Micrograms Of Misoprostol Research Articles

Effectiveness of Misoprostol Versus Manual Vacuum Aspiration for the Treatment of the First Trimester Pregnancy Termination

Objective: To compare the effectiveness of misoprostol versus manual vacuum aspiration (MVA) in the treatment of pregnancy termination at first 12 weeks of pregnancy, evaluating the outcomes among women undergoing these procedures. Methodology: A comparative analysis was carried out at the Obstetrics and Gynaecology department of Bakhtawar Amin Hospital, Multan from January 2023 to December 2023, included pregnant women presented with age of gestation age up to 12 weeks, open cervical os and indication for elective termination of pregnancy. Participants were randomized into two groups. Misoprostol group received 400 mcg of misoprostol intravaginally every 4 hours for up to three doses for softening cervix, its dilatation, and uterine contractions, with starting oxytocin infusion after 6 hours. While manual vacuum aspiration group underwent the procedure under general anesthesia without receiving any uterotonics. Patients were followed up on the 7th day post-procedure, undergoing ultrasonography to measure endometrial thickness for efficacy assessment based on complete abortion. Results: A total of 126 patients were comparatively studied; 63 in each group with mean age in the Misoprostol group was 33.45±3.11 years, and was slightly lower the MVA group as30.22±4.76 years. The average gestational age at the time of treatment was almost similar between the groups, 8.33 ±1.29 weeks for Misoprostol group and 7.99±2.56 weeks for the MVA group. The Misoprostol group exhibited an efficacy rate of 95.20% among patients, compared to 90.50% in the MVA group (P=0.148). Furthermore, the efficacy between Misoprostol and MVA across different age groups, gestational ages, and parity, was statistically insignificant (p->0.05). Conclusion: Basis on the study findings, the efficacy of misoprostol for first trimester termination of pregnancy was observed to be 95.20%, slightly higher than the 90.50% with manual vacuum aspiration (MVA).

Unusual clinical case: Pharmabortion in a patient with a donor kidney

The study presents an algorithm for drug-induced abortion and prevention of complications after the procedure, with a clinical efficacy rate of 99.7%. In addition, a unique case is presented, involving the use of drugs to terminate a short-term pregnancy in a patient with chronic glomerulonephritis that affecting her kidney and chronic pyelonephritis in a previously transplanted second kidney. Given the lack of urinary organ dysfunction and the absence of clinical worsening of any somatic pathology at present, the medical consilium has determined that pharmabortion is permissible under dynamic monitoring of the patient. A single oral dose of 600 mg of mifepristone, followed by twice-daily administration of 400 mcg of misoprostol (per os) 36 h later, effectively terminated the unwanted pregnancy without adverse effects on extragenital diseases. Administering the gestagenic drug during the second phase of the menstrual cycle after abortion prevented ovarian dysfunction and endometrial hyperplasia.

Pharmacist provision of medication abortion: A pilot study

ObjectivesThis study aimed to perform a “proof of concept” pilot and assess patient satisfaction of pharmacist provision of medication abortion utilizing an implementation toolkit. Study designPharmacists completed an online and in-person training followed by an online assessment prior to participating in the pilot. Pharmacists provided medication abortion care using a “no-test” protocol and an implementation toolkit. Participants were administered 200 mg of mifepristone orally on the day of their abortion visit and instructed to take 800 mcg of misoprostol buccally 24 to 48 hours later (with an additional 800 mcg buccally 4 hours after the first dose for patients 63–70 days' gestation). Visits were completed in person in a private room adjacent to the pharmacy. We assessed the rate of completed abortions and any complications. Following their abortion, patients completed a brief interviewer-administered survey and semistructured qualitative interview. ResultsTen patients completed medication abortion visits. Nine of 10 participants had complete abortions. One participant identified that she did not pass her pregnancy and underwent an in-office aspiration. One participant visited an emergency department for pain and received pain medication. No serious adverse events occurred. All patients completed the postabortion survey, and all were “very satisfied” with their abortion experience. Nine patients completed postabortion interviews. ConclusionsIn this pilot study, pharmacists were successful at providing medication abortion to patients. Satisfaction was high, and complications were uncommon. ImplicationsPatients were highly satisfied with pharmacist provision of medication abortion and are likely to utilize this service if available.

