Use Of Misoprostol Research Articles

Combination of Mifepristone and Misoprostol for First-Trimester Medical Abortion: A Comprehensive Review of the Literature.

Several medications have been used to achieve medical abortion in the first trimester of pregnancy. The most commonly used is the combination of mifepristone and misoprostol; however, different doses and routes of administration have been proposed. The aim of this study was to summarize published data on the effectiveness, adverse effects, and acceptability of the various combinations of mifepristone and misoprostol in medical abortion protocols in the first trimester of pregnancy. This was a comprehensive review, synthesizing the findings of the literature on the current use of mifepristone and misoprostol for first-trimester abortion. The combination of mifepristone and misoprostol seems to be more effective than misoprostol alone. Regarding the dosages and routes, mifepristone is administered orally, and the optimal dose is 200 mg. The route of administration of misoprostol varies; the sublingual and buccal routes are more effective; however, the vaginal route (800 μg) is associated with fewer adverse effects. Finally, the acceptability rates did not differ significantly. Different schemes for first-trimester medical abortion have been described so far. Future research needs to focus on identifying the method that offers the best trade-off between efficacy and safety in first-trimester medical abortion.

Investigation of the Effectiveness of Misoprostol and Foley Catheter Use Alone or Together in Second Trimester Pregnancy Terminations

Investigation of the Effectiveness of Misoprostol and Foley Catheter Use Alone or Together in Second Trimester Pregnancy Terminations

Comparison of the Efficacy and Safety of Sublingual Versus Oral Misoprostol for the Induction of Labor: A Randomized Open-Label Study.

Introduction Misoprostol (prostaglandin E1 analog) is being used for the induction of labor by vaginal, oral, and sublingual routes. Oral misoprostol is the preferred route for induction of labor, but the use of sublingual misoprostol appears promising due to a faster onset of action. This study was done to compare the efficacy and safety of oral and sublingual misoprostol for induction of labor in term pregnancy. Materials and methods One hundred and sixty patients were randomly allocated to one of the two groups to receive 50 micrograms oforal and sublingual misoprostol four hourly for a maximum of six doses. Primigravida at 37-42 weeks of gestation with singleton pregnancy, cephalic presentation, Bishop score (<5), and reassuring fetal heart rate were included in the study. Misoprostol dose was withheldif the active phase of labor was reached or if the cervixwas favorable for amniotomy (Bishop score greater than or equal to eight). The change in the Bishop score with misoprostol was studied along with adverse effects and neonatal outcomes. Results The mean number of 50 mcg misoprostol doses required was significantly less in the sublingual group (2.94±0.97 versus 2.13±0.92; p<0.0001). The rate of change of the mean Bishop score was faster in the sublingual group. After four hours of the first dose, the mean Bishop score changed to 3.52±2.14 versus 4.68±2.34 (p=0.001), and, similarly, after eight hours, it was 10.48±2.59 versus 11.39±2.06, and this difference was statistically significant (p=0.015). The mean induction delivery interval was significantly lower in the sublingual group. The need for labor augmentation, mode of delivery, andadverse effects were similar in both groups. The incidence of meconium-stained liquor and NICU admission was also similar in both groups. Conclusion Sublingmisoprostolstol has a short induction delivery interval and comparable side effects when compared to omisoprostolstol. Sublingmisoprostolstol is recommended for induction of labor at term.

Prior Cesarean Birth and Risk of Uterine Rupture in Second-Trimester Medication Abortions Using Mifepristone and Misoprostol: A Systematic Review and Meta-analysis.

To assess the risk difference of uterine rupture when using current mifepristone and misoprostol regimens for second-trimester abortion among individuals with prior cesarean birth compared with those without prior cesarean birth. We searched the terms second trimester, induction, mifepristone, and abortion in PubMed, EMBASE, POPLINE, ClinicalTrials.gov , and Cochrane Library from inception until December 2022. We included randomized trials and observational studies including a mixed cohort, with and without uterine scar, of individuals at 14-28 weeks of gestation who used mifepristone and misoprostol to end a pregnancy or to manage a fetal death. We excluded case reports, narrative reviews, and studies not published in English. Two reviewers independently screened studies. Absolute risks with binomial CIs were calculated from pooled data. Using R software, we estimated total risk difference by the Mantel-Haenszel random-effects method without continuity correction. For studies with zero events, a continuity correction of 0.5 was applied for individual risk differences and plotted graphically with forest plots. Statistical heterogeneity was assessed with Higgins I2 statistics. Funnel plot assessed for publication bias. Of 198 articles identified, 22 met the inclusion criteria: seven randomized trials (n=923) and 15 observational studies (n=6,195). Uterine rupture risk with prior cesarean birth was 1.1% (10/874) (95% CI 0.6-2.1) and without prior cesarean birth was 0.01% (2/6,244) (95% CI 0.0-0.12). The risk difference was 1.23% (95% CI 0.46-2.00, I2 =0%). Of the 12 reported uterine ruptures, three resulted in hysterectomy. Uterine rupture with mifepristone and misoprostol use during second-trimester induction abortion is rare, with the risk increased to 1% in individuals with prior cesarean birth. PROSPERO, CRD42022302626.

