Misoprostol Treatment Research Articles

Surgical versus expectant management in women with an incomplete evacuation of the uterus after treatment with misoprostol for miscarriage: the MisoREST trial

BackgroundMedical treatment with misoprostol is a non-invasive and inexpensive treatment option in first trimester miscarriage. However, about 30% of women treated with misoprostol have incomplete evacuation of the uterus. Despite being relatively asymptomatic in most cases, this finding often leads to additional surgical treatment (curettage). A comparison of effectiveness and cost-effectiveness of surgical management versus expectant management is lacking in women with incomplete miscarriage after misoprostol.Methods/DesignThe proposed study is a multicentre randomized controlled trial that assesses the costs and effects of curettage versus expectant management in women with incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage.Eligible women will be randomized, after informed consent, within 24 hours after identification of incomplete evacuation of the uterus by ultrasound scanning. Women are randomly allocated to surgical or expectant management. Curettage is performed within three days after randomization.Primary outcome is the sonographic finding of an empty uterus (maximal diameter of any contents of the uterine cavity < 10 millimeters) six weeks after study entry. Secondary outcomes are patients’ quality of life, surgical outcome parameters, the type and number of re-interventions during the first three months and pregnancy rates and outcome 12 months after study entry.DiscussionThis trial will provide evidence for the (cost) effectiveness of surgical versus expectant management in women with incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage.Trial registrationDutch Trial Register: NTR3110

Rebamipide Helps Defend Against Nonsteroidal Anti-Inflammatory Drugs Induced Gastroenteropathy: A Systematic Review and Meta-Analysis

Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) has been perplexing most clinicians and users of NSAIDs. Rebamipide is increasingly advocated as a candidate option for the prevention of NSAIDs induced gastrointestinal mucosal injury. To assess the efficacy and the safety of rebamipide for the prevention and treatment of NSAID-induced gastroenteropathy. PubMed, Embase, Web of Science, Google Scholar, the Cochrane Library, Japan Science and Technology Information Aggregator, and China Biology Medicine Disc were searched up to December 2011. Randomized controlled trials (RCTs) recruiting subjects with co-prescriptions of NSAIDs and rebamipide were eligible. Efficacy and safety of rebamipide were reevaluated, and dichotomous data were pooled to obtain relative risk (RR) with a 95 % confidence interval. Heterogeneity and publication bias were assessed by the inconsistency index statistic and funnel plot analysis, respectively. The search identified 338 citations, and 15 RCTs including 965 individuals were eligible. In general, rebamipide acted better than placebo against short-term NSAID-induced gastroduodenal injury. Separate studies showed rebamipide was equal to or not superior to traditional strategies (including PPIs, H2RA and misoprostol treatment). Especially, rebamipide showed a beneficial effect against the small bowel damage (total RR = 2.70, 95 % confidence interval = 1.02-7.16, P = 0.045) when compared with placebo group. The average incidence of adverse events was about 36.1 % (0-70.0 %) but no serious event was recorded. Current evidences show rebamipide is effective and safe for defending against NSAID-induced gastroduodenal and lower-gastrointestinal injuries. However, more well-designed trials should be conducted to fully confirm the practical value of rebamipide.

Can isosorbide mononitrate be useful in second trimester termination of pregnancies?

BackgroundIsosorbide mononitrate (IMN) administration is thought to enhance in the cervical ripening process. We sought to identify the clinical usefulness and safety of IMN administration for shortening the time to termination of the second trimester pregnancy procedures when used in addition to misoprostol. Study DesignWomen were randomly selected to receive either the standard misoprostol treatment (control group) or, additionally, receive vaginally IMN as well as the misoprostol treatment. ResultsThe mean induction to complete abortion interval was 20.4 h [95% confidence interval (CI)=16.63–24.17] in the misoprostol group compared with 12.4 h (95% CI=10.33–14.47) in the misoprostol plus IMN group. This difference was statistically significant (p<.05). In the subgroups of nulliparas and multiparas, the shortening effect of the IMN was also statistically significant. ConclusionsA net benefit after the combined use of IMN and misoprostol was noted. Therefore, we believe that IMN has a clinical role in the ripening process.