Propranolol and Misoprostol versus Misoprostol Alone for Induction of Labour in Primigravidas

Background Induction of labor is indicated when risks to maternal or fetal health out weight benefits of continuing the pregnancy. One of the most common reasons for labor induction is postterm pregnancy (ie,> 41 weeks of gestation). Objectives The aim of the study is to compare propranolol and misoprostol versus misoprostol alone for induction of labour in primigravidas. Patients and Methods This study included one hundred and twenty eight pregnant fullterm primigravida women, they were divided randomly into two equal groups. In both group, every patient received 25 microgram of misoprostol vaginally under aseptic prequations then every 6 hours with maximum 4 doses until efficient uterine contractions is reached three or more in 10 minutes each lasting for 45 seconds for induction of labor. Then after 30 minutes patients in group A received oral propranolol 20 mg and patients in group B received oral placebo in the form of sugary tablets, then womens monitored for fetal and maternal wellbeing and progress of labor. Results In this study, all the parturients were primigravid, it was highly considered to recruit parturient of almost similar conditions. The mean age of women included in the study was (23.3+/4.1) and the mean gestational age of the parturient was range (38 – 42) weeks. The mean pre induction Bishop score was range (2-6), we select only women with Bishop score of 6 or less considering the fact that the main goal for using medication for induction of labor was the reppening of an unfaverable cervix. There was no statistical difference between both groups as regards initial basic characteristics. There was no statically significant difference between propranolol and placebo research group regarding birth weight, apgar score at 1 and 5 minutes and NICU administration and patients satisfaction. Conclusion From the previous results regarding the propranolol effectiveness and safety, it dose not seem to negatively influence the fetus as apgar score at 1 and 5 minutes and the need for NICU admission were not influenced by its administration. And on the other hand, propranolol was significant in reduction the time latent phase and therefore the total duration of labor. Taking in mind this significant results it seems that propranolol might become a useful obestetrical tool for induction of labor in the future.

Maternal and fetal outcomes in women undergoing induction of labor with low dose vaginal misoprostol.

To determine Maternal and Fetal outcome in women undergoing induction of labour with low dose misoprostol. A cross-sectional study was carried out to determine the efficacy of Misoprostol for induction of labor (IOL) in MTI, Lady Reading Hospital (LRH), Peshawar from 21st January to 31st December 2021. All pregnant women with singleton pregnancy and cephalic presentation admitted for Induction of Labor were included in the study. Maternal and Fetal outcome was noted. Induction of labor was started with 25 micrograms of Misoprostol, repeated every six hours depending on Bishop Score. Three hundred and thirty-seven women were included in this study. The majority of females (76%) were in 18-35 years age group. In 92.3% of females, the Bishop score was less than six. The maximum number of females (33.5%) delivered after eight hours of IOL. Sixty-six (66.46%) of females had gestational age of 37-40 weeks. Premature rupture of membranes was the most common indication (32.9%). Three doses of misoprostol were required in 31.2% of females. Only 5.6% of females required six doses of misoprostol for induction. With Misoprostol 85.1% of females delivered spontaneously, 2.37% required forceps delivery, 1.7% required vacuum delivery, and 10.68% delivered by Caesarean Section. APGAR score was 8 /10 in 84% of neonates at birth. Eighty-seven %(87.8%) of neonates did not require NICU admission. Misoprostol is a safe medicine to be used to induce labor in females. It can help shorten the duration of labor, with good fetomaternal outcome.

