Misoprostol Tablets Research Articles

Implementation of community based advance distribution of misoprostol in Himachal Pradesh (India): lessons and way forward

BackgroundPostpartum Hemorrhage remains the leading cause of maternal mortality. To prevent PPH, Misoprostol tablet in a dose of 600 micrograms is recommended for use immediately after childbirth in home deliveries wherein the use of oxytocin is difficult. The current article describes an implementation of “community based advance distribution of Misoprostol program” in India which aimed to design an operational framework for implementing this program.MethodsThe intervention was carried out in Janjheli block in Mandi district of the state of Himachal Pradesh which is a mountainous terrain with limited geographical access and reported 90% home deliveries in the year 2014–15. An operational framework to implement program activities was designed which was based on WHO HSS building blocks. Key implementing steps included- Ensuring local ownership through program leadership, forecasting and procurement of 600 mcg misoprostol tablets, training, branding and communication, community engagement and counselling, recording and reporting, monitoring, supportive supervision and feedback mechanisms.ResultsOver the one year of implementation, 512 home deliveries were reported, out of which 89% received the tablets and 84% consumed the tablet within one minute of delivery. No incidence of PPH in tablet consuming mothers was reported. On account of periodic counselling and effective community engagement the intervention also contributed to better tracking of pregnancies till delivery and institutional delivery rates which increased to 93% from 45% and 57% from 11% respectively as compared to the preceding year.ConclusionsThe model has successfully shown the use of single misoprostol tablets of 600 mcg, first time in this program. We also demonstrated a HSS based operational framework, based on which the program is being scaled to additional blocks in Himachal Pradesh as well as to other states of India.

428. Trials in low-resource settings: the INFORM study (oral misoprostol versus balloon induction in women with PIH or pre-eclampsia)

Between 62,000 and 77,000 women die annually from pre-eclampsia/eclampsia. Prompt delivery, preferably by the vaginal route, is vital for good maternal and neonatal outcomes. Two low cost interventions -low dose oral misoprostol tablets and transcervical Foley catheterisation- are already used in low resource settings. In this open label, parallel randomised study, our objective was to compare their relative risks and benefits. 602 women with a live fetus requiring delivery for pre-eclampsia or hypertension were randomly assigned to labour induction with oral misoprostol 25 micrograms every 2 h (maximum of 12 doses) or a transcervical Foley catheter (size 18 F with 30 ml balloon) which remained until active labour started, the Foley catheter fell out, or 12 h elapsed. Randomisation was computer-generated with allocation concealment by opaque sequentially numbered sealed envelopes. Induction continued with artificial membrane rupture and oxytocin, administered through a micro-drip gravity infusion set. Fetal monitoring was by intermittent auscultation. The primary outcome was vaginal birth within 24 h, and trial registration as with ClinicalTrials.gov (NCT01801410). 302 women were allocated to misoprostol and 300 women to Foley catheter; all were analysed. More women in the misoprostol arm had a vaginal birth within 24 h (57.0% vs. 47.0%; absolute risk difference (RD) 10.0%, with 95%CI 2.0% to 17.9%). Rates of uterine hyperstimulation were very low in both groups (0.7% vs 0.3%; RD 0.3%; −0.8% to 1.5%) and no differences were seen in neonatal morbidity. More women in the misoprostol group would use the same method in the future should they require another induction (82.8% vs. 72.0%; RD 10.8%; 4.2% to 17.4%). Oral misoprostol 25 micrograms was more effective and more acceptable to women than a transcervical Foley catheter for induction of labour in women requiring delivery because of pre-eclampsia or hypertension. MRC/DFID/Wellcome Trust Joint Global Health Trials Scheme (Ref. G1100686/1).

Use of Combination of Mifepristone and Misoprostol to Terminate Early Pregnancy: Experience at a Tertiary Care Teaching Hospital

