and placebo, respectively (P = 0.804). The limitations were that the majority of the women chose the LNG-IUS, and consequently the data for the Cu-IUD were limited, and there was a small number of nulligravidas. The results show that IUC insertion difficulties and failures are not common. Pretreatment with intravaginal misoprostol facilitated IUC insertion after failure of insertion at the first attempt, and insertion failure was associated with number of Caesarean sections. This study received partial financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant # 2012/10085-0, and from the National Research Council (CNPq), grant #573747/2008-3. All the TCu380A IUDs were donated by Injeflex, São Paulo, Brazil, and all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA), Turku, Finland. Both donations were provided in the form of unrestricted grants. The authors declare that there are no conflicts of interest associated with this study. ClinicalTrial.gov NCT01754649.

MISOPROSTOL VS OXITOCINA EN LA INDUCCIÓN DEL PARTO EN LA RUPTURA PREMATURA DE MEMBRANAS

OBJETIVO: Evaluar las características y complicaciones del trabajo de parto inducido con misoprostol intravaginal versus oxitocina endovenosa, en gestantes a término con ruptura prematura de membranas (RPM) sin evidencia de trabajo de parto espontáneo. DISEÑO: Estudio retrospectivo, descriptivo y comparativo. LUGAR: Servicio de Obstetricia del Hospital Loayza. MATERAIL Y MÉTODOS: Se revisó las historias clínicas de 92 gestantes a término con RPM, en condiciones para ser inducidas. Se evaluó los efectos de la oxitocina endovenosa en 49 pacientes (grupo 1], según protocolo, versus misoprostol intravaginal en 43 pacientes (grupo2), u dosis de 50 mg cada 4 horas hasta conseguir una dinámica uterina adecuada o alcanzar 300 mg. RESULTADOS: La inducción fue más exitosa en el grupo de misoprostol (74,4%) en comparación a oxitocina (61,2%), pero sin significación estadística (p= 0,18). El intervalo desde el inicio de la inducción hasta el parto fue significativamente menor en multíparas y con empleo de oxitocina (426,1 ± 208,4 min) que con misoprostol (621,9 ± 267,7) (p&lt;0,001). No hubo diferencia significativa en el tipo de parto, signos de sufrimiento fetal, distocia funicular y otras complicaciones en el parto y posparto. CONCLUSIONES: El misoprostol por vía intravaginal es una alternativa efectiva en la inducción del trabajo de parto en gestantes a término con RPM; en nuestro estudio no incrementó la tasa de cesáreas y las complicaciones maternas y neonatales fueron similares.

MISOPROSTOL EN LA INDUCCIÓN DEL TRABAJO DE PARTO EN EL EMBARAZO POSTÉRMINO

OBJETIVO: Evaluar las características y complicaciones de trabajo de parto inducido con misoprostol intravaginal, en gestantes postérmino (edad gestacional &gt; 41 semanas) y cervix no favorable. DISEÑO: Estudio descriptivo y retrospectivo. LUGAR: Servicio de Obstetricia del Hospital Uldarico Roca Fernández, EsSALUD, desde enero hasta diciembre de 2001. MATERIAL Y MÉTODOS: A 104 pacientes con diagnóstico de embarazo pstérmino, con pruebas de bienestar fetal adecuadas, se administró una dosis de 50 microgramos de misoprostol intravaginal cada 6 horas hasta un máximo de 4 dosis o alcanzar 200 microgramos, hasta conseguir una dinámica adecuada de trabajo de parto. RESULTADOS: Se obtuvo 87 partos vaginales, de los cuales 67 (77%) ocurrieron antes de las 24 horas, observandose un menor tiempo en las multíparas (11,5 + 7,1 horas) versus las nulíparas (17,1+11,4 horas); 74 (85%) casos sólo requirieron dos dosis de misoprostol. La tasa de cesáreas fue 16,3% (17 casos), siendo la causa principal inducción fallida en 11 casos (64,7%). Hubo 4 casos de taquisistolia (3,6%) y 2 casos dee hipertonía (2,9%). No hubo recién nacidos con Apgar menor de 7 a los 5 minutos. CONCLUSIONES: El uso de 50 microgramos de misoprostol intravaginal es un método eficaz y relativamente seguro para la inducción de parto, asociándose a una disminución significativa en la tasa de cesáreas, requiriéndose de monitorización cardiofetal estricto durante la inducción.

