Micrograms Of Vaginal Misoprostol Research Articles

Optimal misoprostol dosing among patients with a body mass index greater than 30: a randomized controlled trial

Patients with obesity experience an increased duration of labor with an increased risk for perinatal morbidity. When compared with parturients without obesity, they also experience fewer uterine contractions after administration of misoprostol. It is unclear if the same dose of misoprostol should be used for induction of labor in patients with obesity compared to non-obese patients. Therefore, we sought to investigate if a higher dose of misoprostol for patients with obesity is more effective. This study aimed to determine if 50 μg compared with 25 μg of vaginal misoprostol reduced the time from induction start to delivery among patients with obesity. We performed a double-blinded, pragmatic randomized controlled trial, between June 1, 2022, and July 17, 2023. Patients with a body mass index ≥30 kg/m2 who underwent labor induction at ≥ 36 weeks' gestation, had a singleton gestation, and a cervical dilation ≤3 cm at admission were included. Patients were excluded if they had a contraindication to vaginal delivery or misoprostol administration. Patients were randomized to 25 or 50 μg of vaginal misoprostol, stratified by parity, body mass index <40 kg/m2 or ≥40 kg/m2, and provider intent to use mechanical dilation at the onset of labor induction. Usual labor management was followed at the discretion of the provider. The primary outcome was time from induction to delivery. A priori, we estimated that 90 subjects per group (N=180) were needed for an 85% power to detect a 3-hour difference between groups with a type I error of 5%. Analysis was by intention-to-treat. A 2-sample t test was used for the primary outcome, Cohen's d was used as a measure of effect, and P values were reported. Of the 180 patients randomized, 88 were assigned to the 25 μg group and 92 were assigned to the 50 μg group. Of those, 96.1% of patients received the designated intervention. The baseline characteristics were similar between groups. No difference was found in the primary outcome of time to delivery (21.6 hours vs 18.6 hours; d=.28; 95% confidence interval,-0.02 to 0.57). In a planned subgroup analysis, multiparous patients delivered faster in the 50 μg group (15.2 hours vs 12.0 hours; d=.51; 95% confidence interval, 0.04-0.97). The risk for tachysystole associated with fetal heart tracing changes was rare overall (2.2%) and not significantly different between groups. No differences in maternal or neonatal adverse effects were observed. Patients with obesity who underwent cervical ripening with 50 μg of vaginal misoprostol experienced a similar time to delivery when compared with those who received 25 μg of misoprostol. However, multiparous patients had a significantly reduced time to delivery when 50 μg was used. A higher dose of misoprostol may be a promising intervention for reducing time in labor, which warrants further study.

Comparison of 25 microgram of sublingual misoprostol with 25 micrograms of vaginal misoprostol for induction of labour at term

Comparison of 25 microgram of sublingual misoprostol with 25 micrograms of vaginal misoprostol for induction of labour at term

Efficacy of 50 µg Versus 25 µg Vaginal Misoprostol for Cervical Ripening and Labor Induction: A Randomized Trial

Background: Cervical ripening is the process of initiating labor in women with an unripe cervix. Vaginally administered prostaglandin E1 analog (misoprostol) has been promising in cervical ripening and labor induction. However, optimal dosage and dose-dependent adverse effects in this administration route need further clarification. Objectives: This trial aimed to compare the efficacy and adverse effects of 50 mcg vs. 25 mcg of vaginal misoprostol in low-risk term pregnant women. Methods: This double-blind, single-center, randomized clinical trial included 200 low-risk term pregnancies undergoing labor induction with a Bishop score of 2 or less. Patients were assigned randomly to receive 25 mcg or 50 mcg of vaginal misoprostol every six hours up to four times until the active phase of labor was reached. The primary outcome included time to vaginal delivery (latent and active phase of labor), and secondary outcomes included the total dosage of prescribed misoprostol, the need for oxytocin for labor augmentation, and the cesarean section rate. Results: Misoprostol 50 micrograms resulted in a significantly shorter time in the first phase of labor (P-value = 0.002), the second phase of labor (P-value = 0.030), and the third phase of labor (P-value = 0.020). The number of administered misoprostol, the need for additional oxytocin, uterine hyperstimulation, cesarean delivery rate, Apgar score, umbilical artery pH, and neonatal intensive care unit (NICU) administration were statistically similar between the two groups. Conclusions: This study showed that 50 mcg of vaginal misoprostol (vs. 25 mcg) for cervical ripening could reduce labor phase duration without significantly increasing adverse maternal and neonatal outcomes.

