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Sample records for del misoprostol intravaginal

  1. Low dose intravaginal misoprostol versus intracervical balloon ...

    African Journals Online (AJOL)

    Background:The efficacy and safety of low dose misoprostol as a ripening agent compared to the widely used balloon catheter in developing countries is undetermined. Objective:To compare the safety and efficacy of a low dose intravaginal misoprostol and intracervical Foley's catheter for cervical ripening. Design:A ...

  2. Cervical ripening: a randomized comparison between intravaginal misoprostol and an intracervical balloon catheter combined with intravaginal dinoprostone.

    Science.gov (United States)

    Perry, K G; Larmon, J E; May, W L; Robinette, L G; Martin, R W

    1998-06-01

    Our purpose was to compare the efficacy of intravaginal misoprostol and intracervical Foley catheter/intravaginal dinoprostone for cervical ripening. Patients admitted for induction of labor were randomized to receive intravaginal misoprostol 25 microg every 4 hours or intracervical Foley catheter/intravaginal dinoprostone 4 mg every 4 hours. Patients not entering active labor and having ruptured membranes or arrest of dilatation received intravenous oxytocin. Sixty-five patients received Foley catheter/dinoprostone gel and 62 patients received misoprostol. The mean time until cervical ripening was less in the catheter/gel group (7.5 +/- 3.4 vs 12.0 +/- 5.9 hours, p Intracervical Foley catheter/intravaginal dinoprostone was associated with more rapid cervical ripening, shorter induction to vaginal delivery interval, and greater number of vaginal deliveries within 24 hours.

  3. Induction of labor in prolonged pregnancy with unfavorable cervix: comparison of sequential intracervical Foley catheter-intravaginal misoprostol and intravaginal misoprostol alone.

    Science.gov (United States)

    Ande, A Babatunde; Ezeanochie, C Michael; Olagbuji, N Biodun

    2012-04-01

    To compare the outcome of induced labor at term using sequential intracervical Foley catheter with intravaginal misoprostol versus intravaginal misoprostol alone. A prospective matched case control study among parturient with prolonged pregnancy and unfavorable cervix at a tertiary hospital in Nigeria. The study population was 100 with a mean age of 29.46 ± 3.88 years. Parturient with prior cervical priming using intracervical Foley catheter had significantly lower oxytocin augmentation of uterine contractions in labor (44 vs. 64%, P = 0.045), shorter mean insertion to active phase labor duration (233 ± 98 vs. 354 ± 154 min, P = 0.0001), shorter insertion to delivery interval (514 ± 175 vs. 627 ± 268, P = 0.014), more vaginal delivery intracervical Foley catheter and intravaginal misoprostol for cervical ripening and induction of labor appears to be a safe and more effective method compared to intravaginal misoprostol in parturient at term with unfavorable cervices.

  4. Second Trimester Medical Termination of Pregnancy with Combined Intracervical and Intravaginal Misoprostol: Comparative Analysis with Intravaginal Misoprostol-A Pilot Study.

    Science.gov (United States)

    Desai, Gaurav Shyam; Chandavarkar, Abhishek; Gopal, Sriram; Sawant, Ganpat; Desai, Shyam V

    2016-10-01

    Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. In this IRB approved prospective study, twenty-two women (mean age 25.4 ± 3.2 years, range 23-32 years; mean BMI 22.3 ± 3.4 kg/m(2); mean parity 2.1 ± 1.4, average gestational age 17.9 ± 2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. Mean induction-abortion interval for intravaginal group and combination group was comparable (t = 7.9 ± 1.8 and 6.5 ± 3.5 h, respectively). Three patients required surgical evacuation for incomplete abortion (n = 2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6 h was more in the intracervical-intravaginal group (36.3 %). Patients with intracervical misoprostol complained of abdominal pain more often than those in other groups. Excessive bleeding and uterine rupture was not seen in any patient. Intracervical misoprostol is an effective method of medical treatment of second trimester pregnancy failure. Its short induction to abortion interval and acceptable safety profile makes induction via the cervical route acceptable for second trimester abortion.

  5. Low dose intravaginal misoprostol versus intracervical baloon catheter for pre-induction cervical ripening.

    Science.gov (United States)

    Tabowei, T O; Oboro, V O

    2003-02-01

    The efficacy and safety of low dose misoprostol as a ripening agent compared to the widely used balloon catheter in developing countries is undetermined. To compare the safety and efficacy of a low dose intravaginal misoprostol and intracervical Foley's catheter for cervical ripening. A prospective randomized controlled trial. Zonal General Hospital, Kwale, Nigeria from June 1, 1998 to May 30, 2001. Candidates for pre-induction cervical ripening were randomized to receive either 250 mcg of intravaginal misoprostol every four hours (n = 60) or intracervical Foley's catheter (n = 61). Failure to achieve cervical ripening within 24 hours, need for augmentation, maternal and foetal complications. Failure to achieve cervical ripening within two hours was reduced with misoprostol (Relative Risk [RR] 0.63, 95% Confidence Interval [CI] 0.43 - 0.92). Need for oxytocin augmentation was less in the misoprostol group (RR 0.76, 95% CI 0.64 to 0.91). No significant differences existed in rates for uterine hyperstimulation, Caesarean section, maternal and neonatal morbidity. Intravaginal misoprostol in a low dose was compared to intracervical balloon catheter for pre-induction ripening of the cervix.

  6. Comparison of intracervical and intravaginal misoprostol for cervical ripening and labour induction in patients with an unfavourable cervix.

    Science.gov (United States)

    Srisomboon, J; Piyamongkol, W; Aiewsakul, P

    1997-03-01

    To compare the efficacy of intracervical versus intravaginal misoprostol for cervical ripening and labour induction at term in patients with an unfavourable cervix. A total of 100 pregnant women with indications for induction of labour and unfavourable cervix (Bishop score intracervically (50 cases) or intravaginally (50 cases). No significant differences were noted between intracervical and intravaginal misoprostol in terms of Bishop score change, (score 7.2 vs score 7.5), interval from gel insertion to vaginal delivery (17.0 hours vs 16.4 hours), meperidine as analgesic requirement (80% vs 76%), route of delivery and perinatal outcome. Uterine tachysystole occurred in 24 per cent and 32 per cent in the intracervical and intravaginal groups respectively which did not significantly differ, however, all could be rapidly resolved by terbutaline injection. No evidence of fetal distress was noted in these events. Spillage of gel out of the cervix was observed in 70 per cent of patients receiving intracervical misoprostol. Fever was observed in one patient of each group. No other serious side effects were found in both groups. One patient in the intravaginal group had postpartum hemorrhage due to delayed placental separation and uterine atony. The two routes of misoprostol gel application appear to be safe and equally effective in ripening cervix and inducing labour, however, the intravaginal application is more convenient to administer practically compared with the intracervical.

  7. Randomised trial of intravaginal misoprostol and intracervical Foley catheter for cervical ripening and induction of labour.

    Science.gov (United States)

    Owolabi, A T; Kuti, O; Ogunlola, I O

    2005-08-01

    Induction of labour may be indicated despite an unripe cervix. The purpose of this study was to compare the safety and efficacy of intravaginal misoprostol and an intracervical Foley's balloon catheter for preinduction cervical ripening and labour induction. A total of 120 patients requiring indicated induction of labour with an unfavourable cervix (Bishop's score intracervical Foley balloon catheter for 12 h followed by an intravenous oxytocin infusion. The two arms of the study were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop's scores. There were significant change in the Bishop's score in the two groups (5.9 +/- 0.2 and 4.0 +/- 0.2, respectively, p < 0.001) but no inter group differences. Oxytocin induction or augmentation of labour occurred more in the catheter group (95%) than in the misoprostol group (43.3%) (p < 0.0001). Induction to delivery interval was significantly shorter in the misoprostol group than in the catheter group (8.7 +/- 2.4 vs 11.9 +/- 2.7 h p < 0.0001). There was no significant difference noted in the caesarean or other operative delivery rates among patients in the two treatment groups. There was a higher incidence of tachysystole and hyperstimulation in the misoprostol group than in the catheter group (p < 0.03). No differences were observed between groups for meconium passage, 1- or 5-min Apgar scores < 7 and admission into the neonatal intensive care unit. In conclusion, the maternal and perinatal outcomes in this study have shown no difference confirming the efficacy and safety of both methods, however we observe a decrease in the induction-to-delivery interval when misoprostol is used for this purpose.

  8. Comparison of intravaginal misoprostol and intracervical Foley catheter alone or in combination for termination of second trimester pregnancy.

    Science.gov (United States)

    Rezk, Mohamed Abd-Allah; Sanad, Zakaria; Dawood, Ragab; Emarh, Mohamed; Masood, Alaa

    2015-01-01

    To examine the effectiveness, safety and acceptability of intravaginal misoprostol and intracervical Foley catheter alone or in combination for termination of second trimester pregnancy. This clinical study was conducted on 90 pregnant patients intended for termination of pregnancy between 13 and 24 gestational weeks for any indication. Enrolled women are equally allocated into three groups: • Group I (Misoprostol group): a standard regimen of moistened misoprostol (400 μg) 4 hourly inserted vaginally. • Group II (Catheter group): intracervical Foley catheter inserted, inflated and placed on traction. • Group III (Combined group): intracervical Foley catheter inserted with a standard regimen of moistened misoprostol (400 μg) 4 hourly intravaginally was used. Procedure efficacy (defined as complete abortion performed on site), safety and acceptability were assessed. The induction to abortion interval was 7.5±1.25 h in the combined group, compared to 11.76±1.63 h in the misoprostol group and 19.76±1.52 h in the catheter group (p valueintracervical Foley catheter and misoprostol for termination of second trimester pregnancy.

  9. Intravaginal Misoprostol for Cervical Ripening and Labor Induction in Nulliparous Women: A Double-blinded, Prospective Randomized Controlled Study

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    Zhang, Yu; Zhu, Hao-Ping; Fan, Jian-Xia; Yu, Hong; Sun, Li-Zhou; Chen, Lian; Chang, Qing; Zhao, Nai-Qing; Di, Wen

    2015-01-01

    Background: In China, no multicenter double-blinded prospective randomized controlled study on labor induction has been conducted till now. This study is to evaluate the efficacy and safety of intravaginal accurate 25-μg misoprostol tablets for cervical ripening and labor induction in term pregnancy in nulliparous women. Methods: This was a double-blinded, prospective randomized controlled study including nulliparous women from 6 university hospitals across China. Subjects were randomized into misoprostol or placebo group with the sample size ratio set to 7:2. Intravaginal 25-μg misoprostol or placebo was applied at an interval of 4 h (repeated up to 3 times) for labor induction. Primary outcome measures were the incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h. Safety assessments included the incidences of maternal morbidity and adverse fetal/neonatal outcomes. Results: A total of 173 women for misoprostol group and 49 women for placebo were analyzed. The incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h was higher in the misoprostol group than in the placebo (64.2% vs. 22.5%, relative risk [RR]: 2.9, 95% confidence interval [CI]: 1.4–6.0). The incidence of onset of labor within 24 h was significantly higher in the misoprostol group than in the placebo group (48.0% vs. 18.4%, RR: 2.6, 95% CI: 1.2–5.7); and the induction-onset of labor interval was significantly shorter in the misoprostol group (P = 0.0003). However, there were no significant differences in the median process time of vaginal labor (6.4 vs. 6.8 h; P = 0.695), incidence (39.3% vs. 49.0%, RR: 0.8, 95% CI: 0.4–1.5) and indications (P = 0.683) of cesarean section deliveries, and frequencies of maternal, fetal/neonatal adverse events between the groups. Conclusion: Intravaginal misoprostol 25 μg every 4 h is efficacious and safe in labor induction and cervical ripening. PMID:26481739

  10. Intravaginal Misoprostol Versus Intra-amniotic 15 Methyl PG F2 a for Termination of Second Trimester Pregnancy

    OpenAIRE

    N. Vimala, V. Dadhwal, S. Kumar, S. Mittal, S. Vinekar

    2005-01-01

    To compare the efficacy of intravaginal application of misoprostol and intra-amniotic injection ofprostaglandin 15-methyl F2 alpha (PG F2α) in terminating second trimester pregnancies, eightypregnant women at 14-20 weeks of gestation with single live fetuses and requesting for terminationof pregnancy were randomised into two groups.Women in group I: received four tablets of vaginalmisoprostol (200 mg/tablet) and in group II : intra-amniotic injection of (10 ml) 2.5 mg 15 methyl -PGF2α. Failur...

  11. PROSPECTIVE STUDY COMPARING EFFECTIVENESS OF SINGLE AND MULTIPLE DOSE 25 MICROGRAMS INTRAVAGINAL MISOPROSTOL FOR INDUCTION OF LABOUR AT TERM

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    Arati Achamma

    2016-06-01

    Full Text Available OBJECTIVES/PURPOSE To compare two dosing regimens of the same 25 mcg misoprostol with respect to Induction delivery interval, successful vaginal delivery and its associated maternal and neonatal outcomes. METHODS Prospective study was conducted among 300 low risk pregnant patients at 40 weeks’ gestation, attending labour room in the Dept. of OBG, Amala Institute of Medical sciences, comparing, A-single dose 25 mcg misoprostol in 24 hours Vs. B-multiple dose 25 mcg misoprostol (4 hourly up to 3 doses intravaginally for its effectiveness. RESULTS Statistically significant difference was obtained in the number of deliveries within 24 hours in group A and B (36.6% Vs. 63.4% with p value 0.002. The induction delivery interval between primigravidae and multigravidae were statistically significant (12.5 =/-3.9 Vs 11.08=/-4.3 with p value 0.035 but not significant between groups A and B. There was no statistical difference in other maternal and neonatal outcomes. Incidence of MSL and foetal distress were higher in primigravidae after single dose itself. Serious adverse outcomes like MAS, NND, APGAR<7 at one minute and uterine rupture were not encountered in this study. CONCLUSION Around 65% of women delivered with a single dose of misoprostol in 24 hours. Most multigravidae delivered vaginally with a single dose in 24 hours. It appears that in multigravidae a single dose induction is adequate; however, in primigravidae multiple doses of 25 mcg misoprostol is best to achieve delivery within 24 hours.

  12. Induction o.t labour with intravaginal misoprostol in the second and ...

    African Journals Online (AJOL)

    the discretion of the labour ward staff, oxytocin was used to augment labour. Otherwise, an intravenous drip was not routinely inserted. If the patient was not in labour within 12 hours of receiving the last dose of misoprostol, the treatment was considered a failure. Objective. To confirm the effectiveness of misoprostol as a.

  13. A randomized clinical trial to compare the efficacy of different doses of intravaginal misoprostol with intracervical dinoprostone for cervical ripening and labor induction.

    Science.gov (United States)

    Saxena, P; Puri, M; Bajaj, M; Mishra, A; Trivedi, S S

    2011-07-01

    To compare the efficacy of 25 vs. 50 microg of intravaginal misoprostol vs. intracervical dinoprostone for cervical ripening and labor induction. 210 women with Bishop's score intracervical dinoprostone to maximum of 3 doses and outcome parameters were compared. Induction to vaginal delivery interval was significantly lower (p < 0.05) for 50 microg (13.8 +/- 6.62 hours) as compared to 25 microg misoprostol (16.4 +/- 7.34 hours) or dinoprostone group (16.3 +/- 7.49 hours). Maximum improvement (p < 0.05) in Bishop's score and minimum oxytocin requirement (p < 0.05) was seen with misoprostol 50 microg. No significant difference was observed for women delivering vaginally within 24 hours (93.8 vs. 89.7 vs. 85.4%), patients delivering after one dose (24.3 vs. 21.4 vs. 20%), cesarean deliveries, fetal outcome, complications like hyperstimulation and fetal heart abnormalities for the 50 vs. 25 microg misoprostol vs. dinoprostone group. Intravaginal misoprostol 50 microg administered 6 hourly appears to be most effective as it has least induction to delivery time, has maximum improvement in Bishop's score, least oxytocin requirement without any increase in complication rate.

  14. Efficacy and safety of intravaginal misoprostol versus intracervical dinoprostone for labor induction at term: a systematic review and meta-analysis.

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    Liu, Aihai; Lv, Jieqiang; Hu, Yue; Lang, Junzhe; Ma, Luhang; Chen, Wenbing

    2014-04-01

    Recent studies suggest that misoprostol may be more effective than dinoprostone in pregnant women with unfavorable cervix. The objective here is to investigate and compare the efficacy and safety of intravaginal misoprostol and intracervical dinoprostone for labor induction, including incidence of cesarean section, vaginal delivery rate within 24 h, uterine hyperstimulation, tachysystole, oxytocin augmentation, neonatal intensive care unit (NICU) admissions, and Apgar score of less than 7 at 1 and 5 min. Databases searched were MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, up to July 2013. Randomized controlled trials comparing intravaginal misoprostol with intracervical dinoprostone in women with singleton pregnancy, intact membranes and unfavorable cervix (Bishop's intracervical dinoprostone; however, dinoprostone has been demonstrated to be safer because of the lower incidence of uterine hyperstimulation and tachysystole. Further high-quality studies assessing the possible effectiveness of misoprostol and dinoprostone in selected groups of patients are warranted. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  15. Misoprostol

    Science.gov (United States)

    Misoprostol is used to prevent ulcers in people who take certain arthritis or pain medicines, including aspirin, ... Misoprostol comes as a tablet to take by mouth. It is usually taken 4 times a day, ...

  16. Prospective randomised controlled trial to compare safety and efficacy of intravaginal Misoprostol with intracervical Cerviprime for induction of labour with unfavourable cervix.

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    Krithika, K S; Aggarwal, N; Suri, V

    2008-04-01

    A randomised prospective trial was carried out to compare the efficacy and safety of intravaginal Misoprostol with intracervical dinoprostone gel for induction of labour in cases of unfavourable cervix. One hundred women with an unfavourable cervix requiring induction of labour were randomised to receive either 25 microm vaginal Misoprostol 4-hourly or 0.5 mg of intracervical dinoprostone 12 hourly. The outcome measured was change in Bishop's score, percentage of women going into labour, induction to delivery interval, need for oxytocin, mode of delivery and complications. The parity, mean period of gestation and Bishop's score were similar in both the groups. The improvement in Bishop's score at 12 h was significantly better in the Misoprostol group. Induction to delivery interval was shorter in the Misoprostol group, 16.59 +/- 5.13 h vs 27.77 +/- 12.71 h. The rate of complications was comparable. Vaginal Misoprostol 25 microg 4-hourly is safe and effective for induction of labour with shorter induction to delivery interval.

  17. Analysis of intravaginal misoprostol 0.2 mg versus intracervical dinoprostone 0.5 mg doses for labor induction at term pregnancies.

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    Górnisiewicz, Teresa; Jaworowski, Andrzej; Zembala-Szczerba, Małgorzata; Babczyk, Dorota; Huras, Hubert

    2017-01-01

    Labor-induction methods are used in about 23% of labors. Most commonly, pharmacological methods are used to pre-induct the labor with dinoprostone - a PGE2 analog, and misoprostol - a PGE1 analog. The aim of this study was to evaluate two pharmacological methods of labor induction with the use of prostaglandins applied via an intravagi-nal insert containing misoprostol at a dose of 0.2 mg and intracervical gel containing dinoprostone at a dose of 0.5 mg. This retrospective study was conducted on a group of 50 adult patients qualified for the pre-induction of labor. Following data were recorded: the time from the drug administration to the beginning of regular contractile function, the time from administration to amniotic fluid rupture, the time from medicament administration to the vaginal labor or caesarean section, the duration of I, II and III stages of labor, the delivery method and in the event of caesarean section - the indications for surgery. In comparison to dinoprostone, the misoprostol application was found to shorten the time from drug administration to amniotic fluid rupture by 14.1 hours, the time to the beginning of the first stage of labor by 11.7 hours and from the drug administration to the delivery by 17.3 hours (p-value intracervical gel with dinoprostone at a dose of 0.5mg. Thorough analysis of these methods requires further studies.

  18. Role of Combination OF Mifepristone and Misoprostol Verses Misoprostol alone in Induction of Labour in Late Intrauterin Fetal Death: A Prospective Study.

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    Subrat Panda

    2013-12-01

    Full Text Available To compare efficacy, safety and tolerance of combination of mifepristone and misoprostol versus misoprostol-only in induction of late intrauterine fetal death (IUFD.This prospective study included a consecutive series of 52 women gravid up to fourth with IUFD after 28 weeks of gestation between January 2008 and June 2011. Women were divided into two groups. First group of women received a single oral dose of 200mg mifepristone, and after 24 hours, 100ug of intravaginal misoprostol was administered, followed by intravaginal 100µg misoprostol at four hourly intervals if required. Second group of women received 100 µg misoprostol at four hourly interval per vaginally (maximum 600µg in 24 hours. Oxytocin was given for augmentation if needed.The induction-to-delivery time was shorter with the combination regimen (p < 0.001 group. The total dose of misoprostol needed was lower in the group pre-treated with mifepristone (p < 0.001. Oxytocin was required only in misoprostol group. The two groups did not differ as regards complications experienced during labor and delivery significantly.Both regimens, misoprostol-only and the combination of mifepristone and misoprostol are safe in induction of labor after intrauterine fetal death (IUFD. Pre-treatment with mifepristone is more effective in terms of reducing of induction delivery interval, requirement of lesser dose of misoprostol and no need of augmentation with oxytocin.

  19. Misoprostol versus misoprostol and foley catheter combination in 2nd trimester pregnancy terminations.

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    Ercan, Önder; Köstü, Bülent; Özer, Alev; Serin, Salih; Bakacak, Murat

    2016-09-01

    The efficacy and safety were assessed of a misoprostol regimen used alone or in combination with foley catheter for second trimester pregnancy termination. A retrospective examination was made of the records of patients who underwent pregnancy termination at 14-24 weeks of gestation in our university hospital between January 2011 and June 2014. Records were available for patients 378 who underwent terminations. Group 1 comprised patients with no history of cesarean section. An initial dose of 200 μg misoprostol was administered intravaginally and then until the termination was completed an additional 200 μgr dose was administered sublingually every 4 hours (Group 1: 234 patients). Group 2 comprised patients with a history of cesarean section. An initial dose of 200 μg misoprostol was administered intravaginally and 2 hours later an intracervical foley catheter was inserted (Group 2: 144 patients). The total misoprostol dosage used was 1160 μg and 560 μg (pmisoprostol tablet until termination were 854.8 and 704.2 minutes (p= 0.03) in Groups 1 and 2, respectively. The misoprostol + foley catheter combination reduces the total dosage of misoprostol required for termination and shortens the termination interval, thereby increasing patient's comfort. Based on these results, the usage of the misoprostol + foley catheter combination can be recommended especially for patients with a history of caesarian section.

  20. Foley Catheter versus Vaginal Misoprostol for Labour Induction

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    Nasreen Noor

    2015-01-01

    Full Text Available Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25 μg of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p<0.01. The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley’s catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour.

  1. COMPARISON OF MISOPROSTOL AND MISOPROSTOL WITH ISOSORBIDE MONONITRATE IN SECOND TRIMESTER TERMINATION OF PREGNANCY

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    Shanthi Sivakumar

    2016-08-01

    Full Text Available BACKGROUND To compare the efficacy and side effect profile of vaginal misoprostol versus misoprostol and isosorbide mononitrate in enhancing cervical ripening in second trimester pregnancy termination. METHODS It is a random clinical trial done in 100 patients for mid trimester termination of pregnancy (between 12 and 24 weeks of gestational age. They were divided into two groups: Group A Combination of 400 mcg of misoprostol and 40 mg of ISMN placed intravaginally. Repeat doses included combination of 400 mcg of misoprostol and 20 mg of ISMN every 4 hours for maximum 4 doses. Group B 400 mcg of misoprostol placed intravaginally every 4 hours for maximum 4 doses for termination. In both the above-mentioned groups, T. mifepristone 600 mg was given orally 36-48 hrs. prior to termination. RESULTS The mean induction abortion interval was significantly less (7 hrs. 36 mins in Group A compared with group B (9 hrs. 55 min. There was no statistical significant difference in the amount of mean dose used in both groups. The complete abortion rate within 48 hrs. in Group A was 94%, which shows no statistical significance when compared with Group B complete abortion rates (80%. However, it is interpreted that on adding ISMN, the number of complete abortion rates are higher. There was no failure of abortion in both the groups. The side effects such as pain abdomen and fever were less in Group A (38% when compared to Group B (78%. CONCLUSION Vaginally administered ISMN seems to be safe and effective method in second trimester pregnancy termination. There is a reduction in hospital stay, manpower, economy spent on patient, and a sense of wellbeing from the patient also.

  2. Comparison of Effectiveness of Laminaria versus Vaginal Misoprostol for Cervical Preparation Before Operative Hysteroscopy in Women of Reproductive Age: A Prospective Randomized Trial.

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    Karakus, Savas; Akkar, Ozlem Bozoklu; Yildiz, Caglar; Yenicesu, Gonca Imir; Cetin, Meral; Cetin, Ali

    2016-01-01

    To compare the effectiveness and safety of intracervical laminaria dilator versus intravaginal misoprostol administered before surgery to facilitate cervical dilation before operative hysteroscopy. A prospective randomized study (Canadian Task Force classification 1). A university hospital. A total of 150 women were assigned at random to the following groups: laminaria dilation (n = 50), misoprostol dilation (n = 50), and mechanical dilation (n = 50). Hysteroscopic surgery of intrauterine lesions. In this study, 150 women were assigned at random to receive cervical priming with an intracervical laminaria dilator, 200 μg of intravaginal misoprostol, or a mechanical dilator before operative hysteroscopy. Cervical response, surgical outcome, and complications of operative hysteroscopy were assessed. Visual analog scale (VAS) pain scores were recorded in the misoprostol and laminaria dilation groups. Demographic variables of the study groups were comparable (p = .278-.988). The duration of cervical pretreatment was similar with the intracervical laminaria dilator and intravaginal misoprostol (p = .803); however, intravaginal misoprostol was associated with more adverse effects (p = .031). Compared with the misoprostol dilation group, in which all patients required additional cervical dilation, notably fewer patients in the laminaria dilation group required additional cervical dilation after cervical preparation (p = .001). VAS pain scores were significantly higher in the laminaria dilation group, however (p = .001). Cervical priming with an intracervical laminaria dilator before operative hysteroscopy reduces the need for cervical dilation and better facilitates hysteroscopic surgery compared with intravaginal misoprostol. Oral analgesic use may be required before the use of this device. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  3. Use of misoprostol for induction of labour in unvaorable cervix in eclampsia

    International Nuclear Information System (INIS)

    Nahar, S.; Begum, S.; Yansur, S.; Rasul, C.H.

