scholarly journals Buccal versus Vaginal Misoprostol for Term Induction of Labor: A Retrospective Cohort Study

2018 ◽  
Vol 36 (07) ◽  
pp. 765-772 ◽  
Author(s):  
Meredith L. Dorr ◽  
Rebecca C. Pierson ◽  
Joanne Daggy ◽  
Sara K. Quinney ◽  
David M. Haas
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Induction Of Labor ◽  
Premature Rupture Of Membranes ◽  
Significant Difference ◽  
Misoprostol Group ◽  
Vaginal Misoprostol ◽  
To Receive ◽  
Time To Delivery ◽  
Labor Outcomes

Objective To compare the efficacy of similar buccal and vaginal misoprostol doses for induction of labor. Study Design Retrospective chart review of 207 consecutive women undergoing term induction of labor with misoprostol. Misoprostol route and dosing were collected. Time to delivery and other labor outcomes (e.g., vaginal delivery less than 24 hours) were compared between women receiving buccal and vaginal misoprostol. Results There was no significant difference in time to delivery for women receiving buccal (median 18.2 hour, 95% confidence interval [CI] = [14.9, 21.5]) versus vaginal (median 18.3 hour, 95% CI = [15.0, 20.4]) misoprostol (p = 0.428); even after adjusting for covariates (p = 0.381). Women who presented with premature rupture of membranes were more likely to receive buccal misoprostol (92.7% received buccal vs. 7.3% received vaginal, p < 0.001). A similar number of women delivered vaginally in the buccal group (88.2%) and vaginal misoprostol group (86.8%, p = 0.835). The proportion of women who experienced uterine tachysystole or chorioamnionitis did not significantly differ by route of administration. Conclusion We found no significant differences in time to delivery or other labor outcomes between buccal or vaginal dosing of misoprostol in women undergoing labor induction at term.

scholarly journals A study of vaginal misoprostol tablet versus intra cervical dinoprostone gel for the induction of labour

2017 ◽  
Vol 6 (4) ◽  
pp. 1404
Author(s):  
Chandni N. Badlani ◽  
Shraddha S. Shastri ◽  
Neelesh S. Risbud
Keyword(s):  
Cost Effective ◽  
Induction Of Labor ◽  
Significant Difference ◽  
Misoprostol Group ◽  
Group A ◽  
The Mean ◽  
Nicu Admission ◽  
Vaginal Misoprostol ◽  
Group B ◽  
To Receive

Background: This was a comparative study conducted to compare the effectiveness of 25 microgram of intravaginal misoprostol with intracervical dinoprostone gel in terms of efficacy of drug, feto-maternal outcome, side effects and complications of drugs.Methods: 400 nulliparas at term, admitted for induction of labor were included in this study. They were randomly selected to receive either intravaginal misoprostol or intracervical dinoprostone gel. Group A (200 women) recieved tablet misoprostol 25 micrograms vaginally 4 hrly to a maximum of 3 doses and Group B (200 women) received dinoprostone gel 0.5mg intracervically 6 hrly to a maximum of 3 doses. Comparison was done in terms of Induction to delivery interval, need for augmentation, LSCS and instrumentation rate, need for NICU admissions and cost effectiveness.Results: The mean induction to delivery interval was less in the misoprostol group than dinoprostone group (12.5 hrs vs. 20 hrs). 78% patients delivered in the first 24 hrs in misoprostol group compared to 52 % patients in dinoprostone group. Group A had a higher success rate (81% vs.76%) and also required less augmentation of labor ( 30% vs. 60%) compared to group B. Need for LSCS was also lower in misoprostol group (11% vs. 16%). Need for instrumentation and incidence of NICU admission was similar in both groups. Misoprostol was more cost effective compared to dinoprostone.Conclusions: The misoprostol group had a shorter induction to delivery interval, more number of deliveries in the first 24 hrs of induction and a reduced need of augmentation of labor with oxytocin. There was no significant difference in the rate of caesarean section, hyper-stimulation syndrome, neonatal and maternal morbidity between the two groups. Thus, misoprosol appears to be safer, cheaper and more efficacious alternative for induction of labor especially for non-fetal indications as compared to dinoprostone gel.

scholarly journals The mortality of ill infants with false tooth extraction in a rural Ugandan emergency department