Is concomitant use of misoprostol and extra amniotic saline infusion more effective or safer for cervical ripening: A RCT in a tertiary center

Various methods have been proposed for cervical ripening. Due to conflicting results and significant heterogenisity among previous studies, we designed a randomized clinical trial to find out wether concomitant use of Misorostol and extra-amnitic saline infusion (EASI) would lead to better outcomes or not. Ninety term pregnant women were randomly assigned to three different groups of ripening methods: vaginal misoprostol, EASI, and concomitant use of both. Time interval to reach a bishop score of five (primary outcome), time interval to amniotic membranes rupture and delivery rate, delivery route, need to oxytocin infusion, fetal distress associated cesarean delivery, meconium staining, and 1st and 5th minute Apgar scores were study outcomes.

MATERNAL AND FETAL FACTORS ASSOCIATED WITH MISOPROSTOL USE IN MUBENDE REGIONAL REFERRAL HOSPITAL, UGANDA

There are numerous obstetric uses for misoprostol. It mimics the normal labour process by causing the uterus to contract strongly and by softening and dilating the cervix. This action makes it a uterotonic. The maternal uses include cervical ripening, initiating labour, treating incomplete abortions, preventing and treating postpartum haemorrhage, and causing abortions. This study sought to identify maternal and foetal risk factors related to misoprostol use among mothers who gave birth at the regional referral hospital in Mubende.&#x0D; A mixed method analytical cross-sectional design was used with mothers, their infants, and healthcare professionals. 385 respondents made up the sample. Interviews, observation, and the review of documents were used to gather the data.&#x0D; 12.4% of mothers had ever used misoprostol. In comparison to mothers who lived in rural areas, urban mothers were two times more likely to have a positive history of misoprostol usage (COR=1.843, 95% CI (0.903-3.763)). Mothers with a parity of 2–4 had a 0.5x lower likelihood of using misoprostol [COR=0.514, 95% CI (0.166–1.595)]. Better APGAR scores of 4-7 (4 times) and 8-10 (2 times) in newborns were associated with a higher likelihood of a positive history of misoprostol use.&#x0D; In conclusion, misoprostol use poses dangers to both the mother and the foetus, necessitating careful observance.

Outpatient Cervical Ripening With Misoprostol to Prevent Post-Term Pregnancy: A Double-Blind Randomized Clinical Trial

Outpatient use of misoprostol is assessed in a few studies and usually in low doses and vaginal routes. This study aimed to evaluate cervical ripening by outpatient administration of misoprostol to prevent post-term pregnancy. This randomized clinical trial study was performed on 140 patients that were randomly allocated into two groups: 25 μg sublingual SL (group A) and 50 μg PO misoprostol (group B). The patients were primigravid with a gestational age of 40 weeks, with an amniotic fluid index (AFI) of ≥5 cm, a reactive non-stress test (NST) with no evident uterine contraction, Bishop Score of &lt;8, and no notable past medical history. Patients who had a normal vaginal delivery before 41 weeks were considered successful delivery. Maternal age, the number of misoprostol doses, vaginal examination, type of interventions before delivery, the indication of hospitalization, delivery route, the indication of cesarean section, delivery complications, and neonatal outcomes were compared using SPSS software. P&lt;0.05 was considered statistically significant. group A had mean age of 23.27±4.03 years and Group B had a mean age of 24.61±5.46 years with no significant difference (P=0.223). The number of misoprostol doses (P=0.001), extra misoprostol, and oxytocin application were significantly lower in group B (P=0.003). Maternal and neonatal complications showed no significant difference between the two groups (P&gt;0.05). Outpatient cervical ripening with misoprostol appears to be an optimal method. More prospective studies with higher sample sizes are required to ensure its safety for routine recommendations for cervical ripening to prevent post-term pregnancy.

Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis.