    2004-01-01

    Objective: To find out safety and efficiency of Misoprostol in cervical ripening and induction of labour to achieve vaginal delivery. Results: From Misoprostol insertion to delivery time was 4-24 hours. Vaginal delivery was achieved in 80.2%, which included spontaneous, forceps and vacuum extraction. Caesarean section rate was 19.7%. Indications for C. Section included Misoprostol unresponsiveness 11% and fetal distress in 8.6%. Oxytocin augmentation was required in 32% of cases. Term babies were 58%. Intrauterine death and neonatal deaths were 9.8% and 8.6% respectively. Hyper stimulation and postpartum haemorrhage was seen in 2.4% and 3.7% of patients respectively. Conclusion: intravaginal Misoprostol is well tolerated and is very effective for the induction of labour in eclampsia. It helps vaginal delivery in toxemic patients, reduces maternal morbidity, mortality and hospital stay. (author)

  4. Penyakit Peptik dan Misoprostol

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    Mariana Raini

    2012-10-01

    Full Text Available Peptic mucus synthesize especially prostaglandine E2 and I2. Prostaglandine E2 and I2 can impede acid secrete and stimulate mucus and bicarbonate secretion. Misoprostof, a synthetic methyl ester analogue of prostaglandin is both a powerful inhibitor of gastric secretion and is able to protect the gastroduodenal mucosa from damage. Misoprostol and other prostaglandine derivatives can be alternative drug of peptic ulcer relapse because the metyl ester of prostaglandin exert an antisecretion and protective effects on peptic mucus. The clinical effectiveness of misoprostol is comparable to cimethidin in short term treatment of peptic and duodenum ulcer as well as reducing duodenal ulcer relapse. Misoprostol may prevent gastrointestinal and peptic ulcer in long term treatment of Non Steroid Anti Jnflamation Drug. The side effect of misoprostol is cervix maturation and uterotonic. This article describe misoprostol effictiveness on peptic and duodenum ulcer treatment.   Key Words: Misoprostol, Peptik ulcer, Sitoproteksi

  5. Efficacy and safety of six hourly vaginal misoprostol versus intracervical dinoprostone: a randomized controlled trial.

    Science.gov (United States)

    Denguezli, Walid; Trimech, Adnene; Haddad, Anis; Hajjaji, Awatef; Saidani, Zahra; Faleh, Raja; Sakouhi, Mohamed

    2007-08-01

    To compare the efficacy and safety of intravaginal misoprostol versus dinoprostone cervical gel for cervical ripening and labour induction. We carried out an experimental clinical trial in which we enrolled 130 cervical consecutive patients with cervical ripening, randomly assigned to one of the following two treatment groups: (1) intravaginal misoprostol and (2) intracervical dinoprostone gel. A total of 50 microm of misoprostol was placed in the posterior vaginal fornix every 6 h for a maximum period of 24 h and 0.5 mg of dinoprostone was administrated in the uterine cervix every 6 h, for a maximum period of 24 h. The primary outcome measure was the number (rate) of women who went to vaginally deliver within 24 h of the protocol initiation. Among 130 patients evaluated, 65 were allocated to the misoprostol group and 65 to the dinoprostone group. The proportion of vaginal delivery within 24 h was significantly higher in the misoprostol group (75%) than in the dinoprostone group (53.8%) (RR = 1.40, 95% CI [1.07-1.45], P = 0.02). There was no significant difference between the mean time interval of delivery in the misoprostol group and the dinoprostone group (14.9 vs.15.8 h) (P = 0.51). The Bishop score was significantly higher in the misoprostol group, 6 h after the onset of the study (1.38; relative risk, 95% CI [1.02-1.85], P = 0.03). The Caesarean delivery rate for fetal distress was higher in the dinoprostone group (21 vs. 10.8%, P = 0.15). The tachysystole (Misoprostol 6.1% vs. dinoprostone 4.6%, relative risk 1.15, 95% CI [0.6-2.24]) and hyperstimulation syndrome rates (Misoprostol 7.6% vs. dinoprostone 4.6%, relative risk 1.26, 95% CI [0.72-2.24]) were slightly increased in the misoprostol group than in the dinoprostone group without reaching the level of statistical signification. Misoprostol as used in this protocol is more effective than cervical dinoprostone gel application in the cervical ripening and labour induction. There is a tendency for an

  6. A comparison of intravaginal misoprostol with sublingual misoprostol for second trimester medical termination of pregnancy

    OpenAIRE

    Ankita Pandey; Sarmila Kundu; Prasad Yeshwant Deshmukh

    2015-01-01

    Background: Second trimester abortions generally account for less number of patients as compared to first trimester abortions as patients generally come earlier as soon as pregnancy is recognized but now days due to advent of USG many cases of fetal anomaly are detected earlier accounting for increasing number of cases of second trimester. Methods: Present study was conducted among patients with pregnancy between 13-20 weeks of period of gestation (to be randomly assigned) after getting a...

  7. A PROSPECTIVE RANDOMEZED CONTROLLED TRIAL OF TWO REGIMENS OF VAGINAL MISOPROSTOL IN SECOND TRIMESTER TERMINATION OF PREGNANCY

    Directory of Open Access Journals (Sweden)

    L. Eslamian

    2007-09-01

    Full Text Available The search continues for a safe effective and cheap method for mid-trimester termination of pregnancy. Misoprostol is a strong contender in this respect. The dose schedule is still not fixed. The objective of this study was to compare the efficacy and adverse effects of two dose regimens of vaginal misoprostol for second trimester termination. Prospective randomized double blind controlled trial was undertaken in 162 women at 14-24 weeks gestation in a teaching hospital. Subjects were randomized to receive either regime A: 400 µg of intra vaginal misoprostol every 6h, or regime B: 200 µg of intravaginal misoprostol every 6h. The main outcome measure was the success rate at 24h, total dose required, induction-abortion interval and adverse effects. Data was analyzed by student's t-test, Mann-whitney U-test, the chi-squared test or Fisher's exact test. There was a significant difference in the success rate at 24 and 48hr (regime A: 74% and 97.5%; regime B: 61.7% and 88.9% P=0.016 & 0.029 respectively and in the mean induction abortion interval (14 Vs 20h, P=0.01 Mean Misoprostol requirement was significantly higher for regime A (731 µg ± 362 µg vs. 531µg ± 357µgm, P=0.001. Use of 400 µg vaginal misoprostol is superior to 200 µg vaginal misoprostol for second trimester abortion.

  8. Misoprostol en obstetricia Misoprostol use in obstetrics

    Directory of Open Access Journals (Sweden)

    1997-04-01

    Full Text Available El misoprostol es una prostaglandina sintética relacionada estructuralmente con la prostaglandina E1, Se emplea principalmente para prevenir la enfermedad ulcerosa inducida por antinflamatorios no esteroideos. Sin embargo, ha demostrado tener efecto sobre el útero causando contracciones, El propósito de esta revisión es analizar lo expuesto por múltiples estudios publicados con respecto al uso de la droga en diferentes situaciones durante el embarazo, especialmente en gestaciones a término con feto vivo ya que podría convertirse en una alternativa económica y eficaz si igualmente pudiera demostrarse que es segura, Misoprostol is a synthetic prostaglandin structurally related to prostaglandin E1. It is mainly used to prevent peptic ulcer disease induced by ingestion of nonesteroidal antinflammatory agents. However, it has been shown to cause uterine contractions. The purpose of this review is to analize several published studies dealing with its use in various situations during pregnancy, especially in term gestations with alive fetus, because this could be an effective and unexpensive option if it were also safe.

  9. Efficacy and safety of misoprostol compared with the dinoprostone for labor induction at term: a meta-analysis.

    Science.gov (United States)

    Wang, Lina; Zheng, Jianlan; Wang, Wenyan; Fu, Jingli; Hou, Li

    2016-01-01

    The purpose of this study was to compare the efficacy and safety of intravaginal misoprostol and the dinoprostone vaginal insert for labor induction at term. PubMed, EMBASE, MEDLINE, CNKI, EBSCO and the Cochrane Library were searched for articles published in English language from 2000 to 2014, Using the keywords misoprostol, dinoprostone, labor induction. Eight of 436 studies (1669 women) identified met the criteria for meta-analysis. We assigned a quality rating to each included article. The use of misoprostol showed less oxytocin augmentation when compared with dinoprostone (RR = 0.78, 95% CI = 0.67-0.90). There was no difference in the risk of tachysystole (RR = 1.18, 95% CI = 0.78-1.79), uterine hyperstimulation (RR = 1.24, 95% CI = 0.75-2.06), vaginal delivery within 24 h (RR = 1.10, 95% CI = 1.00-1.20), cesarean delivery (RR = 0.84, 95% CI = 0.56-1.24), Neonatal Intensive Care Unit admission (RR = 0.86, 95% CI = 0.58-1.28), Apgar scores misoprostol and dinoprostone. Misoprostol compared with dinoprostone appears to show less oxytocin augmentation for labor induction at term. The other outcomes of both drugs were similar. However, these findings were based on small-scale trials. Further studies assessing the effectiveness and safety of misoprostol and dinoprostone in selected groups of patients are warranted.

  10. Letrozole and misoprostol versus misoprostol alone for termination of pregnancy: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Zahra Rezai

    2014-02-01

    Conclusion: Combination of letrozole and misoprostol is as effective as misoprostol alone in complete abortion rate. Based on these results, the use of misoprostol in combination with letrozole is safe and not expensive.

  11. Misoprostol versus oxytocin for labor induction in term and post-term pregnancy: randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Márcia Maria Auxiliadora de Aquino

    Full Text Available CONTEXT: Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness. OBJECTIVE: To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. DESIGN: Randomized controlled trial. SETTING: The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000. PARTICIPANTS: 210 pregnant women with intact membranes and indication for labor induction were selected. PROCEDURES: The women randomly received 25 µg of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women, or oxytocin in a continuous infusion (105 women. MAIN MEASUREMENTS: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used. RESULTS: There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups. CONCLUSION: 25 µg of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin.

  12. A Comparative Study of Vaginal Misoprostol and High Dose Intravenous Oxytocin for Second Trimester Pregnancy Termination

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    M. Rajaee

    2010-04-01

    Full Text Available Introduction & Objective: Second trimester labor induction is a major problem in obstetrics and is the cause of two-thirds of all abortion related complications and more than half of the maternal deaths associated with abortion. The goal of this study was to compare the effectiveness of vaginal misoprostol and intravenous oxytocin for termination of second trimester pregnancy.Materials & Methods: One hundred women were allocated in a randomized controlled way to one of the two induction groups: oxytocin group patients initially received an infusion of 50 units of oxytocin in 500 ml of ringer over 3 hours, 1 hour of no oxytocin followed by alternating 3 hours of oxytocin with 1 hour of rest. Oxytocin was increased by 50 units in each successive period until a final concentration of 300 units per 500 ml has been reached. Another group received 200 µg misoprostol tablets in posterior fornix vagina and was repeated after 12 hours if needed. The two groups were compared for induction to delivery intervals and their safety during induction. Results: The success rate within 24 hours of induction was 94% in the misoprostol group and 86% in oxytocin group (p= 0.182. The mean induction to delivery time was significantly longer in the oxytocin group compared with the misoprostol group.(13.5 versus 9.93 hours ; P=0.0057. Retained placenta requiring curettage was lower in the misoprostol group than the oxytocin group.Conclusion: Intravaginal misoprostol is more effective than high dose intravenous oxytocin in women with second trimester termination.

  13. COMPARATIVE EFFICACY OF MISOPROSTOL AND OXYTOCIN AS LABOR PREINDUCTION AGENTS: A PROSPECTIVE RANDOMIZED TRIAL

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    Zh. Abedi Asl

    2007-09-01

    Full Text Available The purpose of this study was to compare the efficacy and safety of misoprostol and oxytocin for induction of labor. In this prospective and randomized controlled trial one hundred twenty women with an unfavorable cervix who underwent labor induction were assigned to receive either intravenous high dose oxytocin(6mIu/min or intravaginal misoprostol 50µg every 6 hours for two doses. Twelve hours later if labor was not stablished oxytocin induction was initiated per standardized protocol (3mIu/min. Mean Bishop Score change (± SD over the initial 12 hours interval was significantly greater in the misoprostol group (11.98± 1.55 compared with the oxytocin group (8.83 ± 2.61. There were no statistically significant differences in the median duration of labor ( 449±261.1 min, 514.5±288.5 min, respectively;p=0.22 , the mode of delivery or the adverse maternal /neonatal out come among the two groups.Use of misoprostol as a labor preinduction / labor induction agent results in greater Bishop score changes compared with high dose oxytocin and both of them are comparable.

  14. Therapeutic termination of second trimester pregnancies with low dose misoprostol

    International Nuclear Information System (INIS)

    Liaquat, N.F.; Javed, I.; Shuja, S.; Shoaib, T.; Bano, K.; Waheed, S.; Ansar, A.

    2006-01-01

    To determine the effectiveness of 50 micro g misoprostol for midtrimester termination of pregnancies. The study subjects were 54 pregnant women admitted during the 2nd trimester (14-26 weeks) of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder (hypertension or diabetes) or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50 micro g misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. Results: The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +- 11.58 (range 4-48 hours). Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01+-8.7 hours in dead and 23.4 +- 15.9 hours in alive fetuses (t -value:1.9, p: 0.05). Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 micro g misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with

  15. Indução do Parto com Misoprostol: Comparação entre duas Doses Labor Induction with Misoprostol: Comparison of Two Dose Regimens

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    Dimas Augusto Carvalho de Araújo

    1999-10-01

    Full Text Available Objetivo: comparar a eficácia e segurança entre duas doses de misoprostol administradas por via vaginal para amadurecimento cervical e indução do parto. Pacientes e Métodos: sessenta e uma pacientes com indicação médica para indução do parto e colo desfavorável foram incluídas neste estudo. Vinte e oito pacientes receberam 25 µg e trinta e três 50 µg de misoprostol, a intervalos de 4 horas, até um período máximo de 24 horas. Resultados: a rotura prematura de membranas, gestação prolongada e doença hipertensiva específica da gestação foram as principais indicações para a indução do parto. O intervalo de tempo, em minutos, entre inserção do misoprostol até o parto vaginal foi similar nos grupos de 25 µg (416,3 ± 148,1 e 50 µg (425 ± 135,9. A porcentagem de parto vaginal foi de 82,2% e 81,9% nos grupos de 25 e 50 µg, respectivamente. Não houve diferença significativa entre os grupos no que se refere a complicações maternas e fetais. Conclusões: a administração de misoprostol por via vaginal mostrou-se um método eficiente e seguro para o amadurecimento cervical e indução do parto. A dose de 25 µg mostrou ter eficácia e segurança comparável à de 50 µg.Purpose: to compare the efficacy and safety between two doses of intravaginal misoprostol for cervical ripening and induction of labor. Patients and Methods: sixty-one patients with medical indication for induction of labor and unfavorable cervix were included in this study. Twenty-eight of them received 25 µg and thirty-three 50 µg misoprostol, every four hours until delivery. Results: premature rupture of membranes, prolonged gestation and preeclampsia were the main indications for labor induction. The time interval, in minutes, from insertion of misoprostol until delivery was similar for the 25 µg (416.3 ± 148.1 and 50 µg (425.0 ± 135.9 groups. The percentage of vaginal delivery was 82.2% and 81.9% in the groups of 25µg and 50 µg

  16. Polymeric gels for intravaginal drug delivery.

    Science.gov (United States)

    Cook, Michael T; Brown, Marc B

    2018-01-28

    Intravaginal drug delivery can elicit a local effect, or deliver drugs systemically without hepatic first pass metabolism. There are a number of emerging areas in intravaginal drug delivery, but the vagina is a challenging route of administration, due to the clearance mechanisms present which result in poor retention of dosage forms, and the potential for irritation and other adverse reactions. Gel formulations are desirable due to the ease of application, spreading and that they cause little to no discomfort to the patient. However, these dosage forms, in particular, are poorly retained and traditional gels typically have little control over drug release rates. This has led to a large number of studies on improving the retention of vaginal gels and modulating the controlled release of drugs from the gel matrix. This review outlines the anatomy and physiology of the vagina, focussing on areas relevant to drug delivery. Medical applications of vaginally administered medicines is then discussed, followed by an overview of polymeric gels in intravaginal drug delivery. The sensorial properties of intravaginal gels, and how these relate to user compliance are also summarised. Finally, some important barriers to marketing approval are described. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. The continuing problem with misoprostol

    African Journals Online (AJOL)

    discovered additional benefit, it is predominantly a psychotropic agent for the treatment of psychotic delusions in schizophrenia. Misoprostol can be used in low doses to soften the cervix to allow instrumentation for suction evacuation of the uterus in termination or incomplete miscarriage, or to soften the cervix prior.

  18. Letrozole and misoprostol versus misoprostol alone for termination of pregnancy: a randomized clinical trial

    OpenAIRE

    Zahra Rezai; Seydeh Sareh Heydari Bazardehi; Azizeh Ghasemi Nezhad; Amir Saeid Sadeghi; Batool Ghorbani Yekta

    2014-01-01

    Background: To compare the success rate and side effects of letrozole and misoprostol versus misoprostol alone for medical termination of early pregnancy. Methods: The patients requesting termination of pregnancy up to 63 days of gestation were randomized into two groups. The letrozole group received letrozole 10 mg daily for 3 days followed by 800 micrograms of vaginal misoprostol, while the placebo group received placebo for 3 days followed by the same dosage of misoprostol. The complete...

  19. Comparative Evaluation of 25µg and 50µg of travaginal Misoprostol for Induction of Labor

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    Buddhi Kumar Shrestha

    2013-06-01

    Full Text Available   Introduction: To compare the efficacy and safety of 25g vs. 50g of intravaginal (Posterior fornix misoprostol for induction of labor in 100 patient from Jan 2012 to Dec 2012 at Lumbini Medical College.   Methods: One hundred pregnant lady requiring induction were randomly assigned to receive either 25 g (group A=50 or 50 g (group B=50 of intra vaginal misoprostol every 4 hrs till adequate contractions were achieved or maximum dose of 150 g was used.   Results: The onset of contraction was earlier in group B in 34 cases as compared to group A, where only 25 cases had earlier contraction ( P> 0.05. 38 cases (76% in Group B and 35 cases (70% in Group A delivered vaginally. Induction to delivery interval was shorter(<12hrs in group B in 15 cases and in 10 cases in group A. Mean dose of Misoprostol (94micrograms for successful induction in group B was high compared to Group A (75.5 microgram. Requirement for oxytocin infusion was higher in group A, 26% vs. 15%. Abnormal contractility pattern was seen in B group 24% cases compared to 14% cases in Group A. APGAR score < 7 at 1 min was seen in 26% neonates in Group B and in only 10% neonates in Group A. Ruptured uterus did not occur in any group.   Conclusion: 50 g dose of misoprostol is more efficacious than 25 g dose as seen in our study. However it appears to be less safe both for mother and baby due to the high incidence of tachysystole, hyperstimulation and intrauterine passage of meconium.

  20. Misoprostol and teratogenesis in neonates

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    Mariana Beatriz Scabora da Silva

    2009-09-01

    Full Text Available This paper is focused in some aspects of maternal exposure to misoprostol during perinatal period, and the abortive and teratogenesis effects on the fetus. The causes of malformations were revised, taking into account chemical, physical and environmental factors as well as the interaction between them. There are evidences that the practice of abortion tripled in Southern and Northeastern Brazil in 15 years, and one of the most frequent forms of abortion is through the use of misoprostol. In Brazil, 1991, 288,700 women were hospitalized as a consequence of complications induced by abortion attempt with this medicine. This fact resulted in the ban of misoprostol across our country, by Decree 344/98 determined by the Health Ministry. The use of misoprostol requires special control and it is allowed only in hospitals, with supervision of the municipal health surveillance. Among the more severe problems affecting the non-aborted child is the injury on the central nervous system, which frequently results in the Moebius syndrome. This is a congenital and non-progressive paralysis of the VI and VII cranial nerves, frequently bilateral, which produces a unexpressive facial appearance and convergent Strabismus. Even banned in our country, abortion is illegally practiced, being deprived of proper knowledge about misoprostol teratogenic effects on the fetus as well as the risks involving mothers.Este trabalho enfoca aspectos relativos à exposição ao misoprostol no período perinatal como abortificante e agente teratogênico, assim como as causas das malformações, considerando-se fatores químicos, físicos e ambientais. A prática do aborto triplicou nas regiões Sul e Nordeste em 15 anos, sendo que entre os métodos mais freqüentes está o uso do medicamento com o princípio ativo do misoprostol. Em 1991 no Brasil, 288.700 mulheres foram socorridas em hospitais devido a complicações por indução de aborto com este medicamento. Isso resultou na

  1. Comparison of efficacy and safety of sublingual misoprostol with intracervical dinoprostone gel for cervical ripening in prelabour rupture of membranes after 34 weeks of gestation.

    Science.gov (United States)

    Jha, Nivedita; Sagili, Haritha; Jayalakshmi, D; Lakshminarayanan, Subitha

    2015-01-01

    To compare the efficacy and safety of sublingual misoprostol with intracervical dinoprostone gel for cervical ripening in prelabour rupture of membrane after 34 weeks of gestation. One eighty-eight women having >34 weeks of gestation with PROM, singleton viable fetus and no prior caesarean section were randomized to sublingual misoprostol (50 μg every 4 h and maximum of 3 doses) and intracervical dinoprostone (0.5 mg every 2 h and maximum of 2 doses). Oxytocin augmentation was commenced in those with a satisfactory Bishop score, inadequate contractions and who did not go into spontaneous active labour. Primary outcome measures were induction-delivery interval and the number of women that went into spontaneous labour without oxytocin augmentation. There was a significant reduction in induction to delivery interval in sublingual misoprostol group compared to intracervical dinoprostone (8.3 ± 3.6 h vs 12.2 ± 6.6 h; p = 0.000). There was a significant reduction in duration of rupture of membrane to delivery interval (p = 0.015), 1st stage of labour (p = 0.000) in sublingual misoprostol group as compared to the intravaginal dinoprostone group. There was no difference observed in spontaneous vaginal delivery between the groups (0.919). Oxytocin requirement was significantly higher in the dinoprostone group p = 0.006). There were more maternal adverse effects of sublingual misoprostol (p = 0.026). However, maternal and neonatal safety profiles were comparable. Sublingual misoprostol and intracervical dinoprostone at the dose studied are equally efficacious in achieving spontaneous vaginal delivery, reduction in induction-delivery interval and in reducing the need for oxytocin, in women after 34 weeks gestation with rupture of membranes.

  2. Oral misoprostol for induction of labour.

    Science.gov (United States)

    Alfirevic, Zarko; Aflaifel, Nasreen; Weeks, Andrew

    2014-06-13

    Misoprostol is an orally active prostaglandin. In most countries misoprostol is not licensed for labour induction, but its use is common because it is cheap and heat stable. To assess the use of oral misoprostol for labour induction in women with a viable fetus. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 January 2014). Randomised trials comparing oral misoprostol versus placebo or other methods, given to women with a viable fetus for labour induction. Two review authors independently assessed trial data, using centrally-designed data sheets. Overall there were 76 trials (14,412) women) which were of mixed quality.In nine trials comparing oral misoprostol with placebo (1109 women), women using oral misoprostol were more likely to give birth vaginally within 24 hours (risk ratio (RR) 0.16, 95% confidence interval (CI) 0.05 to 0.49; one trial; 96 women), need less oxytocin (RR 0.42, 95% CI 0.37 to 0.49; seven trials; 933 women) and have a lower caesarean section rate (RR 0.72, 95% CI 0.54 to 0.95; eight trials; 1029 women).In 12 trials comparing oral misoprostol with vaginal dinoprostone (3859 women), women given oral misoprostol were less likely to need a caesarean section (RR 0.88, 95% CI 0.78 to 0.99; 11 trials; 3592 women). There was some evidence that they had slower inductions, but there were no other statistically significant differences.Nine trials (1282 women) compared oral misoprostol with intravenous oxytocin. The caesarean section rate was significantly lower in women who received oral misoprostol (RR 0.77, 95% CI 0.60 to 0.98; nine trials; 1282 women), but they had increased rates of meconium-stained liquor (RR 1.65, 95% CI 1.04 to 2.60; seven trials; 1172 women).Thirty-seven trials (6417 women) compared oral and vaginal misoprostol and found no statistically significant difference in the primary outcomes of serious neonatal morbidity/death or serious maternal morbidity or death. The results for vaginal birth not

  3. Efecto de un dispositivo intravaginal con progesterona sobre la actividad ovárica en yeguas cíclicas Effect of an intravaginal device containing progesterone on the ovarian activity in cyclic mares

    OpenAIRE

    C.P Bianchi; R Guerrero; I Videla Dorna; M.V Cavilla; M.A Aba

    2011-01-01

    Se evaluó el efecto de un dispositivo intravaginal conteniendo progesterona más una inyección de prostaglandina F2α (PGF2α) al retiro del dispositivo y la aplicación de Gonadotrofina Coriónica humana (hCG) al día 5 post retiro sobre la actividad ovárica en yeguas cíclicas. Adicionalmente, se evaluaron los porcentajes de preñez. Los animales se dividieron en: grupo T: animales tratados a partir del día 0 con dispositivo intravaginal conteniendo 1,38 g de progesterona durante 8 días m...