Background: Termination of pregnancy is well prescribed method all over the world to terminate the early pregnancy with the combination of mifepristone and misoprostol tablet orally.Objective: The purpose of this present study was to determine the efficacy of mifipristone (200 mg) for medical termination of early pregnancy with oral misoprostol 800 mcg 24 hours later.Methodology: This observational study was done in the Department of Gynaecology & Obstetrics at Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh among outdoor patients in 6 months period from July 2014 to December 2014. The patients with intrauterine pregnancy up to 9 weeks and blighted ovum were included. Incomplete abortion and extrauterine pregnancy were excluded. Mifepristone 200 mg followed by misoprostol 800 mg after 24 hours had been given.Result: Total 50 patients with 9 weeks of pregnancy were selected over the period of 6 months requesting termination of pregnancy. This study showed termination of early pregnancy up to 9 weeks with tablet mifepristone and tablet misoprostole which was effective as well as the expulsion rate of the product of conception was 92.0% cases and among them 32.0% patients were needed extended dose of misoprostol and 8.0% cases had incomplete abortion who needed surgical evacuation. Some patients had some complications like vomiting, fever, abdominal pain and excessive per vaginal bleeding which were managed accordingly.Conclusion: Mifepristone 200 mg followed by misoprostol 800 mcg orally is an effective method for termination early pregnancy with minimum side effects.Journal of Science Foundation 2017;15(1):9-13

Electroacupuncture of Hegu(LI 4) and Sanyinjiao(SP 6) Assists Medicinal Abortion

To observe the effectiveness of electroacupuncture (EA) therapy in promoting medicinal abortion. Sixty participants with early pregnancy were randomly divided into medication (control) and EA+ medication groups (n=30 in each). Participants in the control group were treated by regular medication (mifepristone and misoprostol tablets), and those of the EA group were treated by EA stimulation (2 Hz/100 Hz, a tolerable strength) of bilateral Hegu(LI 4) and Sanyinjiao(SP 6) for 25 min, and also by the same medication method mentioned in the control group. Participants of both groups were admitted to the hospital for observation on the 3rd day after taking medication. The abdominal pain was assessed by visual analogue scale (VAS) score, and the foetal sac discharge duration and the complete abortion rate were recorded. After the treatment, the VAS scores of both groups were significantly reduced in comparison with their own pre-treatment in each group (P<0.01), and the VAS score of the EA+ medication group was significantly lower than that of the medication group (P<0.01). The foetal sac discharge duration was significantly shorter in the EA+ medication group than in the medication group (P<0.01). The abortion rates showed no significant difference between the two groups (P>0.05). EA stimulation of Hegu(LI 4) and Sanyinjiao(SP 6) has a positive effect in assisting medicinal abortion in reducing abdominal pain and shortening foetal sac discharge duration.

COMPARISON OF RECTALLY ADMINISTERED MISOPROSTOL AND OXYTOCIN INFUSION FOR MANAGEMENT OF 3RD STAGE OF LABOUR IN 2ND TRIMESTER PREGNANCY LOSS

Misoprostol and oxytocin are two common medications used to prevent PPH and other pregnancy related complications, particularly in pregnancy loss. Both of these drugs can be administered through different routes and have different effectiveness. So this study was done to compare the effectiveness of these drugs.&#x0D; Objective: To compare the outcome of rectally administered misoprostol and oxytocin infusion for management of 3rd stage of labour in 2nd trimester pregnancy loss.&#x0D; Material &amp; Methods: The randomized control trial was conducted at department of Obstetrics and Gynaecology, Lady Willingdon Hospital, Lahore. Then patients were randomly divided into two groups by using lottery method. In group A, 600 μg tablets of misoprostol was used rectally at the time of delivery of foetus. In group B, 20 IU of oxytocin was given I/V infusion at the time of delivery of foetus. For comparison independent sample t-test was used to compare blood loss in both study groups. P-value&lt;0.05 was taken as significant.&#x0D; Results: In our study the mean age of the patients was 27.35±6.35 years and the mean gestational age was 18.21±3.95 weeks, the mean blood loss was 369.28±87.26 ml. Retained placenta was observed in 48(17.1%) patients and the PPH was found in 15% patients. Statistically there is significant difference was observed between the study groups and retained placenta of the patients i.e. p-value=0.011.&#x0D; Conclusion: The results of our study concluded that the use of misoprostol is an effective and feasible drug in blood loss, PPH and Retained placenta as compared to oxytocin drug in the managmenet of 3rd stage of labour in 2nd trimester pregnancy loss

Misoprostol administered sublingually at a dose of 12.5\xa0\u03bcg versus vaginally at a dose of 25\xa0\u03bcg for the induction of full-term labor: a randomized controlled trial protocol