Comparison between different dose regimens of misoprostol in termination of early pregnancy

Objective: compares efficacy & side effects of vaginal put of 400 or 600 microgram of cytotic in repeated doses in termination of first trimester gestational age. Desgn: Randomized prospect study. Setting and duration of study: Maternity teaching hospital in Sulaimani from 1st of January to the end of June 2009. Patients and methods: This study was included 90 pregnant women admitted during first trimester of gestation, requiring termination of pregnancy because of fetal demise. These patient are divided into two groups: (45) women received 600 mcg of misoprostol vaginally and other group 45 were received 400 mcg of it also vaginally. Misoprostol was given every 6hr for three doses. They were observed and evaluated in 24 hours.Result: Group1 had a complete abortion rate of 35.6% while group2 abortion rate of 13.3% this was significant. The time interval from put abortion was 8.04 ± 4.280 hours in group1 and 9.62 ± 5.237 hours in group2. Side effects such as diarrhea, nausea and headache showed no statistically significant difference in both patients.

Medical Termination of Pregnancy up to 28 Weeks -A Tertiary Care Hospital Study in Bangladesh

Background: Early pregnancy failure is a major public health problem throughout the world. It has been estimated that over 10-20% of pregnancies end up in spontaneous abortion and 80% of all these occur before 12 weeks. Mifepristone and Misoprostol are drugs, which are easy to store and require no surgical skills to administer, providing an alternative to surgical intervention that could increase access to abortion care. Objective: The objective of the study was to evaluate the safety, effectiveness, and acceptability of oral mifepristone and misoprostol for the termination of first- trimester pregnancy. The study was carried out in the department of Obstetrics and Gynecology, Holy Family Red Crescent Medical College Hospital, Dhaka, conducted from June 2021 to May 2022. Methods: A total of 80 women participants of reproductive age group with miscarriage at gestational age up to 28 weeks attended the outdoor of Holy Family Red Crescent Medical College Hospital, Dhaka. A complete history was taken from each patients and accompanying attendants. A thorough clinical examination was done. Relevant investigation reports were collected. Patients were given a tablet of Misoprostol on day 1. Mifepristone & Misoprostol, in the divided dose and repeated after 2 weeks & after 2 weeks only misoprostol is given for 3 days as per needed. They were followed up for 1-3 days before discharge. Participants were asked to return to the hospital two weeks later to conform to clinical status. If incomplete termination was determined by clinical exam or by ultrasound in either of the study arm, women were given the option for surgical evacuation or 500 mcg of Misoprostol for additional follow-up 1 week later to see if expulsion would have occurred spontaneously. If, after the second follow-up visit, abortion was not complete, a surgical completion was performed. Results: Patients belonged to the age group 18-25 years. Maximum numbers of cases were multiparous and belonged to 7-8 .........

Efficacy of Preoperative Misoprostal in Reducing Hemorrhage during Abdominal Myomectomy

Objective: The aim of this study is to determine the efficacy of preoperative misoprostal in reducing hemorrhage during abdominal myomectomy. Study Design: Prospective comparative randomized double blinded Place and Duration: Conducted at DHQ Zanana hospital Dera Ismail Khan for one year duration from January 2019 to December 2019. Methods: Total 100 patients underwent abdominal myomectomy were presented in this study. Patients were aged between 18-45 years of age. Patients’ detailed demographics including age, body mass index and parity were recorded after taking informed written consent. Patients were categorized equally into two groups, I and II. Group I had 50 patients and received single dose 400 micrograms of misoprostol transrectally one hour preoperatively and group II had 50 patients and received 2-tablets of placebo preoperatively. Outcomes intraoperative blood loss, blood transfusion, hysterectomy and complications among both groups were assessed. Complete data was analyzed by SPSS 23.0 version. Results: Mean age of the patients was 32.16±9.44 with mean BMI 26.07±10.44 kg/m2. There were no significantly difference among age and body mass among both groups. 60 Patients had 0 parity, 30 patients had parity 1 and the rest were had parity 2. Mean pre-operative hemoglobin in group I was 13.64±8.55 and post-operative was 9.88±8.55 and in group II mean pre-operative hemoglobin was 13.55±8.55 and post-operative was 9.12±5.55. Mean intraoperative blood loss in group I was 388.17±37.18 ml and in group II was 501.16±17.64 ml. Post-operatively blood transfusion in group I was among 2(4%) cases and 3 (6%) in group II. Mean hospital stay in group II was greater as compared to group I. Nausea, vomiting and shivering were the complications found in this study. Conclusion: We concluded in this study that the use ofmisoprostol preoperatively during abdominal myomectomy was effective safe and useful in reduction of intraoperative blood loss and post-operatively blood transfusion among patients. Keywords: Abdominal myomectomy, Misoprostol, Placebo, Intraoperative, Blood loss

