Misoprostol For Termination Of Pregnancy Research Articles

Multi-target mechanism of misoprostol in pregnancy termination based on network pharmacology and molecular docking.

Misoprostol is a prostaglandin analogue that contracts the uterus, prompting the expulsion of the embryo. No systematic evaluation of the mechanisms of misoprostol has previously been performed. In this study, known targets of misoprostol were obtained from the DrugBank database; potential targets of misoprostol were predicted using data from the SwissTargetPrediction and PharmMapper databases; and the main targets of pregnancy termination were obtained from the GeneCards database. The protein-protein interaction (PPI) network of the shared genes between misoprostol and pregnancy termination was constructed using data from the STRING database, and the "misoprostol-pregnancy termination-pathway" network was constructed and potential targets was verified through molecular docking. We analyzed 37 shared target genes and obtained a network diagram of 134 potential targets, which the core therapeutic targets were HSP90AA1, EGFR, and MAPK1. GO functional and KEGG pathway enrichment analyses showed that misoprostol can modulate the VEGF signaling pathway, calcium signaling pathway, and NF-κB signaling pathway in pregnancy termination and mainly interferes with protein phosphorylation, cell localization, and protein hydrolysis regulation processes. This research illustrates the mechanism underlying the pharmacological effect of misoprostol, namely pregnancy termination. However, further experimental verification is warranted for optimal use of misoprostol during clinical practice.

Single dose letrozole and misoprostol for termination of pregnancy through 63 days’ gestation: A pilot study

ObjectivesWe conducted a pilot study to evaluate a single dose of letrozole 30 mg prior to misoprostol 800 mcg buccally for medication abortion Study designWe enrolled 40 participants seeking medication abortion up to 63 days’ gestation at a site in Salt Lake City, UT. Participants received a single dose of letrozole 30 mg in-clinic followed 2 days later by misoprostol 800 mcg buccally at home. They took a second dose of misoprostol if they had no bleeding within 24 hours of the first. Participants returned 7 to 10 days later for assessment of abortion outcome and side effects ResultsThirty-seven participants (93%) returned for follow-up and 2 (5%) went to another facility from which research staff obtained outcome data. Three-fourths (29/39, 74%, 95% CI: 60%−89%) had a complete abortion; 4 (10%, 95% CI: 0.3%−20%) had an incomplete abortion and opted for aspiration, and 6 (15%, 95% CI: 4%−27%) had an ongoing pregnancy. All subjects with follow-up reported taking the first dose of misoprostol. Ten (27%) took the second dose as well; only three did so due to no bleeding. Nineteen participants (51%) reported side effects after letrozole prior to misoprostol and two people (5%) rated these effects as severe. Side effects following misoprostol occurred in 33 participants (89%) and were as expected based on previous literature. No serious adverse events were reported ConclusionA single dose of letrozole 30 mg followed by misoprostol had lower than desirable efficacy and does not warrant further study. ImplicationsA single dose of letrozole does not appear to be an effective adjunct to misoprostol for medication abortion.

Evaluation of the Effectiveness of Intravaginal Misoprostol in Termination of Pregnancy