BackgroundVarious methods are currently used for the induction of labor. Nevertheless, the most effective method with the fewest side effects remains to be established. Misoprostol, administered vaginally, has been routinely used for this purpose; however, other forms of administration are being proposed, including the use of sublingual tablets. No studies have yet compared the effectiveness and safety of 12.5-μg misoprostol administered sublingually compared to a 25-μg vaginal dose of the drug for the induction of labor.MethodsA triple-blind, multicenter, placebo-controlled, randomized clinical trial will be conducted in Brazil at the Instituto de Medicina Integral Prof. Fernando Figueira and at the Assis Chateaubriand Maternity Teaching Hospital of the Federal University of Ceará. A total of 140 patients with full-term pregnancies, a live fetus, a Bishop score ≤ 6 and a recommendation of induction of labor will be randomized to one of two groups. One group will receive 12.5-μg sublingual tablets of misoprostol and placebo vaginal tablets, while the other group will receive placebo sublingual tablets and vaginal tablets containing 25 μg of misoprostol. The principal endpoint is the rate of tachysystole. The secondary endpoints are vaginal delivery within 24 h of induction, uterine hyperstimulation, Cesarean section, severe neonatal morbidity or perinatal death, severe maternal morbidity or maternal death, and maternal preference regarding the route of administration of the drug. Student’s t-test, and the chi-square test of association or Fisher’s exact test, as appropriate, will be used in the data analysis. Risk ratios and their respective 95% confidence intervals will be calculated.DiscussionMisoprostol has been identified as a safe, inexpensive, easily administered option for the induction of labor, with satisfactory results. An experimental study has shown that misoprostol administered sublingually at a dose of 25 μg appears to be effective and is associated with greater maternal satisfaction when labor is induced in women with an unfavorable cervix. Nevertheless, the rate of tachysystole remains high; therefore, further studies are required to determine the ideal dose and the ideal interval of time between doses.Trial registrationClinicalTrial.gov, NCT01406392.

Task shifting in active management of the third stage of labor: a systematic review

BackgroundActive management of the third stage of labor (AMTSL) describes interventions with the common goal to prevent postpartum hemorrhage (PPH). In low- and middle-income countries, implementation of AMTSL is hampered by shortage of skilled birth attendants and a high percentage of home deliveries. Task shifting of specific AMTSL components to unskilled birth attendants or self-administration could be a strategy to increase access to potentially life-saving interventions. This study was designed to evaluate the effect, acceptance and safety of task shifting of specific aspects of AMTSL to unskilled birth attendants.MethodsA systematic search was conducted in five databases in September 2015 to identify intervention studies of AMTSL implemented by unskilled birth attendants or pregnant women themselves. Quality of studies was evaluated with an adapted Cochrane Collaboration assessment tool.ResultsOf 2469 studies screened, 21 were included. All studies assessed implementation of uterotonics (misoprostol tablets or oxytocin injections), administered by community health workers (CHWs), auxiliary midwives, traditional birth attendants (TBAs) or self-administration at antenatal (home) visits or delivery. Task shifting for none of the other AMTSL components was reported. Task shifting of provision of uterotonics reduced the risk of PPH (RR 0.16 to 1) compared to standard care (13 studies, n = 15.197). The correct dose and timing was reported for 83.4 to 99.8% (5 studies, n = 6083) and 63 to 100% (9 studies, n = 8378) women respectively. Uterotonics were recommended to others by 80 to 99.7% (7 studies, n = 6445); 80 to 99.4% (5 studies, n = 2677) would use the drug at next delivery. Willingness to pay for uterotonics varied from 54.6 to 100% (7 studies, n = 6090).ConclusionTask shifting of AMTSL has thus far been evaluated for administration of uterotonics (misoprostol tablets and oxytocin injected by CHWs and auxiliary midwives) and resulted in reduction of PPH, high rates of appropriate use and satisfaction among users.In order to increase AMTSL coverage in low-staffed health facilities, task shifting of uterine massage or postpartum tonus assessment to unskilled attendants or delivered women could be considered. Task shifting of controlled cord traction is currently not recommended.