Misoprostol treatment of dystocia due to ringwomb in Awassi ewe: a case report

Incomplete dilatation of the cervix of the ewe is descriptively named ‘ringwomb’ (1). A small hole, the size of a ring (hence the name) is felt (2). Cervical priming refers to dilating and softening of the cervix in the first stage of labor is a gradual process (3). A Caesarean section mostly performed to treat such cases in ewes. Misoprostol an analogue of prostaglandin E1 is widely used to ripen the cervix and/or initiate labor at term in human and it is more widely used to control postpartum bleeding (4,5). PGE1 has never been used in ovine obstetrics to dilate the cervix in dystocia cases due to ringwomb. Previously in this clinic misoprostol had been used successfully to treat incomplete dilatation in a cow (6). This report describes the first successful use of misoprostol (PGE1) for the treatment of ringwomb in Awassi ewe.

Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

BackgroundIn low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful.MethodsA total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation.ResultsBoth misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%). Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92). Both tolerability of side effects and women’s satisfaction were similar in the two study arms.ConclusionMisoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability.Trial registrationThis study has been registered at clinicaltrials.gov as NCT00466999 and NCT01539408

Vaginal acidity enhancement with a 3% acetic acid gel prior to misoprostol treatment for pregnancy termination in the midtrimester

ObjectiveTo investigate whether enhancing vaginal acidity improves the success of medical abortions in the midtrimester. MethodsA double-blind, randomized, placebo-controlled trial was conducted with 48 women with missed midtrimester abortions. Twice daily, the study participants (n=24) were treated with a 3% acetic acid gel and the controls (n=24) with a placebo gel, starting 2days prior to initiating the misoprostol treatment. The primary outcome measures were the rates of successful abortion within 24 and 48hours. Secondary measures included gel tolerability and adverse effects of the misoprostol treatment. ResultsThe success rates were higher in the study group, within both 24hours (11/23 vs 3/24; P=0.011) and 48hours (18/23 vs 6/24; P<0.001). Among the women with a vaginal pH of 5 or higher at baseline, acidic gel was also associated with higher success rates within 24hours (8/13 vs 2/15; P<0.01) and 48hours (13/13 vs 3/15; P<0,001). The vaginal gels were well tolerated and the misoprostol treatment produced no serious adverse effects. ConclusionA 3% acetic acid gel appears to be an effective and safe preparatory adjuvant to vaginal misoprostol treatment for midtrimester medical abortions, especially in women with a vaginal pH of 5 or higher.www.controlledtrials.com: ISRCTN75746444

Clinical study on misoprostol with combined calcium in the treatment of postpartum hemorrhage of cesarean section

Objective To investigate the misoprostol and calcium combined treatment of postpartum hemorrhage of cesarean section clinical curative effect.Methods The subjects were cesarean section 68 cases of pregnant women,which were randomly divided into the observation group and the control group,34 cases in each group,the control group at 600 micrograms misoprostol,observed in this group based on the use of calcium(before skin incision slow intravenous push 50％ GS 20 ml + 10％ calcium gluconate 10 ml),observe two groups of intraoperative,postpartum 2 hours and 24 hours postpartum hemorrhage volume.Results In the observation group,intraoperative blood loss[(188.47 + 13.29) vs(385.24±14.16 ml)]was significantly less than that of the control group,2 hours postpartum bleeding volume[(133.56±11.45) vs(219.4±12.73) ml]was significantly less than that of the control group,24 hours postpartum bleeding volume[(171.29±21.91) vs(257.36±33.42) ml]was also significantly less than that of the control group,the difference was statistically significant(t =1.982,1.895,1.714,all P ＜0.05).Conclusion Misoprostol and calcium combined treatment can significantly reduce postpartum hemorrhage of casarean section on maternal and child safety,security,worthy of clinical application. Key words: Misoprostol; Calcium; Cesarean section; Postpartum hemorrhage

Mid‐gestation pregnancy is not disrupted by a 5‐day gastrointestinal mucosal cytoprotectant oral regimen of misoprostol