Amaç: Çalışmamızın amacı Trakya Üniversitesi Tıp Fakültesi Doğum Kliniğinde Mayıs 2016 –Aralık 2018 tarihleri arasındaki 2,5 yıllık zaman aralığında terminasyon yapılan gebeliklerin endikasyonlarının dağılımını değerlendirmek ve 10 (on) hafta üzeri gebelik sonlandırmasında dört saatte bir intravajinal ve yirmi dört saatte bir vajinal yolla uygulanan sırasıyla 400 μg ve 600 μg mizoprostolün etkinliğini karşılaştırmak. Gereç ve Yöntem:Retrospektif dosya incelemesi şeklinde planlanan çalışmamızda kliniğimizde terminasyon kararı verilen 10 (on) hafta üzeri gebeliklerin sonlandırılma endikasyonları ve uygulanmakta olan mizoprostol tedavi protokollerinin etkinliği incelendi. 18-45 yaş arası, 10 (on) hafta ve üzeri olan gebeliklerin sonlandırılmasının planlandığı toplam 128 kadının dosyası değerlendirildi. 63 hastaya (Grup 1) 4 saat ara ile tekrarlanan 400 μg vajinal yolla mizoprostol uygulandı. 65 hastaya (Grup 2) 24 saat ara ile tekrarlanan 600 μg vajinal yolla mizoprostol uygulandı. Her iki grupta yeterli uterin kontraksiyon elde edilene kadar doz tekrarlanıp 48 saat sonrasında abortus/doğum gerçekleşmemesi halinde yöntem başarısız olarak kabul edildi. Bulgular: Çalışmamızda termine edilen 128 hastanın terminasyon endikasyonları belirlendi. Gebelik terminasyon endikasyonları: Missed Abort ve IUGR (in utero mort fetus) 32(%25), santral sinir sistemi anomalileri 30(%23,4), anhidramniyoz 28(%21,8), kromozal anomaliler 11(%8,5), kardiyak anomaliler 7(%5,4), çoklu sistem anomalileri 6(%4,6), kas iskelet anomalileri 5 (%3,9), gastrointestinal ve genitoüriner sistem anomalileri 5(%3,9), teratojen ilaç kullanımı ve radyasyona maruz kalma 4(%3,1) bulundu. Grup 1 olgularda 48 saatte abortus oranı (%90.4) idi. Grup 2 olgularda 48 saatte başarı oranı ise (%92,3) bulundu.Sonuç: İlk trimester ve ikinci trimesterde yapılan obstetrik ultrasonografi fetal yapısal anomalilerin tanısında tek yöntemdir. Santral sinir sistemi anomalileri fetal anomaliler içerisinde en büyük grubu oluşturmaktadır. Hastanemizde 10 (on) hafta ve üzeri gebelik sonlandırılmasında kullanılan mizoprostolün etkili ve güvenilir olduğu düşünülmektedir.

USE OF MIFEPRISTONE AND MISOPROSTOL COMBINATION FOR FIRST TRIMESTER MTP UP TO 9 WEEKS

In India about 6.7 million abortions takes place every year of which 4 million are induced and 2 millions are spontaneous. WHO estimates that unsafe abortion kills about 70,000 women annually, many more suffer serious injuries and permanent disability. In spite of legalization of medical termination of pregnancy in India, the incidence of illegal abortion is at time more common than legal abortion. Unsafe abortion is major cause of mortality among women in India accounting for 12% of all maternal death. One way of reducing mortality and morbidity associated with unsafe abortion is early decision by women for termination of pregnancy by use of combination of mifepristone and misoprostol for termination of pregnancy up to 9 weeks. So the present study aims to study the efficacy of mifepristone and misoprostol for medical termination of pregnancy up to 9 weeks of pregnancy. This is a prospective randomized study undertaken in 100 patients seeking MTP, in the reproductive age group with a history of less than or equal to 9 weeks gestation, attending Obstretic and Gynace OPD of Sir Takhsinhji Hospital attached to Govt. Medical College, Bhavnagar from March 2018 to August 2019. They were administered 200 mg of mifepristone followed by oral misoprostol 400 ug after 48 hours and another 400ug misoprostol after 24 hours. Results show Overall success rate of 92% abortion failure rate of 8% were achieved. This treatment regimen was more effective in earlier gestational age group.
 Keywords: Abortion, MTP, Mifepristone , Misoprostol

VAGINAL AND ORAL MISOPROSTOL FOLLOWING MIFEPRISTONE ADMINISTRATION IN MEDICAL TERMINATION OF PREGNANCY UP TO 49 DAYS: A COMPARATIVE STUDY

Objective: The objective of this study was to compare and evaluate the efficacy, safety, adverse effects, and patient compliance of vaginal versus oral misoprostol in medical termination of pregnancy after tablet misoprostol up to 49 days of gestation.
 Methods: A comparative study of 100 patients divided randomly assigned to two control groups.
 Results: The study showed that 200 mg mifepristone followed by 800 mcg vaginal misoprostol is more effective for medical termination in gestational age up to 49 days as compared to 200 mg mifepristone followed by 400 mcg oral misoprostol.
 Conclusion: While both routes of administration are safe, gastrointestinal side effects are more with oral misoprostol. The vaginal route is more acceptable to the patients enrolled in the study.