Quality medicines in maternal health: results of oxytocin, misoprostol, magnesium sulfate and calcium gluconate quality audits

BackgroundThe high level of maternal mortality and morbidity as a result of complications due to childbirth is unacceptable. The impact of quality medicines in the management of these complications cannot be overemphasized. Most of those medicines are sensitive to environmental conditions and must be handled properly. In this study, the quality of oxytocin injection, misoprostol tablets, magnesium sulfate, and calcium gluconate injections was assessed across the six geopolitical zones of Nigeria.MethodSimple, stratified random sampling of health facilities in each of the political zones of Nigeria. Analysis for identification and content of active pharmaceutical ingredient was performed using high-performance liquid chromatography procedures of 159 samples of oxytocin injection and 166 samples of misoprostol tablets. Titrimetric methods were used to analyze 164 samples of magnesium sulfate and 148 samples of calcium gluconate injection. Other tests included sterility, pH measurement, and fill volume.ResultsSamples of these commodities were procured mainly from wholesale and retail pharmacies, where these were readily available, while the federal medical centers reported low availability. Approximately, 74.2% of oxytocin injection samples failed the assay test, with the northeast and southeast zones registering the highest failure rates. Misoprostol tablets recorded a percentage failure of 33.7%. Magnesium sulfate and Calcium gluconate injection samples recorded a failure rate of 6.8% and 2.4%, respectively.ConclusionThe prevalence of particularly of oxytocin and misoprostol commodities was of substandard quality. Strengthening the supply chain of these important medicines is paramount to ensuring their effectiveness in reducing maternal deaths in Nigeria.

Comparison of 50 μg Oral and Vaginal Misoprostol Tablets in Induction of Labor at Term

Comparison of 50 μg Oral and Vaginal Misoprostol Tablets in Induction of Labor at Term

Comparison of 25 Microgram of Sublingual Misoprostol with 25 Microgram Vaginal Misoprostol for Induction of Labour at Term

Comparison of 25 Microgram of Sublingual Misoprostol with 25 Microgram Vaginal Misoprostol for Induction of Labour at Term

Moistening the new vaginal misoprostol tablets: does it increase the efficacy of cervical priming before manual vacuum aspiration in first-trimester miscarriage? A randomised clinical trial

Objectives: The primary objective of our study was to ascertain whether moistening the Brazilian formulation of vaginal misoprostol tablets increases cervical dilation before manual vacuum aspiration (MVA), compared with use of dry misoprostol, in first-trimester miscarriage. The secondary objective was to ascertain whether there was any correlation between vaginal pH and the degree of cervical dilation using a moistened or dry misoprostol tablet.Methods: In a single-centre, double-blind, randomised trial, 46 patients with first-trimester miscarriage were randomly allocated to treatment with dry or moistened (with 200 µl distilled water) 2 × 200 μg misoprostol tablets.Results: The median (range) cervical dilation in the wet and dry groups was 8 mm (6–12 mm) and 7 mm (5–10 mm), respectively (p = .06). The median time between misoprostol insertion and carrying out the procedure did not differ between the dry (406 min, range 180–550 min) and wet (448 min, range 180–526 min) groups (p = .1). No correlation was found between vaginal pH and cervical dilation using continuous data (p = .57; r= 0.08; 95% confidence interval −0.02, 0.3) or dichotomous data (pH ≤5/>5; cervical dilation ≥8 mm or <8 mm; p = .8).Conclusion: No difference was observed in cervical dilation between moistened and non-moistened misoprostol use prior to MVA.

Lessons from implementation of ‘community based use of Misoprostol tablets to prevent PPH, in India’

Lessons from implementation of ‘community based use of Misoprostol tablets to prevent PPH, in India’

Exploring the feasibility of obtaining mifepristone and misoprostol from the internet

ObjectivesWe aimed to document the experience of buying abortion pills from online vendors that do not require a prescription and to evaluate the active ingredient content of the pills received. Study designWe searched the internet to identify a convenience sample of websites that sold mifepristone and misoprostol to purchasers in the United States and attempted to order these products. We documented price, shipping time and other aspects of ordering. We sent the samples received to a testing laboratory that measured the amount of active ingredient in individual tablets. ResultsWe identified 18 websites and ordered 22 products: 20 mifepristone–misoprostol combination products and 2 that contained only misoprostol. We received 18 combination products and the 2 misoprostol products from 16 different sites. No site required a prescription or any relevant medical information. The time between order and receipt of the 20 products ranged from 3 to 21 business days (median 9.5 days). The price for the 18 combination products ranged from $110 to $360, including shipping and fees; the products without mifepristone cost less. Chemical assays found that the 18 tablets labeled 200 mg mifepristone contained between 184.3 mg and 204.1 mg mifepristone, while the 20 tablets labeled 200 mcg misoprostol contained between 34.1 mcg and 201.4 mcg of the active ingredient. ConclusionsObtaining abortion medications from online pharmaceutical websites is feasible in the United States. The mifepristone tablets received contained within 8% of the labeled amount of active agent. The misoprostol tablets all contained that compound but usually less than labeled. Implications statementGiven our findings, we expect that some people for whom clinic-based abortion is not easily available or acceptable may consider self-sourcing pills from the internet to be a rational option.

Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial

Aims: To assess the effectiveness of vaginal misoprostol in minimizing the pain perceived by patients with no risk factors for cervical stenosis (i.e., parous women of reproductive age who have no history of cesarean section or cervical surgery) during diagnostic office hysteroscopy. Methods: A total of 100 patients with no risk factors for cervical stenosis were randomized to the misoprostol group (n = 50) or the placebo group (n = 50). In the misoprostol group, 2 misoprostol tablets (400 µg) were administered vaginally 12 h before office hysteroscopy. In the placebo group, 2 placebo tablets were administered. The patients rated the intensity of pain perceived during the procedure and at 30 min after the procedure with the use of a 100 mm visual analog scale (VAS). The hysteroscopists also scored the difficulty of hysteroscope insertion into the uterine cavity with the use of a 100 mm VAS. Results: There were no significant differences between both groups in the VAS pain scores during or at 30 min after the procedure (28.3 ± 13.58 vs. 30.42 ± 15.13 and 11.1 ± 10.23 vs. 13.32 ± 11.12, respectively). The difficulty of hysteroscope insertion into the uterine cavity was comparable between both groups. Conclusion: Misoprostol administration prior to diagnostic office hysteroscopy appears to have no beneficial role in the subgroup of patients with no risk factors for cervical stenosis.

Misoprostol for termination of first trimester missed abortion.

Background: misoprostol is prostaglandin E1 analogue that can be given by oral, sublingual, vaginal or rectal route. It is cheap and can be stored at room temperature and because of its utero-tonic action, it become an important drug in obstetric and gynecological practice.Objectives: to evaluate the effectiveness of intravaginal followed by oral misoprostol tablets for medical termination of missed abortionbetween 8 – 13 weeks.&#x0D; Methods : a prospective study of (60) women with diagnosed missed abortion admitted to AL- Zahraa General hospital – Wassit Governorate Iraq from July 2006 through July 2007 . 800 micrograms (4 tablets) of misoprostol inserted in the posterior fornix of the vagina after moisture with normal saline followed by oral 400 micrograms (2 tablets) 6 hours later. Another 400 micrograms were given orally 6 hours from the last dose for those patients whodid not respond to theprevious two doses.Results: (48) patients (80%) had complete expulsion . (21) Patients (35%) after the vaginal dose. (15) Patients (25%) respond after the first oral dose and (12) patients (20%) after the second oral dose. (6) Patients (10%) had incomplete abortion; the remainder (6) patients (10%) failed to respond within 24 hours of starting treatment and require surgical evacuation. The mean time for expulsion was 10 hours.Conclusion: first trimester missed abortion medical termination by misoprostol is effective, save and a practical Methods .

Induction of Labor using Misoprostol in a Tertiary Hospital in the Southeast of Brazil.

Purpose To assess cases of labor induction with vaginal 25-µg tablets of misoprostol and maternal outcomes in a tertiary hospital in southeastern Brazil. Methods This was a retrospective cohort study of 412 pregnant women with indication for labor induction. Labor induction was performed with vaginal 25-µg tablets of misoprostol in pregnant women with Bishop scores < 6. Stepwise regression analysis was used to identify the factors present at the beginning of induction that could be used as predictors of successful labor induction. Results A total of 69% of the pregnant women who underwent labor induction progressed to vaginal delivery, and 31% of the women progressed to cesarean section. One or two misoprostol tablets were used in 244 patients (59.2%). Of the 412 patients, 197 (47.8%) required oxytocin later on in the labor process, after induction with misoprostol. The stepwise regression analysis showed that only Bishop scores of 4 and 5 and previous vaginal delivery were independent factors with statistical significance in the prediction of successful vaginal labor induction (β = 0.23, p < 0.001, for a Bishop score of 4 and 5, and β = 0.22, p < 0.001, for previous vaginal delivery). Conclusion Higher Bishop scores and previous vaginal delivery were the best predictors of successful labor induction with vaginal 25-µg tablets of misoprostol.

What can we do to reduce the associated costs in induction of labour of intrauterine growth restriction foetuses at term? A cost-analysis study.