In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age. This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018-2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area-level deprivation. The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post-approval. The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre-approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post-approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.

Trends in the Use of Mifepristone for Medical Management of Early Pregnancy Loss From 2016 to 2020

This study assesses the use of mifepristone plus misoprostol for miscarriage management among commercially insured adults in the US.

A PROSPECTIVE STUDY TO COMPARE COMBINED USE OF INTRAVAGINAL MISOPROSTOL AND INTRACERVICAL FOLEY CATHETER VERSUS INTRAVAGINAL MISOPROSTOL ALONE FOR TERMINATION OF MID-TRIMESTER PREGNANCY IN DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY SMS MEDICAL COLLEGE, JAIPUR

Aims and Objectives: The aims and objectives of the study are to compare the mean induction to abortion interval and efficacy of intra-vaginal misoprostol alone versus combined use of intravaginal misoprostol and intracervical Foley catheter in termination of mid-trimester pregnancy. Methods: This was prospective, comparative study conducted during March 2021 to April 2022 at Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur. The study included sample size of 60 cases (30 cases in each group). 60 cases were randomly allocated to either intravaginal misoprostol alone (Group A) or combined use of intravaginal misoprostol and Foley catheter (Group B) for termination of mid-trimester pregnancy. The study included all pregnant females between 14 and 20 weeks of gestation who were admitted for termination of pregnancy. Results: Mean induction to abortion interval±standard deviation for Group A was 20.79±2.01 h and for Group B, it was 17.29±3.58 h. Mean dose of tablet misoprostol required for Group A±standard deviation was 1453.3±267.47 mcg and for Group B, it was 1053.33±267.47 mcg. Conclusion: In this study, we found that with the combined use of intravaginal misoprostol and intracervical Foley catheter, there was a significant reduction in duration of induction to abortion, total dose misoprostol required, and hospital stay than in intravagnial misoprostol alone in termination of mid-trimester pregnancy.

Association between misoprostol and non-steroidal anti-inflammatory drug-induced kidney injury: a systematic review and meta-analysis.

Misoprostol is a prostaglandin E1 analog that is used to prevent non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal disorders. The aim of this systematic review and meta-analysis was to evaluate whether use of misoprostol also decreases the risk of NSAID-induced kidney injury. Randomized controlled trials that compared misoprostol versus placebo in an adult patient population were selected. The primary outcome was kidney injury and the secondary outcome was severe adverse events. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Twelve studies were eligible for inclusion. Although the rates of kidney injury and severe adverse events did not differ significantly between misoprostol and placebo, a post-hoc sub-group analysis that excluded studies in which different NSAIDs were used in the misoprostol and placebo groups suggested that misoprostol may reduce the risk of NSAID-induced kidney injury (risk difference -0.09, 95% confidence interval -0.15 to -0.03, P<0.01, I2 = 87%; evidence of very low certainty). There is limited evidence that misoprostol reduces the risk of NSAID-induced kidney injury. Misoprostol possibly contributes to reducing the risk of kidney injury associated with chronic NSAID use. The findings of this meta-analysis suggest further high-quality clinical trials are warranted.

P-373 Low-Dose Vaginal Misoprostol Application Before Office Hysteroscopy

Abstract Study question In gynecological interventional procedures what should be the minimum misoprostol dose for achieving cervical maturation? Summary answer 50mcgr vaginal misoprostol before office hysteroscopy; decreases the VAS score, bleeding and the total procedure time. What is known already Misoprostol has been on the World Health Organization (WHO) essential drugs list since 2005 due to its uterotonic effect.FIGO (The International Federation of Gynecology and Obstetrics) published a posology table in 2017 that does not cause side effects in off-label use of misoprostol in the obstetric field.There are many publications that misoprostol facilitates interventional gynecologic procedures by allowing cervical maturation . However, no guidelines have yet been published on the dose and route of administration Study design, size, duration This Prospective Randomized Clinical Research was approved by Ankara City Hospital Clinical Research Ethics and Academic committee . Then, 100 women who underwent office hysteroscopy in Ankara City Hospital Gynecology and Obstetrics Clinic gynecology-infertility outpatient clinic between 01/12/2021-01/05/2022 were included in the study after their informed consent was obtained. Participants/materials, setting, methods 50 women who self-administered 50 mcg vaginal misoprostol the night before the office hysteroscopy procedure and 50 women who did not administer the drug were compared. The primary outcome of the study was the duration of the procedure, with the pain score during the procedure used being the (VAS) score system. The secondary outcome was procedure and drug-related side effects Statistical evaluation of the data was performed using the SPSS for Windows version 20.0 Main results and the role of chance In the medicated group the mean of VAS scores during and after the procedure, and the transition and the total time of the procedure were significantly lower than non-medicated group. Limitations, reasons for caution In Turkey, there is only one misoprostol product (CYTOTEC Ali Raif İlaç Sanayi A.Ş) with the 200 mcg posology Off label use of misoporostol in obstetrics is legal since 2021 but not for gynecological practice. We do not have country guidelines on misoprostol posology in obstetrics and gynecology usage also Wider implications of the findings In gynecological interventional procedures especially before office hysteroscopy, it is important to apply a minimum dose of misoprostol for cervical maturation due to its bleeding-increasing effect in patients whith endometrial polyps or hyperplasia .Because bleeding is the most important factor affecting image quality and procedure efficacy during hysteroscopy. Trial registration number E2-21-1068 dated 24.11.2021