  4. Profound Hyperthermia After Postpartum Rectal Misoprostol Administration.

    Science.gov (United States)

    Kaiser, Jennifer; Royer, Pamela A

    2016-06-01

    Misoprostol, a synthetic prostaglandin E1 analog, is commonly used for treatment and prevention of postpartum hemorrhage. Known side effects include transient hyperthermia, chills, nausea, vomiting, and diarrhea. After a precipitous vaginal delivery complicated by postpartum hemorrhage (600-mL blood loss), a healthy 21-year-old multiparous patient received 800 micrograms rectal misoprostol. Within 30 minutes, she developed rigors, severe hyperthermia (41.5°C [106.7°F]), tachycardia (170s), and transient encephalopathy. Antibiotics and a cooling protocol were initiated in the intensive care unit. Her abnormal vital signs resolved 7-8 hours later. Extensive workup was negative. It is important to consider misoprostol toxicity in postpartum hyperthermia, rigors, and tachycardia. Misoprostol should be used judiciously given a lack of evidence for its effectiveness and its potential for serious side effects.

  5. Maternal death related to misoprostol overdose.

    Science.gov (United States)

    Henriques, Alexandra; Lourenço, Alexandre V; Ribeirinho, Ana; Ferreira, Helena; Graça, Luís M

    2007-02-01

    Misoprostol is an important drug in obstetrics and gynecology because of its uterotonic and cervical-ripening activities. The side effects are dose-related, usually transitory, and well tolerated. The toxic dosage in humans is unknown, and there is no specific antidote. An adolescent developed upper gastrointestinal bleeding after self-medication with misoprostol orally (12 mg) to cause abortion. She presented with multiorgan failure, acute abdominal signs, and hemodynamic instability. Emergency laparotomy showed gastric and esophageal necrosis. After several episodes of cardiac arrest, and despite resuscitation efforts, the patient died. Temporal relationship (48 hours after the beginning of medication) strongly suggests that misoprostol was the agent directly involved in the maternal death. The mechanism implicating misoprostol in gastrointestinal ischemia and necrosis is unknown.

  6. Mifepristone and Misoprostol Induced Abortion with A Large Myomatous Uterus

    Directory of Open Access Journals (Sweden)

    Yiu-Tai Li

    2005-06-01

    Conclusion: Supplementary use of high-dose vaginal misoprostol may be considered as an alternative to terminate an early pregnancy in association with a myomatous uterus when the conventional combination of mifepristone and misoprostol fails.

  7. Community-based availability of Misoprostol: Is it Safe? | Prata ...

    African Journals Online (AJOL)

    Misoprostol users were significantly more likely to experience shivering, high temperature, nausea, and vomiting after delivery; adjustment for gynecological history and delivery characteristics revealed no significant differences in experience of symptoms. Misoprostol was highly acceptable to all women surveyed.

  8. Misoprostol-induced radioprotection of oncogenic transformation

    International Nuclear Information System (INIS)

    LaNasa, P.; Miller, R.C.; Hanson, W.R.; Hall, E.J.

    1994-01-01

    Prostaglandins are associated with a variety of both pathologic and normal physiological effects in mammals. Among this broad array of effects, prostaglandins have been shown to provide protection of tissues from a variety of injurious agents including ionizing radiation. Of the prostaglandins tested to date, an analogue of prostaglandins E 1 , misoprostol (cytotec trademark ) was found to be a very effective radioprotector. The purpose of this study was to assess the ability of misoprostol to protect cells from the cytotoxic and oncogenic effects of ionizing radiation. Pregnant Syrian hamsters were injected subcutaneously with 125 μg misoprostol/100 g body weight 2 h before being exposed to graded doses of X rays. Embryos were excised immediately after irradiation and cells were explanted into culture dishes. Following 14 days of incubation, cells were fixed in formalin and stained with giemsa for examination of cell clonogenicity and morphological transformation. First, misoprostol protected cells from some degree of radiation toxicity. A reduction in cell killing by a factor of 1.5 was seen at 10% cell survival. Second, based on transformation studies, a higher frequency of oncogenic transformations is seen for cells exposed in utero to graded doses of X rays alone than for cells exposed to the combination of misoprostol followed by radiation. In the presence of misoprostol, transformation is reduced by a factor of 20 at the level of 10 -3 transformants per surviving cell. Misoprostol may have clinical utility, not only in protecting selected normal tissues during cancer therapy, but it may also be useful in protecting cells from secondary tumors caused by ionizing radiation. 14 refs., 3 figs

  9. Misoprostol With Foley Bulb Compared With Misoprostol Alone for Cervical Ripening: A Randomized Controlled Trial.

    Science.gov (United States)

    Al-Ibraheemi, Zainab; Brustman, Lois; Bimson, Brianne E; Porat, Natalie; Rosenn, Barak

    2018-01-01

    To test the hypothesis that cervical ripening using a combination of misoprostol and a transcervical Foley bulb leads to delivery within a shorter time compared with misoprostol alone. This randomized controlled trial was offered to women admitted for cervical ripening. Inclusion criteria were gestational age 37 weeks or greater with intact membranes, singleton fetus, cephalic presentation, and Bishop score 6 or less. Exclusion criteria included, among others, prior uterine surgery, ruptured membranes, and any contraindication to vaginal delivery. Patients were randomized to cervical ripening using misoprostol and a transcervical Foley bulb simultaneously or misoprostol alone. Primary outcome was time from placement of the misoprostol to delivery. Secondary outcomes included time to active phase, time from active phase to delivery, cesarean delivery rate, uterine tachysystole, estimated blood loss, chorioamnionitis, cord pH, 5-minute Apgar score, and neonatal intensive care unit admission. Sample size calculation revealed that 94 participants were required in each group to detect a 3-hour difference with 80% power and α error of 0.05. Intention-to-treat analysis was performed. From September 2015 to July 2016, a total of 200 patients were randomized, 100 to each group. There were no differences between groups with respect to parity, body mass index, gestational age, Bishop score, birth weight, or indication for induction. Time to delivery was significantly shorter in the combined misoprostol-transcervical Foley group: 15.0 (11.0-21.8) hours (median [interquartile range]) vs 19.0 (14.0-27.3) hours in the misoprostol-only group (P=.001). This time difference remained significant after subanalysis by parity or after excluding cesarean deliveries. There was no difference between groups with respect to the rate or indication for cesarean delivery, estimated blood loss, rate of tachysystole, chorioamnionitis, or neonatal outcomes. Cervical ripening using misoprostol in

  10. Stakeholder perceptions of misoprostol: a qualitative investigation

    Directory of Open Access Journals (Sweden)

    Bazzano AN

    2014-04-01

    Full Text Available Alessandra N Bazzano,1 Lea Jones,1 Thoai D Ngo2 1Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; 2Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK Abstract: The study aimed to explore perceptions of stakeholders regarding misoprostol use in Cambodia, a setting with high maternal mortality. Semi-structured expert interviews were conducted with 21 participants in the capital, Phnom Penh. The sample included participants involved in providing reproductive health services through international and local health agencies and the pharmaceutical industry. A theme of controversy over the role of misoprostol in the context of reproductive health services emerged, along with a need to reconcile legitimate viewpoints in order to understand the place of misoprostol in the Cambodian reproductive health setting. Understanding stakeholder perspectives on misoprostol can shed light on the drug's role in reproductive health programming where maternal mortality is high and health facilities are still improving. Keywords: maternal mortality, misoprostol, post-partum hemorrhage, medical abortion, unsafe abortion, Cambodia

  11. Intracervical misoprostol and prostaglandin E2 for labor induction.

    Science.gov (United States)

    Chang, Y-K; Chen, W-H; Yu, M-H; Liu, H-S

    2003-01-01

    To compare the safety and efficacy of misoprostol with PGE(2) for induction of labor by intracervical administration. Eighty-six women with indications for labor induction at term were randomly assigned to two groups. Each woman received either 50 microg of misoprostol or 0.5 mg of prostaglandin E(2) intracervically. If labor was not initiated after 4 h, the same dose was repeated every 4 h to a maximum of 200 microg of misoprostol or 1.5 mg of PGE(2) until adequate labor was achieved. Forty-three women were allocated to the misoprostol group and 43 to the prostaglandin E(2) group. Misoprostol was more effective than PGE(2) in producing cervical changes (Pintracervical misoprostol is more effective in cervical ripening and labor induction at term. The higher frequency of uterine hypercontractility associated with the use of misoprostol did not increase the risk of adverse intrapartum and neonatal outcomes.

  12. Uterotonic Medications: Oxytocin, Methylergonovine, Carboprost, Misoprostol.

    Science.gov (United States)

    Vallera, Cristianna; Choi, Lynn O; Cha, Catherine M; Hong, Richard W

    2017-06-01

    Uterine atony is a common cause of primary postpartum hemorrhage, which remains a major cause of pregnancy-related mortality for women worldwide. Oxytocin, methylergonovine, carboprost, and misoprostol are commonly used to restore uterine tone. Oxytocin is the first-line agent. Methylergonovine and carboprost are both highly effective second-line agents with severe potential side effects. Recent studies have called into question the effectiveness of misoprostol as an adjunct to other uterotonic agents, but it remains a useful therapeutic in resource-limited practice environments. We review the current role these medications play in the prevention and treatment of uterine atony. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Ulcerating and stenosing enteropathy treated with misoprostol

    DEFF Research Database (Denmark)

    Havelund, Troels; Jensen, Boye L; Vinholt, Pernille Just

    2012-01-01

    A case of a 40-year-old man with chronic anaemia because of nonspecific ulcerating and stenosing enteropathy is presented. The diagnosis was made on the basis of capsule endoscopy, histology of resected ileum and no use of NSAIDs. He showed a clinical response to treatment with misoprostol...... phospholipids. Ex-vivo cyclooxygenase (COX) assays showed normal COX-1 and COX-2 activities. The clinical response to treatment with the prostaglandin E1 analogue misoprostol suggests a defective prostaglandin E synthesis in the intestinal mucosa....

  14. The effect of adding hyoscine to vaginal misoprostol on abortion induction success rate

    Directory of Open Access Journals (Sweden)

    Tehranian A

    2010-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Intravaginal misoprostol has been shown to be an effective agent for cervical ripening and induction of labor. The aim of present study was to assess the effects of adding hyoscine to vaginal misoprostol on its success rate. "n"nMethods: In a clinical trial, 74 women who were referred to undergo legal induction of labor during first pregnancy trimester in Arash Hospital, in Tehran, Iran, between March 2006 and March 2007 were enrolled, and were randomly divided in to two groups of misoprostol (400 µg/4h, vaginal (n=37 or misoprostol (400 µg/4h, vaginal plus hyoscine (20 mg IV (n=37. Their complications including nausea, vomiting, fever, abdominal pain, need for analgesics, diarrhea, vaginal bleeding, decline in hemoglobin more than 3 g/dl, need for blood transfusion and failure of treatment according to the failure of induction of labor or cervical opening in 24 hours after starting treatment and the total duration of hospitalization were compared between groups. "n"nResults: There were no significant differences between groups regarding the rate of side effects like nausea, abdominal pain and vaginal bleeding. In misoprostol plus hyoscine group, the success rate in abortion was significantly higher (40

  15. Clinical evaluation of different applications of misoprostol and aglepristone for induction of abortion in bitches.

    Science.gov (United States)

    Agaoglu, A R; Aslan, S; Emre, B; Korkmaz, O; Ozdemir Salci, E S; Kocamuftuoglu, M; Seyrek-Intas, K; Schäfer-Somi, S

    2014-04-15

    The aim of the present study was to compare the clinical and endocrinological effects of different applications of misoprostol (MIS) and aglepristone (AGL) for the induction of abortion in bitches. For this purpose, 28 healthy pregnant bitches from different breeds, ages, body weights (Body weigt, BWs, 10-40 kg), and between Days 25 to 35 of gestation were used. Bitches were randomly assigned to four groups. In group 1 (GI, n = 7), AGL (10 mg/kg BW, s.c. on 2 consecutive days); in group 2 (GII, n = 7), AGL (as in GI), intravaginal MIS (IVag, 200 μg for bitches with ≤20 kg BW, 400 μg for bitches with >20 kg BW, daily intravaginally until completion of abortion); in group 3 (GIII, n = 7), AGL (as in GI), ICVag (as in GII), per os MIS (400 μg for bitches with ≤20 kg BW, 800 μg for bitches with >20 kg BW, daily orally, until completion of abortion); in group 4 (GIV, n = 7), AGL (as in GI), per os MIS (as GIII) were used. Clinical, vaginal, and ultrasonographic examinations were performed daily until abortion was completed. For measurement of serum progesterone, blood samples were collected in all groups immediately after the first AGL administration and every other day until completion of abortion. No statistical differences were found between groups concerning the duration until completion of abortion after treatment (nonsignificant); however, in GII, one bitch completed abortion 2 days after the start of treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Misoprostol in obstetrics and gynaecology - unregistered ...

    African Journals Online (AJOL)

    Misoprostol (Cytotec; Searle) is a methyl ester of prostaglandin E, and is marketed for use in the prevention and/or treatment of peptic ulcer disease caused by prostaglandin synthetase inhibitors. It is inexpensive, easily stored at room temperature and rapidly absorbed orally, and has few side-effects. Several studies have ...

  17. Misoprostol alone for the termination of Pregnancy

    African Journals Online (AJOL)

    The use of Misoprostol for ter- mination of pregnancy has been approved by the Medicines Control. Council of South Africa. It is part of the approved protocol for termina- tion of pregnancy in public sector facilities in the Western Cape.1. Reference. 1. Provincial Administration: Western Cape: Termination of Pregnancy (Top):.

  18. Misoprostol-induced radioprotection of oncogenic transformation

    Energy Technology Data Exchange (ETDEWEB)

    LaNasa, P. (St. Barnabas Medical Center, Livingston, NJ (United States)); Miller, R.C. (St. Barnabas Medical Center, Livingston, NJ (United States) Columbia Univ., New York, NY (United States)); Hanson, W.R. (Loyola Univ., Maywood, IL (United States)); Hall, E.J. (Columbia Univ., New York, NY (United States))

    1994-05-15

    Prostaglandins are associated with a variety of both pathologic and normal physiological effects in mammals. Among this broad array of effects, prostaglandins have been shown to provide protection of tissues from a variety of injurious agents including ionizing radiation. Of the prostaglandins tested to date, an analogue of prostaglandins E[sub 1], misoprostol (cytotec[sup [trademark

  19. Titrated Misoprostol Versus Dinoprostone for Labor Induction

    African Journals Online (AJOL)

    . Studied women were randomized into; Group I: 104 women included and received oral 200 µg misoprostol in 200 ml water titrated over 12 h and Group II: 108 women included and received vaginal dinoprostone tablet (3 mg) maximum two ...

  20. Mifepristone and misoprostol compared with misoprostol alone for induction of labor in intrauterine fetal death: A randomized trial.

    Science.gov (United States)

    Chaudhuri, Picklu; Datta, Sutapa

    2015-12-01

    To assess whether mifepristone and misoprostol are more beneficial than misoprostol alone for the induction of labor in women with intrauterine fetal death. A randomized double blind placebo-controlled parallel group superiority trial was conducted. One hundred and ten women who had experienced fetal death at or later than 20 weeks of gestation were randomized by computer-generated random number sequence to receive 200 mg of mifepristone or matched placebo tablets orally. Misoprostol was administered vaginally to women of both groups after 36-48 h. The main outcomes studied were the fetal-placental delivery rate within 24 hours of commencement of the first dose of misoprostol without additional intervention and the induction-delivery interval. Successful delivery occurred significantly more frequently in women who received mifepristone prior to misoprostol than in women who received only misoprostol (92.5% [49/53] compared with 71.2% [37/52] respectively; P = 0.001). The mean induction-delivery interval was also significantly shorter when using mifepristone plus misoprostol than using misoprostol alone (9.8 h, standard deviation, 4.4 compared with 16.3 h standard deviation, 5.7, respectively; P misoprostol significantly improved the rate of successful delivery and shortened the induction-delivery interval in women who had experienced fetal death compared with the use of misoprostol alone. © 2015 Japan Society of Obstetrics and Gynecology.

  1. Effect of vaginal administration of misoprostol before intrauterine contraceptive insertion following previous insertion failure: a double blind RCT.

    Science.gov (United States)

    Bahamondes, M Valeria; Espejo-Arce, Ximena; Bahamondes, Luis

    2015-08-01

    Is pretreatment with misoprostol useful in insertion of intrauterine contraceptives (IUCs) after insertion failure at the first attempt? Pretreatment with intravaginal administration of 200 mcg of misoprostol after IUC insertion failure 10 and 4 h before the second attempt of IUC placement was significantly better than placebo at facilitating the insertion of an IUC. One of the reasons for low use of IUCs is the concept that insertion is difficult. Misoprostol was used in several randomized clinical trials (RCT) before IUC insertion to facilitate the insertion. In general, the results showed no significant differences when compared with placebo. However, most previous studies have been carried out among unselected women whereas the present study is among women with previous insertion failure. This was a double blind RCT conducted between February 2013 and October 2014. Participants were 104 women who requested an insertion of an IUC and the insertion failed at the first attempt. After insertion failure, the women received a sealed envelope with misoprostol or placebo. The randomization system (1: 1) in one block size was computer-generated. The study was conducted at a tertiary care centre. The women were instructed to insert vaginally one tablet of misoprostol 200 µg (Prostokos, Hebron, Cariacica, PE, Brazil) or placebo 10 and 4 h before the woman returned to the clinic for a new insertion attempt. The outcomes were successful IUC insertion and the use of a cervical dilator immediately prior to the insertion procedure. A total of 2639 women requested the insertion of an IUC during the study period. The IUC was inserted at the first attempt in 2535 women (96%) and 104 women in whom we were unable to insert the device were eligible to participate in the RCT. Four women declined and 100 women were randomized (55 for the misoprostol group and 45 for the placebo group). From the 100 participating women, the levonorgestrel-releasing intrauterine system (LNG-IUS) was

  2. A COMPARATIVE STUDY OF MIFEPRISTONE AND MISOPROSTOL VERSUS MISOPROSTOL ALONE IN MID TRIMESTER TERMINATION OF PREGNANCY

    Directory of Open Access Journals (Sweden)

    Surendra Nath Soren

    2018-01-01

    Full Text Available BACKGROUND Termination of pregnancy in second trimester continues to be a challenge in developing countries especially in rural areas. There is an exponential rise in complications of abortion along with advancing gestational age. The search is on for an ideal method of abortion, which is reliable, safe and cheap. This study was conducted in M.K.C.G. Medical College and Hospital, Berhampur, from November 2015 to October 2017 with the aim of finding an effective method to induce second trimester abortion within reasonable time with fewer complications. MATERIALS AND METHODS A total of 80 patients were studied to compare combination of mifepristone and misoprostol (30 patients with single drug misoprostol alone (50 patients for second trimester abortion. The Induction Abortion Interval (IAI, success rate, misoprostol dose requirement and side effects with demographic characteristics were compared between the two groups. RESULTS There was a significant difference in the IAI in both the groups. The mean IAI was 562.218 minutes in study group, whereas in control group, IAI was 922.698 minutes. The success rate (complete abortion was 92.5% in study group and 68.4% in control group, and this was statistically significant. Misoprostol dose requirement (average in study group was 1081.48 μg and in control group was 1675.67 μg. More side effects were observed in the control group. CONCLUSION Mifepristone followed by misoprostol was more effective than misoprostol alone as it had a shorter IAI, better success rate, less requirement of misoprostol and fewer side effects.

  3. Misoprostol for cervical ripening at and near term - a comparative ...

    African Journals Online (AJOL)

    The control group received dinoprostone 1 mg inserted in the posterior fornix and repeated 6-hourly to a maximum of three doses. The study group received either oral misoprostol 20 pμ 2-hourly to a maximum of four doses (80 μg), or vaginal misoprostol 25 μg in the posterior fornix with a switch to the oral misoprostol ...

  4. Meta-analysis of Foley catheter plus misoprostol versus misoprostol alone for cervical ripening.

    Science.gov (United States)

    Chen, Wenhang; Xue, Jing; Gaudet, Laura; Walker, Mark; Wen, Shi Wu

    2015-06-01

    The effectiveness of Foley catheter plus misoprostol for cervical ripening has not been convincingly shown in trials. To summarize the evidence comparing Foley catheter plus misoprostol versus misoprostol alone for cervical ripening. Embase, Medline, and Cochrane Collaboration databases were searched with the terms "Foley catheter," "misoprostol," "cervical ripening," and "labor induction." Randomized controlled trials comparing the methods of cervical ripening for delivery of a viable fetus were included. Study characteristics, quality, and outcomes were recorded. Random-effects models were used to combine data. Eight trials were included, with 1153 patients overall. In a pooled analysis of seven high-quality studies, the combination group had a decreased time to delivery (mean difference -2.36 hours, 95% confidence interval [CI] -4.07 to -0.66; P=0.007). Risk of chorioamnionitis was significantly increased in the combination group (risk ratio [RR] 2.07, 95% CI 1.04-4.13; P=0.04), and that of tachysystole with fetal heart rate changes was decreased (RR 0.58, 95% CI 0.38-0.91; P=0.02). Frequency of cesarean did not differ (P=0.77). The combined use of Foley catheter and misoprostol results in a reduced time to delivery, a reduced frequency tachysystole with fetal heart rate changes, and an increased incidence of chorioamnionitis. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Introducing Misoprostol for the Treatment of Incomplete Abortion in ...

    African Journals Online (AJOL)

    ... providers and patients. In remote areas of Nigeria with limited post-abortion care (PAC), misoprostol administration is an important potential PAC treatment modality. Features of misoprostol-low cost, room temperature stability, and ease of introduction-render it an important treatment option, particularly in low resource and ...

  6. Titrated oral misoprostol solution- a new method of labour induction ...

    African Journals Online (AJOL)

    Titrated oral misoprostol solution- a new method of labour induction. ... To develop a new method of misoprostol use for labour induction using very small, frequent, titrated oral dosages, and to pilot effectiveness. Study design. Open clinical pilot ... A multicentre randomised trial of this method is underway. We emphasise the ...

  7. Hjertestop induceret af vasospastisk angina pectoris efter vaginalt administreret misoprostol

    DEFF Research Database (Denmark)

    Matthesen, Terese; Olsen, Rasmus Huan; Bosselmann, Helle Skovmand

    2017-01-01

    A 41-year-old woman developed cardiac arrest after administration of misoprostol in order to induce an abortion. She was successfully resuscitated. Coronary angiography revealed coronary artery spasm which responded to nitroglycerine. Misoprostol is first-line treatment for medically induced...

  8. Radioprotective effect of misoprostol on mouse spermatogonial stem cells

    NARCIS (Netherlands)

    de rooij, D. G.; van Beek, M. E.; Rutgers, D. H.; van Duyn-Goedhart, A.; van Buul, P. P.

    1998-01-01

    The radioprotective effects of misoprostol, a synthetic stable analogue of prostaglandin E1, on spermatogonial stem cells of C3H/HeH x 101/F1 hybrid mice (3H1) were analysed by establishing dose--response relationships for stem cell killing by X-rays in mice that were pretreated with misoprostol.

  9. Is misoprostol a suitable alternative to the surgical evacuation of ...

    African Journals Online (AJOL)

    Background: Research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion. However, few studies have focused on the feasibility of treating incomplete abortion with misoprostol at the rural clinic level in sub-Saharan Africa. Objective: To determine the effectiveness, safety and acceptability ...

  10. Beliefs and practices in using misoprostol for induction of labour ...

    African Journals Online (AJOL)

    Background. Misoprostol is commonly used for induction of labour in term pregnancy. There are different routes and dosing schedules for administering the drug. Objectives. To describe the prescribing pattern (dose, route, duration), beliefs and factors affecting use of misoprostol for inducing term pregnancy among ...

  11. Misoprostol use in developing countries: results from a multicountry study.

    Science.gov (United States)

    Sherris, J; Bingham, A; Burns, M A; Girvin, S; Westley, E; Gomez, P I

    2005-01-01

    To identify information and service delivery needs for obstetric/gynecologic uses of misoprostol in developing countries. The study included a survey of reproductive health providers in 23 countries and a qualitative study of misoprostol use in four developing countries. Researchers used purposive sampling methods for the survey and qualitative study and conducted a descriptive statistical analysis of survey data and computer-assisted text-based content analysis of qualitative data. In some developing countries, women frequently access misoprostol through pharmacies and self-medicate to induce early abortion. Some clinicians expressed concern about this use of misoprostol, but many stated that its availability had reduced serious complications resulting from unsafe abortions. Although misoprostol is routinely used for a range of off-label obstetric/gynecologic indications, evidence-based, up-to-date information about safety, effectiveness, and appropriate regimens is not widely available. This information is requested by providers, including pharmacists. Women need information and guidance about its use.

