Adjuvant administration of 17-α-hydroxy-progesterone caproate in women with three or more second trimester pregnancy losses undergoing cervical cerclage is no more effective than cerclage alone

2018 ◽  
Vol 46 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Fernand D. Samson ◽  
Amanda L. Merriman ◽  
Danielle L. Tate ◽  
Katherine Apostolakis-Kyrus ◽  
Luis M. Gomez
Keyword(s):  
Perinatal Outcomes ◽  
Cervical Insufficiency ◽  
Second Trimester ◽  
Trimester Pregnancy ◽  
Significant Difference ◽  
Gestational Age At Delivery ◽  
Adverse Neonatal Outcomes ◽  
Second Trimester Pregnancy ◽  
Prophylactic Cerclage ◽  
Hydroxy Progesterone

AbstractObjective:To investigate the role of adjuvant 17-α-hydroxy-progesterone caproate (17OHP-C) in reducing the risk of preterm delivery <34 weeks and adverse perinatal outcomes in women with ≥3 second trimester pregnancy losses attributed to cervical insufficiency undergoing prophylactic cerclage.Material and methods:Retrospective cohort study of women with prophylactic cerclage placed between 2006 and 2014 divided into a cohort of (i) those receiving adjuvant 17OHP-C (n=43), and (ii) controls with cerclage alone (n=59).Results:Demographic characteristics were comparable in both groups. There was no significant difference in gestational age at delivery between the cerclage-17OHP-C group (33.4±5.6 weeks) and the cerclage-alone group (34.4±4.6 weeks); P=0.33. We noted a non-significant increase for deliveries <34 weeks in the cerclage-17OHP-C group (44.2%) compared to controls (28.8%) which remained non-significant after adjusting for confounders; P=0.46. There was no statistically significant difference in the rate of delivery <37, 32, 28 and 24 weeks. Adverse neonatal outcomes were comparable in both groups (cerclage-17OHP-C 48.8% vs. cerclage-alone 39%); P=0.43.Conclusion:Intramuscular 17OHP-C in combination with prophylactic cerclage in women with cervical insufficiency and ≥3 second trimester pregnancy losses had no synergistic effect in reducing the rate of recurrent preterm birth or improving perinatal outcomes.

scholarly journals Comparing two regimens of intravaginal misoprostol with intravaginal gemeprost for second-trimester pregnancy termination: a randomised controlled trial

2017 ◽  
Vol 43 (4) ◽  
pp. 252-259 ◽  
Author(s):  
Daniel Seow Choon Koh ◽  
Esther Pei Jing Ang ◽  
Jurja Chua Coyuco ◽  
Hua Zhen Teo ◽  
Xiaoling Huang ◽  
...  
Keyword(s):  
Pregnancy Termination ◽  
Controlled Trial ◽  
Second Trimester ◽  
First Line ◽  
Trimester Pregnancy ◽  
Significant Difference ◽  
High Incidence ◽  
Second Trimester Pregnancy ◽  
Randomised Controlled ◽  
The Cost

AimTo compare the efficacy and safety of intravaginal misoprostol 200 µg, 400 µg and gemeprost regimens for second-trimester termination of pregnancy (TOP).MethodsA three- armed randomi sed controlled trial (Clinical Trial Certificate 1100015) where 116 women undergoing second-trimester TOP were given intravaginal misoprostol 200 µ g (n=37), misoprostol 400 µg (n=40) or gemeprost 1 mg (n=39) at 4- hour intervals until abortion occurred with a maximum of five doses.ResultsThe misoprostol 400 µg group had the highest incidence of successful abortions (92.5%) compared to the misoprostol 200 µg (70.3%; p=0.017) and gemeprost 1 mg (74.4%; p=0.037) within 48 hours. There was no significant difference in abortion rate between misoprostol 200 µg and gemeprost. The misoprostol 400 µg group had the highest incidence of fever (70.0%) compared to misoprostol 200 µg (24.3%; p<0.001) and gemeprost 1 mg (46.2%; p=0.041). The gemeprost group had the highest incidence of diarrhoea (38.5%) compared to misoprostol 400 µg (10.0%; p=0.004) and misoprostol 200 µg (8.1%; p=0.003) groups.ConclusionsIntravaginal misoprostol 400 µ g at 4- hour intervals was the most effective regimen but was associated with a high incidence of fever. Misoprostol 200 µg demonstrated similar effectiveness as gemeprost and had lower incidence of diarrhoea. Gemeprost should not be first line for medical therapy given the cost, storage requirements and lower efficacy.

scholarly journals Misoprostol only or in combination with intra cervical Foley’s catheter for termination of the second trimester demise pregnancy in patient with previous caesarean sections

2020 ◽  
Vol 11 (6) ◽  
Author(s):  
Hend S Saleh ◽  
Mohamed El-Husseny El Kadosi ◽  
El Kadosi
Keyword(s):  
P Value ◽  
Safe Procedure ◽  
Second Trimester ◽  
Trimester Pregnancy ◽  
Significant Difference ◽  
Misoprostol Group ◽  
Second Trimester Pregnancy ◽  
Vaginal Misoprostol ◽  
Foley’S Catheter ◽  
Scarred Uterus

