Medicinal Plants with Abortifacient or Emmenagogue Activity: A Narrative Review Based on Traditional Persian Medicine

Introduction: Traditional Persian medicine (TPM) has a rich background and has introduced various plants with abortive or emmenagogue activity since ancient times. However, many of them are unknown in modern medicine, and a few trials have been conducted describing their efficacy and safety. These plants may be helpful for the management of incomplete abortion, with potentially lower side effects than chemical agents. Objectives: This review introduced these plants and their potential efficiency to link traditional and modern medicine and suggested further studies. Methods: The search strategy for citations in this narrative review was performed in two steps. At first, medicinal plants used as abortifacient or emmenagogue to manage incomplete abortions or retained products of conception were searched and extracted in the most famous TPM literature, including Al-Qanun Fi at-Tibb, Tuhfat-al-Momenin, and Makhzan-ul-advia. The next step was searching electronic databases including PubMed, Scopus, Web of Science, and Google Scholar with the same keywords and herbal plants between 1970 and 2021. The overlapped plants between the manual and electronic search were found and briefly described. Results: In TPM literature, 88 plants with abortifacient activity were found, of which 47 were used to manage incomplete abortions or retained products of conception. Also, in the electronic database search, 14 plants were found to have abortifacient or emmenagogue activity. Among them, six plants, including Sesamum indicum L. (Sesame), Commiphora myrrha (myrrh), Lawsonia inermis L. (Henna), Opopanax chironium L. (Jooshir), Plumbago rosea (Shitraj or Stumbag), and Juniperus sabina (Abhal), overlapped with the manual search results. The abortifacient or emmenagogue activity and properties of all these 14 plants were described. Conclusions: The properties of many traditional plants with abortifacient activity are unknown in modern medicine; however, they should not be used in pregnant women. Nonetheless, they may have the power to be entered into modern medicine. Identifying their pharmacology and action mechanisms may be helpful to introduce them as a potential alternative to chemical agents in the management of induced or incomplete abortion with possibly lower side effects.

A Case Report On: Incomplete Abortion with Chronic Hypertension

Introduction: Abortion is a distressing experience that affects the mother in a variety of ways by influencing on emotional status that can finally result in psychological disorders such as depression [1]. An incomplete abortion occurs when the products of conception are lost in the first 20 weeks of pregnancy. Moderate to severe vaginal bleeding, as well as lower abdomen and/or pelvic pain, are common symptoms of incomplete abortion [2]. Substantial evidence indicates that women with a history of spontaneous abortion have a greater risk of non-communicable diseases, including hypertension, cardiovascular diseases, and type 2 diabetes [3]. In low and middle-income nations, abortion is one of the most common causes of maternal death [4]. In general, incomplete abortions are unavoidable, with chromosomal abnormalities accounting for 50% of all occurrences. Age, maternal disorders (diabetes, hypertension, renal disease, thyroid issue, polycystic ovarian syndrome, lupus, thrombophilia), under or overweight, aberrant uterus, teratogen exposure (drug, alcohol, caffeine, radiation), and infections are all changeable etiologies and risk factors (human immunodeficiency virus, sexually transmitted infections, Listeria monocytogenes) [2]. Case Presentation: A 30-year-old woman's case study with 15 weeks pregnant admitted in the obstetric and gynecological unit on the date 11 June 2021 with complaints of amenorrhea since 4 months, bleeding per vaginam, passage of clots, blurring of vision, pain in abdomen, breathlessness and her blood pressure was noted as 140/100mm of Hg. Interventions: Generally, the patient with abortion and raised blood pressure is hospitalized and care is provided in the obstetric and gynecological unit or ward. The goals during this phase are saving a life of mother, maintaining and restoring hemodynamic stability and preventing the spread of infection or correcting the complication. Outcomes: During the period of five days treatment, the client was having raised blood pressure but significantly the client’s health was improved with further treatment and management .After a hospital stay of five days the markable progress was seen further before returning to the home. Discussion: Although the patient reacted well to treatment, more interventions and health education could be used in the future to help the patient to achieve the better health results.

Clinical outcomes after telemedicine abortion with and without ultrasound: a multinational cohort study

Objective: To evaluate the association between pre- and postabortion ultrasound and clinical outcomes after telemedicine abortion. Design: Cohort study Setting: Chile, Northern Ireland, Poland, South Korea. Population: 5298 women who performed abortion through the telemedicine service Women on Web (WOW), January 1st 2016 – December 31st 2019. Methods: We performed a retrospective cohort study on the associations between use of ultrasound pre-abortion and clinical outcomes using unconditional multivariate logistic regression. Intervention rates following routine or clinically indicated postabortion ultrasound were analysed using descriptive statistics. Main outcome measures: Self-reported rates of heavy bleeding, clinical visits within 2 days of the abortion, treatment for incomplete abortion, continuing pregnancy, and satisfaction. Results: Women with and without a pre-abortion ultrasound had similar rates of heavy bleeding (10.5% vs10%, AOR 0.98, 95% CI= 0.8-1.19), continuing pregnancy (1% vs 1.3%, AOR 0.68, 95% CI= 0.39-1.19), and satisfaction (96.8% vs 97%, AOR 0.95, 95% CI= 0.67-1.35). Women with a pre-abortion ultrasound were more likely to visit a hospital within two days of the abortion (6.6% vs 4.4%, AOR 1.35, 95% CI= 1.04-1.75) and receive treatment for incomplete abortion (13.7% vs 8.7%, AOR 1.58, 95% CI= 1.32-1.9). Overall rates of surgical evacuation for incomplete abortion were 9.8% after routine postabortion ultrasound and 27.6% for clinically indicated ultrasound. Conclusion: Non-use of pre-abortion ultrasound was not associated with higher rates of adverse clinical outcomes or lower satisfaction. Routine postabortion ultrasound may result in unnecessary clinical interventions. The results come from observational data where a certain selection bias is possible.