  12. Comparison Between Use of Oral Misoprostol Versus Vaginal Misoprostol for Induction of Labour at Term.

    Science.gov (United States)

    Prameela; Sharma, Kavya D

    2018-04-01

    In modern obstetrics, around 30% of cases require induction of labour for various reasons. Misoprostol is gaining popularity as pharmacological inducing agent, though the route and dosage of administration are not standardised. The objective of the study is to compare the safety and efficacy of the two routes of misoprostol administration-oral (100 μg 4th hourly) and vaginal (25 μg 4th hourly), for induction of labour at term. In this randomised trial, 104 women having crossed the expected date of delivery without going into spontaneous labour and cases which had premature rupture of membranes <12 h were considered for labour induction and were divided into two equal groups. Group A received 100 μg misoprostol orally 4th hourly, and group B received 25 μg misoprostol vaginally 4th hourly. Labour characteristics and maternal and foetal outcome were compared. In terms of maternal outcome, mean number of doses for oral group is 2.73 and vaginal group is 3.04. In oral group, mean induction to vaginal delivery interval was 13 h 43 min and in vaginal group interval is 13 h 26 min which was statistically not significant. The need for oxytocin augmentation was also statistically not significant. Both groups had equal number of failed inductions. Emergency LSCS done for foetal distress was more in vaginal group 2.9% compared to oral group which is 1%, but difference was not statistically significant ( p value -0.55). Number of thick MSL in oral group was 3.2% as compared to vaginal group which is 10.7% which was statistically significant ( p value -0.04). APGAR score at 5 min 7/10 was seen in 7.7% in vaginal group as compared to 0% in oral group which was also statistically significant (0.004). Number of NICU admissions was also more in vaginal group compared to oral group. Misoprostol in either oral or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. However, occurrence of lesser incidence of meconium

  13. Anterior intravaginal slingplasty tunneller device for stress incontinence and posterior intravaginal slingplasty for apical vault prolapse: a 2-year prospective multicenter study.

    Science.gov (United States)

    Vardy, Michael D; Brodman, Michael; Olivera, Cedric K; Zhou, Huan-Sue; Flisser, Adam J; Bercik, Richard S

    2007-07-01

    The purpose of this study was to report the outcome for (1) anterior intravaginal slingplasty in the treatment of urodynamic stress incontinence and (2) posterior intravaginal slingplasty for apical prolapse (> or = stage II). This was a 2-year prospective multicenter study: patients, 430; anterior intravaginal slingplasty, 144; posterior intravaginal slingplasty, 164; both procedures, 122 (552 tapes total). At 6 and 12 months, the results of the Pelvic Floor Impact Questionnaire, cough stress test, and Pelvic Organ Prolapse Quantitation were assessed. Statistical analyses used paired t-tests. Of the women in the study, 95% (42 women) had a negative cough stress test result through 12 months (n = 44 women), and 96% (127 women) had a negative cough stress test result at 6 months (n = 132). At 6 months, apical support was optimal in 95.3% (143/150 women) and was satisfactory in 2.7% (4/150 women) and at 12 months, 98.1% (52/53 women), 1.9% (1/53 women). Seventeen of 430 patients (4.0%) had vaginal mesh extrusion. Pelvic Floor Impact Questionnaire scores significantly improved (P < .0001). Anterior intravaginal slingplasty and posterior intravaginal slingplasty are safe and effective when performed with other procedures. For anterior intravaginal slingplasty, the rates of perforation and retention are low, but early extrusions are seen. Patients showed improvements in the Pelvic Floor Impact Questionnaire, regardless of extrusion.

  14. Comparison of Vaginal Misoprostol, Combined Letrozole and Misoprostol and Combined Laminaria and Misoprostol in the Preparation of Second-Trimester Cervical Abortion

    OpenAIRE

    Faiba Kahnamooi; Firooz Amani; Mahsa vallaei; Mahnaz Azari

    2018-01-01

    Background & objectives: Therapeutic abortion in the second trimester of pregnancy can be done by a number of medical or mechanical methods. The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria in preoperative cervical ripening among women with under second-trimester abortion. Methods: In this interventional study, 120 pregnant women with the gestational age of 20 weeks, who were candidates for ther...

  15. Misoprostol-induced termination of second-trimester pregnancy in women with a history of cesarean section: a retrospective analysis of 56 cases.

    Science.gov (United States)

    Turgut, Abdulkadir; Ozler, Ali; Görük, Neval Yaman; Karaçor, Talip; Yalinkaya, Ahmet

    2013-04-01

    To assess the effectivity and safety of misoprostol induced termination of pregnancy in the second trimester in women with a history of previous caesarean section. Retrospective analysis of case records from the obstetrics and gynecology department of a tertiary care center between January 2009 and February 2012 was performed. Data derived from 219 women, who underwent a second trimester termination of pregnancy, was analyzed in terms of demographics, clinical findings, laboratory and procedural data. The study group consisted of 56 women with a previous caesarean section and the control group was composed of 163 women without such a history. Termination of pregnancies was conducted by administration of misoprostol at doses of 50-600 mcg intravaginally or by surgical evacuation in cases of failure of medical measures. There was no statistically significant difference between two groups in terms of demographics such as age, menarche, number of pregnancies or live births, smoking habit and co-morbidities. Necessity for blood transfusion (p = 0.05) and additional procedure for abortion (p = 0.056) were found to be similar in both groups. However laparotomy (p = 0.004), uterine rupture (p = 0.016), hysterotomy (p pregnancies in women with a history of CS. Increased possibility of uterine rupture and requirement of interventions such as laparotomy or hysterotomy is more likely in these patients.

  16. Sublingual misoprostol and hyperpyrexia: case report with temperature curve.

    Science.gov (United States)

    Tolefac, Paul Nkemtendong; Minkande, Jacqueline Ze

    2017-07-26

    Misoprostol has a wide range of applications in obstetrics and gynaecology. It is widely recommended by WHO, FIGO and ACOG for the treatment of postpartum haemorrhage due to it safety and cost-effectiveness. However, usage might be associated to hyperpyrexia and shivering. We present a 30 year old Cameroonian female gravida 1 para 1 who had a vaginal delivery at 40 weeks of gestation complicated by primary postpartum haemorrhage (PPH). PPH was managed by sublingual misoprostol that induced shivering and hyperpyrexia managed successfully with paracetamol and cooling. The occurrence of fever and shivering should be kept in mind when administering misoprostol for PPH.

  17. Comparison of manual vacuum aspiration and misoprostol in the ...

    African Journals Online (AJOL)

    Comparison of manual vacuum aspiration and misoprostol in the management of inc omplete abortion. Gabkika Bray Madoue, Dangar Daniel, Adoum Tchari, Mahamat Chene, Khadidja Mahayedine Salah, Zakaria Brahim, Constant Naîm, Ndilbe Steve ...

  18. Self medication with vaginal misoprostol in a term pregnancy: case ...

    African Journals Online (AJOL)

    eclampsia at term, who self administered misoprostol by the vaginal route - without its being prescribed - in an attempt to avoid repeat caesarean section, is described. She eventually had vaginal delivery of a live female infant with cardiopulmonary ...

  19. Effectiveness and Safety of 2-Hourly 20 MCG Oral Misoprostol ...

    African Journals Online (AJOL)

    Results: The overall induction success rates in the misoprostol arm was 81% versus 83% in the oxytocin arm (P=0.447). The mean induction to vaginal delivery interval in the misoprostol arm was 8.4 hours as compared to 9.45 hours in the oxytocin arm (P=0.116). The induction to active labour interval was similar in the two ...

  20. The Use of Misoprostol for Induction of Labour in a Low-Resource ...

    African Journals Online (AJOL)

    ) responded very well to misoprostol, with majority requiring only a single 50µg dose to go into active labour. Women with sickle cell disease showed no adverse effect to misoprostol responded in a manner similar to the normal population.

  1. Comparison of Sublingual and Vaginal Misoprostol for Second-Trimester Pregnancy Terminations

    OpenAIRE

    Milani, Forozan; Sharami, Seyede Hajar; Arjmandi, Saeedeh

    2014-01-01

    Objective Comparing sublingual and vaginal misoprostol in second trimester pregnancy termination. Materials and methods In this study 268 women at 12-24 weeks of gestation candidate for pregnancy termination were enrolled. Women were randomly divided in two groups. The first group received 400 µg sublingual misoprostol and vaginal placebo and the second group received 400 µg vaginal misoprostol and sublingual placebo every 4 hours for a maximum of five doses. The course of misoprostol was rep...

  2. A New Wireless Biosensor for Intra-Vaginal Temperature Monitoring

    Directory of Open Access Journals (Sweden)

    Isabel de la Torre

    2010-11-01

    Full Text Available Wireless Body Sensors for medical purposes offer valuable contributions to improve patients’ healthcare, including diagnosis and/or therapeutics monitoring. Body temperature is a crucial parameter in healthcare diagnosis. In gynecology and obstetrics it is measured at the skin’s surface, which is very influenced by the environment. This paper proposes a new intra-body sensor for long-term intra-vaginal temperature collection. The embedded IEEE 802.15.4 communication module allows the integration of this sensor in a Wireless Sensor Network (WSN for remote data access and monitoring. We present the sensor architecture, the construction of the corresponding testbed, and its performance evaluation. This sensor may be used in different medical applications, including preterm labor prevention and fertility and ovulation period detection. The features of the constructed testbed were validated in laboratory tests verifying its accuracy and performance.

  3. Sustained delivery of commensal bacteria from pod-intravaginal rings.

    Science.gov (United States)

    Gunawardana, Manjula; Mullen, Madeline; Yoo, Jennifer; Webster, Paul; Moss, John A; Baum, Marc M

    2014-01-01

    Topical administration of live commensal bacteria to the vaginal tract holds significant potential as a cost-effective strategy for the treatment of sexually transmitted infections and the delivery of mucosal vaccines. Probiotic-releasing intravaginal rings (IVRs) embody significant theoretical advantages over traditional daily-dosage forms, such as sustained and controlled delivery leading to improved adherence to therapy compared to that of frequent dosing. The conventional IVR designs, however, are not amenable to the delivery of live bacteria. We have developed a novel pod-IVR technology where polymer-coated tablets ("pods") of Lactobacillus gasseri strain ATCC 33323, a commensal microorganism of human origin, are embedded in silicone IVRs. The release rate of bacterial cells is controlled by the diameter of a delivery channel that exposes a portion of the pod to external fluids. In vitro studies demonstrated that the prototype devices released between 1.1×10(7) and 14×10(7) cells per day for up to 21 days in a controlled sustained fashion with stable burst-free release kinetics. The daily release rates were correlated with the cross-sectional area of the delivery channel. Bacteria in the IVR pods remained viable throughout the in vitro studies and formed biofilms on the surfaces of the devices. This proof-of-principle study represents the first demonstration of a prolonged, sustained release of bacteria from an intravaginal device and warrants further investigation of this device as a nonchemotherapeutic agent for the restoration and maintenance of normal urogenital flora.

  4. Effect of intravaginal practices on the vaginal and cervical mucosa of Zimbabwean women

    NARCIS (Netherlands)

    van de Wijgert, J. H.; Chirenje, Z. M.; Iliff, V.; Mbizvo, M. T.; Mason, P. R.; Gwanzura, L.; Shiboski, S.; Padian, N. S.

    2000-01-01

    OBJECTIVES: Lesions on the vaginal and cervical mucosa may facilitate transmission of HIV and other sexually transmitted diseases (STDs). We evaluated the relationship between intravaginal practices and the presence of colposcopic lesions in Zimbabwean women. METHODS: Users and nonusers of

  5. Effect of misoprostol and cimetidine on gastric cell labeling index

    International Nuclear Information System (INIS)

    Fich, A.; Arber, N.; Sestieri, M.; Zajicek, G.; Rachmilewitz, D.

    1985-01-01

    The effect of misoprostol and cimetidine on gastric cell turnover was studied. Endoscopic biopsy specimens of fundic and antral mucosa were obtained from duodenal ulcer patients before and after 4 wk of therapy with cimetidine 1.2 g/day or misoprostol 800 micrograms/day. Biopsy specimens were incubated with [ 3 H]thymidine. Glandular column length and number of labeled cells were determined after autoradiography. There was no significant difference in column length of antral or fundic glands before or after therapy with cimetidine and misoprostol. The number of antral and fundic labeled cells was significantly decreased after misoprostol treatment (3.6 +/- 0.3 and 4.6 +/- 0.4, mean +/- SE), as opposed to their respective number before therapy (6.9 +/- 0.5 and 8.3 +/- 0.8) (p less than 0.01). On the other hand, after treatment with cimetidine, the number of antral and fundic labeled cells was significantly higher (11.8 +/- 0.9 and 7.5 +/- 1.0, respectively) as compared with their number before therapy (5.7 +/- 0.5 and 5.6 +/- 0.6, respectively). The decreased gastric cell turnover induced by misoprostol indicates that the trophic effect of prostanoids on gastric mucosa is not due to an increase in cellular kinetics. The increased gastric cell turnover induced by cimetidine may contribute to its therapeutic effect in peptic ulcer disease

  6. Effect of misoprostol and cimetidine on gastric cell labeling index

    Energy Technology Data Exchange (ETDEWEB)

    Fich, A.; Arber, N.; Sestieri, M.; Zajicek, G.; Rachmilewitz, D.

    1985-07-01

    The effect of misoprostol and cimetidine on gastric cell turnover was studied. Endoscopic biopsy specimens of fundic and antral mucosa were obtained from duodenal ulcer patients before and after 4 wk of therapy with cimetidine 1.2 g/day or misoprostol 800 micrograms/day. Biopsy specimens were incubated with (/sup 3/H)thymidine. Glandular column length and number of labeled cells were determined after autoradiography. There was no significant difference in column length of antral or fundic glands before or after therapy with cimetidine and misoprostol. The number of antral and fundic labeled cells was significantly decreased after misoprostol treatment (3.6 +/- 0.3 and 4.6 +/- 0.4, mean +/- SE), as opposed to their respective number before therapy (6.9 +/- 0.5 and 8.3 +/- 0.8) (p less than 0.01). On the other hand, after treatment with cimetidine, the number of antral and fundic labeled cells was significantly higher (11.8 +/- 0.9 and 7.5 +/- 1.0, respectively) as compared with their number before therapy (5.7 +/- 0.5 and 5.6 +/- 0.6, respectively). The decreased gastric cell turnover induced by misoprostol indicates that the trophic effect of prostanoids on gastric mucosa is not due to an increase in cellular kinetics. The increased gastric cell turnover induced by cimetidine may contribute to its therapeutic effect in peptic ulcer disease.

  7. Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage

    Science.gov (United States)

    Chu, Christina S; Brhlikova, Petra; Pollock, Allyson M

    2012-01-01

    This article describes and critically appraises clinical trials assessing misoprostol effectiveness in preventing primary postpartum haemorrhage (PPH) in home and community settings in low- and middle-income countries. Of 172 identified studies of misoprostol use in labour only six fulfilled the inclusion criteria. All trials used 600μg misoprostol in the intervention arm; three assessed misoprostol alongside components of active management of the third-stage labour (AMTSL), two used expectant management of labour and one allowed birth attendants to choose management practice. The three AMTSL studies showed no significant differences in PPH incidence or referral to higher centres and only one study showed significant decrease in severe PPH using misoprostol. One expectant management study and the choice of management by birth attendants study found significant decreases in PPH incidence with misoprostol. All studies showed significantly increased risk of shivering with misoprostol. Studies were biased by use of alternative uterotonics in the control arm, confounding management practices, and subjective assessment and, with one exception, exclusion of high-risk women. PPH incidence fell in both the control and intervention groups in both the landmark papers that informed the World Health Organization (WHO) decision to admit misoprostol to the Essential Medicines List. This suggests factors other than misoprostol use are crucial. Current evidence does not support misoprostol use in home and community settings in low- and middle-income countries for PPH prevention. WHO should rethink its recent decision to include misoprostol on the Essential Medicines List. PMID:22907551

  8. Comparison of two misoprostol regimens for mid-trimester pregnancy terminations after FIGO's misoprostol dosage recommendation in 2012.

    Science.gov (United States)

    Cetin, Cihan; Buyukkurt, Selim; Seydaoglu, Gulsah; Kahveci, Bekir; Soysal, Cenk; Ozgunen, Fatma Tuncay

    2016-01-01

    To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations. Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics's (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications. Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates. We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.

  9. Absence of Effect of Intravaginal Miconazole, Clindamycin, Nonoxynol‐9, and Tampons on the Pharmacokinetics of an Anastrozole/Levonorgestrel Intravaginal Ring

    OpenAIRE

    Nave, Rüdiger; Klein, Stefan; Müller, André; Chang, Xinying; Höchel, Joachim

    2017-01-01

    Abstract A study was performed to investigate the effect of an intravaginally administered antimycotic, an antibiotic, and a spermicide plus the co‐usage of tampons on the pharmacokinetics (PK) of levonorgestrel (LNG) and anastrozole (ATZ) administered as an intravaginal ring (IVR) releasing 1050 μg ATZ per day and 40 μg LNG per day. In this parallel‐group, randomized, open‐label study, healthy premenopausal women received an IVR as the main treatment. Comedications were administered on 3 con...

  10. Quality assessment of patient leaflets on misoprostol-induced labour

    DEFF Research Database (Denmark)

    Clausen, Jette Aaroe; Juhl, Mette; Rydahl, Eva

    2016-01-01

    Objectives: The need for thorough patient information is increasing as maternity care becomes more medicalised. The aim was to assess the quality of written patient information on labour induction. In most Danish hospitals, misoprostol is the first-choice drug for induction in low-risk pregnancies....... Misoprostol has been associated with adverse side effects and severe outcomes for mother and child and is not registered for obstetric use in Denmark. Setting: Secondary care hospitals in Denmark. Data: Patient information leaflets from all hospitals that used misoprostol as an induction agent by June 2015 (N......=13). Design: Patient leaflets were evaluated according to a validated scoring tool (International Patient Decision Aid Standards instrument, IPDAS), core elements in the Danish Health Act, and items regarding off-label use and non-registered medication. Two of the authors scored all leaflets...

  11. Rectal misoprostol for myomectomy: A randomised placebo-controlled study.

    Science.gov (United States)

    Abdel-Hafeez, Mohamed; Elnaggar, Ahmed; Ali, Mohamed; Ismail, Abdel Mgeed; Yacoub, Mina

    2015-08-01

    Uterine leiomyomas are the most common benign tumours in women. Misoprostol, which is widely used in the treatment and prevention of postpartum haemorrhage in obstetrics, may decrease intra-operative bleeding in abdominal myomectomies when haemorrhage constitutes a challenging problem. To assess the effect on intra-operative blood loss of using a single pre-operative dose of rectal misoprostol in abdominal myomectomy surgeries. In a randomised double-blind placebo-controlled trial, 50 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre-operative of rectal 400 μg misoprostol (n = 25) or placebo (n = 25) 1 h before the operation. The primary outcome was intra-operative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT02061657. Intra-operative blood loss was significantly lower in those women randomised to receive rectal misoprostol versus the placebo group (574 ± 194.8 mL vs 874 ± 171.5 mL). Additionally, the drop in postoperative haemoglobin was significantly less in the misoprostol group (1.7 ± 0.4 g/dL) compared with the placebo group (2.1 ± 0.5 g/dL). A single pre-operative dose of rectal misoprostol (400 μg) is a simple applicable method for reducing intra-operative blood loss and operative time in abdominal myomectomy. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  12. Outcome of misoprostol and oxytocin in induction of labour

    Directory of Open Access Journals (Sweden)

    Trishna Acharya

    2017-03-01

    Full Text Available Background: Induction of labour is the process of initiating the labour by artificial means from 24 weeks of gestation. The main aim of this study is to find out the maternal and foetal outcomes after induction of labour with misoprostol and oxytocin beyond 37 weeks of gestation. Methods: This was a hospital-based observational study carried out at Paropakar Maternity and Women’s Hospital, Nepal. Misoprostol of 25 µg was inserted in posterior fornix of vagina or oxytocin infusion was started from 2.5 units on whom induction was decided. Maternal and foetal/neonatal outcomes were observed. Collected data were analysed using SPSS and MS Excel. Results: General induction rate was found to be 7.2%. In this study, post-term pregnancy was found to be the most common reason for induction of labour. Analysis of onset of labour led to the finding that mean onset of labour was much rapid in oxytocin (6.6 h than misoprostol (13.6 h. However, there is similarity in induction–delivery interval in both groups. Overall, the rate of normal delivery and caesarean section was found to be 64.9% and 33.2%, respectively. Similarly, normal delivery within 12 h was seen in 18.4% of the patients given with misoprostol and 43.5% in oxytocin group. Foetal distress was found as the most common reason for caesarean section. The overall occurrence of maternal complication was found to be similar in misoprostol and oxytocin groups, nausea/vomiting being the most common (36.7% complication followed by fever (24.1%. Besides this, the most common neonatal complication found in overall cases was meconium stained liquor (49.2%. Conclusion: It was found that misoprostol was used most frequently for induction of labour compared to oxytocin. The onset of labour was found to be rapid in oxytocin than misoprostol. However, the occurrence of side effects was found to be similar in both misoprostol and oxytocin groups.

  13. A randomised clinical trial of misoprostol for radiation mucositis

    International Nuclear Information System (INIS)

    Faroudi, F.; Timms, I.; Sathiyuaseelan, Y.; Cakir, B.; Tiver, K.W.; Gebski, V.; Veness, M.

    2003-01-01

    Radiation mucositis is a major acute toxicity of radiation therapy for head and neck malignancies. We tested whether Misoprostol, a synthetic prostaglandin E 1 analogue given prophylactically decreased intensity of radiation mucositis. A double blind randomized trial was conducted. The intervention consisted of swishing dissolved drug or placebo as a mouthwash, and then swallowing two hours prior to radiation treatment. Patients were stratified based on concurrent chemotherapy, altered fractionation, smoking, extent of oral mucosa in radiation field, and institution. The main end point was the extent of RTOG grade III mucositis, taking into account both time and duration of mucositis. 42 patients were randomized to active drug, and 41 patients to placebo. The trial was designed to have 70 patients in each arm. The trial closed due to poor accrual. In the Misoprostol group 18/42 (43%) had grade III/IV mucositis, and in the placebo group 17/40 (42%). The mean difference between the areas under the curve was 0.38 (p-value: 0.38). For grade II mucositis the corresponding figures were 18 (42%) and 19 (47%). The time from commencement of radiation therapy to the development of peak mucositis was 49 days in the misoprostol patients and 51 days in the placebo group. The duration of grade III mucositis 12.5 days in the Misoprostol patients and 7 days in the placebo patients. In the Misoprostol arm 4 patients had an interruption to their Radiation Therapy, in the Placebo arm 5 had interruptions. Patients average weight loss was 8.1 and 8.2kg. Average self-assessment was via a 10cm LASA scale for soreness of throat and overall well-being. Misoprostol showed a worse QoL on soreness of mouth (mean difference: 0.84 units (p-value .03), but overall well-being was similar on both treatment arms 1 patient withdrew in the Misoprostol arm and 2 in the placebo arm. Misoprostol given prophylactically does not reduce the incidence of Grade III/IV mucositis, is associated with a shorter

  14. Intravaginally applied oxytocin improves post-menopausal vaginal atrophy.

    Science.gov (United States)

    Al-Saqi, Shahla H; Uvnäs-Moberg, Kerstin; Jonasson, Aino F

    2015-09-01

    To explore the efficacy of local oxytocin for the treatment of post-menopausal vaginal atrophy. Double-blinded randomised controlled trial. Healthy post-menopausal women in Stockholm, Sweden. Sixty four post-menopausal women between February and June 2012 at the Karolinska University Hospital Huddinge/Sweden. The efficacy of oxytocin for treatment of vaginal atrophy after seven weeks and cytological evaluation. The percentage of superficial cells in the vaginal smears and the maturation values were significantly increased after seven weeks of treatment with vagitocin 400 IU (p = 0.0288 and p = 0.0002, respectively). The vaginal pH decreased significantly after seven weeks of treatment with vagitocin 100 IU (p = 0.02). The scores of vaginal atrophy, according to the histological evaluation, were significantly reduced after administration of vagitocin 100 IU (p = 0.03). The thickness of the endometrium did not differ between the treatment and placebo groups after seven weeks of treatment. The symptom experienced as the most bothersome was significantly reduced after seven weeks of treatment in the women receiving vagitocin 400 IU compared to women in the placebo group (p = 0.0089). Treatment with intravaginally applied oxytocin could be an alternative to local estrogen treatment in women with post-menopausal vaginal atrophy. © The Author(s) 2015.

  15. is misoprostol a suitable alternative to the surgical evacuation

    African Journals Online (AJOL)

    2013-06-11

    Jun 11, 2013 ... EAST AFRICAN MEDICAL JOURNAL. 172. East African Medical Journal Vol. ... an alternative to the surgical treatment of incomplete abortion at a rural clinic. Design: Open-label randomised controlled trial. ... misoprostol or other prostaglandin, suspected ectopic pregnancy and haemodynamic instability or ...

  16. [Vaginal misoprostol in the prevention of postpartum hemorrhage].

    Science.gov (United States)

    Quiroga Díaz, Ricardo; Esparza Arechiga, Miguel; Batiza Reséndiz, Víctor; Coronado López, Oscar; Hernández Ayup, Samuel; Martínez Cuervo, Jesús

    2002-11-01

    To show the advantages of the use of vaginal misoprostol, a prostaglandine E1 analogue, in the prevention of the post-partum haemorrhage. This was a prospective, observational, comparative study. The study included 400 patients with high risk of postpartum haemorrhage at our center between January 1999 and may 2001. Patients were divided in two groups. In group I (208 patients) misoprostol was used in a dose of 800 ugr and in group II (192 patients) in whom misoprostol was not used. Both groups were treated initially with our conventional oxytocin protocol. We evaluated the use of additional oxytocin or ergotamine, haemoglobin levels pre and post-partum, the amount of blood loss, and the need for blood transfusion or hysterectomy. The need for additional oxytocin or ergotamine was reduced to less than 10% in group I when compared to group II; the drop in haemoglobin levels and the amount of blood loss were also less in group I (p: 0.03). In this group only one patient needed for blood transfusion and no patient needed hysterectomy. In group II six patients need a blood transfusion and there was the need for two hysterectomies. The use of vaginal misoprostol is effective to control the postpartum bleeding, reducing the blood loss after birth in women with high risk of post-partum haemorrhage as well as the need for blood transfusion. It's use has mild side effects and is of low cost.