Misoprostol como inductor del parto serie de casos en el HNCH 2003-2004

OBJETIVO: Evaluar las características del trabajo de parto, parto y resultados perinatales de las pacientes que fueron inducidas con misoprostol intravaginal. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo desarrollado en el Departamento de Ginecología y Obstetricia del Hospital Nacional Cayetano Heredia durante el período julio 2003 a junio 2004. Se evaluó las historias clínicas de 139 pacientes con indicación de terminar gestación y a las que se había administrado una dosis de 25 microgramos de misoprostol intravaginal. RESULTADOS: Se obtuvo 113 partos vaginales, de los cuales 85 (61,2%) ocurrieron antes de las 24 horas, observándose un menor tiempo en las multíparas (17,4 ± 10,4 horas) versus las nulíparas (21,1 ± 13,3 horas); 58 (41,7%) pacientes sólo requirieron 1 dosis de misoprostol para tener un parto vaginal. La tasa de ceráreas fue 18,7% (26 casos), siendo la causa principal patrón no tranquilizador en 8 pacientes (30,8%). hubo 2 casos de taquisistolia (1,4%) y 1 de síndrome de hiperestimulación (0,7%). El 20% de partos presentó líquido amniótico meconial. hubo 1 (0,7%) caso de Ápgar &lt;7 a los 5 minutos. Se hospitalizó 4 neonatos (2,8%). No hubo muerte materna ni neonatal. CONCLUSIONES: El uso de misoprostol intravaginal es útil para la inducción del trabajo de parto. Se presentaron tasas bajas de efectos adversos maternos y perinatales.

FREQUENCY OF COMPLETE ABORTION WITH INTRAVAGINAL MISOPROSTOL VERSUS EXTRA AMNIOTIC CATHETER IN TERMINATION OF SECOND TRIMESTER PREGNANCY

Termination of pregnancy in Mid-trimester is one of the most controversial areas in gynecological practice. As a cause of maternal mortality, it is one of the major neglected health issues in Pakistan and it is the third major cause of maternal mortality in our country. The study aim was to establish safe and effective method for abortion in second trimester.&#x0D; Objectives: The objectives of this study was to compare the frequency of complete abortion with intravaginal misoprostol versus extra amniotic catheter in termination of second trimester pregnancy.&#x0D; Main outcome measure: It was the frequency of complete abortion in second trimester.&#x0D; Study design: Randomized Controlled Trial&#x0D; Setting: Obstetrics &amp; Gynaecology Department, PGMI / AIMC/LGH, Lahore.&#x0D; Subjects: Female patients of age range 18-35years with gestational age 13-20 weeks calculated through last menstrual period (LMP).&#x0D; Duration: 6 months (1st November 2015 to 30th April 2016)&#x0D; Methods: Two hundred ten patients were admitted from OPD of LGH. Informed consent. We randomly divided patients in equally two groups by lottery method. In group A, females were given misoprostol 600g vaginally followed by 400g eight hourly till expulsion of products or up to 48 hours(n=105). Group II, had Foley’s catheter traction and 1ml PGF2 alpha diluted in 19cc normal saline and 1cc/hr injected extra amniotically in control group (n=105), which was removed after expulsion of products of conception or after 24 hours. Women were observed for 48 hours for spontaneous expulsion of products.&#x0D; Results: 210 patients were included in the study. The mean age of patients was 27.50 years with standard deviation of 2.82 years with most of the patients in the age range 25-30 years. Most of women in the study group were multiparous (54.8%) with 52.9% of sample in gestational age range 17-20 weeks with mean gestational age 17.5 weeks. A total of 173 patients (82.4%) out the 210 patients included in the study had complete abortion as per the operational definition. No statistically significant difference was found when comparison was done with respect to age, gestational age and parity (p&gt;0.05). Frequency of complete abortion was then compared in the study groups (misoprostol versus extra amniotic catheter). It was found that patients in the misoprostol group had significantly higher complete abortion rate as compared to those who were in the extra amniotic catheter group with a p value of 0.007.&#x0D; Conclusion: This study showed that misoprostol results in significantly higher frequency of complete abortion in second trimester compared to extra amniotic catheter. So Misoprostol is a very effective, easily useable, safe and cheap drug for second trimester termination of pregnancy.

Comparing vaginal misoprostol versus Foley catheter plus vaginal isosorbide mononitrate for labor induction

Objective(S): To compare the effectiveness and safety of intra-cervical Foley catheter combined with intra-vaginal isosorbide mononitrate (IMN) versus intra-vaginal misoprostol for cervical ripening and labor induction in pregnant women with unripe cervices.Methods: Open-labeled randomized controlled trial in Cairo university hospital, Cairo, Egypt during 2012–2014. Three hundred and ninety-five pregnant women at term or post-term with an indication for labor induction and unripe cervix were included in the study. The subjects were randomly divided into two groups. Vaginal misoprostol was used in group 1 (n = 197) and intra-cervical Foley catheter plus vaginal IMN in group 2 (n = 198). Our main outcome measure was cesarean section rate.Results: Among the 395 included patients there were significantly lower duration of induction of labor (p < 0.001) in group 1with lower cesarean section rates [22.8% in group 1versus 33.3% in group 2; RR 0.7 (0.6–0.9), (p = 0.020)]. Whereas the uterine hyperstimulation (p < 0.001) was significantly higher in group 1. There were no significant differences between both groups as regard patients’ demographic characteristics.Conclusions(s): Vaginal misoprostol is more effective but less safe than Foley catheter combined with vaginal IMN for induction of labor in term and post-term pregnancy.

