Patients In Misoprostol Group Research Articles

Medical and Surgical Treatment of First Trimester Miscarriage, A Randomized Controlled Trial

Background: Abortion is a common complication of early pregnancy that can have both medical and psychological consequences. Complications following spontaneous or induced abortion are a major cause of maternal morbidity. Objective: To better management and improving outcome of first trimestric miscarriage. Patients and Methods: A randomized clinical trial study was conducted at obstetric outpatient clinic, Gynecology and Obstetrics Department, Zagazig University during the period from May 2019 until June 2021. The study included 52 women suffering from abortion who were randomized to receive either medical treatment: 800 µg misoprostol prescribed as 400 mg orally and 400 mg vaginally or surgical treatment: evacuation with dilatation and curettage. All patients were followed up with a transvaginal ultrasonography (U/S). Results: The mean of endometrial thickness after treatment was 12.5±2.65 mm and 8.3±1.97 mm in misoprostol and surgical evacuation group respectively, the difference between both groups was statistically significant (p < 0.05). Failed treatment was in 8 (30.7%) patients in misoprostol group and in 2 (7.7%) patients in surgical evacuation group. The difference in failure rate between both groups was significant statistically. Conclusions: A single dose of 800µg misoprostol given as outpatient treatment may be used as first line in management of incomplete abortion.

Comparison of Misoprostol and PGF2a for second trimester termination of Pregnancy

Aims: To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostaglandin F2alpha (PGF2alpha) injection for termination of pregnancy. Study Design: Interventional study. Setting: This study was conducted in gynae unit III Nishter hospital Multan over period f 15 months. Material & Methods: Patients admitted to labour ward with pregnancy of less than 20 weeks of gestation requiring termination of pregnancy due to fetal and maternal causes were included in this study. A detailed history was taken followed by clinical examination especially the cervical scoring was done. Sixty patients were randomly assigned to receive either tablet misoprostol (cytotec) intravaginally or extra-amniotic injection of prostaglandin F2a Induction-expulsion interval, need for evacuation and the incidence of side effects were analyzed for both groups. Results: Successful termination was achieved in 98% patients with misoprostol and 94% with PGF2a Induction expulsion interval was < 12 hrs in 80% patients in misoprostol group and 60% in PGF2a group (P value < 0.000). Evacuation rate was 23.3% with PGF2a and 10% with misoprostol group. The incidence of prostaglandin-associated pyrexia, vomiting and diarrhea were significantly increased in the PGF2alpha group (p<0.05). Conclusion: In this study, vaginal misoprostol has been found to be more effective and associated with a shorter induction to expulsion interval, fewer ERPOC for incomplete evacuation and less side effects when compared with extra-amniotic PGF2alpha. In view of its effectiveness, as shown in this study, vaginally administered misoprostol has the potential to provide a better option for medical abortion in many parts of the world.

Efficacy of misoprostol over dinoprostone gel and Foley's catheter as a cervical ripening agent

Background: Induction of labor is one of the most important and irrevocable interventions in obstetric practice. Timely induction could reduce maternal mortality and morbidity and assure a delivery of a healthy baby. Objective: To evaluate the efficacy of misoprostol as a cervical ripening agent and its comparison with dinoprostone gel and Foley’s catheter in terms of success rate, safety, side effects, patient’s compliance, and cost factor. Materials and Methods: A total of 175 pregnant women requiring induction of labor were recruited. Of the 175 cases, 75 were induced with 50 µg misoprostol, 50 cases with intracervical Foley’s catheter No. 18, and 50 cases with 0.5 mg intracervical dinoprostone gel, selected by purposive sampling method during April to August 2002, at the Department of Obstetrics and Gynecology, Guru Gobind Singh Hospital, Jamnagar, and M.P. Shah Medical College, Jamnagar, Gujarat, India. Written and informed consent was taken from the patients. Outcome measures such as change in Bishop’s score, need of augmentation, and induction delivery interval and complications such as hyperstimulation, fever, and meconium passage were compared between the three groups. Statistical analysis was performed by ANOVA test. Results: The age range of the patients was 21 to 35 years; 76% of the patients were in the 21–25 years age group. Thirty-eight (50.6%) patients were multigravida, and 45 (60%) patients reported more than 37 weeks of pregnancy. Thirty-five (46.6%) of the patients showed premature rupture of membrane as indication of labor. The mean Bishop’s score for induction was 3.20 in misoprostol group. Only 12% of the patients required augmentation in misoprostol group, while it was 48% in dinoprostone group and 72% in Foley’s catheter group. Sixty-three (84%) patients in misoprostol group and 94% of patients in dinoprostone group delivered by vaginal delivery; 57.3% patients delivered within 6 h in misoprostol group (misoprostol: 57.3%, dinoprostone: 28%, Foley’s catheter: 8%; p < 0.001). Incidence of thin meconium occurred in 12% in misoprostol group, 10% in dinoprostone group, and 18% in Foley’s catheter group. In misoprostol and Foley’s catheter groups, three patients developed fever after induction. No patient reported diarrhea and vomiting. Incidence of cervical tear and vaginal laceration was similar in all the groups. No case of hyperstimulation was observed in our study. Misoprostol is quite cheaper than dinoprostone gel and Foley’s catheter. Conclusion: Vaginal misoprostol is safe and effective for induction of labor with lesser need of oxytocin augmentation and shorter induction delivery interval and possess some advantages compared with dinoprostone and Foley’s catheter including improved efficacy and lower cost of the drug.