  17. Oral misoprostol versus intracervical dinoprostone for induction of labor.

    Science.gov (United States)

    Langenegger, E J; Odendaal, H J; Grové, D

    2005-03-01

    To compare oral misoprostol with dinoprostone for induction of labor and their effects on the fetal heart rate patterns. In a randomized controlled trial, 200 patients received either misoprostol 50 mug orally for every 4 h, or dinoprostone 0.5 mg intracervically for every 6 h. Cardiotocographic recordings, in 10-min windows 30, 60, and 80 min after prostaglandin administration during induction and continuously during labor, were compared between the two groups. Primary outcome for effectiveness and safety was assessed in terms of the number of vaginal deliveries within 24 h and fetal heart rate abnormalities during induction and labor respectively. Data from 96 patients in the misoprostol group and 95 in the dinoprostone group were analyzed. There were no significant differences in respect of the number of vaginal deliveries within 24 h (RR 1.12; 95% CI 0.88-1.42). The frequency of suspicious and pathological fetal heart rate patterns did not differ significantly but significantly more cardiotocographs in the dinoprostone group had non-reassuring baseline variability 60 min after dose administration (RR 0.33; 95% CI 0.14-0.77). Maternal and neonatal outcomes did not differ significantly. Oral misoprostol is as effective as intracervical dinoprostone for induction of labor with no difference in the frequency of fetal heart rate abnormalities.

  18. Efficacy of dinoprostone, intracervical foleys and misoprostol in labor induction.

    Science.gov (United States)

    Saleem, Samina

    2006-04-01

    To compare the efficacy for Dinoprostone, intracervical foleys and misoprostol in labor trial regarding effects on cervical ripening, mode of delivery, induction to delivery interval and maternal complications i.e. tachysystole and postpartum haemorrhage. Randomized clinical trial. Hamdard University Hospital and Patel Hospital between July 2004-June 2005. Randomized trial was conducted such that group-A received Dinoprostone at 6 hourly intervals upto two doses. Group-B was induced with intracervical foley catheter. Group-C received 50 micro g oral misoprostol 4 hourly to a maximum of four doses. Cervical ripening, induction to delivery time interval, mode of delivery and maternal morbidity were main outcome measures. Test of proportions was used to compare the significance between the managements. In 226 cases, 219 (97%) were successfully induced while 7(3%) did not respond the labour induction. The rates of caesarean section in dinoprostone, intracervical foley and misoprostol were 14.7%, 14.1% and 12.3%, respectively, however, this difference was insignificant among three groups (p=0.911). Rate of earlier response (< or = 12 hours) to labor induction among three groups was insignificant (3.8% vs 4% and 13.7% respectively, p=0.125). Marginal significance of higher rate of complications was observed in those patients who were given misoprostol (p=0.08). In this series, all three agents were equally effective in terms of cervical ripening, induction-delivery interval, mode of delivery and maternal complications.

  19. A comparative study of vaginal misoprostol and intravenous oxytocin ...

    African Journals Online (AJOL)

    Background : Intrauterine fetal death is a major problem in obstetrics particularly in developing countries such as Uganda. Induction of labour in cases of fetal death using the available method of oxytocin is often difficult, expensive and frustrating. Objectives : To compare the effectiveness of vaginal misoprostol and ...

  20. Beliefs and practices in using misoprostol for induction of labour ...

    African Journals Online (AJOL)

    To describe the prescribing pattern (dose, route, duration), beliefs and factors affecting use of misoprostol for inducing term pregnancy among practising obstetricians in Zimbabwe. Methods. A cross-sectional descriptive survey was undertaken among practising obstetricians in Zimbabwe. A questionnaire was sent as an ...

  1. Oral misoprostol in the prevention of uterine bleeding after surgical ...

    African Journals Online (AJOL)

    2013-03-13

    Mar 13, 2013 ... Oral misoprostol in the prevention of uterine bleeding after surgical evacuation of first trimester abortion: A comparative study of three uterotonic agents. TM Aramide, AK Olusegun1, AC Akinfolarin2, DF Oriola. Department of Obstetrics and Gynaecology, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, ...

  2. ORIGINAL ARTICLES Misoprostol for cervical ripening at and near ...

    African Journals Online (AJOL)

    Design. Three hundred and ninety-six women with term pregnancies were randomised to receive either oral or vaginal misoprostol, or dinoprostone. Women who had had a previous caesarean section (CS) or those with a malpresentation or who were parity~ 5, were excluded. The control group received dinoprostone 1 mg ...

  3. Misoprostol for treatment of incomplete abortion- providers practice ...

    African Journals Online (AJOL)

    Remnant products of conception in the uterine cavity following a miscarriage or induced abortion presents a serious threat to a woman because it increases the risk of infection or continued bleeding and therefore uterine evacuation in such cases is imperative. Surgical and medical methods using drugs like misoprostol may ...

  4. Misoprostol in obstetrics and gynaecology — benefits and risks ...

    African Journals Online (AJOL)

    Misoprostol is currently being used for induction of labour at or near term and also for termination of pregnancy. Its use without proven dosage regimens is possibly associated with an increase in the incidence of uterine hyperstimulation, preterm labour, induced abortion above 20 weeks' gestation, meconium-stained liquor ...

  5. Introducing Misoprostol for the Treatment of Incomplete Abortion in ...

    African Journals Online (AJOL)

    Erah

    Despite legal restriction, induced abortions and resulting complications are common in Nigeria. Misoprostol administration for incomplete abortion was introduced in 3 Nigerian hospitals. The feasibility of the hospitals, patient and provider acceptability were assessed using questionnaire and interview guides administered ...

  6. A comparison of orally administered misoprostol and membrane ...

    African Journals Online (AJOL)

    Objectives. This study assessed the efficacy of the two outpatient processes of single-dose 50 μg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/labour induction in uncomplicated post-term singleton ...

  7. Update on the use of misoprostol in current obstetric practice ...

    African Journals Online (AJOL)

    Misoprostol is one of the most important drugs in obstetric practice today. However, because of its uterotonic effects and consequent adverse effects on the pregnant uterus and foetus, the use of this drug requires extreme caution and very close monitoring particularly in developing countries. The aim of this update is to ...

  8. Women's preferences for misoprostol in case of early pregnancy failure

    NARCIS (Netherlands)

    Graziosi, Giuseppe C.; Bruinse, Hein W.; Reuwer, Paul J.; Mol, Ben W.

    2006-01-01

    OBJECTIVE: The aim of this study was to assess the preference of women with early pregnancy failure for treatment with misoprostol as compared to curettage. STUDY DESIGN: Women with early pregnancy failure were interviewed and asked whether they were motivated to trade a non-invasive but potentially

  9. Misoprostol for uterine evacuation during miscarriage: A systematic ...

    African Journals Online (AJOL)

    Miscarriage is an important cause of morbidity and mortality especially in developing countries. Traditionally, miscarriage is treated by surgical curettage. Misoprostol has been introduced in recent years for treatment of miscarriage. In this review, we systematically searched for and combined the evidence from randomized ...

  10. Comparing the outcomes of labour induction with misoprostol and ...

    African Journals Online (AJOL)

    Context: Induction of labour is an old procedure performed to artificially terminate pregnancy for various indications in the interest of the mother, the fetus or both. The aim is to achieve vaginal delivery. Various methods have been in use which include the use of Misoprostol, Dinoprostone, oxytocin infusion and others.

  11. Labor Induction with Orally Administrated Misoprostol: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Tove Wallstrom

    2017-01-01

    Full Text Available Introduction. One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings. Material and Methods. Retrospective cohort study of 4002 singleton pregnancies with a gestational age ≥34 w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously used methods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS rate, acid-base status in cord blood, Apgar score 1500 ml (PPH. Results. The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p<0.001. No significant difference in the frequency of low Apgar score (p=0.3, low aPh in cord blood (p=0.1, or PPH (p=0.4 between the different methods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston⁎⁎ (Propess® (aor = 2.9 (1.6–5.2. Conclusion. Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.

  12. Randomization of two dosing regimens of vaginal misoprostol for ...

    African Journals Online (AJOL)

    Objectives: To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour. Materials and Methods: Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to receive either 25 µg or 50 µg of vaginal ...

  13. Misoprostol alone for the termination of pregnancy | Torriente | South ...

    African Journals Online (AJOL)

    The administration of mifepristone, a powerful antiprogestin, coupled with a prostaglandin, is a highly effective medical method of terminating pregnancy. Of the most widely used prostaglandins, namely gemeprost and misoprostol, the latter shows the greater promise for developing countries, since it can be administered ...

  14. Efficacy of misoprostol for the first trimester pregnancy termination

    Directory of Open Access Journals (Sweden)

    Moezzi-Madani M

    2008-06-01

    Full Text Available Background: Medical induction abortion is an acceptable alternative to surgical abortion for pregnancy termination. Misoprostol is an inexpensive PGE1 analogue that can be used easily and safely as a single agent for first- and second-trimester pregnancy termination. The objective of this study was to evaluate the efficacy of two different doses of vaginal misoprostol for pregnancy termination with gestational age up to 16 weeks.Methods: This clinical trial included 100 pregnant women with gestational age up to 16 weeks requesting legal termination of pregnancy. The subjects were randomized in two equal groups, and received either 200 (group 1 or 400 µg (group 2 misoprostol vaginally every 6 hours with a maximum of four doses. Response to treatment was defined as complete or incomplete abortion within 48 hours after initial dose. Curettage was performed for patients with heavy bleeding or incomplete abortion. The abortion outcome and side-effects were assessed.Results: The groups were similar in maternal age, gestational age, parity and obstetrical history and indication for pregnancy termination. The side effects in group 2 were significantly higher than in group 1 (P<0.05. There were no statistically significant differences between the two groups regarding completeness of the abortion and mean time to abortion induction.Conclusions: In the termination of pregnancies up to 16 weeks, the 200 µg per dose regimen of misoprostol was as effective as the 400 µg regimen; however, side-effects were more common with the higher dose.

  15. Community-level Distribution of Misoprostol to Prevent Postpartum ...

    African Journals Online (AJOL)

    In Nigeria, most deaths due to postpartum hemorrhage (PPH) occur in the absence of skilled birth attendants. A study using community mobilization and the training of community drug keepers to increase access to misoprostol for PPH prevention was conducted in five communities around Zaria in Kaduna State, Nigeria.

  16. Comparison of vaginal and oral misoprostol, for the induction of ...

    African Journals Online (AJOL)

    Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra-uterine foetal death. ... It is a tertiary institution serving predominantly black indigenous population. Main outcome measures: The primary outcome measure was the induction to delivery time, and secondary outcome measures were ...

  17. Misoprostol in obstetrics and gynaecology — benefits and risks

    African Journals Online (AJOL)

    Enrique

    fetal tachycardia were detected on electronic fetal heart rate and external uterine pressure monitoring. A tablet. (200 µg) of misoprostol was found in the posterior vaginal fornix. The tablet was removed, 10 µg of intravenous ipradol given and labour managed expectantly, with normal delivery of a healthy baby. She informed ...

  18. randomised controlled trial of the efficacy of misoprostol used

    African Journals Online (AJOL)

    Background. Misoprostol is being used increasingly in clinical practice for cervical ripening in first-trimester abortions, but because of lack of good evidence of its effectiveness, administration consensus has not been reached on dosage, route of administration, time of administration pre- operatively and gestational age ...

  19. Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review.

    Science.gov (United States)

    Chen, Melissa J; Creinin, Mitchell D

    2015-07-01

    To summarize clinical outcomes and adverse effects of medical abortion regimens consisting of mifepristone followed by buccal misoprostol in pregnancies through 70 days of gestation. We used PubMed, ClinicalTrials.gov, and reference lists from published reports to identify relevant studies published between November 2005 and January 2015 using the search terms "mifepristone and medical abortion" and "buccal and misoprostol." Studies were included if they presented clinical outcomes of medical abortion using mifepristone and buccal misoprostol through 70 days of gestation. Studies with duplicate data were excluded. We included 20 studies with a total of 33,846 women through 70 days of gestation. We abstracted efficacy and ongoing pregnancy rates as an overall rate and by gestational age in days in reference to completed weeks (eg, 49 days or less, 50-56 days, 57-63 days, 64-70 days) and adverse effects when reported. The overall efficacy of mifepristone followed by buccal misoprostol is 96.7% (95% confidence interval [CI] 96.5-96.8%) and the continuing pregnancy rate is 0.8% (95% CI 0.7-0.9%) in approximately 33,000 pregnancies through 63 days of gestation. Only 332 women with pregnancies between 64 and 70 days of gestation are reported in the literature with an overall efficacy of 93.1% (95% CI 89.6-95.5%) and a continuing pregnancy rate of 2.9% (95% CI 1.4-5.7%). Currently available data suggest that regimens with a 24-hour time interval between mifepristone and buccal misoprostol administration are slightly less effective than those with a 24- to 48-hour interval. Rates of surgical evacuation for reasons other than ongoing pregnancy range from 1.8% to 4.2%. Severe adverse events like blood transfusion (0.03-0.6%) and hospitalization (0.04-0.9%) are uncommon. Outpatient medical abortion regimens with mifepristone followed in 24-48 hours by buccal misoprostol are highly effective for pregnancy termination through 63 days of gestation. More data are needed to

  20. Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.

    Directory of Open Access Journals (Sweden)

    Nicola Low

    2011-02-01

    Full Text Available Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition.We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I(2 values 0.0%-16.1%. Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83, insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71, and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53 remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47. Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p<0.001 or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001, respectively.This study provides evidence to suggest that some intravaginal practices increase

  1. Sequential use of mifepristone and misoprostol in treatment of early pregnancy failure appears more effective than misoprostol alone: a retrospective study

    NARCIS (Netherlands)

    Berg, J. van den; Bent, J.M. van den; Snijders, M.P.; Heus, R. de; Coppus, S.F.P.J.; Vandenbussche, F.P.H.A.

    2014-01-01

    OBJECTIVE: Is treatment of early pregnancy failure (EPF) with sequential use of mifepristone and misoprostol more effective than treatment with misoprostol alone? STUDY DESIGN: In a retrospective cohort study at the Department of Obstetrics and Gynaecology of the Radboud University Medical Centre,

  2. Early versus late misoprostol administration after mifepristone for medical abortion.

    Science.gov (United States)

    Tendler, Rene; Bornstein, Jacob; Kais, Mohamad; Masri, Irina; Odeh, Marwan

    2015-11-01

    To evaluate the successful medical termination of pregnancy comparing two regimens: misoprostol 2 or 48 h after mifepristone administration. Prospective randomized study. Department of Obstetrics and Gynecology. One hundred pregnant women admitted for medical termination of pregnancy were enrolled; no pregnancies were over 55 days gestational age. All subjects were randomly assigned for misoprostol administration either 2 or 48 h after mifepristone. All participants underwent transvaginal ultrasound examination for uterine contents 48 h and 3 weeks after mifepristone. Procedure failure, defined as the presence of fetal heart activity, presence of a gestational sac, or a need for uterine curettage after misoprostol administration. Each group consisted of 50 women. Fetal heart activity was significantly more frequent after 48 h in the 2-h interval group (10/50) than in the 48-h interval group (0/50) (p = 0.002). Three weeks after misoprostol administration, fetal heart activity was present in 4/50 (8 %) in the 2-h interval group (p = 0.118) and none of the 48-h interval group. At 48 h residual tissue was present in 13/50 (26 %) and 5/50 (10 %) in the 2 and 48-h interval groups, respectively (p = 0.031); this was reduced to 12/50 (24 %) compared to 5/50 (10 %) in the two groups, respectively (p = 0.054) after 3 weeks. Successful medical termination of pregnancy can be achieved using misoprostol administration 2 h after mifepristone in 76 % of cases. However, this regimen is not recommended as it is significantly inferior to the traditional 48-h interval regimen.

  3. Protective role of misoprostol in prevention of gentamicin ototoxicity.

    Science.gov (United States)

    Dogan, Murat; Polat, Halil; Yasar, Mehmet; Bayram, Ali; Karatas, Duran; Hira, İbrahim; Kale, Ahmet; Senel, Fatma; Özcan, İbrahim

    2017-05-01

    To demonstrate potential protective effect of misoprostol on cochlear toxicity caused by gentamicin with electrophysiological tests and histopathological studies. The study included 80 ears of 40 rats with normal hearing threshold and DPOAE value in both ears. Animals were assigned into 4 groups. The rats were randomized into 4 groups. Group I (n = 10): Gentamicin, Group II (n = 10): Gentamicin plus misoprostol, Group III (n = 10): Saline; Group IV (n = 10): Misoprostol. All drugs used in the study were given once daily for 15 days. DPOAE and ABR measurements were repeated after drug administration. Subsequently, the rats' cochleae were examined histopathologically. Baseline DPOAE and ABR values were compared to those obtained after drug exposure and cochlear toxicity was evaluated in electrophysiological manner. When At baseline, there were no significant differences in DPOAE responses at frequencies of 1001, 1501, 2002, 3003, 4004, 6006 and 7996 Hz among groups. However In DPOAE test, statistically significant difference was observed between the pre-study basal values and post-study results in groups other than gentamicin + misoprostol group. Additionally, It was found that there was a significant difference in DPOAE response at frequency of 4004 Hz obtained at baseline and after drug exposure according to measurements of epithelial vacuolization in stria vascularis. While ABR threshold values were compared at baseline, there were no significant difference in ABR threshold values of left and right ear between groups. Histopathologically it was also found that there were significant differences measurements of epithelial vacuolization in stria vascularis and inflammation among groups (p misoprostol, a potent antioxidant, has protective effect against cochlear damage, and that may be a safe alternative. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Medicamentous abortion with mifepristone and misoprostol in Serbia and Montenegro

    Directory of Open Access Journals (Sweden)

    Stojnić Jelena

    2006-01-01

    Full Text Available Background/Aim. Medicamentous abortion was first introduced in Serbia and Montenegro in September 2001. The aim of this study was to assess the efficiency, side effects, and acceptability of medicamentous abortion using mifeprostone orally (600 mg, and 48 hours later, misoprostol both orally and vaginally in different regiments in our population (400 mcg, 600 mcg, 800 mcg. Methods. A total of 235 consecutive women with pregnancies up to 49 days of gestational age were assigned to 4 groups according to the different misoprostol regiment (group I 400 mcg, group II 600 mcg, group III 800 mcg orally, and group IV 800 mcg both orally and vaginally. The principal outcome measure was a successful abortion defined as a complete expulsion of intrauterine contents without a need for surgical intervention 14 days after the procedure. Other outcome measures were the following: drug related effects, and adverse effects related to the abortion process. Results. In general, the success rate was 50%, 89.48%, 75% and 92.11% in the groups I, II, III, and IV, respectively, as judged by the complete expulsion of the intrauterine contents without surgical intervention (t1:4 = 7.005; t2:4 = 0.3872, t3:4 = 2.9784, p < 0.01. The incidence of adverse effects (vomiting, abdominal pain, bleeding, and fever was low in general, but among our groups it occurred mostly with the higher doses of orally applied misoprostol (800 and 600 mcg. Only one case required urgent curettage for heavy vaginal bleeding, and two blood transfusions, as well. No cases of intact pregnancies were recorded in the study. Conclusion. Our study showed that a mifepristone dose of 600 mg orally, and misoprostol 400 mcg orally and 400 mcg vaginally were most effective. Thus, a combination of mifepristone and misoprostol for medicamentous abortion should take a higher proportion in the termination of early pregnancy in our population.

  5. Laminaria tent vs misoprostol for cervical priming before hysteroscopy: Randomized study.

    Science.gov (United States)

    Lin, Yu-Hung; Hwang, Jiann-Loung; Seow, Kok-Min; Huang, Lee-Wen; Chen, Heng-Ju; Hsieh, Bih-Chwen

    2009-01-01

    To compare the efficacy of laminaria tents and orally administered misoprostol in priming the cervix before operative hysteroscopy. Randomized, controlled study (Canadian Task Force classification I). Tertiary medical center. One hundred twenty premenopausal women who underwent operative hysteroscopy between March 2005 and January 2007. The women were randomized to receive a laminaria tent or misoprostol for cervical priming. The primary outcomes were postpriming cervical width insofar as size of Hegar dilators and need for cervical dilation. The secondary outcomes were adverse effects from the priming methods. Postpriming cervical width was greater in the laminaria group but not significantly different from that in the misoprostol group. However, cervical dilation before hysteroscopy was required in more patients in the misoprostol group. Nausea, vomiting, diarrhea, and bleeding were more common in the misoprostol group, and the incidences of chills and headache were similar between the 2 groups. Laminaria tents are superior to oral misoprostol insofar as less need for cervical dilation and fewer adverse effects.

  6. Posterior intravaginal slingplasty with preservation of the uterus: a modified surgical technique in a young myelomeningocele patient

    NARCIS (Netherlands)

    Verguts, Jasper; Roovers, Jan-Paul; de Ridder, Dirk; Coremans, Georges; Deprest, Jan

    2007-01-01

    We report a case of uterine prolapse in a young woman, treated by posterior intravaginal slingplasty with preservation of the uterus as a feasible and safe surgical procedure. Posterior intravaginal slingplasty is commonly used to correct vaginal vault prolapse, but may be a valuable alternative to

  7. Intravaginal insertion in KwaZulu Natal: sexual practices and preferences in the context of microbicide gel use

    NARCIS (Netherlands)

    Gafos, M.; Mzimela, M.; Sukazi, S.; Pool, R.; Montgomery, C.; Elford, J.

    2010-01-01

    Intravaginal insertion is often associated with the concept of ‘dry’ sex. All HIV-prevention microbicides tested to date have been vaginally applied lubricant-based gels. In this paper, we examine whether the use of intravaginal insertions could be in conflict with the introduction of vaginal

  8. Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

    Science.gov (United States)

    2014-01-01

    Background Bangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh. Methods Using data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions. Results Using project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births. Conclusion This theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further

  9. High-Dose Misoprostol as An Alternative Therapy After Failed Medical Abortion

    OpenAIRE

    Li, Yiu-Tai; Hou, Guang-Qiong; Chen, Tien-Hui; Chu, Yi-Chih; Lin, Ta-Chin; Kuan, Long-Ching; Lin, Mau; Huang, Shu-Feng; Chen, Fu-Min; Kuo, Tsung-Cheng

    2008-01-01

    Objective: The aim of this study was to determine the complete abortion rate for the vaginal administration of high-dose misoprostol after a failed medical abortion. Materials and Methods: When their medical abortions failed after the conventional oral administration of mifepristone and misoprostol, participants then received 1,000 μg of misoprostol vaginally. The efficacy and side effects of this treatment were evaluated. Results: Twenty-seven women who failed to abort after the conven...

  10. Mifepristone-misoprostol dosing interval and effect on induction abortion times: a systematic review.

    Science.gov (United States)

    Shaw, Kate A; Topp, Nicole J; Shaw, Jonathan G; Blumenthal, Paul D

    2013-06-01

    To examine the effect of the interval between mifepristone and misoprostol administration on induction time (first misoprostol dose to abortion), total procedure time (mifepristone administration to abortion), and safety and efficacy in second-trimester induction abortion (13-24 weeks). We searched MEDLINE (1966-2012), ClinicalTrials.gov, POPLINE, and the Cochrane Controlled Trials Register using search terms for second trimester, abortion, misoprostol, and mifepristone and reviewed reference lists of published reports. Our search revealed 138 articles of which 29 met inclusion criteria: 20 randomized controlled trials and nine observational studies. Studies were included if, in any study arm, mifepristone and misoprostol were used for medical abortion in the second trimester. Two authors independently reviewed the articles and abstracted the data using standardized data abstraction templates to summarize data. Discrepancies were resolved by consensus. Three studies directly compared a 1-day to 2-day mifepristone-misoprostol interval; they showed small differences in median induction times (weighted average 7.3 hours, range 7-8.5 for a 1-day interval; weighted average 6.8 hours, range 6.3-7.2 for a 2-day interval) and no significant difference in percent expelled by 12 hours or 24 hours. When all randomized studies using mifepristone and misoprostol were pooled by comparable mifepristone-misoprostol interval and misoprostol dose, induction times (first misoprostol dose to expulsion) were only 1-2 hours longer for a 12- to 24-hour interval compared with a 36-48-hour interval, whereas total abortion times (mifepristone to expulsion) were at least 18 hours longer in the 36- to 48-hour group. Induction times varied by misoprostol dosing, with 400-microgram misoprostol protocols resulting in shorter induction times than 200-microgram protocols. Shortening the mifepristone-misoprostol interval, thereby reducing total abortion time, does not compromise the safety or

  11. Evaluation of effect of letrozole prior to misoprostol in comparison with misoprostol alone in success rate of induced abortion.

    Science.gov (United States)

    Behroozi-Lak, T; Derakhshan-Aydenloo, S; Broomand, F

    2018-03-01

    Abortion, spontaneous or induced, is a common complication of pregnancy and exploration of available and safe regimens for medical abortion in developing countries seems crucial. The present study was aimed to assess the effect of letrozole in combination with misoprostol in women eligible for legal therapeutic abortion with gestational age ≤14weeks. This clinical randomized trial was conducted on 78 women who were candidate of medical abortion and eligible for legal abortion with gestational age ≤14 weeks that were randomly divided into two groups of case and controls. Case group received daily oral dose of 10mg letrozole for three days followed by vaginal misoprostol. In control group the patients received only vaginal misoprostol. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed. Complete abortion was observed in 30 patients (76.9%) in case group and 9 (23.1%) cases were failed. In control group there was 16 (41.03%) complete abortions and 23 (58.97%) cases were failed to abort. Patients with gestational age of between 6 and 10 weeks did not show significant difference in both groups (P=0.134). Regarding pregnancy remnants there were significant differences between two groups (P=0.034). The time form admission to discharge in case groups were significantly shorter than those in control group (P=0.001). The indication for curettage in case group was significantly less than control group (P=0.001). A 3-day course of letrozole (10mg/daily) followed by misoprostol was associated with a higher complete abortion and lower curettage rates and reduction in time from admission to discharge in women with gestational age ≤14 weeks compared to misoprostol alone. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  12. Laminaria tent versus Misoprostol for cervical ripening before surgical process in missed abortion.