Evaluation of the effect of preoperative rectal misoprostol use on the postoperative outcomes of hysteroscopic myomectomy.

In this study, we aimed to evaluate the effect of using two doses of rectal misoprostol on postoperative results in hysteroscopic myomectomy. This retrospective study was carried out at two hospitals in which the medical records of patients who underwent hysteroscopic myomectomy between November 2017 and April 2022 were evaluated, and subjects were grouped depending on the administration of misoprostol before hysteroscopy. In recipients, two rectal doses of misoprostol (400 μg) were administered, 12 h and 1 h before the planned operation. Outcomes evaluated were: postoperative reduction in hemoglobin (Hb), pain at 12 and 24 h (VAS score), and length of hospital stay. The mean age of 47 women in the study group was 27.38 ± 5.12 (range 20-38) years. Hb levels reduced significantly in both groups after hysteroscopic myomectomy (p < 0.001). In misoprostol recipients, VAS score was found to be significantly lower at 12 h (p < 0.001) and 24 h after the operation (p = 0.004). Multiple linear regression analyses for each of the outcomes revealed the following: greater myoma size was associated with greater Hb decrease (p = 0.010), misoprostol use was associated with lower 12th and 24th hour VAS scores (p < 0.001), longer duration of operation was associated with higher 12th and 24th hour VAS scores (p < 0.001), and finally, longer duration of operation was associated with prolonged hospital stay (p = 0.001). The use of two doses of rectal misoprostol before hysteroscopic myomectomy was effective in reducing postoperative pain. Prospective, population-based studies evaluating different uses of misoprostol in hysteroscopic myomectomy are needed.

Foley catheter (80 vs 60 mL) and misoprostol for labor induction in nulliparous women: a randomized controlled trial

Induction of labor is a common intervention in obstetrics worldwide. Foley catheter is a commonly used mechanical method for labor induction in nulliparous women with an unfavorable cervix at term. We hypothesize that a higher volume of Foley catheter (80 mL vs 60 mL) will shorten the induction-delivery interval for labor induction in nulliparous women at term with an unfavorable cervix with simultaneous use of vaginal misoprostol. This study aimed to evaluate the effect of transcervical Foley catheter (80 mL vs 60 mL) with simultaneous use of vaginal misoprostol on the induction-delivery interval in nulliparous women at term with an unfavorable cervix for induction of labor. In this double-blind, single-center, randomized controlled trial, nulliparous women with a term singleton gestation with unfavorable cervix were randomized to either group 1 (Foley catheter [80 mL] simultaneously with vaginal misoprostol 25 µg every 4h) or group 2 (Foley catheter [60 mL] with vaginal misoprostol 25 µg every 4h). The primary outcome was induction-delivery interval. Secondary outcomes were duration of the latent phase of labor, number of doses of vaginal misoprostol required, mode of delivery, as well as maternal and neonatal morbidity. Analyses were based on the intention-to-treat method. A sample size of 100 women per group (N=200) was selected. Between September 2021 to September 2022, 200 nulliparous women at term with an unfavorable cervix were randomized to labor induction with either FC (80 mL vs 60 mL) and vaginal misoprostol. Induction delivery interval (in minutes) was statistically significantly shorter in Foley catheter (80 mL) (median [interquartile range], 604 [524-719] vs 846 [596-990]; [P<.001]). Median time to labor onset (in minutes) (240 [120-300] vs 360 [180-600]; P<.001) was also shorter in group 1 (80 mL). The number of doses of misoprostol required for labor induction was statistically significantly less than with 80 mL (mean±standard deviation, 1.4±0.7 vs 2.4±1.3; P<.001). There was no statistically significant difference in the mode of delivery (vaginal delivery: 69 vs 80; odds ratio, 0.55 [1.1-0.3]; P=.104 and cesarean delivery: 29 vs 17; odds ratio, 0.99 [0.9-1.1]; P=.063, respectively). The relative risk of delivery within 12 hours with 80 mL was 2.4 [95% confidence interval, 1.68-3.43], P<.001. Maternal and neonatal morbidity were similar across the 2 groups. FC (80 mL) simultaneously with vaginal misoprostol significantly shortens the induction-delivery interval (P<.001) in nulliparous women at term with an unfavorable cervix, as compared with Foley catheter 60 mL and vaginal misoprostol.