To investigate effects of a 5-day oral misoprostol regimen recommended for use in horses as a gastrointestinal mucosal cytoprotectant during colic on mid-gestation pregnancies. To monitor cervical tone, ultrasonographic characteristics of the uterus, cervix and conceptus, as well as serum progesterone and oestrone sulphate concentrations, and observations of general health, behaviour and comfort of mid-gestation mares given a 5-day course of misoprostol or control treatment. Eleven light horse and pony mares with known breeding dates were administered 5 µg/kg bwt misoprostol orally, twice daily for 5 days. General health and pregnancy status were monitored daily during treatment via general physical examination, as well as palpation and ultrasonography per rectum of the uterus, cervix and conceptus. Jugular serum was obtained during and for 5 days following treatment for assay of progesterone and oestrone sulphate concentrations. Additionally, daily 12 h video samples of the mares were obtained to evaluate behaviour and comfort. All findings, including cervical tone, ultrasonographic characteristics of the uterus, cervix and conceptus, as well as progesterone and oestrone sulphate concentrations, and observations of general health, behaviour and comfort, were similar during misoprostol and control treatment. Treatment of pregnant mares with a gastrointestinal mucosal cytoprotectant regimen of oral misoprostol for 5 days did not disrupt pregnancy, nor adversely affect the general health and comfort of these mares. Additional investigation of treatment at earlier and later stages of gestation, for longer-term treatment, as well as evaluating neonates for developmental disturbances, would add further information on safety of misoprostol during gestation. These results provide some assurance of safety of a 5-day gastrointestinal mucosal cytopretectant regimen of oral misprostol in mid-gestation pregnant mares.

Prostaglandin-induced cervical remodelling in humans in the first trimester is associated with increased expression of specific tight junction, but not gap junction proteins

BackgroundProstaglandins (PG) are widely employed to induce cervical remodelling (CR) in pregnancy. However, the underlying molecular mechanisms are not fully elucidated. Tight junctions (TJ) and gap junctions (GJ) regulate paracellular and intercellular solute transport respectively but their role in the process of CR remains unexplored. We hypothesized that the synthetic prostaglandin E1 analogue Misoprostol (M), widely used in clinical practice to induce CR, may alter TJ and GJ expression as part of the changes in the extracellular matrix (ECM) associated with remodelling. We investigated the effects of Misoprostol exposure on the expression of cervical TJ (claudins 1, 2, 4, 5, 7 and occludin) and GJ (connexins 43, 30 and 26) in the 1st trimester.MethodsCervical biopsies were obtained from pregnant women and comparisons of TJ and GJ protein expression (by western blotting) and immunolocalisation (laser scanning confocal microscopy) made between those who were administered vaginal Misoprostol (n = 10) and those who were not (n = 5).ResultsWe found that Misoprostol-treated tissue (M+) had higher expression of Claudins 1,2,4,7 and occludin (p < 0.05) than untreated (M-) tissue. Expression levels of Claudins 1, 2 and 4 were positively correlated to interval from Misoprostol treatment to biopsy, whilst occludin was negatively correlated. Misoprostol-treated cervical tissue demonstrated more endothelial claudin-5 and occludin, whilst expression of GJs were unchanged.ConclusionOur observations suggest, for the first time, that increased expression of tight junction proteins may be one of the mechanisms by which Misoprostol induces CR in humans. Further studies are needed to explore if TJ proteins may be therapeutic targets to alter timing of CR in clinical practice.