RETRACTED ARTICLE: Sublingual vs vaginal misoprostol for completion of first trimester missedabortion: a randomised controlled trial

Statement of Retraction [Sublingual vs vaginal misoprostol for completion of first trimester missed abortion: a randomised controlled trial] We, the Editor and Publisher of European Journal of Contraception and Reproductive Health Care, have retracted the following article: Abdelshafy A, Awwad H, Abo-Gamra A, et al. Sublingual vs vaginal misoprostol for completion of first trimester missed abortion: a randomised controlled trial. Eur J Contraception Reprod Heal Care. 2019;24(2):134–139. DOI: 10.1080/13625187.2019.1569224 Since publication, significant concerns have been raised about the validity of the statistical analysis and reported results in the article, as well as whether the study received the necessary ethical approval. When approached for an explanation, the authors provided responses to some of our queries, but these responses did not sufficiently address the concerns raised, and the authors were unable to provide their raw data for review. We also contacted the Faculty of Medicine, Ain Shams University Research Ethics Committee (FMASU REC), which informed us that the study did not receive ethics approval. As the study did not receive ethical approval and we cannot confirm the validity of the trial as reported, we are therefore retracting the article. The corresponding author has been informed of this decision. We have been informed in our decision-making by our editorial policies and COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

Medical termination of pregnancy in bicornuate uterus with twin gestation

The incidence of uterine anomalies in general population is about 3-5 %.abnormalities of fusion of mullerian duct during embryogenesis results in varied congenital abnormalities like arcuate, septate, uni-cornuate, bi-cornuate uterus. Majority of them are asymptomatic. The suspicion of uterine abnormalities is always considered when there is a history of recurrent abortions, intrauterine growth restrictions, preterm labour, mal-presentations. We are presenting a 31 year old pregnant women who came with history of urine pregnancy test positive at 56 days of amenorrhea and requested medical termination of pregnancy. On ultrasound examination a bi-cornuate uterus with pregnancy in both horns of the uterus was imaged. Her first pregnancy was a normal full term delivery one year ago. She was not diagnosed with bi-cornuate uterus in her previous pregnancy. She was given a combination of mifepristone and misoprostol for termination of pregnancy, which ended in a successful medical termination of pregnancy, confirmed by transvaginal ultrasound done two weeks later.

Letrozole pretreatment prior to medical termination of pregnancy: a systematic review

ObjectiveThe purpose of this systematic review was to evaluate the efficacy of pretreatment with letrozole prior to either a first- or second-trimester medical termination of pregnancy. Study designWe searched letrozole, femara, aromatase inhibitors, abortifacient agents, termination of pregnancy and labor induction in MEDLINE, EMBASE, Cochrane Database, Google Scholar and PubMed from inception of each database until September 2015 with no language limitation. A systematic review of all randomized controlled trials (RCTs) was performed where women received either letrozole and misoprostol or placebo and misoprostol for termination of pregnancy. The primary outcome was complete abortion rate, defined as complete evacuation of the products of conception from the uterus. Relative risk with 95% confidence intervals was used to report data. ResultsOur systematic review identified 7 studies; 4 RCTs were included in the review. Two RCTs evaluated terminations of pregnancy up to 9 weeks’ gestation, while 2 evaluated terminations over 9 weeks’ gestation. For each gestational age group, one trial supported an increase in complete abortion rate, while the other showed no difference, with letrozole and misoprostol compared with placebo and misoprostol. Time-to-abortion interval for terminations up to 9 weeks’ gestation was not improved with the addition of letrozole to misoprostol. For terminations over 9 weeks’ gestation, one trial supported and one trial refuted a decrease in time-to-abortion interval with letrozole and misoprostol. Similarly, for each gestational age group, one study supported a decrease and one study showed no difference in rate of dilation and curettage (D&C) with letrozole and misoprosol. Medication side effects were similar between both treatment groups. There was significant heterogeneity between the trials, and therefore, the results were not meta-analyzed. ConclusionsSome studies and trials report better outcomes (i.e., complete abortion rates, time-to-abortion and D&C rates) in women exposed to letrozole and misoprostol compared to placebo and misoprostol, while other trials demonstrate no difference. Further research exploring letrozole pretreatment prior to medical abortion is required. ImplicationsThis systematic review demonstrated that a combination of letrozole and misoprostol increased the rate of complete abortion compared to misoprostol alone in some studies but not in others; additional well-designed RCT's are needed.

Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy

In this prospective randomized parallel group study, subjects with a pregnancy of less than 63 d were randomized to receive either (i) 200 mg oral mifepristone plus 400 μg misoprostol per vaginally concurrently (group A); (ii) or the administration of misoprostol after 48 h (group B). Transvaginal sonography was performed on the 14th day of misoprostol administration to confirm complete abortion. The primary outcome was to compare the rates of complete abortion in two groups. Secondary outcomes were to compare induction abortion interval, side effects and compliance. A total of 200 subjects included in the study were randomized into groups A and B (100 each). Both the groups were comparable for age, parity, gestational age and history of previous abortion. The complete expulsion rate in group A was 96% (95% confidence interval (CI) 95.1–98.2%) and group B was 95% (95% CI 93.0–96.8%) (p > 0.100). A gestational age of more than 56 d was found to predict failure of treatment in both groups. The adverse effect profile in the two groups was the same. Efficacy of concurrent mifepristone and misoprostol in combination is similar to that when misoprostol is given 48 h later (ctri.nic.in CTRI/2010/091/001422).

Efficacy of mifepristone and misoprostol in termination of pregnancy in second and third trimester versus intraamniotic application of prostaglandins

Introduction: According to the published data, a combination of mifepristone and misoprostol is recommended in literature for labour induction in the second and third pregnancy trimester after a foeticide due to a fetal malformation or intrauterine fetal death and for abortion induction in the first pregnancy weeks. At our department we perform foeticide by applying Fentanyl and Xylocaine into the fetal heart. Since the intraamnial input is applied in this procedure, we also perform labour induction by intraamnial prostaglandin application. During the first weeks of pregnancy we performs abortion induction with mifepristone and misoprostol. Through the analysis of our own data, we aimed at establishing in what time fetal expulsion occurs after abortion induction with mifepristone and misoprostol compared to labour induction through intraamnial prostaglandin application. Methods: The retrospective study included all women on whom abortion or labour induction was performed between 2010 and 2015 due to fetal malformations established by means of ultrasound. The first group included all participants in the 16th–24th week of pregnancy or with the fetus weight under 500 g determined through ultrasound where the abortion induction was performed with mifepristone and misoprostol according to the following protocol: mifepristone 200 mg orally, followed 36–48 h later by misoprostol 800 μg vaginally, then misoprostol 400 μm orally, 3-hourly, to a maximum of four further doses. The second group included women after the 24th week of pregnancy or with the fetus weight above 500 g determined through ultrasound. Labour induction were performed through intraamnial 1000 μg prostaglandin application. We compared the time at which the fetal expulsion occurred after the beginning of induction in the first group with the same time in the second group. Results and conclusions: Based on the data from literature, the best abortion or labour induction method is the application of mifepristone and misoprostol regardless of the duration of pregnancy. The aim of our research was to establish whether the cases when a foeticide needs to be performed and therefore intraamnial input is already being used it also makes sense to apply prostaglandins in order to commence induction at the same time. Compared to the protocol with mifepristone and misoprostol we benefit from extra time since it is recommended to wait 36–48 h after mifepristone application before misoprostol application is continued. Based on the data from literature, the time to fetal expulsion in case of induced abortions or labours is proportional to the duration of pregnancy. With our research, we aimed to prove that in the group with the labour induction by means of intraamnial prostaglandin application despite being further into the pregnancy, the time to fetal expulsion is shorter due to the 36–48-h-long break in the mifepristone and misoprostol protocol.

Clinical effect of mifepristone combined with misoprostol for termination of pregnancy in high risk pregnant women