EVALUATION OF THE OUTCOME OF ORAL VERSUS VAGINAL MISOPROSTOL IN TERMINATION OF ALL CASES OF INTRAUTERINE FETAL DEATH

Introduction: Misoprostol a potent uterotropic and uterotonic agent which causes cervical effacement &amp;dilatation and stimulates myometrial contractions, is effective in terminating intrauterine foetal death. The Objective of the study was to compare the effectiveness of oral misoprostol versus vaginal misoprostol in termination of all cases of intrauterine foetal death and its outcome. Details of induction –delivery interval and maternal morbidities were also analysed. A prospective comparative study.Al Methodology: l pregnant women indicated for termination of intrauterine foetal death satisfying both inclusion and exclusion criteria being admitted in our Labour Room during the period of this study were included.Total 60 patients were included out of which 30 receiving oral misoprostol forms the rst group and the other 30 receiving vaginal misoprostol forms the second group. For the rst group, 200 mcg of oral misoprostol tablet was dissolved in 200ml water and 25 mcg, ie. 25ml of the solution was given rst and then every two hours till pain occurs. Second group was given 25 mcg of vaginal misoprostol every 4 hourly. Induction-delivery interval and maternal morbidities were compared in both groups. The me Results: an induction-delivery interval was higher in Oral misoprostol when compared to vaginal route and this difference was found to be statistically signicant (p &lt;0.001). However, the oral route was much easier when compared to vaginal route.The maternal morbidities like diarrhoea, fever, PPH, shivering, vomiting and tachysystole were similar in both groups.There were no cases of uterine rupture in the study. The effe Conclusion: ctiveness of different routes of administration was signicant in our study with signicantly shorter mean induction-delivery interval in vaginal route compared to oral route.Although there were few maternal morbidities seen in both groups, there were no statistically signicant differences between two groups

A Comparative Study on the Effects of Vaginal Misoprostol and Vaginal Misoprostol Plus Estradiol on Labor Induction

Background: Cervical ripening is an important factor in predicting successful labor induction. In an unfavorable cervix, ripening should be done before induction. In this study, the effect of misoprostol and that of misoprostol plus estradiol on cervical ripening were compared. Methods: This randomized, double-blinded study included a total of 190 pregnant women who were identified for pregnancy termination due to maternal or fetal cause at 37 weeks with Bishop score of less than 4. The patients were assessed between April 2015 to April 2016 in two university hospitals at northeast Iran (Omol-Banin Hospital and Emam Reza Hospital, Mashhad). The patients who met the inclusion criteria were randomly assigned to two groups: the intervention group (Group A), who received 25 micrograms of vaginal misoprostol plus 50 micrograms of estradiol, and the control group (Group B), who received 25 micrograms of vaginal misoprostol only. Misoprostol was administered at 4-hour intervals until cervical ripening (Bishop score ? 8) or upon initiation of active phase in both the groups. The maximum dosage of misoprostol was three doses, whereas estradiol was administered only once. Results: In this study, the main causes of pregnancy termination were ROM and post-term. There was no significant statistical difference in the Bishop score between the two groups (P = 0.13). In addition, no significant difference was observed in the duration of time for cervical ripening (Bishop ? 8) between the two groups (P = 0.7). The duration between drug administration to the initiation of active phase and also from active phase to delivery showed no significant differences between the two groups (P = 0.49 and 0.24, respectively). There was also no significant difference in the delivery route (operative vaginal delivery or Cesarean section) (P = 0.2 and P = 0.91, respectively). Conclusion: From this study, the use of misoprostol plus estradiol did not improve cervical ripening or decrease the induction time. Further studies are recommended to investigate complementary results.