English

Annual incidence of induced or strengthened labor in the United States, with nearly doubled increase, has risen from 20% in 1989 to 38% in 2002. For the success of labor induction, cervical status or its desirability is important.&nbsp;Different techniques are used to prepare the cervix. One of these techniques is using misoprostol tablets (Prostaglandin E1 (PGE1)). The aim of this study is to evaluate the maternal and neonatal results after immediate labor induction by vaginal misoprostol and expectational treatment. In a clinical trial conducted in Kosar hospital on 100 patients with diagnosis of&nbsp;premature rupture of the membranes&nbsp;(PROM) in 2006, the maternal and neonatal results that followed the immediate labor induction by vaginal misoprostol and expectational treatment for 12 h and then induction by oxytocin were investigated. The mean age of women was 23.8&nbsp;&plusmn;&nbsp;4.9 years in misoprostol group and 25.2&nbsp;&plusmn;&nbsp;5.6 years in the expectational treatment group (P = 0.197). The mean duration of pregnancy in women was 38.5&nbsp;&plusmn;&nbsp;1.2 weeks in misoprostol group and 38.5&nbsp;&plusmn;&nbsp;1.1 weeks in the expectational treatment group (P = 0.927). Mean parity of women was 1.74&nbsp;&plusmn;&nbsp;0.98 in misoprostol group and 1.56&nbsp;&plusmn;&nbsp;0.86 in the expectational treatment group (P = 0.333). The mean latency was 9.5 &plusmn; 2.6 in misoprostol group and 14 &plusmn; 4.3 expectational treatment group, which in misoprostol group was significantly less than that in the expectational treatment group (P &lt; 0.000). The mean interval from peak recruitment contraction was 12.3 &plusmn; 2.9 in misoprostol group and 17.5 &plusmn; 4.9 in the expectational treatment group which in misoprostol group was significantly less than in the expectational treatment group (P &lt; 0.000). Mean Apgar score in misoprostol group was significantly greater than that in the expectational treatment group (P = 0.02). The mean hospitalization duration of misoprostol group was significantly less than that of the expectational treatment group (P &lt; 0.000). Frequency of vaginal delivery was 92% in the misoprostol group and 76% in the expectational treatment group; and the frequency of cesarean delivery was 8% in the misoprostol group and 24% in the expectational treatment group; so, frequency of cesarean delivery in the misoprostol group was significantly lower than that in the expectational treatment group (P &lt; 0.029). Whereas labor induction by misoprostol shortens the duration of delivery and requires no long-term hospitalization and reduces costs for patient and hospital, its application is recommended in all low-risk patients. Since misoprostol reduces&nbsp;cesarean sections&nbsp;(CS) level, it is better to be used in low-risk women and this way, the risks of surgery and anesthesia risks related problems would be decreased. Also, regarding the fact that misoprostol, when compared with oxytocin, it administration requires no tight control and no individuals to constantly be on the clinical presence of the patient, it is more economical in terms of employment and need for medical personnel. &nbsp; Key words:&nbsp;Premature rupture of the membranes&nbsp;(PROM), labor induction, misoprostol.&nbsp

Misoprostol treatment of dystocia due to incomplete dilatation of the cervix in a cow: a case report

Incomplete dilatation of the cervix is a common cause of dystocia in cattle (1). Cervical priming refers to dilating and softening of the cervix in the first stage of labor is a gradual process (2). Incomplete dilatation in multiparous cows may be associated with uterine inertia caused by hypocalcaemia; in these animals, the response to calcium therapy is rapid (1). Misoprostol an analogue of prostaglandin E

Effects of misoprostol on cisplatin-induced renal damage in rats

Cisplatin (CP) is a potent anticancer drug. However, it has side effects on kidney such as nephrotoxicity. Abnormal production of reactive oxygen species (ROS) has been accused in the etiology of CP-induced nephrotoxicity. Several ROS scavengers have been reported to prevent nephrotoxicity after CP administration. In this study, we used prostaglandin E1 (PGE1) analogues misoprostol (MP) to reduce this damage. MP has gained considerable interest as a ROS scavenger. Rats were received a single injection of CP (5mg/kg, i.p.) with or without MP pretreatment (200mcg/kg, orally). The renal tissue morphology was investigated by light microscopy. Trunk blood was also obtained to determine lipid peroxidation product malondialdehyde (MDA) and activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT). CP administration increased MDA production and decreased SOD and CAT levels in the kidney tissue when compared to the control group. Morphological damage in CP administrated rats was also severe in the kidney tissue. MP treatment after CP application protected the renal tissues from CP’s side effect. These findings indicate that MP has beneficial effects on CP induced nephrotoxicity in rats.