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Amyna Husain ◽  
M. Douglas Baker ◽  
Mark C. Bisanzo ◽  
Martha W. Stevens
Keyword(s):  
Emergency Department ◽  
Tooth Extraction ◽  
Chart Review ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cultural Practice ◽  
Fluid Bolus ◽  
Significant Difference ◽  
To Receive

False tooth extraction (FTE), a cultural practice in East Africa used to treat fever and diarrhea in infants, has been thought to increase infant mortality. The mortality of clinically similar infants with and without false tooth extraction has not previously been examined. The objective of our retrospective cohort study was to examine the mortality, clinical presentation, and treatment of infants with and without false tooth extraction. We conducted a retrospective chart review of records of infants with diarrhea, sepsis, dehydration, and fever in a rural Ugandan emergency department. Univariate analysis was used to test statistical significance. We found the mortality of infants with false tooth extraction (FTE+) was 18% and without false tooth extraction (FTE−) was 14% (P=0.22). The FTE+ study group, and FTE− comparison group, had similar proportions of infants with abnormal heart rate and with hypoxia. There was a significant difference in the portion of infants that received antibiotics (P=0.001), and fluid bolus (P=0.002). Although FTE+ infants had clinically similar ED presentations to FTE− infants, the FTE+ infants were significantly more likely to receive emergency department interventions, and had a higher mortality than FTE− infants.

scholarly journals Sublingual vs Vaginal Misoprostol for Labor Induction

2012 ◽  
Vol 46 (3) ◽  
pp. 138-143
Author(s):  
Sujata Siwatch ◽  
Vanita Jain
Keyword(s):  
Uterine Contraction ◽  
Controlled Trial ◽  
Mode Of Delivery ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Randomized Controlled ◽  
Sublingual Misoprostol ◽  
Misoprostol Group ◽  
Vaginal Misoprostol ◽  
To Receive

ABSTRACT Background This study is a randomized controlled trial comparing the efficacy and safety of sublingual vs vaginal misoprostol for induction of labor. Materials and methods A total of 160 women admitted for induction of labor at the PGIMER, Chandigarh, India were randomized to receive 25 μg of vaginal or sublingual misoprostol for labor induction. The two groups were compared for mode of delivery, induction delivery interval, misoprostol dose required, uterine contraction abnormalities and neonatal outcomes. Results Majority of women in both groups delivered vaginally (91 and 89% in vaginal and sublingual misoprostol groups respectively). Mean number of doses of misoprostol required for induction of labor was similar in vaginal misoprostol group and sublingual misoprostol group (1.81 ± 0.84 vs 2.05 ± 0.98). The occurrence of uterine contraction abnormalities and neonatal outcome was similar in both groups. Conclusion The low dose of 25 μg is equally efficacious and safe by both vaginal and sublingual routes. How to cite this article Siwatch S, Kalra J, Bagga R, Jain V. Sublingual vs Vaginal Misoprostol for Labor Induction. J Postgrad Med Edu Res 2012;46(3):138-143.

scholarly journals A comparative study of 25 mcg vs 50 mcg of vaginal misoprostol for induction of labour

2018 ◽  
Vol 7 (5) ◽  
pp. 1730
Author(s):  
Amika Aggarwal ◽  
Sangeeta Pahwa
Keyword(s):  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
Induction Of Labor ◽  
Bishop Score ◽  
Uterine Contractions ◽  
Significant Difference ◽  
Misoprostol Group ◽  
Vaginal Misoprostol ◽  
A Prospective Study

Background: The objectives of the current study were to compare the efficacy and safety of 25μg and 50μg of intravaginal misoprostol for induction of labor at term and to study the maternal and fetal outcome.Methods: A Prospective Study was done on 50 cases with 25μg misoprostol and 50 cases of 50μg of misoprostol intravaginal, repeated every 6 hourly till adequate uterine contractions or maximum 5 doses. Total dose of induction, induction delivery interval, mode of delivery, maternal and fetal outcome were recorded.Results: Mean induction delivery interval was 13.8±5.9 and 14.0±5.7 hours (P=0.9) with the 25μg and 50μg misoprostol respectively. The 25μg misoprostol group had a lower delivery rate with a single dose compared with the 50μg group (38% and 42% respectively). However, 25μg group had more deliveries than 50μg group with increasing number of misoprostol doses (36% vs. 38%, and 20% vs. 16% for 2 doses and 3 doses respectively). The need for oxytocin augmentation among participants was higher in the 25μg group (20%) than in 50 μg group (16%).This was however not statistically significant (P=0.603). At lesser initial bishop score, with 50µg misoprostol less doses are needed as compared to 25 µg and hence induction delivery interval decreases. The rates of caesarean section and operative vaginal delivery were similar in both groups. There was no significant difference in maternal side effects and neonatal outcomes among the women in the two groups.Conclusions: The 25 µg of intravaginal misoprostol administered six‑hourly appears to be as effective but safer than 50 µg for induction of labor. The use of 50 µg misoprostol may be recommended when there is a need to expedite vaginal delivery especially in cases of lesser initial bishop score.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Incidence of hypersensitivity reactions in patients on H1-receptor antagonists receiving oxaliplatin-based chemotherapy