Induction of Abortion in the Second Trimester by Misoprostol or Misoprostol with Letrozole

Abstract Background Abortion is the termination of pregnancy by any means (surgical or medical) before the age of viability. The definition varies in duration of gestational age according to the countries and available facilities. Estrogen is important in the maintenance of pregnancy. Aromatase inhibitors such as letrozole, suppress the peripheral conversion of androgen to estrogen, the use of letrozole combined with vaginal misoprostol was more effective than misoprostol alone in termination of pregnancy. Objective Assessing the efficacy of addition of letrozole to Misoprostol in medically induced abortion in the second trimester of pregnancy in the Maternity hospital of Ain Shams University. Methods This clinical trial was conducted at Ain Shams University Maternity hospital in the period between December 2018 and May 2019. Patients that seem to be fulfilling the inclusion criteria were recruited, then informed written consent was taken from every patient before starting the examination That was followed by detailed history and examination of all patients to confirm fulfilling the inclusion and exclusion criteria. Results This study demonstrated that 10 mg letrozole for three days followed by 800 mcg of vaginal misoprostol is more effective than misoprostol alone for second trimester abortion. In the total of 72 women were recruited the complete abortion rate of the letrozole group was significantly higher than that of the control group (61,1% in the letrozole group compared with 33,3% in the control group). Conclusion s: The use of letrozole in addition to misoprostol was associated with a higher complete abortion rate, shorter induction to abortion interval and shorter curettage rates compared to a placebo followed by misoprostol in patients undergoing induction of abortion between 12 &amp; 24 weeks gestation.

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.

Intravaginal isonicotinic acid hydrazide (INH) versus misoprostol for cervical ripening prior to hysteroscopy.

ObjectiveThe aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery.MethodsThis randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed.ResultsBaseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001).ConclusionVaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.Trial RegistrationIranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4

Comparison of Effectiveness and Patient Satisfaction of Vaginal Versus Oral Misoprostol in Treatment of Missed Miscarriage.

BACKGROUND:In recent years’ medical management with misoprostol is an effective alternative to surgical evacuation. But there is a dearth of evidence to reveal the effectiveness of the different routes of misoprostol and satisfaction rate among the patients treated with these routes.AIM:This study was conducted to compare the effectiveness and patient’s satisfaction rate of vaginal versus oral misoprostol.METHODS:It was a prospective non-interventional study. One hundred women of having missed abortion confirmed by ultrasonography examination were enrolled in the trial. Fifty-eight subjects were administered 200 mcg of oral and 42 subjects received 200 mcg of vaginal misoprostol every four hours up to four doses. If complete expulsion did not occur 12 hours after the last dose, the surgical evacuation was done.RESULTS:There was no significant statistical difference between the effectiveness of treatment with vaginal (78.57%) and oral misoprostol (79.31%) (p = 0.928). The difference between Patients’ satisfaction at the time of discharge for the vaginal group (64.29%) and oral group (65.52%) was not statistically significant (P = 0.991). There was an increase in patients’ satisfaction for both groups at the follow-up session, but still, the difference was not significant (P = 0.897).CONCLUSION:This study confirms that there is no statistical difference between the effectiveness and patient satisfaction of oral and vaginal misoprostol in the treatment of missed abortion.

Effect of extra-amniotic Foley\u2019s catheter and vaginal misoprostol versus vaginal misoprostol alone on cervical ripening and induction of labor in Kenya, a randomized controlled trial