Objective: Termination of second trimester pregnancy is unique obstetric contest due to its difficulty and risky especially if the condition is associated with prior Caesarean deliveries. Aim of the work: To compare the safety and efficacy of two regimens for termination of the second trimester pregnancy in ladies with scarred uterus by prior Caesarean deliveries either by using sublingual and vaginal misoprostol or sublingual misoprostol in a combination with intra cervical Foley’s catheter. Patients and methods: 163 pregnant ladies with second trimester demise pregnancy at14-24 gestational weeks in scarred uterus (≥ one cesarean sections) participated in this prospective randomized comparative study which was performed in obstetric emergency unit in Zagazig University Hospitals, Egypt from June 2019 to May 2020. 140 patients only far-reached the trial through termination of the pregnancy via induction of abortion by sublingual and vaginal misoprostol Group 1 (GI) or Foley’s catheter with vaginal misoprostol Group 2 G (II). Whichever of those methods sustained for 48 hours else the fetus expulsed formerly .Outcomes was determined by comprehensive expulsion of fetus and placenta, Induction Abortion interval, Incidence of side effects, requirement for surgical intervention and complications" rate. Results: The demographic criteria of both groups revealed no significant difference (P-value>0.05). The mean (SD) of Induction to abortion interval (hours) in GI was significant longer than in G II (51.07±23.84, 45.20±31.28) respectively with (P- value 0.021). Total dose (μg) of misoprostol used in GI (1100.72±23.54) was higher than G II (645.35± 322) with p value 0.001. Admission-termination hospitalization (days) was significant longer in G I (4.11±1.02) than in G II (2.371±1.98) with P value 0.004. No significant difference as regard occurrence of adverse effects between both groups except the incidence of fever (17.1%) in G I and (5.7%) in G II with P value 0.01. Success rate in GI and G II were (80%, 95%) respectively with P-value 0.01. Incomplete expulsion was higher in GI (14.3%) in comparison with G II (4.2%) with P value 0.04. Incidence of haemorrhage was significant higher in G II than in GI P value 0.03. No significant differences between both groups as regard incidence of rupture uterus or occurrence of infection. Conclusion: Practice of inserting Foley’s catheter through cervix with misoprostol sublingually for termination of mid-trimester pregnancy in preceding uterine scar(s) is efficient, inexpensive and safe procedure.

scholarly journals Misoprostol for Termination of Second Trimester Pregnancy

2015 ◽  
Vol 1 (1) ◽  
pp. 16-19
Author(s):  
Sarada Duwal Shrestha ◽  
Alka Singh ◽  
Laxmi RC ◽  
Benita Pradhan ◽  
Wufei Shah ◽  
...  
Keyword(s):  
Side Effects ◽  
Success Rate ◽  
Congenital Anomalies ◽  
Second Trimester ◽  
Plain Language ◽  
Fetal Demise ◽  
Trimester Pregnancy ◽  
Second Trimester Pregnancy ◽  
Vaginal Misoprostol ◽  
Maternal Side

Introductions: The termination of second trimester pregnancy is challenging due unfavorable cervix. This study evaluate the efficacy and maternal side effects of intravaginal misoprostol for termination of second trimester pregnancy. Methods: During one year period from 15th June 2011 to 14th June 2012, Department of Obstetrics and Gynaecology of Patan Hospital, women admitted for second trimester termination of pregnancy for fetal congenital anomalies and intrauterine fetal demise were studied using the International Federation of Gynaecology and Obstetrics recommended doses of vaginal misoprostol. For congenital anomalies, 400 mcg 3 hourly to a maximum of 5 doses were used. For fetal demise, gestational age of 13-17 weeks received 200 mcg every 6 hourly to a maximum of 4 doses, and 18-26 weeks dose was adjusted to 100 mcg. Main outcome measures included success rate of abortion within 48 hours, induction to delivery interval and maternal side effects. Results: There were 40 patients during study period. Success rate for termination of 2nd trimester pregnancy within 48 hours was 88.8% for congenital anomalies. For fetal demise, success of termination was 90.9% at 13-17 weeks and 100% at 18-26 weeks. Median time from induction to delivery was 26.8 hours for congenital anomalies. For fetal demise, it was 18 hours for 13-17 weeks was and 24 hours at 18 to 26 weeks respectively. Abdominal pain was seen in all doses of misoprostol. Conclusions: Vaginal misoprostol is an effective method for termination of second trimester pregnancy. Plain Language Summary: The study was conducted to see the effectiveness of vaginal misoprostol for termination of second trimester pregnancy. The success rate of termination for congenital abnormality and fetal demise was high. Vaginal misoprostol was an effective method for termination of second trimester pregnancy. DOI: http://dx.doi.org/10.3126/jpahs.v1i1.13010 Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):16-19

Complex Enterotubal Fistula and Abdominal-Pelvic Abscess Complicating Second Trimester Pregnancy Termination

1994 ◽  
Vol 10 (4) ◽  
pp. 263-269
Author(s):  
JOEL SOROSKY ◽  
ROBERT SQUATRITO ◽  
JOSEPH CONNOR ◽  
CHARLES DE PROSSE ◽  
JO ANN BENDA
Keyword(s):  
Pregnancy Termination ◽  
Pelvic Abscess ◽  
Second Trimester ◽  
Trimester Pregnancy ◽  
Second Trimester Pregnancy
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