Induction of labour with oral misoprostol solution 20 microgram versus vaginal misoprostol 25 microgram 6th hourly

Induction of labour is the artificial initiation of labour before the spontaneous onset, and it is the common obstetric intervention. To compare the potency of oral misoprostol solution with vaginal misoprostol to induce labour at term. This randomized control study was carried out from July 2020 to September 2020 at Government General Hospital, Kakinada. : 80 women requiring induction were recruited in the study. The women were randomized to receive 20 micrograms of oral misoprostol solution every 2 hourly or vaginally 25 micrograms of misoprostol every 6 hourly until the labour sets in the active phase of labour. Delivery within 24 hours was the outcome in the study. Data were documented in Microsoft excel and analyzed using SPSS software. : 82.5% of women in the oral group delivered by spontaneous vaginal delivery, whereas 75% in the vaginal group. In the oral group, 37.5% of delivery occurred within 6-12 hours, 40% delivered within 12-18hours duration, whereas in the vaginal group, 12.5% delivered within 6-12hours duration, 50% delivered within 12-18hours duration. Oxytocin augmentation was required in 25% of the oral group, whereas 42.5% in the vaginal group. Meconium stained liquor was 12.5% in the oral group, whereas 20% in the vaginal group.12.5% underwent cesarean section in the oral group, 10% in the vaginal group. Compared with vaginal misoprostol, oral misoprostol solution results in shorter induction delivery interval and less oxytocin augmentation required.

CLINICAL ORAL ABSTRACTS: Safety and efficacy of no-test medication abortion: A retrospective multi-site study

<h3>Introduction</h3> The COVID-19 pandemic brought new attention to medication abortion because it does not require direct physical contact between patient and clinical staff. No-test approaches for medication abortion preserve the usual standard of care, except that they replace the in-person ultrasound or physical exam before the abortion with other evidence-based methods to assess the patient's duration of pregnancy and screen for ectopic pregnancy. Early in the pandemic, a no-test sample protocol was published to offer guidance for clinical practice. However, little has been published on the safety and efficacy outcomes of no-test approaches. <h3>Method</h3> Through webinars and personal contacts, we invited US-based clinics that had adopted the no-test medication abortion protocol to join the study. A no-test medication abortion was defined as not having a preabortion ultrasound or physical exam. Participating clinics abstracted data from medical records of all patients who received a no-test medication abortion and entered them into a REDCap database. We conducted descriptive analyses of the clinic protocols and the patient sample. We also developed a multilevel, multivariable model that accounted for clustering at the clinic-level to estimate the adjusted odds of medication abortion failure and adverse events. <h3>Results</h3> We included 11 clinics, 4 of which contributed some data from the TelAbortion Study. Clinics shared data on 791 patients served from Jan. 1 to Dec. 31, 2020. Among all patients, 58.1% received mifepristone in person and 41.9% received it by mail. At mifepristone provision, patients' pregnancy durations ranged from 27 to 74 days; 36.4% were <=42 days, 45.3% were 43 to 56 days, 16.4% were 57 to 70 days, and 1.9% were >71 days. We received at least some follow-up data for 626 patients (79.1%) and excluded 14 patients who did not take mifepristone. Of the remaining 612 patients, 5 (0.8%) experienced serious adverse events defined as hospital admission, abdominal surgery and blood transfusion. One patient had a confirmed ectopic pregnancy and was admitted to a hospital for salpingectomy 9 days after provision of mifepristone (included as a serious adverse event). Abortion outcome data were available for 394 patients (64.4%). Overall, 94.7% (95% CI: 92.0% to 96.7%) of patients had a complete abortion with <1600 mcg of misoprostol, without an aspiration, procedure, or more mifepristone and misoprostol. 2 patients had suspected or confirmed ongoing pregnancies. Outcomes were similar for those who received medications in-person and those who received them by mail. <h3>Conclusions</h3> No-test medication abortion with either in-person pick up or mailing of medications is effective and safe, with outcomes similar to rates found in the published literature. Moreover, omitting tests reduce COVID-19 risk and conform with FDA REMS requirements when combined with in-person pick up. Follow up rates (64.4%) with the NTMA approach were similar to other medication abortion protocols. Combining no-test medication abortion protocols with mailing of medications to patients would support public health efforts for those who want to avoid a clinic visit.