2021 ◽  
pp. 107815522110039
Author(s):  
Christine Barrett ◽  
Seon Jo Park ◽  
Lindsay Edmondson ◽  
Dulabh Monga
Keyword(s):  
Observational Study ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Controlled Trials ◽  
Severe Reaction ◽  
Hypersensitivity Reactions ◽  
H1 Receptor ◽  
Receptor Antagonists ◽  
Randomized Controlled ◽  
To Receive

Objective This study determined the incidence of hypersensitivity reactions in patients receiving oxaliplatin-based chemotherapy while on H1-receptor antagonists (H1RAs). Prophylaxis for patients receiving oxaliplatin is not currently recommended. H1RAs are used for the treatment of reactions; however, prophylactic H1RAs have not been well-studied. Methods This retrospective chart review included patients with solid tumor malignancies who received H1RAs while on oxaliplatin-based chemotherapy between August 1, 2016 and October 31, 2019. Results Of fifty-one patients, there were four hypersensitivity reactions (8%), most of which were mild, occurred within 60 minutes of the start of the infusion, and did not result in an interruption in treatment. One severe reaction occurred, which required discontinuation of therapy. Forty-two patients (82%) were able to receive at least 9 cycles of oxaliplatin without a reported reaction. Conclusion In this observational study, the incidence rate of hypersensitivity reactions in patients receiving oxaliplatin while on H1RAs was lower than reported in previous literature. Most reactions were mild, and patients were able to continue oxaliplatin-based therapy. With future, randomized controlled trials, H1RAs may prove to be effective in preventing or delaying the onset of hypersensitivity reactions related to oxaliplatin.

An Evaluation of the Effects of Elevated Body Mass Index on Skeletal Age

2021 ◽  
Author(s):  
Michael H. French ◽  
Michael S. Kung ◽  
W. Nathan Holmes ◽  
Hossein Aziz ◽  
Evelyn S. Thomas ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Intraclass Correlation ◽  
Retrospective Chart Review ◽  
Skeletal Age ◽  
Chronological Age ◽  
Age Group ◽  
Obese Children ◽  
Significant Difference ◽  
Hand Radiographs

Abstract BackgroundMany treatment decisions in children’s Orthopaedics are based on age. This study determined whether a discrepancy between chronological age (CA) and skeletal age (SA) is dependent on BMI and if overweight or obese children would have an advanced SA.Materials and Methods120 children between ages 8-17 with an adequate hand radiograph and a correlating BMI were enrolled by retrospective chart review. Stratification based on age, sex, ethnicity, and BMI percentile was performed. For each age group, 6 males and 6 females were selected with 50% of each group having an elevated BMI. Two blinded physicians independently evaluated hand radiographs and recorded the SA. Statistical analyses evaluated inter-rater reliability and any discrepancy between groups.ResultsThe final statistical analysis included 96 children. The Intraclass Correlation Coefficient for SA determined by the two reviewers was excellent at 0.95. A difference of 13 months was found between CA and SA in the elevated BMI cohort versus the non-elevated BMI cohort, (p<0.001). No significant difference was seen between CA and SA for the non-elevated cohort (p=0.72), while matching for age and sex. ConclusionChronological age and skeletal age are not always equivalent especially in pediatric patients who are overweight or obese.