BackgroundThe safest, most effective and fastest combined approaches to induction of labor is unknown. In an open-label randomized clinical trial we evaluated the efficacy of combination of extra-amniotic Foley’s catheter and vaginal misoprostol compared to vaginal misoprostol alone for cervical ripening and induction of labor on the incidence of failed induction, induction-to-delivery interval and adverse maternal and perinatal outcomes.MethodsPregnant women at gestational age of 28 weeks or greater admitted at Kenyatta National Hospital, Kenya for induction of labor were enrolled then randomized to either a combination of extra-amniotic Foley’s catheter inflated by 30 cm3 of normal saline and 25 micrograms of vaginal misoprostol or 25 micrograms of vaginal misoprostol alone. Women underwent 6 hourly reviews and additional misoprostol inserted if required. The primary outcome was incidence of failed induction. Secondary outcomes were induction-to-delivery interval and adverse maternal and perinatal outcomes. We conducted an intent-to-treat analysis and compared means or medians using t-test or Wilcoxon rank, proportions using Chi-square or Fishers test as appropriate. Induction-to-delivery interval were compared using the log-rank test. P-values of < 0.05 and 95% confidence intervals that excluded the null were considered statistically significant.ResultsBetween February and May 2016, we enrolled 180 of 237 pregnant women admitted for induction of labor and randomized them to either a combination of extra-amniotic Foley’s catheter and vaginal misoprostol (n = 90) or vaginal misoprostol alone (n = 90). The socio-demographic and obstetric characteristics were similar between the two groups. Failed induction rates were lower but not statistically significant following combined extra-amniotic Foley’s catheter and vaginal misoprostol (8.9%) versus vaginal misoprostol alone (11.1%). The mean induction-to-delivery time was 4.8 h shorter in the combined extra-amniotic Foley’s catheter and vaginal misoprostol (mean 18.9, standard deviation (SD) 7.2 h) compared to misoprostol only group (mean 14.1, SD 6.9 h) (log-rank test, p < 0.001). Maternal and perinatal complications were similar between the two groups.ConclusionsExtra-amniotic Foley’s catheter and vaginal misoprostol for cervical ripening and induction of labor did not significantly lower the incidence of failed induction but safely shortened induction-to-delivery time compared to vaginal misoprostol only.Trial registrationTrial was retrospectively registered on 14–03-2016 PACTR201604001535825.

Vaginal Misoprostol versus Bilateral Uterine Artery Ligation in Decreasing Blood Loss in Transabdominal Myomectomy : A Randomized Controlled Trial

Background: Uterine leimyomas are tumors of the smooth muscles and the connective tissues of the uterus. They are considered to be the most common benign pelvic tumor affecting about 20% of women above the age of 35. The diverse symptomatology of fibroids can be attributed to size, number and location of the tumors. The common symptoms include menorrhagia, infertility, abdominal mass and pressure effects. Aim of the Work: The aim of this study is to compare between the effect of medical (preoperative vaginal misoprostol) and non-medical (bilateral uterine artery ligation) regarding their efficacy to decrease blood loss in trans- abdominal myomectomy. Patients and Methods: Prospective randomized controlled interventional clinical trial. The study was conducted in Ain Shams University Maternity Hospital, Cairo, Egypt in the period between August 2015 till December 2016. It was approved by the Ethical Research Committee, Obstetrics and Gynecology Department, Ain Shams University, Cairo, Egypt. It included 60 women recruited from those attending the outpatient gynecology clinic, seeking treatment for symptomatic uterine myomas. Results: The current study revealed that there was no statistically significant difference between both groups regarding operative time, blood loss and postoperative hospital stay. Conclusion: A single pre-operative dose of 400 micrograms of vaginal misoprostol is as effective as uterine artery ligation in decreasing blood loss in transabdominal myomectomy. Misoprostol is a simple, cheap, fast, available and applicable tool that can be administered even an hour preoperatively. Recommendations: Preoperative vaginal misoprostol is an effective practical tool in decreasing blood loss in transabdominal myomectomy. Investigation of misoprostol use in larger population groups and with different dosages and administration routes, together with comparison of other methods used to reduce bleeding during myomectomy, is recommended.

The effect of 7 days of letrozole pretreatment combined with misoprostol on the expression of progesterone receptor and apoptotic factors of placental and decidual tissues from first-trimester abortion: a randomized controlled trial