Letrozole And Misoprostol Vs. Misoprostol Alone In Management of First Trimester Missed Abortion, A Randomized Controlled Trial At Banha University Hospitals.

Foundation: Miscarriage occurs when a pregnancy ends before 20 weeks of gestation or when an embryo is conceived that weighs less than 500 grams. Inducing early termination with drugs is a medical treatment mediation option with financial benefits but lower outcomes, and a 60 to 95 percent success rate. The aim of this study was to determine the efficacy and safety of letrozole pretreatment with misoprostol versus misoprostol alone in the treatment of missed first-trimester abortions. The outpatient clinic and emergency division of the obstetrics and gynecology department at Banha university hospitals were the focus of this investigation. For each patient, an itemized history was taken and a careful review was completed. Basic tests such as hemoglobin, blood collection, RH, and trans-vaginal ultrasound were also performed on patients prior to the investigation First group, the patients were given 600 mcg of misoprostol (three tablets, each 200 mcg) orally as a single dose. second group, the patients were given letrozole 10 mg (4 tablets, each 2.5 mg) as a single dose for three days, followed by 600 mcg misoprostol orally. Results and end: When letrozole is used before misoprostol for the termination of a missed abortion in the first trimester, the full fetus removal rate is higher than when misoprostol is used alone. Along these lines, in cases of first trimester missed abortion, it is recommended to use letrozole accompanied by misoprostol instead of misoprostol alone for enlistment of early termination.

Labor Induction with Oral Misoprostol in Term Pregnancy: A Clinical Trial

Introduction: Induction of labor has become an increasingly utilized obstetric intervention in developed countries. It contributes to reduce the maternal and perinatal morbidity and mortality. Dinoprostone derivatives are often used under cardiotocography. In poor countries, health structures have neither fetal monitoring, nor means of preserving Dinoprostone derivatives. Misoprostol therefore constitutes an alternative. This study seeks to establish the efficacy and safety of oral Misoprostol and to assess maternal and perinatal prognosis in an area with limited resource. Methods: This is a multi-center clinical trial, conducted in 3 hospitals centers in Kisangani, Tshopo Province/Democratic Republic of Congo from December 1, 2020 to May 31, 2021. Our sample was constituted with 68 pregnant women with term pregnancy. Fifty micrograms of Misoprostol was administered orally. The data were collected prospectively, their encoding was carried out on an Excel sheet 2013 and their analysis carried out using the EPI INFO software. Results: The average age of the pregnant women was 23.17 ± 5.76 years. The average parity was 1.02 ± 1.2. The average body mass index (BMI) was 24.98 ± 2.55 Kg/m2. 66 (97.1%) patients had received a maximum of 3 doses of Misoprostol. Out of the 16 parturients who received 3 doses or more, 11 (68.8%) had a BMI ≥ 25. The average duration of labor was 16.03 ± 7.99 hours. 66 (97.1%) pregnant women had delivered vaginally. 57 (83.8%) patients delivered within 24 hours. Out of the 11 patients who delivered after 24 hours, 7 (63.6%) had a BMI ≥ 25. The induction failure rate was 2.9% (2 patients). 2 (2.9%) fetuses had presented pathological modification of fetal heart rate (FHR). 2 (2.9%) patients had undergone cesarean section. Conclusion: Labor induction with oral Misoprostol is effective and associated with low maternal and perinatal morbidity. A BMI ≥ 25 kg/m2 increases the number of doses to be given and the duration of labor.