Randomized Trial of Oral Misoprostol Treatment for Cervical Ripening Before Tandem Application in Cervix Cancer

To investigate the efficacy of oral misoprostol administered to facilitate tandem application to the cervix as a part of brachytherapy in patients with cervical cancer. Eighty patients with cervical cancer who had been planned to undergo brachytherapy at Dr. Lütfi Kırdar Kartal Training and Research Hospital were evaluated in a double-blind, prospective, randomized trial. Patients were divided randomly into two groups of 40 patients. The first and second groups received 400 μg of misoprostol orally and placebo, respectively, 3 h before tandem application. The two groups were compared in terms of age, diameter of tumor, parity, age at first intercourse, amount of bleeding and pain at first tandem application, length of endometrial cavity measured by hysterometer, and size of Hegar dilators used for cervical dilatation. Of all cases, 63.6%, 16.3%, 10%, 6.3%, 2.5%, and 1.3% were Stage IIB, IIIB, IIIA, IVA, IIA and IIC, respectively. Mean (±SD) age (range) was 49.3 ± 13.1 (25-83) years and 56.6 ± 13.2 (30-78) years in the study and control groups, respectively (p = 0.015). Age at first intercourse, diameter of tumor, parity, amount of bleeding at first tandem application, and length of endometrial cavity measured by hysterometer were not significantly different between the two groups. Pain score was significantly higher in the control group (p < 0.001). Application was significantly easier in the study group compared with controls (p < 0.001). Average size of initial Hegar dilators used for cervical dilatation was significantly higher in the study group compared with controls (p = 0.017). Administration of misoprostol 400 μg orally for cervical ripening before tandem application facilitates the procedure, increases patient tolerability and comfort, and may decrease complication rates.

Low Dose Vaginal Misoprostol Versus Prostaglandin E2 Suppository for Early Uterine Evacuation: A Randomized Clinical Trial

Misoprostol is a cheap product of prostaglandin E1 which has gained interest in pregnancy termination. The aim of this study was to compare the effect of vaginal misoprostol and prostaglandin E2 suppository in pregnancy termination before 20 weeks of gestational age. In this clinical trial, 111 participants under 20 weeks of gestational age who needed pregnancy termination were enrolled. They were divided into two groups misoprostol and prostaglandine E2 treatment. Fifty four people received vaginal misoprostol as 25 microg per 4 h up to 3 days and 57 participants received prostaglandine E2 vaginal suppositories. Data were analyzed using SPSS software. Mean age of participants was 27.5 years and its standard deviation was 6.1 years. Mean gestational age was 13.1 weeks based on sonographic measurement and it was 14.5 weeks by LMP estimation. Mean induction to evacuation time was 3.1 days and in misoprostol group was 2.4 +/- 0.88 days. Half of the patients in control group and 70% of them in misoprostol group succeeded pregnancy termination in 48 h. Vaginal misoprostol compared to prostaglandine E2 vaginal suppository has higher efficacy in shorter time.

A randomized controlled trial of 400-μg sublingual misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion in two Egyptian hospitals

Objective To compare the safety, efficacy, and acceptability of 400-μg sublingual misoprostol with that of manual vacuum aspiration (MVA) in 2 Egyptian hospitals. Methods Participating women were randomized to either MVA or misoprostol treatment for incomplete abortion. The primary outcome, complete uterine evacuation, was determined 1 week later, as were adverse effects, change in hemoglobin, acceptability, and satisfaction. Results Complete uterine evacuation was achieved in 98.3% of women who received misoprostol and 99.7% who underwent MVA (relative risk [RR] 0.99; 95% confidence interval [CI], 0.97–1.00). A decrease in hemoglobin of 2 g/dL or more was comparably rare in the 2 groups (0.3% misoprostol vs 0.9% MVA; RR 0.34 [95% CI, 0.04–3.21]). Mean change in hemoglobin was also clinically similar (–0.5 g/dL misoprostol vs –0.4 g/dL MVA; P < 0.01). Heavy bleeding was rare (2.4% misoprostol vs 1.6% MVA; RR 1.55 [95% CI, 0.51–4.68]) following treatment. Nearly all women (96.8% misoprostol vs 98.3% MVA) were satisfied with their treatment but those who received misoprostol were significantly more likely to prefer that method in the future (81.9% vs 62.8%; RR 1.30 [95% CI, 1.19–1.43]). Conclusion The high efficacy, safety, and acceptability of 400-μg sublingual misoprostol indicate that it is analogous to surgery as a first-line treatment for incomplete abortion. Misoprostol might improve post-abortion care when resources are limited and surgical treatment is unavailable.