    Science.gov (United States)

    Firouzabadi, Raziah Dehghani; Sekhavat, Leila; Tabatabaii, Afsar; Hamadani, Sedighah

    2012-03-01

    To compare the efficacy of Laminaria tents with Misoprostol for cervical ripening before surgical process in missed abortion. In a prospective study, 70 women with missed abortion were assigned to have either insertion of a 3 mm intracervical Laminaria tent (n = 35) or vaginal Misoprostol 400 μg (n = 35) on the day prior to suction dilation and curettage (D/C). The women were interviewed just prior to the D/C with regard to pain, vaginal bleeding, and cervical dilator preference. Cervical dilation was greater in the Laminaria group but not significantly different from that in the Misoprostol group. However, additional cervical dilation before D/C was required in more patients in the Misoprostol group (45.7 vs 14.3%, P = 0.001). Women who received Laminaria reported significantly more pain at the time of insertion (62.8% in Laminaria group vs 22.8% in Misoprostol group) compared with women who received Misoprostol. Conversely, Misoprostol was associated with more nausea, vomiting, diarrhea and vaginal bleeding. Laminaria tents are more effective cervical dilators than vaginal Misoprostol when inserted the day prior to suction D and C. Vaginal Misoprostol insertion is more comfortable, although it is associated with an increased risk of vaginal bleeding.

  13. A comparative study between isosorbide mononitrate (IMN versus misoprostol prior to hysteroscopy

    Directory of Open Access Journals (Sweden)

    Waleed El-Khayat

    2010-10-01

    Conclusion: Misoprostol is superior to isosorbide mononitrate regarding better baseline cervical dilatation, less duration of dilatation, less incidence cervical injury and finally better feasibility of the procedure.

  14. Exacerbation of celecoxib-induced renal injury by concomitant administration of misoprostol in rats.

    Directory of Open Access Journals (Sweden)

    Dustin L Cooper

    Full Text Available Nonsteroidal anti-inflammatory drugs (NSAIDs can produce adverse effects by inhibiting prostaglandin (PG synthesis. A PGE1 analogue, misoprostol, is often utilized to alleviate NSAID-related gastrointestinal side effects. This study examined the effect of misoprostol on celecoxib renal toxicity. Additionally, the effects of these drugs on cardiovascular parameters were evaluated. Four randomized rat groups were orally gavaged for 9 days, two groups receiving vehicle and two groups receiving misoprostol (100 µg/kg twice daily. Celecoxib (40 mg/kg was co-administered once daily to one vehicle and one misoprostol group from days 3 to 9. Urine and blood samples were collected and blood pressure parameters were measured during the study period. Hearts and kidneys were harvested on final day. Day 2 urinary electrolyte samples revealed significant reductions in sodium excretion in misoprostol (0.12 ± 0.05 µmol/min/100 g and misoprostol+celecoxib groups (0.07 ± 0.02 µmol/min/100 g. At day 3, all treatment groups showed significantly reduced sodium excretion. Potassium excretion diminished significantly in vehicle+celecoxib and misoprostol+celecoxib groups from day 3 onward. Urinary kidney injury molecule-1 levels were significantly increased in vehicle+celecoxib (0.65 ± 0.02 vs. 0.35 ± 0.07 ng/mL, p = 0.0002 and misoprostol+celecoxib (0.61 ± 0.06 vs. 0.37 ± 0.06 ng/mL, p = 0.0015 groups when compared to baseline; while plasma levels of cardiac troponin I increased significantly in vehicle+celecoxib (p = 0.0040 and misoprostol+misoprostol (p = 0.0078 groups when compared to vehicle+vehicle. Blood pressure parameters increased significantly in all misoprostol treated groups. Significant elevation in diastolic (p = 0.0071 and mean blood pressure (p = 0.0153 was noted in misoprostol+celecoxib compared to vehicle+celecoxib. All treatments produced significant tubular dilatation/necrosis compared to control. No significant myocardial changes were

  15. Misoprostol modulates the gene expression prostaglandin E2 and oxidative stress markers in myometrial cells.

    Science.gov (United States)

    Konopka, Cristine Kolling; Azzolin, Verônica Farina; Cadoná, Francine Carla; Machado, Alencar Kolinski; Dornelles, Eduardo Bortoluzzi; Barbisan, Fernanda; da Cruz, Ivana Beatrice Mânica

    2016-11-01

    Misoprostol, prostaglandin E1 analogue, used for labour induction. However, one-third of patients who have labour induced with prostaglandins do not reach vaginal delivery. The differential expression of prostaglandin receptors in myometrial cells could account for this differential response. Since delivery physiology also involves modulation of oxidative metabolism that can be potentially affected by pharmacological drugs, in the present investigation the role of misoprostol on expression of prostaglandin receptors, and oxidative markers of myometrial cells was evaluated. Samples of myometrial tissues procured from women with spontaneous (SL) and nonspontaneous (NSL) labours were cultured in vitro and exposed to different concentrations of misoprostol. Gene expression was evaluated by qRT-PCR and oxidative biomarkers were evaluated by spectrophotometric and fluorometric analysis. Cells from SL women presented greater responsiveness to misoprostol, since an upregulation of genes related to increased muscle contraction was observed. Otherwise, cells from NSL women had low responsiveness to misoprostol exposure or even a suppressive effect on the expression of these genes. Oxidative biomarkers that previously have been related to labour physiology were affected by misoprostol treatment: lipoperoxidation and protein carbonylation (PC). However, a decrease in lipoperoxidation was observed only in SL cells treated with low concentrations of misoprostol, whereas a decrease of PC occurred in all samples treated with different misoprostol concentrations. The results suggest a pharmacogenetic effect of misoprostol in labour induction involving differential regulation of EP receptor genes, as well as some minor differential modulation of oxidative metabolism in myometrial cells. Copyright © 2016. Published by Elsevier Inc.

  16. Exacerbation of Celecoxib-Induced Renal Injury by Concomitant Administration of Misoprostol in Rats

    Science.gov (United States)

    Cooper, Dustin L.; Murrell, Derek E.; Conder, Christopher M.; Palau, Victoria E.; Campbell, Grace E.; Lynch, Shaun P.; Denham, James W.; Hanley, Angela V.; Bullins, Kenny W.; Panus, Peter C.; Singh, Krishna; Harirforoosh, Sam

    2014-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) can produce adverse effects by inhibiting prostaglandin (PG) synthesis. A PGE1 analogue, misoprostol, is often utilized to alleviate NSAID-related gastrointestinal side effects. This study examined the effect of misoprostol on celecoxib renal toxicity. Additionally, the effects of these drugs on cardiovascular parameters were evaluated. Four randomized rat groups were orally gavaged for 9 days, two groups receiving vehicle and two groups receiving misoprostol (100 µg/kg) twice daily. Celecoxib (40 mg/kg) was co-administered once daily to one vehicle and one misoprostol group from days 3 to 9. Urine and blood samples were collected and blood pressure parameters were measured during the study period. Hearts and kidneys were harvested on final day. Day 2 urinary electrolyte samples revealed significant reductions in sodium excretion in misoprostol (0.12±0.05 µmol/min/100 g) and misoprostol+celecoxib groups (0.07±0.02 µmol/min/100 g). At day 3, all treatment groups showed significantly reduced sodium excretion. Potassium excretion diminished significantly in vehicle+celecoxib and misoprostol+celecoxib groups from day 3 onward. Urinary kidney injury molecule-1 levels were significantly increased in vehicle+celecoxib (0.65±0.02 vs. 0.35±0.07 ng/mL, p = 0.0002) and misoprostol+celecoxib (0.61±0.06 vs. 0.37±0.06 ng/mL, p = 0.0015) groups when compared to baseline; while plasma levels of cardiac troponin I increased significantly in vehicle+celecoxib (p = 0.0040) and misoprostol+misoprostol (p = 0.0078) groups when compared to vehicle+vehicle. Blood pressure parameters increased significantly in all misoprostol treated groups. Significant elevation in diastolic (p = 0.0071) and mean blood pressure (p = 0.0153) was noted in misoprostol+celecoxib compared to vehicle+celecoxib. All treatments produced significant tubular dilatation/necrosis compared to control. No significant myocardial changes were

  17. Oral misoprostol versus dinoprostone vaginal tablets for labor induction

    Directory of Open Access Journals (Sweden)

    Khaled Ibrahim Abu El aish

    2013-06-01

    Full Text Available Background: Induction of labour is common in obstetric practice. We conducted this study to find the appropriate and safe drug for labour induction and to compare the safety and efficacy of oral misoprostol and vaginal dinoprostone for labour induction. Methods: In a provisional, prospective and cross-sectional study, one hundred and fifty five singleton cephalic presentation full term pregnancies with medical or obstetric indication for labour induction were allocated in two groups. First group received oral 50 micrograms for nulliparas and low parity group (1-4, and 25micrograms for grand multiparas (≥ 5 misoprostol orally every 6 hours to a maximum of four doses daily. In the second group vaginal tablets of dinoprostone 3mg then 1.5mg for nulliparas and 1.5mg for low parity and grand multiparas groups were inserted in the posterior fornix, every 8 hours. Primary outcome measures were: induction success, induction-delivery interval and number of used doses. Secondary outcome measures included: maternal side effects, caesarean section rate, mode of delivery and neonatal outcome. Data was collected from patient case notes and analyzed using software SPSS (version 13.0 and p-value < 0.05 was used as statistical significance of differences. Results: In our study there were no significant differences in baseline parameters in the two groups nor in the indications for labor induction except misoprostol was used in premature rupture of membrane. Induction of labor succeeded in 123 (79.35% women without other interventions from other methods (80.26%misoprostol group versus 78.5% dinoprostone p=0.492. It was observed that there were no significant differences between the two groups in final outcomes nor in obstetrical complications. There was no significance in differences between misoprostol and dinoprostone groups in induction-delivery interval (15.2 ± 14.5 hours versus 16.4 ± 11.3 hours p=0.6 resp.. Conclusions: This study demonstrated that oral

  18. Knowledge and provision of misoprostol among pharmacy workers in Senegal: a cross sectional study.

    Science.gov (United States)

    Reiss, Kate; Footman, Katharine; Burke, Eva; Diop, Nafissatou; Ndao, Ramatoulaye; Mane, Babacar; van Min, Maaike; Ngo, Thoai D

    2017-07-03

    Making misoprostol widely available for management of postpartum haemorrhage (PPH) and post abortion care (PAC) is essential for reducing maternal mortality. Private pharmacies (thereafter called "pharmacies") are integral in supplying medications to the general public in Senegal. In the case of misoprostol, pharmacies are also the main supplier to public providers and therefore have a key role in increasing its availability. This study seeks to understand knowledge and provision of misoprostol among pharmacy workers in Dakar, Senegal. A cross-sectional survey was conducted in Dakar, Senegal. 110 pharmacy workers were interviewed face-to-face to collect information on their knowledge and practice relating to the provision of misoprostol. There are low levels of knowledge about misoprostol uses, registration status, treatment regimens and side effects among pharmacy workers, and corresponding low levels of training on its uses for reproductive health. Provision of misoprostol was low; of the 72% (n = 79) of pharmacy workers who had heard of the product, 35% (n = 27) reported selling it, though rarely for reproductive health indications. Almost half (49%, n = 25) of the respondents who did not sell misoprostol expressed willingness to do so. The main reasons pharmacy workers gave for not selling the product included stock outs (due to product unavailability from the supplier), perceived lack of demand and unwillingness to stock an abortifacient. Knowledge and availability of misoprostol in pharmacies in Senegal is low, posing potential challenges for delivery of post-abortion care and obstetric care. Training is required to address low levels of knowledge of misoprostol registration and uses among pharmacy workers. Barriers that prevent pharmacy workers from stocking misoprostol, including weaknesses in the supply chain and stigmatisation of the product must be addressed. Low reported sales for reproductive health indications also suggest limited prescribing of

  19. Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage

    International Nuclear Information System (INIS)

    Jabir, Maysoon M.; Smeet, Rania I.

    2009-01-01

    Objective was to assess the effectiveness of misoprostol in cervical ripening before evacuation of conception in the first trimester missed miscarriages and to compare between oral and vaginal routes of administration. A randomized control study was carried out in Baghdad Teaching Hospital, Baghdad, Iraq in 2006. One hundred and twenty women with first fist trimester missed miscarriages were divided into 2 study groups, randomized for oral and vaginal (400 mcg) misoprostol priming of cervix and 2 control groups randomized for oral and vaginal placebo, before undergoing surgical evacuation of conception after 3 hours. Measured outcomes were: post medication cervical dilatation, time needed to dilate the cervix surgically, blood loss and developments of the side effects of misoprostol. Post medication cervical dilation was higher in the misoprostol group (7.07+-1.36 mm for oral misoprostol, 7.77+-1.22 mm for vaginal misoprostol), versus the control groups (2.43+-0.5 mm). Post medication cervical dilatation was significantly higher in the vaginal misoprostol group, compared to the oral group (p=0.04). The time required to dilate the cervix in the misoprostol group was shorter, compared with placebo. There were no significant differences in the amount of blood loss between oral (p=0.074) and vaginal misoprostol groups (p=0.62) and gastrointestinal side effects were significantly more in the oral misoprostol group (p=0.014). Misoprostol is an effective cervical priming agent when administered either orally or vaginally before evacuation of conception in the termination of the first trimester missed miscarriage. (author)

  20. Misoprostol and the politics of abortion in Sri Lanka.

    Science.gov (United States)

    Kumar, Ramya

    2012-12-01

    Misoprostol, a WHO essential medicine indicated for labour induction, management of miscarriage and post-partum haemorrhage, as well as for induced abortion and treatment of post-abortion complications, came up for registration in Sri Lanka in December 2010. The decision on registration was postponed, indefinitely. This has wide-ranging implications, as misoprostol is widely available and used, including by health professionals in Sri Lanka, without guidance or training in its use. This paper attempts to situate the failure to register misoprostol within the broader context of unsafe abortion, drawing on data from interviews with physicians and health policymakers in Sri Lanka. It demonstrates how personal opposition to abortion infiltrates policy decisions and prevents the issue of unsafe abortion being resolved. Any move to reform abortion law and policy in Sri Lanka will require a concerted effort, spearheaded by civil society. Women and communities affected by the consequences of unsafe abortion need to be involved in these efforts. Regardless of the law, women will access abortion services if they need them, and providers will provide them. Decriminalizing abortion and registering abortion medications will make provision of abortion services safer, less expensive and more equitable. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  1. Time-dose relationships of PMSG and map-intravaginal sponges ...

    African Journals Online (AJOL)

    Different dosage levels of pregnant mare serum gonadotrophin (PMSG) were applied in conjunction with medroxyprogesterone acetate impregnated intravaginal sponges at different times in relation to sponge removal the object of the study was to find the most economical dose level and the correct time of application ...

  2. Intravaginal practices, vaginal flora disturbances, and acquisition of sexually transmitted diseases in Zimbabwean women

    NARCIS (Netherlands)

    van de Wijgert, J. H.; Mason, P. R.; Gwanzura, L.; Mbizvo, M. T.; Chirenje, Z. M.; Iliff, V.; Shiboski, S.; Padian, N. S.

    2000-01-01

    One hundred sixty-nine Zimbabwean women were studied to determine whether the use of intravaginal practices (cleaning with the fingers, wiping the vagina, and inserting traditional substances) are associated with disturbances of vaginal flora and acquisition of sexually transmitted diseases (STDs).

  3. Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.

    Science.gov (United States)

    Low, Nicola; Chersich, Matthew F; Schmidlin, Kurt; Egger, Matthias; Francis, Suzanna C; van de Wijgert, Janneke H H M; Hayes, Richard J; Baeten, Jared M; Brown, Joelle; Delany-Moretlwe, Sinead; Kaul, Rupert; McGrath, Nuala; Morrison, Charles; Myer, Landon; Temmerman, Marleen; van der Straten, Ariane; Watson-Jones, Deborah; Zwahlen, Marcel; Hilber, Adriane Martin

    2011-02-15

    Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition. We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I(2) values 0.0%-16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, pflora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal

  4. The use of misoprostol in termination of second-trimester pregnancy

    Directory of Open Access Journals (Sweden)

    Chen-Ju Lin

    2011-09-01

    Full Text Available Misoprostol, a synthetic prostaglandin E1 analog, is initially used to prevent peptic ulcer. The initial US Food and Drug Administration-approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory drugs use. In recent two decades, misoprostol has approved to be an effective agent for termination of pregnancy in various gestation, cervical ripening, labor induction in term pregnancy, and possible management of postpartum hemorrhage. For the termination of second-trimester pregnancy using the combination of mifepristone and misoprostol seems to have the highest efficacy and the shortest time interval of abortion. When mifepristone is not available, misoprostol alone is a good alternative. Misoprostol, 400 μg given vaginally every 3–6 hours, is probably the optimal regimen for second-trimester abortion. More than 800 μg of misoprostol is likely to have more side effects, especially diarrhea. Although misoprostol can be used in women with scarred uterus for termination of second-trimester pregnancy, it is recommended that women with a scarred uterus should receive lower doses and do not double the dose if there is no initial response. It is also important for us to recognize the associated teratogenic effects of misoprostol and thorough consultation before prescribing this medication to patients regarding these risks, especially when failure of abortion occurs, is needed.

  5. Survey on the use of misoprostol for induction of labour among ...

    African Journals Online (AJOL)

    Context: Wide spread use of misoprostol is increasingly commoner in our obstetrics and gynaecological practice, most especially for Induction of labour in spite of its serious associated risks of maternal and fetal complications. Objective: To determine the use of Misoprostol for induction of labour among the Obstetricians in ...

  6. Knowledge, acceptability, and use of misoprostol for preventing postpartum hemorrhage following home births in rural Ethiopia.

    Science.gov (United States)

    Gebre, Betemariam; Taddese, Zinaw; Deribe, Kebede; Legesse, Tsigereda; Omar, Meftuh; Biadgilign, Sibhatu

    2016-07-01

    To assess knowledge of, and intentions to use misoprostol to preventing postpartum hemorrhage by women in a pastoralist community of the Somali Region of Ethiopia. A cross-sectional study enrolled women aged 15-49years living in Adadle district, Ethiopia, between April 26 and May 3, 2012. A structured questionnaire was used to collect data on participants' knowledge of misoprostol and if they had any intention to use it in the future. Participants also detailed their preferred healthcare provider for administering misoprostol. A total of 829 women were enrolled in the study. Among the participants, 42 (5.1%) had knowledge of misoprostol and 302 (36.4%) described themselves as being willing to use misoprostol in the future. Among respondents who were willing to use misoprostol in the future, traditional birth attendants were the preferred healthcare practitioners to administer it. Awareness of misoprostol was low in the study sample but willingness to use the drug was somewhat higher. Raising awareness and knowledge among communities and traditional birth attendants regarding the advantages of misoprostol is crucial to enhance uptake and reduce the incidence of postpartum hemorrhage. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Diclofenac/misoprostol during early pregnancy and the risk of miscarriage: a Danish nationwide cohort study.

    Science.gov (United States)

    Andersen, Jon T; Mastrogiannis, Dimitrios; Andersen, Nadia L; Petersen, Morten; Broedbaek, Kasper; Cejvanovic, Vanja; Nielsen, Torben K; Poulsen, Henrik E; Jimenez-Solem, Espen

    2016-08-01

    Misoprostol can be used in the prevention of gastric ulcer in treatment with diclofenac and is used in rheumatic diseases. Since misoprostol causes contractions of the uterus, it can also be used to induce abortions when administrated vaginally. The aim of the study was to investigate if early pregnancy exposure to oral diclofenac/misoprostol was associated with miscarriage. We conducted a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2011. All births were identified using the Medical Birth Registry, and all records of induced abortion and miscarriage were from the National Hospital Register. Data on drug use were from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women exposed to diclofenac/misoprostol in early pregnancy. We identified 1,338,824 pregnancies (970,491 births, 142,147 miscarriages, 226,145 induced abortions). One hundred sixty-six were exposed to diclofenac/misoprostol in the early pregnancy of which 28.3 % (47) ended up in a miscarriage compared to 10.6 % among unexposed. The adjusted hazard ratio of having a miscarriage after exposure to diclofenac/misoprostol in the first trimester was 3.6 (CI 95 % 2.6-4.9). We found an increased risk of miscarriage after exposure to diclofenac/misoprostol during the early pregnancy. Women in the fertile age should not be treated with the combination of diclofenac/misoprostol if other options were available.

  8. Side-effects of oral misoprostol in the third stage of labour – a ...

    African Journals Online (AJOL)

    Background. Misoprostol, an irlexpensive, stable, orally active prostaglandirl analogue, has been suggested for use in the prevention of postpartum haemorrhage. Potential side-effects, however, need to be quantified. Objective. To compare the rate of postpartum shivering and pyrexia following oral misoprostol 600 pg and ...

  9. Comparison of 25 and 50 microgram of misoprostol for induction of ...

    African Journals Online (AJOL)

    Background: Induction of labor for postdate pregnancy using misoprostol is one of the most common interventions in pregnancy. However, the optimal dose of misoprostol is yet to be determined with previous reports utilizing different dosages. Objective: The main objective of this study was to compare the effectiveness and ...

  10. Association between infection and fever in terminations of pregnancy using misoprostol : A retrospective cohort study

    NARCIS (Netherlands)

    Nijman, Tobias A.J.; Voogdt, Kevin G.J.A.; Teunissen, Pim W.; van der Voorn, Patrick J.J.P.; de Groot, Christianne J.M.; Bakker, Petra C.A.M.

    2017-01-01

    Background: Fever is a well-known side effect of misoprostol, but clinically difficult to distinguish from an intra uterine infection. The aim of this study was to determine the incidence of fever in terminations of pregnancy (TOP) using misoprostol and to evaluate fever as indication of intra

  11. Pretreatment with Misoprostol Reduces Intrauterine Adhesions After Surgical Termination of Missed Abortion

    Directory of Open Access Journals (Sweden)

    Sedat Akgöl

    2012-08-01

    CONCLUSION: Misoprostol reduces intrauterine adhesions after surgical termination of missed abortion, possibly by improving the convenience of curettage. Pretreatment with misoprostol can be justified for women who have history of infertility or recurrent pregnancy loss and who are to undergo curettage.

  12. Misoprostol in the intestinal lumen protects against radiation injury of the mucosa of the small bowel

    Energy Technology Data Exchange (ETDEWEB)

    Delaney, J.P.; Bonsack, M.E.; Felemovicius, I. (Univ. of Minnesota Medical School, Minneapolis, MN (United States))

    1994-03-01

    Systemically administered misoprostol, a PGE analog, has been shown to be an intestinal radioprotector. The purpose of this study was to determine if administration of misoprostol into the intestinal lumen can also reduce the severity of acute radiation enteritis. The rat small bowel was operatively exteriorized and segmented by means of suture ties. The remainder of the intestine and the rat were shielded in a lead box. Misoprostol was introduced into the lumen in various doses. After 30 min exposure to misoprostol, the isolated, exteriorized, segmented bowel was subjected to 11 Gy X irradiation. Five days later the animals were sacrificed and the intestines harvested for evaluation. Surviving crypt numbers per circumference and mucosal height were the criteria used for quantification of damage. Mucosa exposed to misoprostol at the time of radiation delivery showed significantly increased crypt numbers and mucosal height compared to adjacent saline-filled intestine. 24 refs., 2 figs., 2 tabs.

  13. Misoprostol in the intestinal lumen protects against radiation injury of the mucosa of the small bowel

    International Nuclear Information System (INIS)

    Delaney, J.P.; Bonsack, M.E.; Felemovicius, I.

    1994-01-01

    Systemically administered misoprostol, a PGE analog, has been shown to be an intestinal radioprotector. The purpose of this study was to determine if administration of misoprostol into the intestinal lumen can also reduce the severity of acute radiation enteritis. The rat small bowel was operatively exteriorized and segmented by means of suture ties. The remainder of the intestine and the rat were shielded in a lead box. Misoprostol was introduced into the lumen in various doses. After 30 min exposure to misoprostol, the isolated, exteriorized, segmented bowel was subjected to 11 Gy X irradiation. Five days later the animals were sacrificed and the intestines harvested for evaluation. Surviving crypt numbers per circumference and mucosal height were the criteria used for quantification of damage. Mucosa exposed to misoprostol at the time of radiation delivery showed significantly increased crypt numbers and mucosal height compared to adjacent saline-filled intestine. 24 refs., 2 figs., 2 tabs

  14. Oral misoprostol versus oxytocin in the management of third stage of labour

    International Nuclear Information System (INIS)

    Aziz, S.; Kazi, S.; Haq, G.; Soomro, N.