To evaluate the costs associated with induction of labour in intrauterine growth restriction fetuses comparing different procedures. 150 pregnancies at term diagnosed with intrauterine growth restriction and indication for induction of labour were included. 24 were ripened with misoprostol 25μg tablets, 24 with dinoprostone 10mg vaginal insert, and 77 with Cook® cervical ripening balloon. To determine the costs of induction of labour, method of induction, intrapartum medication, epidural analgesia, type of delivery, and maternal and neonatal admissions were considered. Statistical analysis was performed using the G-Stat 2.0 free statistical software. ANOVA test was used for comparisons between quantitative parametric variables. Chi-squared test or Fisher test was used for qualitative variables. A value of p<0.05 was considered statistically significant. Up to 70.83% women in dinoprostone group gave birth within the first 24h compared to 42.66% in misoprostol group and 36.36% in CG (p<0.01). Misoprostol tablets were cheaper (9.45±1.52 US dollars) than dinoprostone or Cook® balloon (41.67±0 and 59.85±0 54.45±0 US dollars, respectively) (p<0.01). Costs related to maternal admissions were higher in CG (475.13±146.95$) than dinoprostone group (475.13±146.95$) or MG (427.97±112.65$) (p=0.03). Total costs in misoprostol group (2765.18±495.38$) were lower than in the dinoprostone group (3075.774±896.14$) or Cook® balloon group (3228.02±902.06$) groups. Misoprostol for induction of labour had lower related costs than dinoprostone or Cook® balloon, with similar obstetrical and perinatal outcomes.

FIRST TRIMESTER MISCARRIAGE;

Objectives: This study was conducted to access the efficacy of misoprostol andmanual vacuum aspiration for the management of first trimester miscarriage. Study Design:Descriptive case series. Setting: This study was conducted in obstetrics and gynecologydepartment of Nishtar hospital Multan. Duration of Study: This study was conducted fromMay, 2015 to October 2015. Material and Methods: Sample including 652 women havinggestational age less than 12 weeks with open os of cervix were taken in the study. Femaleswith previous cesarean section, multiple gestation or with history of asthma, ischemic heartdisease, hepatitis, glaucoma, or known allergy to prostaglandins were excluded. Total womenwere divided into two groups. i.e. 326 in misoprostol while 326 in manual vacuum aspirationgroup. Misoprostol group received misoprostol tablet 400μg vaginally at intervals of four hoursdepending on the degree of cervical dilatation and frequency of uterine contractions. A total of 3doses of misoprostol were given. Six hours after the first dose of misoprostol syntocinon infusionwas started. Infusion rate was 2mIU/min. Dose was increased after every 30 minutes at the rateof 1mIU/min to maximum of 8mIU/min. Manual vacuum aspiration group did not receive anyuterotonics and directly underwent manual vacuum aspiration. Patients were asked to revisit 7days after the procedure. Transvaginal ultrasound was done to access endometrial thicknessin the longitudinal view of the uterus at the maximal AP diameter. Efficacy was measuredin the form of complete abortion. Results: In the study, misoprostol group mean age was31.79±4.86 years while age range was 18-40 years. In manual vacuum aspiration group meanage was 32.38±4.86 years. Majority of patients were between 31-35 years in both groups. Meangestational age was 9.89±1.38 weeks in misoprostol group and 9.871±1.22 weeks in manualvacuum aspiration group, while mean dose in misoprostol group was 2.358±0.65. Conclusion:Regarding management of first trimester miscarriage both options including manual vacuumaspiration and 400μg intra vaginal misoprostol can be considered. Both methods are affectivetreatment options, decision that which method be opted should be based on, availability of twomethods and wishes of the patient.