A 10-Year Retrospective Analysis of Uterine Rupture in a University Teaching Hospital in Nnewi, Nigeria

Background: One of the most serious obstetric emergencies that seriously endanger both mother and fetus and dramatically increase maternal and perinatal mortality in our community is uterine rupture. The aim of the study is to ascertain the prevalence of uterine rupture and the various aetiologies/predisposing factors associated with it. Methods: From January 1, 2007, to December 31, 2016, patients with ruptured uteruses were studied retrospectively and cross-sectionally at the Nnamdi Azikiwe University Teaching Hospital in Nnewi, Nigeria. Outcome measures included prevalence rate, surgical choices, maternal and fetal outcomes, and maternal case fatality rate. Stata 13.0 (StataCorp LP, Texas, USA) was used to analyze the data. Results: There were 10,777 deliveries and a total of 66 cases of ruptured uterus were treated, giving a ratio of 1 in 163 deliveries or prevalence of 6.0/1000 deliveries. Sixty four case notes were retrieved giving retrieval rate of 97.0% and prolonged obstructed labour was the commonest aetiologic factor identified (42.2%). Other associated factors were grand multiparity (36.0%), previous caesarean section (28.1%), previous myomectomy (3.1%), injudicious use of oxytocin (25.0%), use of misoprostol (3.1%) and abnormal lie (17.2%). Twenty of the patients (31.3%) had repair of the ruptured uterus alone, and 28(43.8%) had repair with bilateral tubal ligation. Six of the patients (9.4%) had total abdominal hysterectomies while 10(15.6%) had sub-total hysterectomies. There were a total of 4 maternal deaths giving a case fatality rate of 6.3%. The fetal outcome was poor with only 11 (17.2%) survivors. Conclusion: Only 17.2% of surviving fetuses had a good result, and 6.1 per 1000 deliveries involved uterine rupture. The rupture of gravid uterus will be decreased, if not completely eliminated, by adequate health education, widespread availability of comprehensive obstetric care facilities, enhanced antenatal care, a decline in the prevalence of primary caesarean sections, and population empowerment of women

The use of misoprostol as a prevention for post-partum hemorrhage after cesarean ection

This systematic literature review was organized to evaluate a potential uterotonic agent named misoprostol, as the choice to prevent and manage PPH. Compiled this systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guide to analyze the role and efficacy of misoprostol for the prevention of post-partum bleeding after cesarean section. A literature search was conducted on five databases, namely MEDLINE, The Cochrane Library, Wiley Sciencedirect, and Google Scholar based on the PRISMA guide lists. Quality and risk assessments were carried out through the Cochrane Risk of Bias Tool 2.0 checklist and any disagreements among the authors that were resolved by discussion. Literature search and selection resulted in ten studies that met the inclusion and exclusion criteria. Misoprostol has been shown to reduce post-caesarean bleeding compared to other agents. Evaluation then was carried out through decreased hemoglobin, hematocrit, visual evaluation of bleeding, as well as the need for additional blood transfusions and uterotonic agents. The high incidence of PPH in caesarean section and the magnitude of the accompanying risks indicate the importance of a form of PPH prevention to improve the safety of mother and baby. The results obtained from this study showed the safety and effectiveness of misoprostol in the treatment of PPH after caesarean section.