One- and two-day mifepristone–misoprostol intervals for second trimester termination of pregnancy between 13 and 16 weeks of gestation

Objective To compare the efficacy of 1-day and 2-day mifepristone and misoprostol intervals for second trimester termination of pregnancy between 13 and 16 weeks. Methods A prospective randomized cohort study of 100 women who underwent voluntary termination between 13 and 16 weeks of gestation. Patients were randomly assigned to receive 200 mg of oral mifepristone, followed 1 day (group 1) or 2 days (group 2) later by 600 μg of vaginal misoprostol. All patients received 400 μg of oral misoprostol every 6 hours for a maximum of 2 doses. Main outcome measure was successful abortion rate at 24 hours after the start of misoprostol treatment. Secondary outcome measures were induction-to-abortion interval and frequency of adverse events. Results The 24-hour successful abortion rate was similar between groups 1 and 2 (47 [94%] vs 50 [100%]; P = 0.241). The mean misoprostol-to-abortion interval was also similar (7.0 ± 3.0 vs 6.8 ± 4.3 hours; P = 0.744). Among the 86 patients for whom histological examination of the products of conception was performed, retained chorionic villi rates were higher in the 1-day regimen group compared with the 2-day regimen group (46.2% [18/39] vs 29.8% [14/47]; P < 0.001). Conclusion A 2-day mifepristone–misoprostol interval resulted in fewer incomplete abortions than a 1-day interval for second trimester termination of pregnancy between 13 and 16 weeks.

Medical treatments for incomplete miscarriage (less than 24 weeks).

Miscarriage occurs in 10% to 15% of pregnancies. The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining pregnancy tissues in the uterus. However, it has been suggested that drug-based medical treatments, or expectant care (no treatment), may also be effective, safe and acceptable. To assess the effectiveness, safety and acceptability of any medical treatment for early incomplete miscarriage (before 24 weeks). We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009). Randomised controlled trials comparing medical treatment with expectant care or surgery. Quasi-randomised trials were excluded. Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. Fifteen studies (2750 women) were included, there were no studies on women over 13 weeks' gestation. Studies addressed a number of comparisons and data are therefore limited.Three trials compared misoprostol treatment (all vaginally administered) with expectant care. There was no significant difference in complete miscarriage (average risk ratio (RR) 1.23, 95% confidence interval (CI) 0.72 to 2.10; two studies, 150 women), or in the need for surgical evacuation (average RR 0.62, 95% CI 0.17 to 2.26; two studies, 308 women). There were few data on 'deaths or serious complications'.Nine studies involving 1766 women addressed the comparison of misoprostol (four oral, four vaginal, one vaginal + oral) with surgical evacuation. There was no statistically significant difference in complete miscarriage (average RR 0.96, 95% CI 0.92 to 1.00, eight studies, 1377 women) with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.07, 95% CI 0.03 to 0.18; eight studies, 1538 women) but more unplanned procedures (average RR 6.32, 95% CI 2.90 to 13.77; six studies, 1158 women). There were few data on 'deaths or serious complications'. Limited evidence suggests that women generally seem satisfied with their care. Long-term follow up from one included study identified no difference in subsequent fertility between the three approaches. The available evidence suggests that medical treatment, with misoprostol, and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service resources to support all three approaches. Women experiencing miscarriage at less than 13 weeks should be offered an informed choice.