    2014-01-01

    Objectives: To compare oral misoprostol versus intramuscular oxytocin in the management of third stage of labour. Methods: The quasi-experimental study was conducted at the Obstetrics and Gynaecology Unit II, Civil Hospital, Karachi, from June 20 to December 19, 2006. A total of 70 patients diagnosed in active phase of labour who fulfilled the inclusion criteria were selected by non-probability convenience sampling. These patients were divided into 2 groups of 35 patients each, for Oxytocin (Group 1) and misoprostol (Group 2). Main and secondary outcome measures were analysed. SPSS 10 was used for statistical analysis. Results: Average amount of blood loss(ml) was 267.14+-140.35 with Oxytocin versus 302.86+-160.4, with Misoprostol, this difference was statistically insignificant (p=0.236). Average drop in haemoglobin concentration (g/dl) with Oxytocin was 1.55+-0.38 vs 1.66+-0.61 with Misoprostol (p=0.684). Drop in haematocrit (%) was 4.18+-0.64 with Oxytocin vs. 4.50+-0.92 with Misoprostol (p=0.133). There was also insignificant difference in duration of third stage of labour, between oxytocin and Misoprostol groups (5.37+-2.20 vs. 5.23+-2.46, p=0.451) Shivering, in Misoprostol group occured in n=11 (31.4%) vs n=3 (8.6%) with Oxytocin (p=0.017) and pyrexia in n=6 (17.1%) with misoprostol vs n=0, with oxytocin (p=0.025) thus significantly higher in misoprostol group. Conclusion: There were no major differences in oral misoprostol and intramuscular oxytocin in the management of third stage of labour. (author)

  15. Möbius Syndrome: Misoprostol Use and Speech and Language Characteristics

    Directory of Open Access Journals (Sweden)

    Guedes, Zelita Caldeira Ferreira

    2014-03-01

    Full Text Available Introduction Möbius syndrome (MS; VI and VII palsy is a rare disease that in Brazil has a great frequency because of the use of misoprostol during pregnancy. Objective Verify if the speech and language performance of children with MS whose mothers reported use of misoprostol (Cytotec, Pfizer, Connecticut, USA are different from the performance of children of mothers who did not report use. Methods The stomatognathic system beyond receptive and expressive language and speech was evaluated in children with MS, and their mothers were questioned whether they used misoprostol during the pregnancy. Results During the interview, 61.11% of mothers reported that they took misoprostol during the pregnancy. Most of the subjects (83.3% whose mothers took misoprostol presented bilateral palsy beyond bad mobility of the tongue (90.9% and speech disorders (63.6%. Conclusion The number of mothers who took misoprostol without knowing the risk for MS was great. The lack of facial expressions and speech disorders were common characteristics of the individuals with MS, whether the mothers took misoprostol during the pregnancy or not.

  16. Misoprostol Inhibits Equine Neutrophil Adhesion, Migration, and Respiratory Burst in an In Vitro Model of Inflammation

    Directory of Open Access Journals (Sweden)

    Emily Medlin Martin

    2017-09-01

    Full Text Available In many equine inflammatory disease states, neutrophil activities, such as adhesion, migration, and reactive oxygen species (ROS production become dysregulated. Dysregulated neutrophil activation causes tissue damage in horses with asthma, colitis, laminitis, and gastric glandular disease. Non-steroidal anti-inflammatory drugs do not adequately inhibit neutrophil inflammatory functions and can lead to dangerous adverse effects. Therefore, novel therapies that target mechanisms of neutrophil-mediated tissue damage are needed. One potential neutrophil-targeting therapeutic is the PGE1 analog, misoprostol. Misoprostol is a gastroprotectant that induces intracellular formation of the secondary messenger molecule cyclic AMP (cAMP, which has been shown to have anti-inflammatory effects on neutrophils. Misoprostol is currently used in horses to treat NSAID-induced gastrointestinal injury; however, its effects on equine neutrophils have not been determined. We hypothesized that treatment of equine neutrophils with misoprostol would inhibit equine neutrophil adhesion, migration, and ROS production, in vitro. We tested this hypothesis using isolated equine peripheral blood neutrophils collected from 12 healthy adult teaching/research horses of mixed breed and gender. The effect of misoprostol treatment on adhesion, migration, and respiratory burst of equine neutrophils was evaluated via fluorescence-based adhesion and chemotaxis assays, and luminol-enhanced chemiluminescence, respectively. Neutrophils were pretreated with varying concentrations of misoprostol, vehicle, or appropriate functional inhibitory controls prior to stimulation with LTB4, CXCL8, PAF, lipopolysaccharide (LPS or immune complex (IC. This study revealed that misoprostol pretreatment significantly inhibited LTB4-induced adhesion, LTB4-, CXCL8-, and PAF-induced chemotaxis, and LPS-, IC-, and PMA-induced ROS production in a concentration-dependent manner. This data indicate that

  17. Misoprostol modulates cytokine expression through a cAMP Pathway: potential therapeutic implication for liver disease

    Science.gov (United States)

    Gobejishvili, Leila; Ghare, Smita; Khan, Rehan; Cambon, Alexander; Barker, David F.; Barve, Shirish; McClain, Craig; Hill, Daniell

    2015-01-01

    Dysregulated cytokine metabolism plays a critical role in the pathogenesis of many forms of liver disease, including alcoholic and non-alcoholic liver disease. In this study we examined the efficacy of Misoprostol in modulating LPS-inducible TNFα and IL-10 expression in healthy human subjects and evaluated molecular mechanisms for Misoprostol modulation of cytokines in vitro. Healthy subjects were given 14 day courses of Misoprostol at doses of 100, 200, and 300 µg four times a day, in random order. Baseline and LPS-inducible cytokine levels were examined ex vivo in whole blood at the beginning and the end of the study. Additionally, in vitro studies were performed using primary human PBMCs and the murine macrophage cell line, RAW 264.7, to investigate underlying mechanisms of misoprostol on cytokine production. Administration of Misoprostol reduced LPS inducible TNF production by 29%, while increasing IL-10 production by 79% in human subjects with no significant dose effect on ex vivo cytokine activity; In vitro, the effect of Misoprostol was largely mediated by increased cAMP levels and consequent changes in CRE and NFκB activity, which are critical for regulating IL-10 and TNF expression. Additionally, chromatin immunoprecipitation (ChIP) studies demonstrated that Misoprostol treatment led to changes in transcription factor and RNA Polymerase II binding, resulting in changes in mRNA levels. In summary, Misoprostol was effective at beneficially modulating TNF and IL-10 levels both in vivo and in vitro; these studies suggest a potential rationale for Misoprostol use in ALD, NASH and other liver diseases where inflammation plays an etiologic role. PMID:26408955

  18. Prevention of postpartum haemorrhage with sublingual misoprostol or oxytocin: a double-blind randomised controlled trial.

    Science.gov (United States)

    Bellad, M B; Tara, D; Ganachari, M S; Mallapur, M D; Goudar, S S; Kodkany, B S; Sloan, N L; Derman, R

    2012-07-01

    Sublingual misoprostol produces a rapid peak concentration, and is more effective than oral administration. We compared the postpartum measured blood loss with 400 μg powdered sublingual misoprostol and after standard care using 10 iu intramuscular (IM) oxytocin. Double-blind randomised controlled trial. A teaching hospital: J N Medical College, Belgaum, India. A cohort of 652 consenting eligible pregnant women admitted to the labour room. Subjects were assigned to receive the study medications and placebos within 1 minute of clamping and cutting the cord by computer-generated randomisation. Chi-square and bootstrapped Student's t-tests were used to test categorical and continuous outcomes, respectively. Measured mean postpartum blood loss and haemorrhage (PPH, loss ≥ 500 ml), >10% pre- to post-partum decline in haemoglobin, and reported side effects. The mean blood loss with sublingual misoprostol was 192 ± 124 ml (n=321) and 366 ± 136 ml with oxytocin IM (n=331, P ≤ 0.001). The incidence of PPH was 3.1% with misoprostol and 9.1% with oxytocin (P=0.002). No woman lost ≥ 1000 ml of blood. We observed that 9.7% and 45.6% of women experienced a haemoglobin decline of >10% after receiving misoprostol and oxytocin, respectively (P ≤ 0.001). Side effects were significantly greater in the misoprostol group than in the oxytocin group. Unlike other studies, this trial found sublingual misoprostol more effective than intramuscular oxytocin in reducing PPH, with only transient side effects being greater in the misoprostol group. The sublingual mode and/or powdered formulation may increase the effectiveness of misoprostol, and render it superior to injectable oxytocin for the prevention of PPH. Further research is needed to confirm these results. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  19. The Efficacy of Vaginal Misoprostol in Treatment of Missed Abortions

    Directory of Open Access Journals (Sweden)

    M Tabatabaei

    2005-07-01

    Full Text Available Introduction: Missed Abortion is a important obstetric and gynecology complication because of its serious outcomes such as DIC, infection, shock, hemorrhage & death. There are various medical and surgical methods for treatment of missed abortion. Medical treatment of missed abortion is safe, effective, acceptable and an inexpensive alternative. Misoprostal is a synthetic prostaglandin (E1 and recommended by FDA for treatment of missed abortion. There are different views about its safety, dosage and effectiveness. Methods: This study was designed in order to determine the efficacy of vaginal misoprostol for termination of pregnancy in women with missed abortions admitted in Shahid Sadoughi, Madar and Mojibian hospitals of Yazd from 2003 to 2004. The method of study was semi-experimental. (Clinical trial without control group 50 women with missed abortion and the required criteria (age 15 – 45 years, gestational age ≤ 25 weeks, no previous medical or surgical complication and confirmation of missed abortion on sonography were selected. The data was collected by a questionnaire filled at the onset of study and after treatment (Misoprostol, (200 micrograms/dose repeated every 4 hours till expulsion of pregnancy products for maximum of 4 doses.The data analysis was done by statistical tests such as x2 and ANOVA. Results: The mean duration of medical treatment in the group with complete expulsion (44% and incomplete expulsion (56% was 12.63± 9.13 hours and 8.81± 2.9 hours, respectively, which was significantly different. (P value = 0.037. Of the total, 29 women had received two tablets of misoprostol, but the highest rate of complete expulsion was observed in women who had received four tablets. This difference in result was statistically significant. (p ≈ 0.000 . Observed side effects included headache (26%, nausea (16%, uterine cramps (12% and diarrhea. (6% There was no serious complication such as uterine rupture, excessive vaginal bleeding

  20. High Infection Rates for Adult Macaques after Intravaginal or Intrarectal Inoculation with Zika Virus.

    Science.gov (United States)

    Haddow, Andrew D; Nalca, Aysegul; Rossi, Franco D; Miller, Lynn J; Wiley, Michael R; Perez-Sautu, Unai; Washington, Samuel C; Norris, Sarah L; Wollen-Roberts, Suzanne E; Shamblin, Joshua D; Kimmel, Adrienne E; Bloomfield, Holly A; Valdez, Stephanie M; Sprague, Thomas R; Principe, Lucia M; Bellanca, Stephanie A; Cinkovich, Stephanie S; Lugo-Roman, Luis; Cazares, Lisa H; Pratt, William D; Palacios, Gustavo F; Bavari, Sina; Pitt, M Louise; Nasar, Farooq

    2017-08-01

    Unprotected sexual intercourse between persons residing in or traveling from regions with Zika virus transmission is a risk factor for infection. To model risk for infection after sexual intercourse, we inoculated rhesus and cynomolgus macaques with Zika virus by intravaginal or intrarectal routes. In macaques inoculated intravaginally, we detected viremia and virus RNA in 50% of macaques, followed by seroconversion. In macaques inoculated intrarectally, we detected viremia, virus RNA, or both, in 100% of both species, followed by seroconversion. The magnitude and duration of infectious virus in the blood of macaques suggest humans infected with Zika virus through sexual transmission will likely generate viremias sufficient to infect competent mosquito vectors. Our results indicate that transmission of Zika virus by sexual intercourse might serve as a virus maintenance mechanism in the absence of mosquito-to-human transmission and could increase the probability of establishment and spread of Zika virus in regions where this virus is not present.

  1. High Infection Rates for Adult Macaques after Intravaginal or Intrarectal Inoculation with Zika Virus

    Science.gov (United States)

    Nalca, Aysegul; Rossi, Franco D.; Miller, Lynn J.; Wiley, Michael R.; Perez-Sautu, Unai; Washington, Samuel C.; Norris, Sarah L.; Wollen-Roberts, Suzanne E.; Shamblin, Joshua D.; Kimmel, Adrienne E.; Bloomfield, Holly A.; Valdez, Stephanie M.; Sprague, Thomas R.; Principe, Lucia M.; Bellanca, Stephanie A.; Cinkovich, Stephanie S.; Lugo-Roman, Luis; Cazares, Lisa H.; Pratt, William D.; Palacios, Gustavo F.; Bavari, Sina; Pitt, M. Louise; Nasar, Farooq

    2017-01-01

    Unprotected sexual intercourse between persons residing in or traveling from regions with Zika virus transmission is a risk factor for infection. To model risk for infection after sexual intercourse, we inoculated rhesus and cynomolgus macaques with Zika virus by intravaginal or intrarectal routes. In macaques inoculated intravaginally, we detected viremia and virus RNA in 50% of macaques, followed by seroconversion. In macaques inoculated intrarectally, we detected viremia, virus RNA, or both, in 100% of both species, followed by seroconversion. The magnitude and duration of infectious virus in the blood of macaques suggest humans infected with Zika virus through sexual transmission will likely generate viremias sufficient to infect competent mosquito vectors. Our results indicate that transmission of Zika virus by sexual intercourse might serve as a virus maintenance mechanism in the absence of mosquito-to-human transmission and could increase the probability of establishment and spread of Zika virus in regions where this virus is not present. PMID:28548637

  2. Differential effects of misoprostol and ranitidine on the pharmacokinetics of diclofenac and gastrointestinal symptoms.

    OpenAIRE

    Dammann, H G; Simon-Schultz, J; Steinhoff, I; Damaschke, A; Schmoldt, A; Sallowsky, E

    1993-01-01

    1. The effects of oral misoprostol (800 microg day(-1)) and ranitidine (300 mg day(-1)) on the pharmacokinetics of diclofenac (100 mg) were assessed in a three-way randomized crossover study in 18 healthy male subjects. 2. Subjects were studied over three 8 day periods, during which they received twice-daily placebo, misoprostol, or ranitidine. A single dose of diclofenac was given orally on days 1 and 8, and plasma diclofenac concentrations were measured by h.p.l.c. over 24 h. 3. Misoprostol...

  3. Efficacy of intra-cervical misoprostol in the management of early pregnancy failure

    OpenAIRE

    Abdulrahim A. Rouzi; Nisma Almansouri; Nora Sahly; Nawal Alsenani; Hussam Abed; Khalid Darhouse; Nabil Bondagji

    2014-01-01

    The aim of this prospective study was to assess the efficacy of intra-cervical misoprostol in the management of early pregnancy failure. Twenty women with early pregnancy failure received intra-cervical misoprostol via an endometrial sampling cannula. The first dose was 50 μg of misoprostol dissolved in 5 ml of normal saline. The administration was repeated after 12 h if there was no vaginal bleeding or pain. Nine (45%) women received 1 dose and 11 (55%) women received 2 doses of intra-cervic...

  4. Misoprostol-induced pulmonary edema in a parturient with postpartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Bikash Ranjan Ray

    2011-01-01

    Full Text Available Misoprostol, a synthetic prostaglandin E1 (PGE1 analogue, although not the first-line drug in the management of postpartum hemorrhage, is frequently used for this purpose due to its safety profile and cost-effectiveness. Cardio-pulmonary complications have been previously reported with use of prostaglandin analogues but not with misoprostol. We describe a case of pulmonary edema after the use of vaginal misoprostol for treatment of postpartum vaginal bleed in an otherwise healthy asymptomatic patient, who was later diagnosed as a case of peripartum cardiomyopathy.

  5. Intravaginal hormonal contraception for women of reproductive age with excessive body mass

    Directory of Open Access Journals (Sweden)

    I. B. Gridina

    2015-12-01

    Full Text Available There are a number of disadvantages inherent in all oral hormonal contraceptives: need for daily administration, fluctuations of hormone levels throughout the day, metabolism in the gastrointestinal tract, the effect of the first passage through the liver. All this became a prerequisite to the creation of prolonged oral hormonal methods of contraception, which would be devoid of these shortcomings. One of such method of hormonal contraception is intravaginal hormonal system. The aim was to determine the safety and efficacy of its use in women of reproductive age with overweight. 43 women were included. State of lipid metabolism, changes of the hemostatic system, blood pressure and weight fluctuations in the past 6 months of using intravaginal hormonal contraceptive system were studied. Results. It is established that hormonal intravaginal contraceptive ring gives minimal metabolic effects. Conclusion. This suggests that this ring can be used successfully in patients with excessive body mass, because there is no effect of the ring on hemostasis, lipid metabolism and body weight.

  6. Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women.

    Science.gov (United States)

    Dessole, Salvatore; Rubattu, Giovanni; Ambrosini, Guido; Gallo, Omar; Capobianco, Giampiero; Cherchi, Pier Luigi; Marci, Roberto; Cosmi, Erich

    2004-01-01

    To assess the efficacy and safety of intravaginal estriol administration on urinary incontinence, urogenital atrophy, and recurrent urinary tract infections in postmenopausal women. Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospective, randomized, placebo-controlled study. Participants were randomly divided into two groups, with each group consisting of 44 women. Women in the treatment group received intravaginal estriol ovules: 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy. Women in the control group received inert placebo vaginal suppositories in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles, and urethrocystometry before as well as after 6 months of treatment. After therapy, the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group. Thirty (68%) of the treated participants, and only seven (16%) of the control participants registered a subjective improvement of their incontinence. In the treated participants, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure, in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra. Urethrocystometry showed positive but not statistically significant modifications. Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo standard hormone therapy.

  7. Preparation and in vitro/in vivo evaluation of gestodene (GEST) intravaginal ring.

    Science.gov (United States)

    Li, Chunxiao; Ning, Meiying; Yao, Xiaodong; Wang, Yankun; Liu, Ying

    2016-09-01

    Preparation and in vitro/in vivo evaluation of gestodene (GEST) intravaginal ring (IVR) formulations which can release a constant dose of GEST during 3 weeks were investigated. In present study a reservoir gestodene intravaginal ring, including a gestodene silicone elastomer core and the non-active silicone layer, was reported, which was manufactured by reaction injection moulding at 80°C for 20 min. The raw materials compatibility experiments showed that the silicone elastomer core carrier wouldn't interact with drugs. In vitro release samples were determined by HPLC and the experiment was performed under sink conditions. The equation of cumulative release verse time was Y=64.76χ+5.44 (r=0.9998), performing zero-order release at about the target dose of 60 µg/day over 21 days. Drug release increased with temperature elevating from 45 to 55°C, which could be attributed to optimizing the prescription. In addition, the pharmacokinetic and safety studies of gestodene intravaginal ring were evaluated in female New Zealand White rabbits. The GEST in plasma was analyzed by LC-MS/MS and the results proved that the correlation between in vitro and in vivo was relatively well.

  8. Diclofenac/misoprostol during early pregnancy and the risk of miscarriage

    DEFF Research Database (Denmark)

    Andersen, Jon T; Mastrogiannis, Dimitrios; Andersen, Nadia L

    2016-01-01

    INTRODUCTION: Misoprostol can be used in the prevention of gastric ulcer in treatment with diclofenac and is used in rheumatic diseases. Since misoprostol causes contractions of the uterus, it can also be used to induce abortions when administrated vaginally. The aim of the study was to investigate...... if early pregnancy exposure to oral diclofenac/misoprostol was associated with miscarriage. METHOD: We conducted a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2011. All births were identified using the Medical Birth Registry, and all records of induced abortion...... and miscarriage were from the National Hospital Register. Data on drug use were from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women exposed to diclofenac/misoprostol in early pregnancy. RESULT: We identified 1...

  9. Randomised controlled trial of the efficacy of misoprostol used as a ...

    African Journals Online (AJOL)

    Randomised controlled trial of the efficacy of misoprostol used as a cervical ripening agent prior to termination of pregnancy in the first trimester. Eric T M de Jonge, Rachel Jewkes, Jonathan Levin, Helen Rees ...

  10. The dose-response of canine focal gastric mucosal blood flow to misoprostol

    International Nuclear Information System (INIS)

    Gana, T.J.; Pherson, B.R.; Koo, J.

    1989-01-01

    The dose-response of focal gastric mucosal blood flow was measured simultaneously by laser-Doppler flowmetry and hydrogen gas clearance in the canine chambered gastric segment to topical misoprostol. Simultaneously obtained mucosal blood flow values showed a highly significant linear correlation in the basal but not misoprostol periods between the two techniques. Laser-Doppler flowmetry measured a dose-dependent increase in blood flow, while in contrast, hydrogen gas clearance showed a gradual decline in blood flow after misoprostol administration throughout all experiments. It is concluded that misoprostol dose-dependently and transiently increases focal gastric mucosal blood flow. However, only laser-Doppler flowmetry is sensitive enough to detect it. Although it can measure steady-state blood flow, owing to the duration of one measurement, hydrogen gas clearance is incapable of detecting rapid flow changes

  11. The dose-response of canine focal gastric mucosal blood flow to misoprostol

    Energy Technology Data Exchange (ETDEWEB)

    Gana, T.J.; Pherson, B.R.; Koo, J. (Alberta Univ., Edmonton, AB (Canada))

    1989-01-01

    The dose-response of focal gastric mucosal blood flow was measured simultaneously by laser-Doppler flowmetry and hydrogen gas clearance in the canine chambered gastric segment to topical misoprostol. Simultaneously obtained mucosal blood flow values showed a highly significant linear correlation in the basal but not misoprostol periods between the two techniques. Laser-Doppler flowmetry measured a dose-dependent increase in blood flow, while in contrast, hydrogen gas clearance showed a gradual decline in blood flow after misoprostol administration throughout all experiments. It is concluded that misoprostol dose-dependently and transiently increases focal gastric mucosal blood flow. However, only laser-Doppler flowmetry is sensitive enough to detect it. Although it can measure steady-state blood flow, owing to the duration of one measurement, hydrogen gas clearance is incapable of detecting rapid flow changes.

  12. Vaginal misoprostol versus vaginal surgical evacuation of first trimester incomplete abortion: Comparative study

    Directory of Open Access Journals (Sweden)

    Mahmoud Shokry

    2014-06-01

    Conclusion: Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to do surgical management.

  13. Six hourly vaginal misoprostol versus intracervical dinoprostone for cervical ripening and labor induction.

    Science.gov (United States)

    Agarwal, Nutan; Gupta, Anjali; Kriplani, Alka; Bhatla, Neerja; Parul

    2003-06-01

    Prospective clinical trials were conducted to assess the safety and efficacy of 6-hourly vaginal misoprostol versus intracervical dinoprostone for induction of labor. A total of 120 pregnant women requiring induction of labor were recruited. Cases were randomized to receive either 50 microg vaginal misoprostol 6 hourly (group 1, n = 60) or 0.5 mg intracervical dinoprostone 6 hourly (group II, n = 60). Outcome measures, such as change in Bishop's score, need of oxytocin, induction delivery interval; complications like tachysystoly, hyperstimulation, abnormal fetal heart rate, and meconium passage were compared between two groups. Statistical analysis was performed by Wilcoxan's Rank sum and Student's t-test. Bishop score rise, after 6 h of initiation of therapy was significantly higher in the misoprostol group than dinoprostone, 2.98 +/- 2.57 versus 2.05 +/- 1.83 (P = 0.04). The need of oxytocin augmentation was reduced in misoprostol versus dinoprostone group, 16.6% versus 78.3% (P = <0.001). Induction delivery interval was shorter in misoprostol; 12.8 +/- 6.4 h versus 18.53 +/- 8.5 h in dinoprostone group (P = <0.01). One case (1.6%) in misoprostol group, but none in dinoprostone had tachystole (P = 1.00). Abnormal heart rate pattern was found more in misoprostol than dinoprostone 16.6% versus 4.9% (P = 0.14) and so was the incidence of cesarean section, 26.6 versus 15%, respectively (P = 0.47). Meconium passage was the same in both groups, 10% in each group. Vaginal misoprostol 50 microg 6-hourly is safe and effective for induction of labor with lesser need of oxytocin augmentation and shorter induction delivery interval.

  14. Foetal fibular hemimelia with focal femoral deficiency following prenatal misoprostol use: A case report.

    Science.gov (United States)

    Pallavee, P; Samal, Rupal; Begum, Jasmina; Ghose, Seetesh

    2016-08-01

    Misoprostol is a well known abortifacient. It can cause teratogenicity like Mobius sequence and terminal transverse limb defects. We report a rare case of proximal focal femoral deficiency with fibular hemimelia in a woman who had attempted abortion with self-administered misoprostol and later continued the pregnancy. Though the absolute risk of congenital malformations with its use is low ∼1%, this should be clearly communicated to the women requesting abortion to help them make fully informed reproductive health decisions.

  15. Misoprostol use under routine conditions for termination of pregnancies with intrauterine fetal death

    OpenAIRE

    Nascimento, Maria Isabel do; Cunha, Alfredo de Almeida; Oliveira, Sandra Regina dos Santos Muri; Nunes, Glaucimara Gonzaga; Alvarez, Felipe Silva; Villas Bôas, Eduardo Loyola

    2013-01-01

    OBJECTIVE: To analyze the misoprostol use in pregnancies with intrauterine fetal death (IUFD), considering mode of delivery and induction-delivery interval. METHODS: Descriptive study including 171 pregnant women with IUFD, in the second or third trimester, submitted to labor induction with vaginal misoprostol and/or induction/augmentation with intravenous oxytocin, from 2005 to 2008, at a teaching-hospital of the Brazilian Unified Health System (Sistema Único de Saúde -SUS). RESULTS: Misopro...

  16. The biomedicalisation of illegal abortion: the double life of misoprostol in Brazil

    OpenAIRE

    Zordo, Silvia De

    2016-01-01

    Abstract This paper examines the double life of misoprostol in Brazil, where it is illegally used by women as an abortifacient and legally used in obstetric hospital wards. Based on my doctoral and post-doctoral anthropological research on contraception and abortion in Salvador, Bahia, this paper initially traces the “conversion” of misoprostol from a drug to treat ulcers to a self-administered abortifacient in Latin America, and its later conversion to aneclectic global obstetric tool. It th...