ObjectiveTo evaluate if letrozole-induced suppression of estradiol reduces progesterone receptor expression and apoptosis in the first-trimester placenta. Study DesignWe performed a double-blinded, randomized, placebo-controlled trial. We randomized 20 women requesting first-trimester abortion with gestation up to 63 days to receive either letrozole 10 mg daily or placebo pretreatment for 7 days before administrating 400 mcg of vaginal misoprostol followed by suction abortion. We collected the placental and decidual tissues on which we performed immunohistochemical staining for progesterone receptor and apoptotic markers (active caspase 3, caspase 3, Bcl2, CD95, fas ligand) and determined H-scores of each based on the intensities of staining. We performed terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay for apoptosis in the samples of four women to confirm the findings from apoptotic markers. ResultsWe excluded one woman in the letrozole group from the analysis because she had passage of abortus after taking letrozole, leaving 19 women (9 in the letrozole group, 10 in the placebo group) for analysis. There was no significant difference in the H-scorings of progesterone receptor and apoptotic markers, as well as proportion of apoptotic cells on TUNEL assay between the two groups. The H-scores for the progesterone receptor were 8.17±2.67 (mean±SD) in the letrozole group and 9.01±2.82 in the placebo group (p=0.36). ConclusionWe did not detect a difference in the expression of progesterone receptor and apoptotic markers in placental and decidual tissues after letrozole pretreatment for 7 days in first-trimester abortion. ImplicationsWe did not confirm the hypothesis that letrozole reduces progesterone receptor expression and induces apoptosis in the first-trimester placenta. Further studies are required to allow better understanding of the mechanism by which estrogen suppression following the use of letrozole can lead to improved abortion rate in the first trimester.

Comparison of the efficacy and safety of sublingual misoprostol with that of vaginal misoprostol for labour induction at term

Objective To compare the efficacy and safety of 50 mcg of sublingual misoprostol with 25 mcg of vaginal misoprostol for induction of labour at term. Method Non blinded randomized prospective control study. 200 women with singleton term pregnancy, admitted for induction of labour, were randomized to receive either 25 mcg of vaginal misoprostol or 50 mcg of sublingual misoprostol. Outcome measures compared were the number of vaginal deliveries, induction-delivery interval, caesarean section for foetal distress, oxytocin for acceleration, number of doses required, side effects and neonatal outcome. Result Mean dose was smaller and induction to delivery interval was significantly shorter in the sublingual group (13.1 ± 4.1 h) compared with the vaginal group (17.9 ± 5.4 h), p value 0.001. There were no statistically significant differences in the other secondary outcome measures. Conclusion 50 mcg of sublingual misoprostol was more effective than and as safe as 25 mcg vaginal misoprostol for labour induction at term.

Efficacy of a single dose vaginal misoprostol 800 microgram in termination of pregnancy in first trimester.

Background and objectives The use of single dose of Misoprostol vaginally at the primary care level where mifepristone is not available and Misoprostol being cost-effective has the potential to significantly increase the rural womens access to safe abortion. The aim of our study was to 1 to evaluate the efficacy of single dose 800 micrograms of vaginal Misoprostol in first trimester pregnancy termination 2 to critically evaluate the percentage of patients needing multiple doses and 3 to study and evaluate the failure rate complications and side effects with Misoprostol usage.Methods This study was carried out in the Department of Obstetrics and Gynaecology Government Rajaji Hospital Madurai during the period of February 2007 to July 2007. Fifty patients with intrauterine pregnancy up to 12 weeks were selected for the study. Under strict aseptic precautions 800 microgram of Misoprostol was kept in posterior fornix. Time of application of tablet was noted. Analysis was done in the following aspects 1 induction abortion interval. 2 efficacy of single dose percentage of patients requiring second dose and curettage.3to note side effects. Analysis was done with the help of computer using epidemiological information package EPI 2002.Results 74 of the patients had a complete expulsion with single dose and the mean induction abortion interval was 11.38 hours.Conclusion Single high dose of vaginal misoprostol was found to be effective in first trimester pregnancy termination with minimal side effects and shorter induction abortion interval and hospital stay.nbsp

A Prospective Trial Using Mifepristone and Vaginal Misoprostol in Termination of Pregnancies up to 63 Days of Gestation