Comparison of Pregnancy Outcomes between Ongoing Pregnancies after Accidental Misoprostol Use and Normal Pregnancies: A Case-control Study

Comparison of Pregnancy Outcomes between Ongoing Pregnancies after Accidental Misoprostol Use and Normal Pregnancies: A Case-control Study

Uterine rupture; An obstetric tragedy still with us. A six year review of cases in a specialist hospital, NorthWest Nigeria

Background: Uterine rupture is a major cause of perinatal and maternal morbidity and mortality, it usually has a devastating outcome if not promptly attended to. The study determined the trends, risk factors, feto-maternal outcomes following uterine rupture as seen at ASYBSH.&#x0D; Method: The study was a retrospective review of cases of uterine rupture managed at the ASYBSH between March 2015 and February 2021. Records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. Relevant information such as socio- demographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma.&#x0D; Results: Deliveries in the hospital during the period were eleven thousand four hundred and twenty (11,420), out of which one hundred and fifty-six (156) were complicated by uterine rupture giving an overall incidence of 1.36 percent or one in every seventy-four (74) deliveries. Uterine rupture occurred mainly among women of low socio-economic status and high parity. The major predisposing factors were injudicious use of oxytocin (62.8%) prolonged obstructed labour (19.8%), previous caesarean section scar (8.5%), use of misoprostol (5.3%), fundal pressure (2.4%) and unexplained factors (1.2%)&#x0D; Conclusion: Uterine rupture remains a devastating obstetric calamity with a high incidence. Injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section scar were the three leading predisposing factors identified in this study.

Effects of misoprostol in reducing blood loss during abdominal myomectomy in Nigeria.

Despite using a tourniquet to reduce bleeding during abdominal myomectomy, the procedure is still complicated by significant intraoperative bleeding. To determine whether misoprostol and tourniquet compared with tourniquet alone would significantly reduce bleeding during abdominal myomectomy at two tertiary hospitals in Enugu. This study is an open-label randomized controlled trial. A total of 126 consenting participants were recruited from women booked for abdominal myomectomy at the study centers over 7 months. They were randomized into groups A (vaginal misoprostol 400 μg) and B (no misoprostol) one hour before surgery. Intraoperatively, all participants had a tourniquet application. Intraoperative and postoperative blood loss was compared between the two groups. Descriptive and inferential analyses were carried out using IBM SPSS Version 22.0. A P- value of < 0.05 was considered statistically significant. An intention-to-treat analysis was carried out. All 63 participants (100%) and 56 (90%) completed the study according to the protocol in groups A and B, respectively. Socio-demographic characteristics were not significantly different in both groups. The mean intraoperative blood loss in the "misoprostol group" (522.6 ± 127.91 ml) was significantly lower than in the "no-misoprostol group" (583.5 ± 186.20 ml), with P = 0.028. The difference in mean hemoglobin (g/dl) was lower in the "misoprostol group" than in the "no-misoprostol group" (1.3 ± 0.79 vs. 1.9 ± 0.89, P < 0.001). The mean 48 hours postoperative blood loss (ml) between the two groups was 323.8 ± 221.44 vs. 549.4 ± 519.72), with P = 0.001. Among women receiving tourniquet during myomectomy in Enugu, the additional use of vaginal misoprostol 400 μg significantly reduced intraoperative blood loss.

Uterine Rupture at Federal Teaching Hospital, Katsina: A Five Year Review

Background: Uterine rupture, despite being one of the most devastating obstetric complication associated with significant maternal and perinatal morbidities and mortality, is still prevalent in developing countries. Objectives: To determine the prevalence, aetiologic risk and other contributing factors, complications as well as outcome of Obstetric Uterine rupture at Federal Teaching Hospital, Katsina. Study Design: A Five year retrospective study that reviewed uterine rupture in Obstetrics and Gynaecology department of Federal Teaching Hospital, Katsina from 1st January 2010 to December 31st 2014. Results: There were 42 uterine ruptures out of 9995 deliveries, with an incidence of 4.2 per 1000 deliveries. The mean age of the patients was 31yrs± 0.9. The highest incidence was among unbooked patients (85%). The diagnosis was made pre-operatively in 88.1% of the cases. Major risk factors were prolonged obstructed labour (26.2%), previous caesarean section scar (19%) and Oxytocin infusion in unscarred (14.3%) and scarred Uteri (11.9%) as well as use of Misoprostol (11.9%). Majority of the ruptures occurred anteriorly (52.4%) while scar dehiscence accounted for 23.8% of cases. Repair with bilateral tubal ligation was the most frequent mode of treatment (47.6%), while hysterectomy was done for patients with extensive ruptures (34.3%). The commonest complication was postoperative Anaemia (38.1%). There were two maternal deaths, with a case fatality rate of 4.8%, while the perinatal mortality was 78.6%. Conclusion: Uterine rupture is still a major cause of maternal and perinatal morbidities and mortality in our setting. Antenatal care with skilled facility-based deliveries will reduce its incidence and associated complications.