COMPARISON OF PROSTAGLANDIN E2 WITH MISOPROSTOL FOR INDUCTION OF LABOUR AT TERM

. Objective: To evaluate the use of vaginal misoprostol compared with vaginal prostaglandin E2(PGE2) for labour induction at term. Design: Experimental. Setting: Gynae Unit III, Department of Obstetrics andGynaecology SIMS / Services Hospital Lahore. Methods: Patients were randomized to two groups with 100 patientsin each group. One group received 50:g of misoprostol vaginally every four hours up till 5 doses , second group wasgiven 3mg PGE2 vaginal tablet every 6hrs up till 3doses. The drug was stopped earlier if active labour started.Results: 96% of patients were successfully induced in misoprostol group verses 84%patients in PGE2 group (P=0.01).Mean induction delivery interval was significantly short in misoprostol group 13.3 + 8.7 hours verses 18.5 + 11.3 hoursin PGE2 group (P=0.01). 35% patients in misoprostol group and 40% in PGE2 group (P=0.46) had C/Sections.Increase Meconium staining and fetal heart rate abnormalities was seen in misoprostol group (P=0.03). 20% of babiesin misoprostol group had low APGR Score and needed neonatal intensive care unit admission, as compared to 12%in PGE2 group but failed to show statistical significance (P=0.12). There was no perinatal death in both groups. Hyperstimulation was seen in only one patient of misoprostol group. Conclusion: Misoprostol is more effective than PGE2in successfully inducing the patient but it does not reduce C/Section rate. Moreover it is associated with increasechances of fetal distress. Despite being cheaper than PGE2, it cannot be advocated superior to PGE2 in terms offetomaternal outcome. Further studies with lower doses of misoprostol are recommended.

Second trimester pregnancy termination including fetal death: comparison of five different methods

Objective: To compare the efficacy of methods for second trimester pregnancy termination. Methods: A prospective randomized study of women undergoing pregnancy termination between 14 and 28 weeks gestation. Three hundred and forty patients with poor cervical condition (Bishop score ≤ 4) in whom one of five termination methods were used were assessed: (i) extraamniotic administration of ethacridine lactate (82 patients); (ii) intracervical prostaglandin (PG) E 2 gel (100 patients); (iii) intravenous infusion of concentrated oxytocin (36 patients); (iv) vaginal misoprostol (49 patients); and (v) balloon insertion (73 patients). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine contractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures. Results: The efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% ( 81 82 ) of the patients in ethacridine group; 97.3% ( 35 36 ) of the patients in concentrated oxytocin group; 90.0% ( 90 100 ) of the patients in PGE 2 group; 97.2% ( 71 73 ) of the patients in balloon group; 77.5% ( 38 49 ) of the patients in misoprostol group ( P = 0.000, P < 0.01, Wilcoxon (Gehan) statistic). The overall median induction-abortion interval ± S.D. (in h) in each group were as follows: ethacridine lactate: 15.7 ± 9.6, PGE 2 gel: 20.0 ± 14.5, concentrated oxytocin: 12.2 ± 14.4, misoprostol: 24.0 ± 22.2, balloon: 16.0 ± 15.4 (one way ANOVA, P = 0.003, P < 0.01). Conclusion: In comparison with the five methods, the use of extraamniotic ethacridine, intravenous concentrated oxytocin, and balloon was found to provide more effective treatment than intracervical PGE 2 and misoprostol in terms of achievement of abortion within 24 and 48 h.