According to the Consortium on National Consensus for Medical Abortion in India, on average about 11 million abortions take place annually, and around 20,000 women die every year due to abortion-related complications. This study was undertaken to determine the efficacy and the side effect profile of a regime of 200 mg of mifepristone administered orally followed by 800 mcg of vaginal misoprostol after 48h. 50 cases of medical abortion meeting the inclusion criteria were included. On day 1, 200 mg of oral mifepristone was given. On day 3, the patient was called back, and 800 mcg of Misoprostol administered per vaginum and was observed for 6h. The patients were then called back for review after two weeks to make sure that the abortion was complete. Although, in most cases, this was clinically evident, an ultrasonography was repeated to confirm the completion. Out of the 50 patients, four were lost to follow up, and of the remaining 46 patients, abortions were complete in 44 (95.65%), while two (4.35%) patients required surgical intervention. Medical abortion with 200 mg oral mifepristone and 800 mcg vaginal misoprostol is an effective, safe, reliable, and noninvasive method with a success rate of 95.65%. The availability of this low-cost medical treatment using agents which do not require special cold storage and transport facilities and negligible operating theater time makes this provision of safe abortion feasible in settings especially of developing countries, like India, where medical facilities are limited.

A Comparative Study of 25 mcg vs 50 mcg of Vaginal Misoprostol for Induction of Labor

ABSTRACT Objectives To compare the efficacy and safety of 25 mcg intravaginal misoprostol vs 50 mcg misoprostol for induction of labor. Material and methods This study group consisted of 100 cases of low-risk singleton pregnancies attending the antenatal clinic of SAH and RC, or admitted to the antenatal ward. Study group included singleton pregnancy, Over 37 weeks of gestation with Vertex presentation, with unfavorable cervix (bishop score &lt;4) and patients not in labor with reactive fetal heart rate pattern with intact membranes. Women were randomized to either 25 mcg (n = 50) or 50 mcg (n = 50) of intravaginal misoprostol. The dose was repeated every 4 hours (maximum number of doses limited to 3 doses). The main outcome was induction vaginal delivery interval. Results Induction delivery interval was significantly less with 50 mcg misoprostol —9.45 hours in comparison to 25 mcg 14.2 hours (p-value &lt;0.001), most cases delivered vaginally with 25 mcg misoprostol p value &lt; 0.013, cesarean section rates were high in 50 mcg misoprostol group p-value &lt;0.007, the proportion of women delivering vaginally with single dose of vaginal misoprostol was high in 50 mcg group, i.e. 64%, incidence of maternal complications like tachysystole and hyperstimulation was more with 50 mcg group. Conclusion In the present study, it is concluded that 25 mcg of misoprostol is safe and effective for labor induction. How to cite this article Bharathi A, Kumar KA, Ganga AP. A Comparative Study of 25 mcg vs 50 mcg of vaginal Misoprostol for Induction of Labor. J South Asian Feder Obst Gynae 2013;5(3):111-115.

Can women accurately assess the outcome of medical abortion based on symptoms alone?

BackgroundThe primary purpose of this study was to evaluate whether women undergoing medical abortion can accurately assess abortion outcome based on symptoms alone. Our secondary aim was to identify predictors of medical abortion failure. Study DesignWe conducted a case–control study of women undergoing medical abortion from January 1, 2004, to December 31, 2005, who were 63 days' gestation or less and received 200 mg mifepristone followed by 800 mcg of vaginal misoprostol 6–72 h later. Cases were defined as women who required uterine evacuation for a retained gestational sac or ongoing pregnancy. Separate analyses were conducted for the subset of cases with ongoing pregnancies. Controls were defined as women who successfully expelled the pregnancy without uterine evacuation. ResultsDuring the study period, 53 women had a retained gestational sac (N=26) or ongoing pregnancy (N=27), and a total of 53 controls were selected, matched by site and date of procedure. Case subjects were more likely than controls to report minimal vaginal bleeding and ongoing pregnancy symptoms and to express doubt that they expelled the pregnancy. When predictive modeling was performed, ongoing pregnancy symptoms, minimal bleeding and gestational age as determined by ultrasound measurement of gestational sac or crown-rump length accurately identified only 68% of medical abortion failures. We also found that the odds of medical abortion failure decreased progressively from approximately 4 to 7 weeks' gestational age, was lowest at approximately 7 weeks and increased from 7 to 9 weeks' gestation. ConclusionPatient symptomatology and self-assessment of complete abortion alone are moderately useful in identifying medical abortion failure. An objective measure of complete abortion, such as a pregnancy test, is still required.