Evaluation of efficiency of Sublingual misoprostal and vaginal misoprostal administration for induction of labour

Objective: To determine the efficacy and safety of misoprostol administered sublingually and vaginally for induction of labour. Material and Method: A randomized control trial was conducted on antenatal women for 18 month period from 1st Jan 2015 - 30th June 2016 admitted to Obstetrics & Gynaecology department of Era’s Lucknow Medical College and Hospital Lucknow. Total 120 antenatal women of 37 weeks or more gestational age fulfilling the inclusion criteria were enrolled in the study and they were randomly divided in to two groups (60 women in each group) sublingual group where they received 25 microgram misoprostol sub lingual and vaginal group where25 microgram of misoprostol was administered per vaginally .Same dose was repeated every four hour until 3 or more uterine contraction of 40sec duration occur over 10 minutes, or when a maximum of six doses i,e 150 microgram was reached and labour outcome was noted. Result: In our study the mean induction –delivery interval in sub lingual group was 13.28 hour and12.96 hour in vaginal group. The rate of caesarean section in the sublingual group was31.7% and invaginal group it was found to be 20%. However, it was not statistically significant. No significant side effect of misoprostol was seen during the study. Conclusion: Sublingual route of misoprostol administration is as efficacious and safe as vaginal route for induction of labour. Keywords: Misoprostol, Caesarean section, Labour.

Use of low dose vaginal misoprostol in office hysteroscopy: a pre–post interventional study

A pre-post interventional study of patients undergoing office hysteroscopy alone and in combination with endometrial biopsy was performed during October 2015–March 2018 to evaluate the effect of low dose vaginal misoprostol on patient’s pain. Pain scores were assessed using the visual analog scale at the completion of the procedure. There were 646 patients included in the study. Of these, 462 had office hysteroscopy alone; 206 (44.6%) received 50 mcg of vaginal misoprostol the night prior to the procedure and the remaining 256 (55.4%) patients had no cervical ripening. The reported pain score following hysteroscopy was significantly lower among patients who received misoprostol [4(0–10) vs. 5(0–10); p=.001]. Most patients (78.2%) did not report any misoprostol related side effects. Of the 184 patients who underwent a combination of office hysteroscopy and endometrial biopsy, 97 (52.7%) received pre-procedure vaginal misoprostol while 87 (47.3%) did not. Post procedure pain was independent of pre-treatment with vaginal misoprostol (6.3 ± 2.7 vs. 6.6 ± 2.7; p = .54). Impact statement What is already known on this subject? Office hysteroscopy and endometrial biopsy is increasingly performed for evaluation of various gynaecologic conditions, however, patients’ perceived pain at the time of procedure may lead to incomplete procedures. Various doses of misoprostol have been tested to reduce patients’ pain, however none lower than 200 mcg vaginally, and at these doses, side effects are reported. What the results of this study add? To date, there is a scarcity of published data on the use of low dose misoprostol (50 mcg) in gynaecologic procedures. Our study found that the use of low dose vaginal misoprostol prior to office hysteroscopy is associated with lower reported pain and tenaculum utilisation during the procedure. However, vaginal misoprostol prior to successive office hysteroscopy and endometrial biopsy failed to decrease the reported pain, and the overall pain score was higher than hysteroscopy alone. What the implications are of these findings for clinical practice and/or further research? The use of low dose vaginal misoprostol (50 mcg) the evening prior to office hysteroscopy is associated with lower reported pain and tenaculum utilisation and is not associated with significant side effects. Therefore, 50 mcg of misoprostol could be used in clinical practice as a method to reduce patients’ reported pain during office hysteroscopy.

Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment.

This study sought to understand the experience of buying misoprostol online for pregnancy termination in Indonesia. We conducted a mystery client study August through October, 2019. Interactions were analyzed quantitatively and qualitatively, along with the contents of the packages. One hundred ten sellers were contacted, from whom mystery clients made 76 purchases and received 64 drug packages. Almost all sellers sold “packets” containing multiple drugs; 73 percent of packets contained misoprostol, and 47 percent contained at least 800 mcg of misoprostol. Thirty‐four packets contained insufficient drugs to complete an abortion. When compared to WHO standards, 87 percent of sellers imparted incomplete information about potential physical effects; no seller provided information about possible complications. Women buying misoprostol from informal online drugs sellers will be underprepared for understanding potential side effects and complications. Educational activities are needed to increase women's access to information about safe use of misoprostol as a harm reduction strategy.

