vaginal misoprostol
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Author(s):  
Reema Khajuria ◽  
Arushi Suri ◽  
Rohini Jaggi

Background: Misoprostol use in early pregnancy failure is varied and dose is not well established. Aim of this study was to compare efficacy and side effects of 600 versus 800 micrograms vaginal misoprostol in early pregnancy failure.Methods: A randomized prospective observational study was conducted in the postgraduate department of obstetrics and gynaecology, SMGS hospital Jammu from November 2018 to October 2019 after getting approval from the ethical committee. Hundred patients (50 in group A and 50 in group B) admitted in labour room before 12 weeks of gestation with an ultrasound diagnosis of early fetal demise (missed abortion or brightened ovum) were treated medically with different doses of vaginal misoprostol.Results: The success rate in patients in group A is 72% and group B is 88%, p=0.045 (difference is statistically significant). Patients who required suction and evacuation were 28% in group A and 12% in group B.Conclusions: Use of misoprostol for medical management of 1st trimester missed/anembryonic is an effective, cheap, safe and convenient alternative to surgical evacuation. It was concluded that 800 micrograms vaginal misoprostol is more effective than 600 micrograms vaginal misoprostol. But 800 micrograms misoprostol has more side effects than 600 micrograms vaginal misoprostol.


Author(s):  
VANREMMAWII ◽  
LALROMAWII ◽  
VANLALHRUAII

Objectives: This study is to compare the efficacy of Mifepristone combined with Misoprostol (Prostaglandin) administered through vaginal and sublingual route in termination of pregnancy of ≤63 days. Methods: Randomized comparative study comprised of 140 pregnant women of ≤63 days gestational age was conducted at Zoram Medical College, Mizoram. Women in group A received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol sublingually 36–48 h later, whereas women in group B received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol vaginally 36–48 h later. A 2nd dose of 400 μg Misoprostol was given through the same route if abortion process does not start within 4 h. All women who aborted were seen at follow-up and ultrasound pelvis done to confirm complete expulsion of products of conceptions. Results: The total number of primigravida was 34 (24.3%) and multigravida was 106 (75.7%). Complete abortion was seen in 91.4% and 94.28% of per sublingual and per vaginal route group, respectively (p = 0.51). Failure of abortion was 8.57% and 5.71%, respectively, in per oral and per vaginal route (p = 0.51). Conclusion: Sublingual and per vaginal misoprostol after pre-treatment with mifepristone are both an effective method for termination of pregnancy for gestational age of 63 days or less, but the tolerance for sublingual misoprostol was poorer.


2021 ◽  
Vol 8 (4) ◽  
pp. 463-469
Author(s):  
Sheryl S Valvi ◽  
Bhavesh B Airao

The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.This is prospective case-control study conducted in department of obstetrics and gynecology, C. U. Shah Medical College and Hospital, Surendranagar over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ashraf Mohamed Farouk Kortam ◽  
Tarek Aly Raafat ◽  
Rehab Mohamed Abd El Rahman ◽  
Amir Hamdy Abd El Hady Mahfouz

Abstract Background Abortion is the termination of pregnancy by any means (surgical or medical) before the age of viability. The definition varies in duration of gestational age according to the countries and available facilities. Estrogen is important in the maintenance of pregnancy. Aromatase inhibitors such as letrozole, suppress the peripheral conversion of androgen to estrogen, the use of letrozole combined with vaginal misoprostol was more effective than misoprostol alone in termination of pregnancy. Objective Assessing the efficacy of addition of letrozole to Misoprostol in medically induced abortion in the second trimester of pregnancy in the Maternity hospital of Ain Shams University. Methods This clinical trial was conducted at Ain Shams University Maternity hospital in the period between December 2018 and May 2019. Patients that seem to be fulfilling the inclusion criteria were recruited, then informed written consent was taken from every patient before starting the examination That was followed by detailed history and examination of all patients to confirm fulfilling the inclusion and exclusion criteria. Results This study demonstrated that 10 mg letrozole for three days followed by 800 mcg of vaginal misoprostol is more effective than misoprostol alone for second trimester abortion. In the total of 72 women were recruited the complete abortion rate of the letrozole group was significantly higher than that of the control group (61,1% in the letrozole group compared with 33,3% in the control group). Conclusion s: The use of letrozole in addition to misoprostol was associated with a higher complete abortion rate, shorter induction to abortion interval and shorter curettage rates compared to a placebo followed by misoprostol in patients undergoing induction of abortion between 12 & 24 weeks gestation.