Objective To explore the clinical effect of mifepristone combined with misoprostol for termination of pregnancy in high risk pregnant women and provide reference for clinical treatment. Methods 182 cases of high-risk maternal were divided into observation group and control group by the random number table method, each group 91 cases.The control group was treated with conventional abortion termination of pregnancy, the observation group was treated with the artificial abortion before oral administration of mifepristone tablets and misoprostol tablets.The operation time, the amount of blood loss, the degree of pain, the degree of cervical softening and the occurrence of complications of induced abortion were compared between the two groups. Results The operation time of the observation group was (2.21±1.41)min, intraoperative bleeding was (15.29 ±4.06)mL, which were significantly less than those of the control group (t=7.122, 8.256, all P<0.05); The pain degree grade I in the observation group was 58.24%, which was significantly higher than that in the control group, grade III accounted for 5.49%, which was significantly lower than the that in the control group (χ2=44.887, 44.121, all P<0.05), the observation group of cervical softening full was 59 cases, full softening rate was 64.84% and the control group in the cervical softening full was 41 cases, softening full rate was 45.05%.Fully softening rate in the observation group was significantly higher than that in the control group (χ2=7.191, 8.411, P<0.05), the control group, the incidence of uterine perforation in 2 cases, the occurrence of artificial abortion syndrome 7 cases, the incidence of complications for 9.89%, the observation group had no uterine perforation occurred, 1 case of artificial abortion syndrome and complications occurred rate was 1.10%.The incidence of complications in the observation group was significantly lower than that in the control group (χ2=6.772, P<0.05). Conclusion Mifepristone combined with misoprostol for high-risk maternal termination of pregnancy could significantly shorten the artificial abortion operation time, reduce intraoperative blood loss, reduce the patient pain, reduce the incidence of complications. Key words: High risk maternal; Termination of pregnancy; Mifepristone; Misoprostol

Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior Cesarean Section

Study ObjectiveTo show the possibility of laparoscopic management of uterine rupture. DesignVideo with explanations. SettingIn the medical management with misoprostol for termination of pregnancy at any time the risk of uterine rupture may be possible. The risk is likely higher in women with a previous uterus surgery. In a systematic review of available studies, the risk of rupture was .28% among women with a prior cesarean delivery who were undergoing second-trimester misoprostol-induced abortion, meaning if 414 women with a history of cesarean delivery were given misoprostol for second-trimester abortion, 1 would experience uterine rupture. Uterine rupture has only been reported 3 times in first-trimester abortion and only once managed via laparoscopy: a missed abortion reported in 2005, a case of a ruptured unscarred uterus in a women undergoing medical abortion, and a case of a delayed miscarriage at 8 weeks’ gestation after misoprostol managed by laparotomy and sharp curettage. InterventionsTotal laparoscopic management in a patient with uterine tear after misoprostol treatment. ConclusionEarly second-trimester medical abortions with misoprostol can cause uterine rupture. In hemodynamically stable cases, total laparoscopic management is possible approach.

Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy.

To determine whether Cesarean scar defect (CSD) parameters assessed by transvaginal sonography (TVS) might affect the outcome of early termination of pregnancy (TOP) with mifepristone-misoprostol. This was a retrospective review of 183 women with previous Cesarean delivery who received oral mifepristone and misoprostol for TOP. A successful TOP was defined by the absence of an intrauterine gestational sac, with no need for surgical intervention. CSD was diagnosed by TVS in the presence of a hypoechogenic indentation within the myometrium of the lower uterine segment at the site of a previous Cesarean incision. Women were analyzed in three subgroups according to size of defect (ratio of residual myometrial thickness over the defect to adjacent myometrial thickness < 30%, 30%-70% and > 70%). Of the 183 women, 43 (23.5%) had failure of TOP. Fifty-nine (32.2%) had CSD detectable at TVS, and these women had a higher failure rate of TOP than did those without CSD (38.9% vs 16.1%; P = 0.001). CSD was associated significantly with failure of TOP (odds ratio, 3.32 (95% CI, 1.64-6.75)). The TOP failure rates in relation to defect size in the myometrial thickness ratio < 30%, 30%-70% and > 70% subgroups were 57.1%, 25.0% and 18.2%, respectively. There was a linear trend in failure rate across these ratios (Cochran-Armitage trend test; P = 0.015). Women with CSD are at increased risk of failed TOP. Women with a defect in which the residual myometrial thickness was < 30% of the adjacent myometrial thickness tended to have a greater chance of failed TOP. CSD detected at TVS is of clinical relevance in counseling women with a history of Cesarean delivery who are considering TOP. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Review of Comparative Study of Mifepristone with Vaginal Misoprostol for First Trimester Termination of Pregnancy with Different Gestational Age

Review of Comparative Study of Mifepristone with Vaginal Misoprostol for First Trimester Termination of Pregnancy with Different Gestational Age

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

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

Misoprostol-Induced Fever and Genetic Polymorphisms in Drug Transporters SLCO1B1 and ABCC4 in Women of Latin American and European Ancestry