Misoprostol With or Without Letrozole for Treatment of Missed Miscarriage: A randomized controlled trial

Presentation Misoprostol is utilized for the clinical administration of unnatural birth cycle as it is more compelling in the beginning phases of pregnancy. Letrozole has an enemy of estrogen impact and is utilized for the pretreatment of premature delivery with misoprostol. Intend To look at the viability and wellbeing of letrozole with fake treatment pretreatment in the clinical administration of first trimester missed unsuccessful labor. Plan an imminent randomized twofold visually impaired case-control study.Patients and Methods Patients with missed unsuccessful labor of pregnancy as long as 63 days. 320 ladies were arbitrarily isolated into two gatherings of 160; the fake treatment bunch got fake treatment tablets once day by day for 3 days, trailed by 800 micrograms of misoprostol vaginally on the Third day of enrolment, while the letrozole bunch got letrozole 7.5 mg once every day for three days followed by same portion of vaginal misoprostol. The total fetus removal rate and Hb shortage of the two gatherings were looked at. The essential result measure was the finished fetus removal rate. Results A sum of 320 ladies were enrolled. The total premature birth pace of the letrozole bunch was fundamentally higher than that of the fake treatment gathering (82.6% contrasted and 68.2% (p < 0.001). There were noteworthy Hb shortage in letrozole gathering (p= 0.011) with non-huge factual distinction deprived for blood bonding. End Adding letrozole to misoprostol is related with a higher complete fetus removal rate

Is Unfavourable Cervix prior to Labor Induction Risk for Adverse Obstetrical Outcome in Time of Universal Ripening Agents Usage? Single Center Retrospective Observational Study.

Cervical assessment on the Bishop scale prior to induction of labor (IOL) is one of the strongest prognostic criteria in relation to the success of the procedure. The commonly used preinduction methods are mainly aimed at reducing the percentage of cesarean sections. Our study has analyzed obstetric results of patients who had unripe cervix (Bishop score <7) before IOL and used preinduction (Foley catheter or misoprostol vaginal insert releasing 7 mcg of misoprostol per hour for 24 hours) with obstetric results of patients in whom, due to favourable cervix, only a low-dose infusion of oxytocin was used. We reviewed the medical records of 1010 single pregnancies in whom IOL was performed. We divided the patients into two groups: group A (where preinduction was used) and group B (Bishop score ≥7 points) where preinduction was not used. Patients in group A were more likely to complete the delivery by caesarean section (OR = 4.58, 95% CI 3.22-6.51), and more likely to have events that were indications for operative delivery: unreassuring fetal heart rate trace (OR = 3.29, 95% CI 2.07-5.23) and arrested labor or failed induction (OR = 3.4, 95% CI 2.06-5.62). The groups did not differ in the percentage of vacuum extraction, postpartum haemorrhage, and meconium stained amniotic fluid. In group B, more infants were born with umbilical cord blood pH <7.1 (1.38% vs. 0%), both groups included no deliveries of newborns with Apgar score ≤3 points, the groups did not differ in terms of the percentage of newborns with Apgar score between 4 and 7 at birth (OR = 0.66, 95% CI 0.29-1.49). The immature cervix and the need to use labor preinduction is a risk factor for caesarean section. The necessity of preinduction does not impair neonatological results.

Randomised Controlled Trial of Sublingual and Rectal Misoprostol in the Prevention of Primary Postpartum Haemorrhage in a Resource-Limited Community.