English

Objectives: This study was conducted to access the efficacy of misoprostol andmanual vacuum aspiration for the management of first trimester miscarriage. Study Design:Descriptive case series. Setting: This study was conducted in obstetrics and gynecologydepartment of Nishtar hospital Multan. Duration of Study: This study was conducted fromMay, 2015 to October 2015. Material and Methods: Sample including 652 women havinggestational age less than 12 weeks with open os of cervix were taken in the study. Femaleswith previous cesarean section, multiple gestation or with history of asthma, ischemic heartdisease, hepatitis, glaucoma, or known allergy to prostaglandins were excluded. Total womenwere divided into two groups. i.e. 326 in misoprostol while 326 in manual vacuum aspirationgroup. Misoprostol group received misoprostol tablet 400μg vaginally at intervals of four hoursdepending on the degree of cervical dilatation and frequency of uterine contractions. A total of 3doses of misoprostol were given. Six hours after the first dose of misoprostol syntocinon infusionwas started. Infusion rate was 2mIU/min. Dose was increased after every 30 minutes at the rateof 1mIU/min to maximum of 8mIU/min. Manual vacuum aspiration group did not receive anyuterotonics and directly underwent manual vacuum aspiration. Patients were asked to revisit 7days after the procedure. Transvaginal ultrasound was done to access endometrial thicknessin the longitudinal view of the uterus at the maximal AP diameter. Efficacy was measuredin the form of complete abortion. Results: In the study, misoprostol group mean age was31.79±4.86 years while age range was 18-40 years. In manual vacuum aspiration group meanage was 32.38±4.86 years. Majority of patients were between 31-35 years in both groups. Meangestational age was 9.89±1.38 weeks in misoprostol group and 9.871±1.22 weeks in manualvacuum aspiration group, while mean dose in misoprostol group was 2.358±0.65. Conclusion:Regarding management of first trimester miscarriage both options including manual vacuumaspiration and 400μg intra vaginal misoprostol can be considered. Both methods are affectivetreatment options, decision that which method be opted should be based on, availability of twomethods and wishes of the patient.

Foley catheterisation versus oral misoprostol for induction of labour in hypertensive women in India (INFORM): a multicentre, open-label, randomised controlled trial

Between 62 000 and 77 000 women die annually from pre-eclampsia and eclampsia. Prompt delivery, preferably by the vaginal route, is vital for good maternal and neonatal outcomes. Two low-cost interventions-low-dose oral misoprostol tablets and transcervical Foley catheterisation-are already used in low-resource settings. We aimed to compare the relative risks and benefits of these interventions. We undertook this multicentre, open-label, randomised controlled trial in two public hospitals in Nagpur, India. Women (aged ≥18 years) who were at 20 weeks' gestation or later with a live fetus and required delivery as a result of pre-eclampsia or hypertension were randomly assigned (1:1), via computer-generated block randomisation (block sizes of four, six, and eight) with concealment by use of opaque, sequentially numbered, sealed envelopes, to receive labour induction with either oral misoprostol 25 μg every 2 h (maximum of 12 doses) or a transcervical Foley catheter (silicone, size 18 F with 30 mL balloon). Randomisation was stratified by study centre. The catheter remained in place until active labour started, the catheter fell out, or 12 h had elapsed. If the catheter did not fall out within 12 h, induction continued with artificial membrane rupture and oxytocin, administered through a micro-drip gravity infusion set. Fetal monitoring was by intermittent auscultation. The primary outcome was vaginal birth within 24 h. Due to the nature of the interventions, masking of participants, study investigators, and care providers to group allocation was not possible. We analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01801410. Between Dec 20, 2013, and June 29, 2015, we randomly assigned 602 women to induction with misoprostol (n=302) or the Foley catheter (n=300; intention-to-treat population). Vaginal birth within 24 h was more common in women in the misoprostol group than in the Foley catheter group (172 [57·0%] vs 141 [47·0%] women; absolute risk difference 10·0%, 95% CI 2·0-17·9; p=0·0136). Rates of uterine hyperstimulation were low in both the misoprostol and Foley catheter groups (two [0·7%] vs one [0·3%] cases; absolute risk difference 0·3%, 95% CI -0·8 to 1·5; p=0·566) and neonatal deaths did not differ significantly between groups (six [2·0%] vs three [1·0%] neonatal deaths; 1·0, -1·04 to 2·97; p=0·322). 17 serious adverse events (3%) were reported during the study: one case of intrapartum convulsion and one case of disseminated intravascular coagulation (both in the Foley group); ten perinatal deaths, including two stillbirths (both in the Foley catheter group) and eight neonatal deaths (n=5 in the misoprostol group and n=3 in the Foley catheter group); and five of neonatal morbidity, comprising birth asphyxia (n=3), septicaemia (n=1), and neonatal convulsion (n=1). Oral misoprostol was more effective than transcervical Foley catheterisation for induction of labour in women with pre-eclampsia or hypertension. Future studies are required to assess whether oxytocin augmentation following misoprostol can be replaced by regular doses of oral misoprostol tablets. Medical Research Council, Department for International Development, and Wellcome Trust Joint Global Health Trials Scheme.