O202 Bleeding following surgical (MVA) and medical (400 μg sublingual misoprostol) treatment of incomplete abortion

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S150-S151 Free communication (oral) presentations O202 Bleeding following surgical (MVA) and medical (400 μg sublingual misoprostol) treatment of incomplete abortion R. Dabash, R. DabashSearch for more papers by this authorM. Cherine, M. CherineSearch for more papers by this authorE. Darwish, E. DarwishSearch for more papers by this authorJ. Blum, J. BlumSearch for more papers by this authorN. Hassanein, N. HassaneinSearch for more papers by this authorT. Abdel Daiem, T. Abdel DaiemSearch for more papers by this authorB. Winikoff, B. WinikoffSearch for more papers by this author R. Dabash, R. DabashSearch for more papers by this authorM. Cherine, M. CherineSearch for more papers by this authorE. Darwish, E. DarwishSearch for more papers by this authorJ. Blum, J. BlumSearch for more papers by this authorN. Hassanein, N. HassaneinSearch for more papers by this authorT. Abdel Daiem, T. Abdel DaiemSearch for more papers by this authorB. Winikoff, B. WinikoffSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60574-9Citations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S150-S151 RelatedInformation

Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention

To evaluate the ability of endometrial thickness after medical abortion to predict the need for subsequent dilatation and curettage (D&C). We pooled data from two multicenter medical abortion trials involving 2208 women who received mifepristone orally followed by misoprostol vaginally. Women returned for transvaginal ultrasonography approximately 7 days later. The endometrial thickness was measured if no gestational sac was present. Final status was confirmed by a phone interview at 5 weeks. The area under the receiver-operating characteristics (ROC) curve was calculated to assess the overall ability of endometrial thickness to predict the need for subsequent D&C. Endometrial thickness was dichotomized using threshold values at 5-mm increments from 10 to 30 mm. The sensitivity, specificity, negative predictive value and positive predictive value were calculated to evaluate the ability of each endometrial thickness threshold value to predict subsequent D&C. Multivariable regression analysis was performed to adjust endometrial thickness values for study, treatment group, and study site. At 7 days after misoprostol treatment, 1870 women (84.7%) had endometrial thickness assessed. Thirty of these women (1.6%) subsequently underwent D&C. The mean endometrial thickness was 14.5 mm for women who underwent D&C and 10.9 mm for those who did not (difference 3.5 mm (95% CI, 1.8-5.3 mm)). Endometrial thickness was poorly predictive of the need for D&C, with an area under the ROC curve of 0.65. All endometrial thickness thresholds had positive predictive values of 25% or less. The results were unchanged by adjustment of endometrial thickness values by multivariable modeling. Although endometrial thickness following successful expulsion of the gestational sac is thicker in women who will eventually require surgical intervention after medical abortion, endometrial thickness is not a clinically useful predictor of the subsequent need for D&C.

A randomized trial to compare two dosing intervals of misoprostol following mifepristone administration in second trimester medical abortion

The conventional timing of misoprostol administration after mifepristone for second trimester medical abortion is 36-48 h, but simultaneous administration, which may make the regimen more convenient, has not been studied. The objective of this randomized comparison study is to compare two intervals of administration of misoprostol after pretreatment with mifepristone for second trimester medical abortion. Eligible women with gestational age between 12 and 20 weeks were randomized to receive mifepristone 200 mg orally followed by 600 microg misoprostol vaginally either immediately or 36-38 h later, followed by 400 microg vaginal misoprostol every 3 h for a maximum of four doses. The primary outcome measure was the success rate at 24 h after the start of misoprostol treatment and the secondary outcome measures were the induction-to-abortion interval and the frequency of side effects. There was a significant difference in the success rate at 24 h (36-38 h: 100%; immediate: 91.5%). The median induction-to-abortion interval was significantly shorter in the 36-38 h regimen (4.9 h) compared with the immediate regimen (10 h). Side effects in terms of febrile episodes and chills/rigors were significantly higher in the immediate administration group. Simultaneous use of mifepristone and misoprostol for second trimester medical abortion is not as effective as the regimen using a 36-38 h dosing interval.