2021 ◽  
Vol 85 (1) ◽  
pp. 3125-3129
Author(s):  
Zaineb Abdusalam Aregeb ◽  
Wael Albromboly ◽  
Azza Abdelmageid Abdelhameid ◽  
Khaled Fathy Helal ◽  
Mohammed Samir Badr

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Mahmoud Salman ◽  
Fekria Ahmed Salama ◽  
Mina Yacoub

Abstract Background Induction of labor is one of the most common procedures performed in the world of Obstetrics. Traditionally, labor induction is performed using prostaglandin and oxytocin. However, usage of corticosteroids nowadays is gaining a lot of interest regarding its effects on cervical ripening and shortening the physiological process of labor. Aim of work to evaluate the efficacy of intravenous dexamethasone versus vaginal misoprostol in enhancing cervical ripening and labor induction. Patients and Methods A randomized controlled clinical trial was carried out at Ain Shams University Maternity Hospital on (60) full term pregnant women between 39 – 42 weeks undergoing induction of labor, during a period from April 01, 2019 to November 30, 2019. Pregnant women were divided into two groups; vaginal misoprostol (control) group and intravenous dexamethasone (experimental) group (30 cases each). Results Our study showed that the mean time interval (hours) from initiation of labor induction to initiation of active phase was statistically significantly shorter among the dexamethasone (experimental) group 7.36 ± 2.23 versus 12.20 ± 4.92 hours among the vaginal misoprostol (control) group (p value < 0.001). Also, the mean time interval of the total duration between the induction of labor to successful vaginal delivery was statistically significantly shorter among the dexamethasone group 10.90 ± 4.17 versus 19.20 ± 5.62 hours among the vaginal misoprostol group (p value < 0.001). The results of this study showed the rate of initiation of active phase and rate of successful vaginal delivery were more in the experimental dexamethasone group than the control vaginal misoprostol control group. Conclusion Intravenous injection of 8 mg of dexamethasone before induction of labor is found to shorten the duration of labor induction by reducing the time interval between the initiation of labor induction and onset of active phase and the total duration from initiation of labor induction to delivery with no marked maternal or fetal complications. Recommendations Intravenous Dexamethasone can help cervical ripening and accelerate induction of labor. Further research should be taken in consideration with more population for more global evaluation.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Shaimaa G Helmy ◽  
Mohammed A El-Kadi ◽  
Mohamed E Elhodiby ◽  
Mohamed H Salama

Abstract Objective This study aims to compare the efficacy and safety of different doses of vaginal misoprostol prior to IUCD insertion among women with nulliparous cervix “those who 29never delivered-vaginally”. Study design: The current study was a randomized, double-blind, placebo-controlled trial conducted in the Family Planning Clinic of Ain Shams University’s Maternity Hospital Egypt. It involved women who delivered only by elective CD (cesarean delivery). One hundred and eighty women were randomized into three groups, Group 1 received misoprostol 200 mcg. Group 2 received misoprostol 100 mcg. Group 3 received placebo. The primary outcome was pain scores which were measured using a visual analogue scale (VAS), the secondary outcome was the ease of insertion score (ES). Results VAS and ES were significantly lower in group 1 compared to group 2 and group 3 (P < 0.001).There was insignificant difference among the three groups as regards successful IUD insertion (P = 0.477). Duration of insertion was significantly lower in group 1 than group 2 (P < 0.001). Satisfaction was significantly higher in group 1 compared to group 2 and group 3 (P < 0.001) Conclusion The effect of misoprostol seems to be dose-dependent. Dose of 200mcg seems to be ideal with best efficacy and with no significant increase in the adverse effects Implications: The dose of 200mcg vaginal misoprostol prior to IUD insertion in women, who had never delivered vaginally before, seems to be the most effective dose. Trail to lower the dose to100mcg significantly compromises the efficacy without remarkable benefit on the side effect profile.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Hassan Swidan ◽  
Ahmed Abdel Shafy El-Shahawy ◽  
; Ahmed Mohamed Abbass ◽  
Huda Mohamed Elsayed Mohamed

Abstract Background Induction of labor should be used in the most efficient way possible that will result in a favorable obstetric outcome with minimum fetal morbidity. Objectives The aim of this study is to compare the efficacy and safety of intravaginal misoprostol alone versus intra cervical Foley catheter combined with vaginal misoprostol in induction of labor at term pregnancy. Methods This study was conducted at Obstetrics & Gynecology Department; Ain Shams University, Maternity Hospital in the period between May 2017 to October 2017. The total number of patients studied was 120 patients, divided into two groups; the first group (A) included 60 patients who received vaginal misoprostol, the second group (B) included 60 patients who received vaginal misoprostol combined with trans cervical Foley catheter. Results The current study found that the combined group has a better chance for NVD 88.3% versus 78.3% in misoprostol alone group, a lesser probability to CS 11.7% in combined group versus 21.7% in misoprostol alone group and a shorter induction delivery interval within 12 hours after induction (81.6% in combined group versus 59.5% in misoprostol group). Regarding the effect of both methods on fetal safety, we found that non reassuring FHR was more common in combined group 8.3% than misoprostol alone group 1.7% but it’s statistically non-significant. There was statistically significant increase in tachysystole in combined group 28.3% versus 13.3% in misoprostol alone group. However, dystocia was more common in misoprostol group 15% than combined group 3.3% that is also statistically significant. Conclusion Both methods can be used in induction of labor at term pregnancy without forgetting the precautions and close observation to the mother and the fetus. Combined method results in a shorter induction-to delivery time, but misoprostol alone was safer for the mother and the fetus.


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