Association between gestational age and induction-to-abortion interval in mid-trimester pregnancy termination using misoprostol

Objective The study was aimed to evaluate the effectiveness, outcome, and pain intensity of the vaginal administration of misoprostol for the induction of abortion between 13 and 24 gestational weeks. Study design A retrospective study was conducted at our tertiary medical center from January 2006 to December 2009 on 122 consecutive women who underwent termination of pregnancy (TOP) in the mid-trimester. They were given 400 mcg of vaginal misoprostol every 6 h, up to four doses. The induction-to-abortion interval and the level of pain experienced during the process were assessed. Success was defined by the fetus being expelled within 48 h. Results Vaginal misoprostol was effective in 84% (98/122) of patients. The median duration of the induction-to-abortion interval was 16 (5–48) h. The induction-to-abortion interval was correlated with gestational age, while inversely correlated with parity. A correlation was also found between gestational age and pain intensity at 12 h from induction. Conclusion Misoprostol is safe and effective in mid-trimester abortion induction. The induction-to-abortion interval is shorter and abortion less painful with lower gestational age. Higher parity is also associated with shorter induction to abortion interval.

Misoprostol With or Without Letrozole Pretreatment for Termination of Pregnancy

To compare the success rate and side effects of letrozole and misoprostol versus misoprostol alone for medical termination of early pregnancy. Patients requesting termination of pregnancy up to 63 days of gestation were randomized into two groups. The letrozole group received letrozole 10 mg daily for 3 days followed by 800 micrograms of vaginal misoprostol, while the placebo group received placebo for 3 days followed by the same dosage of misoprostol. The complete abortion rate and the side effects profiles of the two groups were compared. The primary outcome measure was the complete abortion rate. A total of 168 women were recruited. The complete abortion rate of the letrozole group was significantly higher than that of the placebo group (86.9% compared with 72.6%, relative risk [RR] 1.20, 95% confidence interval [CI] 1.03-1.40). The complete abortion rate in gestations up to 49 days was significantly higher in the letrozole group than in the placebo group (93.3% compared with 78.7%, RR 1.19, 95% CI 1.002-1.40), while the corresponding rates for gestation between 50 and 63 days were not significantly different between the two groups. There were significantly fewer women complaining of vomiting in the letrozole group than those in the placebo group (8.3% compared with 19.0%, P=.043, RR 2.29, 95% CI 1.005-5.27). The use of letrozole and misoprostol is associated with a higher complete abortion rate. HKClinicalTrials.com, http://www.hkclinicaltrials.com, HKCTR-349. I.

Can Vaginal Misoprostol Effectively Increase Rate of a Satisfactory Colposcopy? A Randomized Double-blind Placebo-controlled Trial

To evaluate the effectiveness of vaginal misoprostol in overcoming an unsatisfactory colposcopy in the patients who had abnormal cervical cytology and to evaluate side effects of vaginal misoprostol. Sixty patients with an unsatisfactory colposcopy during the period of September 2007-November 2008 were recruited and randomly allocated to receive either two tablets of 200 microg misoprostol (400 microg) or two tablets of similar-looking placebo vaginally. Colposcopic re-examination was performed approximately 6 h later. The results and side effects before and 2 weeks after the colposcopic re-examination were recorded. Six out of 30 patients in the misoprostol group (20.0%) had a satisfactory colposcopic re-examination compared with 2 out of 27 patients (7.4%) in the placebo group without statistically significant difference (P = 0.172). Three patients in the placebo group dropped out due to not present at the appointment time. Six out of 30 patients (20.0%) and 1 out of 30 patients (3.3%) in the misoprostol group had side effects before and 2 weeks after the colposcopic re-examination orderly. Twenty-seven patients in the placebo group did not have any side effects before and 2 weeks after the colposcopic re-examination. All side effects occurred were minimal and well tolerated. Four hundred micrograms of vaginal misoprostol were not proved to be effective in converting an unsatisfactory to a satisfactory colposcopy.