Misoprostol is beneficial in preventing postpartum haemorrhage (PPH). However, there is no consensus yet as to which route will give the balance of efficacy, safety and patient preference, especially at the recommended dose of 600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual misoprostol for the prevention of PPH. In a prospective fashion, consenting eligible parturients were randomised into two groups to receive either 600 mcg of misoprostol rectally or sublingually after vaginal delivery. All study participants were followed up till 24h postpartum. Primary outcomes were blood loss of 500ml or greater and at least 10% change in peripartum haematocrit levels. Seven (6.7%) and 16 (15.7%) of the sublingual and rectal routes, respectively, had PPH. However, the odds of having PPH after rectal misoprostol were at least twice the odds after the sublingual route (p = 0.041). Also, the mean blood loss after the first, fourth and 24th hour postpartum were significantly higher after rectal administration. Although significantly more patients had shivering and pyrexia after sublingual misoprostol, it was acceptable to more participants than the rectal route. At the recommended dose, sublingually administered misoprostol ('the sweet of life') is associated with a lower incidence of PPH than the rectal route. Despite its higher incidence of shivering and pyrexia, it was accepted by more women than rectally administered misoprostol.ClinicalTrials.gov identifier PACTR201911500348367.

The Effectiveness of Misoprostol Single Dose Oral for Evacuation of Incomplete Abortion

This study is aimed to find out the effectiveness of oral 600 mcg single dose misoprostol for the evacuation of conception remnant in cases of incomplete abortion. This research is done by quasi experimental method with one group pretest – posttest design. The population of the study is all women who were diagnosed with incomplete abortion in less than 12 weeks of gestation in Cipto Mangunkusumo National general Hospital and affiliations hospital from June 2018 to June 2019. Women who met the study criteria, was treated with oral misoprostol 600 mcg single dose and then undergo conception evacuation evaluation and side effects evaluation. Effectiveness evaluation was seen after 7 days of single dose 600 mcg of misoprostol by measuring &lt;15 mm endometrial thickness on transvaginal ultrasound. The effectiveness of using single dose oral misoprostol 600 mcg in the study participants was 93.55%, which were 29 out of a total of 31 participants. The side effects experienced after being given misoprostol were bleeding with less than the same amount as menstruation (71.0% and 9.0%), diarrhea (6.5%), and shivering (67.7%), and not found side effects of vomiting. Based on data analysis using paired T test before and 24 hours after administration of misoprostol, there was a significant difference between endometrial thickness (p value &lt;0.001). Misoprostol 600 mcg per oral dose is effective for the evacuation of retained conception tissue of incomplete abortion at less than 12 weeks gestation, so that it can be an alternative non-operative method of evacuating retained conception tissue in incomplete abortion cases other than the operative method. Side effects found were bleeding, diarrhea, and chills. Side effects of vomiting were not found in this study.

Mifepristone Followed by Misoprostol or Ethacridine Lactate and Oxytocin for Second Trimester Abortion: A Randomized Trial.

To compare two medical methods for second-trimester abortion, mifepristone followed by misoprostol versus mifepristone followed by ethacridine lactate and oxytocin for success rate, induction to abortion time and acceptability. This is a randomized trial conducted from July 2014 to May 2016 and enrolled 120 women undergoing second trimester abortion (13-20 weeks). All patients received 200mg mifepristone orally and were randomized to receive further treatment after 36 hrs. Patients in Group M (n=60) received 400 microgram of misoprostol vaginally every 3 hours (maximum - 5 doses) and Group E (n=60) had extra-amniotic ethacridine lactate instillation followed by oxytocin infusion (max-100miu). Baseline demographic characteristics were comparable in both the groups. Success rate was 100% in group M and 98.3% in group E (p=0.31). Mean induction to abortion time was significantly shorter in group M than group E (8.2+2.3hours & 10.9+2.6 hours respectively; p=0.001). Majority of women reported side effects, 96.7% women in group M and 75% women in group E (p=0.001). Fall in hemoglobin after procedure was significantly higher in group M (0.70+0.33gram %) than group E (0.52+0.23 gram %) (p=0.001). Perception of intensity of pain was significantly more in group M but patient satisfaction in both groups was similar. Both methods are comparable for success rate, induction interval was more for ethacridine lactate compared to misoprostol.