589 Methadone in Procedural Care for Burn Injuries of 20–30% Total Burn Surface Area: A Retrospective Chart Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S146-S146
Author(s):  
Loryn Taylor ◽  
Kimberly Maynell ◽  
Thanh Tran ◽  
David J Smith
Keyword(s):  
Physical Therapy ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Surface Area ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Opioid Consumption ◽  
Burn Injuries ◽  
Methadone Group ◽  
Significant Difference

Abstract Introduction Prolonged opioid usage remains a concern in pain management in procedural care. Recent evidence also suggests that a considerable number of patients who were prescribed opioids struggle with transitioning to non-opioid pain medications. As a continuous effort to reduce opioid consumption following burn surgical procedures, our institution recently evaluated methadone administration for burn procedural care in patients with 20–30% total burn surface area (TBSA) requiring excision and grafting. Methods After IRB approval, we performed a retrospective chart review of patients who underwent excision and grafting procedure for 20–30% TBSA burn injuries between January 1, 2019 and June 30, 2020. The following data was evaluated: postoperative opioid consumption, postoperative pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), time to physical therapy and time to hospital discharge. Data was analyzed using chi square/Fisher exact test for categorical variables and t-test/Wilcoxon rank sum test for continuous variables. Results Our preliminary data included 12 patients who met inclusion criteria, of which two patients received methadone administration. Our patient sample consisted of average age of 43 years, 75% male, and 24% TBSA (92% were flame burns). Patients in both methadone and non-methadone groups had no significant differences in medical histories and TBSA (23% TBSA in methadone, 25% TBSA in non-methadone). There was no significant difference in reported preoperative pain intensity between the two groups, rating moderate to severe. Postoperative pain intensity remained the same, rating moderate to severe and controlled with fentanyl, oxycodone, morphine and non-opioid analgesics. While there was no difference in postoperative fentanyl, opioid and non-opioid analgesic consumptions between the two groups, morphine consumption was significantly lower in the methadone group compared to non-methadone group (2±2 mg vs 51±54 mg, respectively, p=0.02). There was no significant difference between average time from surgery to first physical therapy session and time to hospital discharge (about 21 days after surgery) between the two groups. Conclusions This evaluation shows a potential trend in reduction of inpatient postoperative opioid consumption with the conjunctive administration of methadone, although a bigger sample size is needed for further assessment.

scholarly journals Oral Misoprostol vs Intravenous Oxytocin Infusion for Induction of Labor in Prelabor Rupture of Membranes

2016 ◽  
Vol 8 (1) ◽  
pp. 4-7
Author(s):  
Rajyashri Sharma
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Fetal Distress ◽  
Induction Of Labor ◽  
Oral Misoprostol ◽  
Oxytocin Infusion ◽  
Misoprostol Group ◽  
The Difference ◽  
Prelabor Rupture Of Membranes ◽  
To Receive

ABSTRACT Objectives To compare the efficacy, side effects and safety of oral misoprostol to intravenous oxytocin infusion for induction of labor in prelabor rupture of membranes (PROM). Materials and methods Two hundred and sixty-six women of prelabor rupture of membranes were assigned to receive either oral misoprostol 100 μg 6 hourly to a maximum 3 doses (misoprostol group, n = 142), or escalating doses of oxytocin infusion up to 20 mIU/min in primigravida and up to 10 mIU/min in multigravida (oxytocin group, n = 114). Results Demographic characteristics were similar in both the groups. The difference in mean induction to delivery interval (8.2 ± 6 hours in misoprostol group vs 12.2 ± 6 hours in oxytocin group) was statistically significant when two groups were compared. The incidence of vaginal delivery (86.1% in misoprostol group vs 84.2% in oxytocin group), and cesarean delivery (13.9% in misoprostol group vs 15.8% in oxytocin group), was almost similar in both the groups. The indication of cesarean delivery was dystocia (40% in misoprostol group vs 67% in oxytocin group), and fetal distress (60% in misoprostol group vs 33% in oxytocin group) and the difference was statistically significant (p < 0.01). Maternal and neonatal safety outcomes were similar for the two treatments. Conclusion Oral misoprostol in prelabor rupture of membrane have almost similar results as intravenous oxytocin in safety, efficacy and side effects except induction delivery interval, which is less in misoprostol group. How to cite this article Anjum S, Sharma R. Oral Misoprostol vs Intravenous Oxytocin Infusion for Induction of Labor in Prelabor Rupture of Membranes. J South Asian Feder Obst Gynae 2016;8(1):4-7.

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