Misoprostol, a prostaglandin analogue used for the treatment of postpartum hemorrhage and termination of pregnancy, can cause high fevers. Genetic susceptibility may play a role in misoprostol-induced fever. Body temperature of women treated with misoprostol for termination of pregnancy in the UK (n = 107) and for postpartum hemorrhage in Ecuador (n = 50) was measured. Genotyping for 33 single nucleotide polymorphisms in 15 candidate genes was performed. Additionally, we investigated the transport of radiolabeled misoprostol acid across biological membranes in vitro. The ABCC4 single nucleotide polymorphism rs11568658 was associated with misoprostol-induced fever. Misoprostol acid was transported across a blood-brain barrier model by MRP4 and SLCO1B1. Genetic variability in ABCC4 may contribute to misoprostol-induced fever in pregnant women. Original submitted 21 January 2015; Revision submitted 24 April 2015.

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.

Uterotonic Use at Childbirth in Ghana: A Qualitative Study of Practices, Perceptions, and Knowledge Among Facility-Based Health Care Providers and Community Members

PURPOSE: Uterotonic drugs, administered immediately after delivery, can prevent postpartum hemorrhage (PPH). As programs expand uterotonic access in settings of high maternal mortality, it is important to understand why and how these drugs are currently used. This qualitative study aimed to describe Ghanaian health care providers’ and community members’ knowledge, perceptions, and practices of uterotonic usage at or near labor and delivery.METHODS: In-depth interviews were conducted in 3 districts with 185 physicians, medical assistants, midwives, nurses, new mothers, mothers aged 50 years and older, traditional birth attendants, and chemists.FINDINGS: Providers described using misoprostol most commonly for labor induction, oxytocin for labor augmentation and PPH prevention, and ergometrine for PPH treatment. Unsafe practices and knowledge gaps were identified regarding labor augmentation and uterotonic storage. Community members reported experience with uterotonics in facility deliveries. Community-based use of pharmaceutical uterotonics was rarely reported, except misoprostol for pregnancy termination; however, community members described use of herbal medicines for intended uterotonic effect. Across respondent categories, uterotonics were more commonly associated with accelerating delivery than PPH prevention.CONCLUSION: Programs promoting facility childbirth and/or uterotonic coverage at home births should consider these underlying patterns of use and encourage safe practices through provider and community engagement.

A pilot study on the combined use of letrozole, mifepristone and misoprostol in termination of first trimester pregnancy up to 9 weeks’ gestation

ObjectiveTo assess the feasibility of adding letrozole to the standard regimen of mifepristone and misoprostol for termination of pregnancy up to 63 days. Study designWe recruited 50 subjects who had requested legal termination of pregnancy up to 63 days. Medical abortion was performed with a singe dose of 200mg mifepristone and 10mg of letrozole daily for 3 days followed by 800mcg vaginal misoprostol. ResultsThe complete abortion rate was 98% (95% CI: 94–100%). The median induction-to-abortion interval of the regimen was 5.1h (range 1.2–56h). No serious adverse effects were reported. ConclusionsThe results of this pilot study suggest that a regimen of mifepristone, letrozole and misoprostol is associated with a high complete abortion rate without major adverse events.

Knowledge of medical abortion among Brazilian medical students

ObjectiveTo assess the knowledge of Brazilian medical students regarding medical abortion (MA) and the use of misoprostol for MA, and to investigate factors influencing their knowledge. MethodsAll students from 3 medical schools in São Paulo State were invited to complete a pretested structured questionnaire with precoded response categories. A set of 12 statements on the use and effects of misoprostol for MA assessed their level of knowledge. Of about 1260 students invited to participate in the study, 874 completed the questionnaire, yielding a response rate of 69%. The χ2 test was used for the bivariate analysis, which was followed by multiple regression analysis. ResultsAlthough all students in their final year of medical school had heard of misoprostol for termination of pregnancy, and 88% reported having heard how to use it, only 8% showed satisfactory knowledge of its use and effects. Academic level was the only factor associated with the indicators of knowledge investigated. ConclusionThe very poor knowledge of misoprostol use for MA demonstrated by the medical students surveyed at 3 medical schools makes the review and updating of the curriculum urgently necessary.