Foley Catheter versus Vaginal Misoprostol for Labour Induction.

Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25 μg of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p < 0.01). The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley's catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour.

Comparison of the efficacy and safety of intracervical dinoprostone gel and intravaginal misoprostol tablet as a cervical ripening agent

Background: Cervical ripening is an important prerequisite for successful induction of labor, a procedure that is frequently necessary because of medical or obstetrical complications. Of several methods of ripening, intracervical dinoprostone gel and intravaginal misoprostol tablet are the most frequently used methods. Objective: To compare the efficacy and safety of intracervical dinoprostone gel and intravaginal misoprostol tablet as a cervical ripening agent. Materials and Methods: A total of 138 pregnant women satisfying the inclusion criteria were studied. They were divided into two groups: 72 in group 1 (dinoprostone gel) and 66 in group 2 (misoprostol tablet). The safety and efficacy of both the drugs were analyzed. The primary outcome variables were change in Bishop’s score, induction to delivery (I-D) time, Apgar score, and incidence of abnormal uterine action. The secondary outcome variables were need for oxytocin, indication for caesarean section, and mode of delivery. Statistical analysis was done using the unpaired t-test and X2-test. Results: No difference was observed between the two groups with respect to change in Bishop’s score (3.015 vs 3.625, p > 0.05), but I-D time was more for group 1 (i.e., 15.04 vs 11.48 h, p < 0.05). Apgar scores were also similar in both the groups, that is, the number of babies with Apgar score of 0.05. Abnormal uterine action was not seen at all in group 1, whereas three patients had this problem in group 2. In secondary variables, requirement of oxytocin was more in group 1 (i.e., 48 vs 22, p < 0.05). In various indications of caesarean section, none got operated for abnormal uterine action in group 1, whereas three patients got operated for this reason in group 2. Mode of delivery was similar in both the groups. Conclusions: Dinoprostone and misoprostol are similar in their action on cervical ripening. Misoprostol has an added benefit of being a uterotonic agent. Therefore, it has less I-D time. Low-dose of misoprostol has decreased the incidence of side effects.

Comparative Study of Efficacy of Extra-amniotic Ethacridine Lactate with Oxytocin Versus Extra-amniotic Ethacridine Lactate with Intravaginal Misoprostol for Termination of Pregnancy with IUD Anamolous Fetuses in Second and Third Trimesters

Termination of a pregnancy in second and third trimesters involving a dead foetus or one with a lethal anomaly is a challenge for health-care professionals in any setting. In addition to the theoretical concern of the dead foetus inutero causing disseminated intravascular coagulation, continuation of such a pregnancy may not be psychologically and socially acceptable to many women, and both the woman and the caretaker are keen to terminate the pregnancy, preferably without an incision on the uterus. Mid-trimester termination of pregnancy is one of the most controversial areas of gynaecological practice. It has moral, emotional, social and technical issues. There is continuous need for termination of pregnancy in second trimester, more recently due to increase in the use of antenatal diagnostic procedures. Nowadays, majority of mid-trimester abortions are carried out medically. The development of prostaglandin analogues has been a major breakthrough in abortion technology. Natural prostaglandins such as PGE1, PGF2a, PGE2, PG analogues like 15-methyl PGF2a have been used by various routes such as intravenous, intramuscular, intra/extra amniotic, oral and vaginal. Ethacridine lactate works by producing prostaglandin from deciduas, whereas misoprostol being synthetic analogue of misoprostol is supposed to act directly. This study aims to evaluate the effectiveness and safety of the extra-amniotic instillation of ethacridine with vaginal misoprostol in comparison to extra-amniotic instillation of ethacridine lactate with oxytocin IV infusion in terminations of second and third trimester pregnanciesin a tertiary referral hospital catering for both rural and urban population. This study concludes that ethacridine lactate with misoprostol is as efficacious as ethacridineplus oxytocinin termination of second and third trimesters anamolus/IUD foetuses. Though there is no significant difference in efficacy between the two. The ethacridineplus misoprostol is slightly effective in reducing the I-A interval. The efficacy of ethacridine plus misoprostol is slightly higher in early second trimester and ethacridine plus oxytocin is effective in the third trimester.