  17. Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days

    Science.gov (United States)

    Fjerstad, Mary; Sivin, Irving; Lichtenberg, E Steve; Trussell, James; Cleland, Kelly; Cullins, Vanessa

    2013-01-01

    Background From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the U.S. provided medical abortion principally by a regimen of oral mifepristone followed 24–48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and employ additional measures to minimize subsequent serious uterine infection. We conducted an extensive audit in August 2006 of medical abortion with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen. Objectives We sought to evaluate the effectiveness of the buccal medical abortion regimen and examine correlates of its success during routine service delivery. Methods Audits at 10 large urban service points were conducted in 2006 to estimate success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted an estimate of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from 2 sites. Results Effectiveness of the buccal misoprostol-mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol-mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%. Conclusion In conjunction with 200 mg of mifepristone, buccal use of 800 mcg of misoprostol up to 59 days of gestation is as effective as vaginal use of 800 mcg of misoprostol up to 63 days of gestation. PMID:19698822

  18. Stakeholder Analysis of Community Distribution of Misoprostol in Lao PDR: A Qualitative Study.

    Science.gov (United States)

    Durham, Jo; Warner, Melissa; Phengsavanh, Alongkone; Sychareun, Vanphanom; Vongxay, Viengnakhone; Rickart, Keith

    2016-01-01

    Globally, significant progress has been made in reducing maternal mortality, yet in many low-resource contexts it remains unacceptably high. Many of these deaths are due to postpartum haemorrhage and are preventable with access to essential obstetric care. Where there are barriers to access, maternal deaths could be prevented if community-level misoprostol was available. The purpose of this study was to explore perceptions of stakeholders regarding misoprostol use in the Lao People's Democratic Republic, a setting with high maternal mortality. Semi-structured interviews were conducted with 35 stakeholders in the capital, Vientiane and in one northern province identified as a site for a possible intervention. The sample included international and national stakeholders involved in policy-making and providing maternal and reproductive health services. Most stakeholders supported a pilot program for community distribution of misoprostol but levels of awareness of the drug's use in preventing postpartum haemorrhage and level of influence over policy direction varied considerably. Some international organizations, all identified as powerful in influencing policy, were ambivalent about the use of community distribution of misoprostol. Concerns related to the capacity of village health workers or lay people to safely administer misoprostol, whether its distribution would undermine efforts to improve access to safe delivery services and active management of the third stage of labour, the ease with which prescription drugs can be bought over the counter, and technical, logistical, and financial constraints. Access to appropriate oxytocic drugs is a matter of health equity. In settings without access to essential obstetrical care, misoprostol represents a viable solution for the prevention of postpartum haemorrhage. Understanding stakeholders' perspectives and their legitimate concerns on misoprostol can inform interventions in order to assuage these concerns and enable

  19. The use of misoprostol in termination of second-trimester pregnancy

    OpenAIRE

    Chen-Ju Lin; Shu-Chin Chien; Chih-Ping Chen

    2011-01-01

    Misoprostol, a synthetic prostaglandin E1 analog, is initially used to prevent peptic ulcer. The initial US Food and Drug Administration-approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory drugs use. In recent two decades, misoprostol has approved to be an effective agent for termination of pregnancy in various gestation, cervical ripening, labor induction in term pregnancy, and possible manageme...

  20. Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

    OpenAIRE

    Hang-lin Wu; Sheeba Marwah; Pei Wang; Qiu-meng Wang; Xiao-wen Chen

    2017-01-01

    The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were includ...

  1. Safe induction of labour with low-dose misoprostol, but less effective than the conventional dinoprostone regimen

    DEFF Research Database (Denmark)

    Petersen, Jesper Friis; Bergholt, Thomas; Løkkegaard, Ellen Christine L

    2013-01-01

    Off-label use of the prostaglandin-E1 analogue misoprostol has become standard practice when inducing labour. In Denmark, a low-dosage misoprostol regimen is common. The regimen consists of one 25 µg application on the first day of induction. The registered prostaglandin-E2 analogue dinoprostone...... is used in 3 and 6 mg doses. This study compared induction procedures with dinoprostone and misoprostol in terms of induction time, foetal outcome and maternal outcome....

  2. safe induction of labour with low-dose misoprostol, but less effective than the conventional dinoprostone regimen

    DEFF Research Database (Denmark)

    Petersen, Jesper Friis; Bergholt, Thomas; Løkkegaard, Ellen Christine L

    2013-01-01

    Off-label use of the prostaglandin-E1 analogue misoprostol has become standard practice when inducing labour. In Denmark, a low-dosage misoprostol regimen is common. The regimen consists of one 25 µg application on the first day of induction. The registered prostaglandin-E2 analogue dinoprostone...... is used in 3 and 6 mg doses. This study compared induction procedures with dinoprostone and misoprostol in terms of induction time, foetal outcome and maternal outcome....

  3. MISOPROSTOL TO REDUCE INTRAOPERATIVE AND POSTOPERATIVE HEMORRHAGE DURING CESAREAN DELIVERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

    Science.gov (United States)

    CONDE-AGUDELO, Agustín; NIETO, Aníbal; ROSAS-BERMUDEZ, Anyeli; ROMERO, Roberto

    2013-01-01

    OBJECTIVE To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials. RESULTS Seventeen studies (3174 women) were included of which 7 evaluated misoprostol versus oxytocin and 8 evaluated misoprostol plus oxytocin versus oxytocin. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, −2.1%; 95% confidence interval [CI], −3.4 to −0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% CI, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia. CONCLUSION Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during caesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations. PMID:23507545

  4. Complications with use of misoprostol for abortion in Madagascar : between ease of access and lack of information

    OpenAIRE

    Pourette, Dolores; Mattern, C.; Ratovoson, R.; Raharimalala, P.

    2018-01-01

    Objective: The objective was to learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post misoprostol use. Study design: This was a qualitative study in 2015-2016 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion; what information they received before use; what dosage and regimens they used; what complications they experienced; and what tre...

  5. Clinical pitfalls in misoprostol-based medical management of first-trimester induced and presumed spontaneous abortion.

    Science.gov (United States)

    Wax, Joseph R; Conroy, Kelley; Pinette, Michael G; Litton, Christian; Cartin, Angelina

    2017-12-28

    When administered inappropriately, first-trimester misoprostol management of induced or spontaneous abortion can result in loss or damage of a continuing pregnancy. Despite these serious consequences, such misoprostol exposures continue to occur. Unfortunately, contributing factors and preventive measures receive little attention. We describe the cases of 4 women in whom misoprostol was inappropriately administered during management of induced and presumed spontaneous abortion. In each case, careful adherence to published clinical guidance could have avoided the exposures. © 2017 Wiley Periodicals, Inc.

  6. INDUCTION OF LABOUR WITH VAGINAL MISOPROSTOL AND INCIDENCE OF MECONIUM STAINED LIQUOR AND FETAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Indira Mani

    2016-01-01

    Full Text Available AIM Induction of labour with low dose of misoprostol and detecting the incidence of meconium stained liquor and foetal outcome. DESIGN Prospective randomized control trail conducted at Niloufer Maternity and Children Hospital from January 2013 to September 2014. PARTICIPANTS 150 pregnant women requiring induction of labour. METHODS The women were divided into 2 groups based on BISHOP score as favorable and unfavorable cervix group. Induction delivery interval, number of misoprostol doses, incidence of meconium stained liquor, NICU admission and APGAR score. RESULTS Among the outcomes compared between unfavorable and favorable cervix groups induction delivery interval, number of misoprostol doses and incidence of meconium stained liquor was more in unfavorable cervix group and ‘p’ value was statistically significant. Long induction delivery interval and higher number of misoprostol doses were associated with higher incidence of meconium stained liquor in primi gravida with unfavorable cervix group. CONCLUSION Misoprostol is an effective priming and labour inducing agent, which fulfils all the criteria of an ideal inducing agent. Though incidence of meconium stained liquor is higher in misoprostol induced labour among women with unfavorable cervix, the foetal outcome seems to be very good.

  7. [Induction of labour at term with misoprostol: the experience of a Tunisian maternity ward].

    Science.gov (United States)

    Ouerdiane, Nadia; Tlili, Nihel; Othmani, Kaouther; Daaloul, Walid; Masmoudi, Abdelwaheb; Hamouda, Sonia Ben; Bouguerra, Badreddine

    2016-01-01

    To evaluate the efficacy and safety of vaginal misoprostol for term labour induction. A prospective study conducted at the Department of Obstetrics and Gynecology B of hospital Charles Nicolle, Tunis, over a period of 4 months. The group of subjects, selected to represent the population of interest, were pregnant patients at term undergoing cervical ripening. Patients received 50 mcg vaginal misoprostol every 12 hours. The parameters studied were: contractile abnormalities, abnormalities of fetal heart rate (FHR), mode of delivery, delayed delivery and neonatal status. 44 patients underwent cervical ripening with misoprostol. The average term was 40 WA. Nulliparous rate was 23/44 (52%). Vaginal birth rate was 31/44 (70.4%). 84% of patients received a single dose of misoprostol. FHR abnormalities were observed in 14/44 (32%). The rates of meconium-stained amniotic fluid was 12/44 (27%). Apgar score of less than 7 at 5 minutes was found in 7/44 (16%). A case of uterine rupture occurred in a primipara after a single dose of misoprostol. Our results are disappointing due to the occurrence of 1 uterine rupture and of 1 significant neonatal morbidity. Other multicentre prospective studies will be useful to better ensure the effectiveness but primarily the safety of low-dose misoprostol for induction of labour at term.

  8. Reduction of aspirin-induced fecal blood loss with low-dose misoprostol tablets in man

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, M.M.; Clark, L.; Armstrong, L.; D' Souza, J.

    1985-07-01

    Misoprostol (SC-29333), a synthetic prostaglandin E1 methyl ester analog, was given simultaneously with acetylsalicylic acid in a double-blind, placebo-controlled randomized prospective study of 32 healthy human male subjects. Fecal blood loss was measured for eight days using the /sup 51/Cr-labeled red blood cell technique. Aspirin (650 mg qid) and misoprostol (25 micrograms qid) or placebo were given during days 3, 4, and 5. There was a significant (P less than 0.05) increase in median blood loss (modified Friedman test) from 0.81 to 6.05 ml/day in the aspirin with placebo group (N = 16). Median blood loss was increased (from 0.75 to 3.75 ml/day) in the aspirin with misoprostol group (N = 16), but this was significantly less (Mann-Whitney U test, P less than 0.01) than the placebo group. Mean serum salicylate concentrations in the placebo and misoprostol groups were similar (7.8 and 6.8 micrograms/ml, respectively). There were no significant changes in laboratory values in any of the subjects studied, nor were any major side-effects encountered. This study demonstrates that oral misoprostol reduces aspirin-induced gastrointestinal bleeding even when administered simultaneously and at a dose level below its threshold for significant acid inhibition. This indicates a potential role for misoprostol in the prevention of gastric mucosal damage in selected patients.

  9. The use of misoprostol for cervical priming prior to hysteroscopy: a systematic review and analysis

    Directory of Open Access Journals (Sweden)

    Hua Y

    2016-09-01

    Full Text Available Ying Hua, Wenwen Zhang, Xiaoli Hu, Ansu Yang, Xueqiong Zhu Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China Abstract: The effects of misoprostol use on cervical priming prior to hysteroscopy have been controversial. Therefore, a systematic literature review and meta-analysis of studies were conducted to assess the effect of misoprostol on cervical priming prior to hysteroscopy. All studies published before July 2014 with data related to the use of misoprostol for cervical priming compared with placebo or no medication prior to hysteroscopy, were identified. Twenty-five randomized controlled trials involving 2,203 females were systematically analyzed. The results showed that, compared with placebo or no medication, the use of misoprostol prior to hysteroscopy led to a significant relief of the need for cervical dilatation, resulted in a significantly greater cervical width, had fewer hysteroscopy complications, and mild and insignificant side effects. Subgroup analyses revealed that the regimen of 200 or 400 µg vaginal misoprostol may be a simple and effective method for cervical priming, especially prior to operative hysteroscopy. Keywords: misoprostol, hysteroscopy, cervical priming, cervical dilatation, complications, systematic review 

  10. A randomised controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum haemorrhage.

    Science.gov (United States)

    Al-Sawaf, A; El-Mazny, A; Shohayeb, A

    2013-04-01

    This study aims to evaluate the efficacy and side-effects of 200 μg sublingual misoprostol vs 5 IU i.m. oxytocin, administered immediately following cord clamping in normal non-augmented vaginal delivery, in prevention of postpartum haemorrhage (PPH). A total of 104 women were randomised into three groups: misoprostol group (28 patients); oxytocin group (37 patients) and control group (39 patients). Misoprostol and oxytocin significantly minimised the blood loss during the third stage of labour and reduced the need for additional treatments for PPH as compared with the control group. Oxytocin was more effective than misoprostol in minimising blood loss and the need for additional uterotonic treatments. However, a significant decrease in systolic and diastolic blood pressure, associated with tachycardia was observed in the oxytocin group. In conclusion, sublingual misoprostol appears to be less effective than i.m. oxytocin in the prevention of PPH; however, it has the potential advantages of being easily used, cost-effective and stable at room temperature. Therefore, sublingual misoprostol is still a feasible drug for routine management of third stage, especially in areas with limited medical facilities.

  11. Reduction of aspirin-induced fecal blood loss with low-dose misoprostol tablets in man

    International Nuclear Information System (INIS)

    Cohen, M.M.; Clark, L.; Armstrong, L.; D'Souza, J.

    1985-01-01

    Misoprostol (SC-29333), a synthetic prostaglandin E1 methyl ester analog, was given simultaneously with acetylsalicylic acid in a double-blind, placebo-controlled randomized prospective study of 32 healthy human male subjects. Fecal blood loss was measured for eight days using the 51 Cr-labeled red blood cell technique. Aspirin (650 mg qid) and misoprostol (25 micrograms qid) or placebo were given during days 3, 4, and 5. There was a significant (P less than 0.05) increase in median blood loss (modified Friedman test) from 0.81 to 6.05 ml/day in the aspirin with placebo group (N = 16). Median blood loss was increased (from 0.75 to 3.75 ml/day) in the aspirin with misoprostol group (N = 16), but this was significantly less (Mann-Whitney U test, P less than 0.01) than the placebo group. Mean serum salicylate concentrations in the placebo and misoprostol groups were similar (7.8 and 6.8 micrograms/ml, respectively). There were no significant changes in laboratory values in any of the subjects studied, nor were any major side-effects encountered. This study demonstrates that oral misoprostol reduces aspirin-induced gastrointestinal bleeding even when administered simultaneously and at a dose level below its threshold for significant acid inhibition. This indicates a potential role for misoprostol in the prevention of gastric mucosal damage in selected patients

  12. A COMPARATIVE STUDY BETWEEN MIFEPRISTONE WITH MISOPROSTOL AND MISO PROSTOL ALONE FOR 2 ND TRIMESTER TERMINATION OF PREGN ANCY

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    Poornima

    2015-03-01

    Full Text Available OBJECTIVE: To compare the efficacy of mifepristone with misoprostol and misoprostol alone for 2 nd trimester termination of pregnancy. MATERIAL AND METHODS : Tota l 100 patients admitted in JSS M edical College & H ospital , Mysuru for termination of p regnancy between 13 - 28 weeks were selected for the study. 50 patient received mifepristone 200 mg orally followed by tab . m isoprostol 200 mg - 400 mg per vaginally after 24 - 36 hour s . Vaginal misoprostol repeated 4 - 6 hourly till pregnancy is terminated other 50 patients received only vaginal misoprostol. The results were analysed. RESULTS: The success rate in both regimens 100%. Induction to abortion interval was shorter in mifepristone with misoprostol group. Mean dose of misoprostol required was around 2.53 (9 00 - 1000 microgm in combined group and 3.44 (1400 microgm in the misoprostol alone group. CONCLUSION: p re - treatment with mifepristone 200mg 2 4 hour s before the induction with misoprostol significantly reduce the induction to abortion significantly reduces the induction to abortion interval and reduces the dose and side effects of misoprostol.

  13. Misoprostol sublingual versus vaginal para indução do parto a termo Sublingual versus vaginal misoprostol for labor induction of term pregnancies

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    Olímpio Barbosa de Moraes Filho

    2005-01-01

    Full Text Available OBJETIVO: comparar efetividade e segurança de uso de comprimido sublingual de 25 µg de misoprostol com o comprimido vaginal de 25 µg do misoprostol na indução do parto com idade gestacional e > 37 semanas e colo uterino desfavorável. MÉTODOS: realizou-se ensaio clínico controlado e aleatorizado, não cego, na Maternidade Monteiro de Morais (CISAM-UPE, em Recife, no período de outubro de 2003 a fevereiro de 2004. Participaram do estudo 123 gestantes com idade gestacional e > 37 semanas, índice de Bishop PURPOSE: to compare the effectiveness and safety of sublingual misoprostol (25 µg versus vaginal misoprostol (25 µg (Prostokos® for labor induction with gestational age > 37 weeks and unripe cervices. METHODS: a randomized controlled clinical trial was performed at the Maternidade Monteiro de Morais (CISAM-UPE, in Recife - PE, Brazil, from October 2003 to February 2004. One hundred and twenty-three women with gestational age > 37 weeks, Bishop score <8, not in labor and with medical indication for interruption of pregnancy were included in this study. The women received randomly 25 µg sublingual misoprostol or 25 µg vaginal misoprostol every 6 h, not exceeding eight doses. In order to evaluate the differences between the groups, means, standard deviations, Student's t-test, c² trend and Mann-Whitney test were used. The statistical significance was considered to be 5%. RESULTS: there were no significant differences between the number of women with vaginal delivery in the sublingual group as compared with the vaginal group (65.5 vs 75.8%, p<0.22, or in the interval of time between the induction onset and delivery (24 h and 42 min vs 20 h and 37 min respectively, p=0.11. The two groups, sublingual and vaginal, also did not differ as to the hyperstimulation syndrome (1.7 vs 3.2%, p=0.95, meconium incidence (5.2 vs 4.8%, p=0.74, Apgar score <7 at 5 min (3.4 vs 4.8%, p=0.98 and other adverse effects. CONCLUSION: twenty-five micrograms of

  14. Abortion and misoprostol: health practices and scientific controversy

    OpenAIRE

    Corrêa, Marilena Cordeiro Dias Villela; Mastrella, Miryam

    2012-01-01

    Este artigo coloca em perspectiva a controvérsia entre a associação do uso de misoprostol para aborto e teratogenicidade, encontrada em estudos do tipo relato de caso, e a consagração do uso de medicamentos à base do fármaco na área médico-obstétrica e em documentos normativos nacionais e internacionais que regulam o registro e a circulação de produtos farmacêuticos. Através do método monográfico, foram revisados, sistematizados e analisados documentos oficiais da Anvisa, Ministério da Saúde ...

  15. Misoprostol Inhibits Lipopolysaccharide-Induced Pro-inflammatory Cytokine Production by Equine Leukocytes

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    Emily Medlin Martin

    2017-09-01

    Full Text Available Pro-inflammatory cytokines including tumor necrosis factor α (TNFα, IL-1β, IL-6, and IL-8 are potent immune mediators that exacerbate multiple equine diseases such as sepsis and laminitis. Unfortunately, safe and effective cytokine-targeting therapies are lacking in horses; therefore, novel mechanisms of inhibiting cytokine production are critically needed. One potential mechanism for inhibiting cytokine synthesis is elevation of intracellular cyclic AMP (cAMP. In human leukocytes, intracellular cAMP production is induced by activation of E-prostanoid (EP receptors 2 and 4. These receptors can be targeted by the EP2/4 agonist and prostaglandin E1 analog, misoprostol. Misoprostol is currently used as a gastroprotectant in horses but has not been evaluated as a cytokine-targeting therapeutic. Thus, we hypothesized that misoprostol treatment would inhibit pro-inflammatory cytokine production by lipopolysaccharide (LPS-stimulated equine leukocytes in an in vitro inflammation model. To test this hypothesis, equine leukocyte-rich plasma (LRP was collected from 12 healthy adult horses and used to model LPS-mediated inflammatory signaling. LRP was treated with varying concentrations of misoprostol either before (pretreated or following (posttreated LPS stimulation. LRP supernatants were assayed for 23 cytokines using an equine-specific multiplex bead immunoassay. Leukocytes were isolated from LRP, and leukocyte mRNA levels of four important cytokines were evaluated via RT-PCR. Statistical differences between treatments were determined using one-way RM ANOVA (Holm–Sidak post hoc testing or Friedman’s RM ANOVA on Ranks (SNK post hoc testing, where appropriate (p < 0.05, n = 3–6 horses. These studies revealed that misoprostol pre- and posttreatment inhibited LPS-induced TNFα and IL-6 protein production in equine leukocytes but had no effect on IL-8 protein. Interestingly, misoprostol pretreatment enhanced IL-1β protein synthesis

  16. Estradiol-induced vaginal mucus inhibits antigen penetration and CD8(+) T cell priming in response to intravaginal immunization.

    Science.gov (United States)

    Seavey, Matthew M; Mosmann, Tim R

    2009-04-14

    Although vaginal immunization has been explored as a strategy to induce mucosal immunity in the female reproductive tract, this site displays unique immunological features that probably evolved to inhibit anti-paternal T cell responses after insemination to allow successful pregnancy. We previously demonstrated that estradiol, which induces an estrus-like state, prevented CD8(+) T cell priming during intravaginal immunization of mice. We now show that estradiol prevented antigen loading of vaginal antigen presenting cells (APCs) after intravaginal immunization. Histological examination confirmed that estradiol prevented penetration of peptide antigen into the vaginal wall. Removal of the estradiol-induced mucus barrier by mucinase partially restored antigen loading of vaginal APC and CD8(+) T cell proliferation in vivo. The estradiol-induced mucus barrier may thus prevent exposure to antigens delivered intravaginally, supplementing additional estradiol-dependent mechanism(s) that inhibit CD8(+) T cell priming after insemination or vaginal vaccination.

  17. Estradiol-induced vaginal mucus inhibits antigen penetration and CD8+ T cell priming in response to intravaginal immunization

    Science.gov (United States)

    Seavey, Matthew M.; Mosmann, Tim R.

    2010-01-01

    Although vaginal immunization has been explored as a strategy to induce mucosal immunity in the female reproductive tract, this site displays unique immunological features that probably evolved to inhibit anti-paternal T cell responses after insemination to allow successful pregnancy. We previously demonstrated that estradiol, which induces an estrus-like state, prevented CD8+ T cell priming during intravaginal immunization of mice. We now show that estradiol prevented antigen loading of vaginal antigen presenting cells (APC) after intravaginal immunization. Histological examination confirmed that estradiol prevented penetration of peptide antigen into the vaginal wall. Removal of the estradiol-induced mucus barrier by mucinase partially restored antigen loading of vaginal APC and CD8+ T cell proliferation in vivo. The estradiol-induced mucus barrier may thus prevent exposure to antigens delivered intravaginally, supplementing additional estradiol-dependent mechanism(s) that inhibit CD8+ T cell priming after insemination or vaginal vaccination. PMID:19428849

  18. Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women.

    Science.gov (United States)

    Capobianco, Giampiero; Donolo, Ermes; Borghero, Gianna; Dessole, Francesco; Cherchi, Pier Luigi; Dessole, Salvatore

    2012-02-01

    To assess the effects of the combination of pelvic floor rehabilitation and intravaginal estriol administration on stress urinary incontinence (SUI), urogenital atrophy and recurrent urinary tract infections in postmenopausal women. Two-hundred-six postmenopausal women with urogenital aging symptoms were enrolled in this prospective randomized controlled study. Patients were randomly divided into two groups and each group consisted of 103 women. Subjects in the treatment group received intravaginal estriol ovules, such as 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation. Subjects in the control group received only intravaginal estriol in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles and urethrocystometry before, as well as after 6 months of treatment. After therapy, the symptoms and signs of urogenital atrophy significantly improved in both groups. 61/83 (73.49%) of the treated patients, and only 10/103 (9.71%) of the control patients referred a subjective improvement of their incontinence. In the patients treated by combination therapy with estriol plus pelvic floor rehabilitation, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure (MUP), in mean urethral closure pressure (MUCP), as well as in the abdominal pressure transmission ratio to the proximal urethra (PTR). Our results showed that combination therapy with estriol plus pelvic floor rehabilitation was effective and should be considered as a first-line treatment for symptoms of urogenital aging in postmenopausal women.

  19. [Preparation and release mechanism of gestodene reservoir-type intravaginal rings].

    Science.gov (United States)

    Li, Chun-Xiao; Wang, Yan-Kun; Ning, Mei-Ying

    2014-03-01

    This study taking gestodene (GEST) as a model, investigated the factors affecting reservoir-type intravaginal ring (IVR)'s drug release. This paper reported a gestodene intravaginal ring of reservoir design, comprising a gestodene silicone elastomer core encased in a non-medicated silicone sheath, separately manufactured by reaction injection moulding at 80 degrees C and heating vulcanization at 130 degrees C is reported. The test investigated the factors affecting drug release through a single variable method, taking the drug release rates of 21 days as standards. When changing the thickness of the controlling sheath outside, the ratio of the first day of drug release and mean daily release (MDR), named the relatively burst effect, is closing to 1 with the thickness of controlling sheath increasing, while the 1.25 mm sheath corresponding to 1.04 controlled the burst release effectively; a positive correlation (r = 0.992 2) existed between the average drug release (Q/t) and drug loading (A) within a certain range. The C6-165 controlling sheath with high solubility of GEST is easier to achieve controlled release of the drug; GEST crystalline power is more effective to implement controlled release of drugs among difficent states of the drug. A 1/4 fractional segment core gives a relatively burst effect of 1.76, while the 1/1 and 1/2 are 1.93 and 1.87 separately, at the same drug loading, concluding that use of a fractional segment core would allow development of a suitable GEST reservoir IVR. In summary, GEST reservoir-type IVR could be adjusted by the thickness of controlling sheath, the loading of drug, the material properties of controlling sheath, the dispersion state of drug, the additive composition and structure of intravaginal ring, to control the drug release behavior and achieve the desired drug release rate.

  20. Laminaria vs. vaginal misoprostol for cervical preparation before second-trimester surgical abortion: a randomized clinical trial.

    Science.gov (United States)

    Sagiv, Ron; Mizrachi, Yossi; Glickman, Hagit; Kerner, Ram; Keidar, Ran; Bar, Jacob; Golan, Abraham

    2015-05-01

    To compare the efficacy and tolerability of vaginal misoprostol and laminaria for cervical preparation before second-trimester surgical abortion. We performed a prospective, randomized trial comparing midnight administration of misoprostol 600 mcg vaginally to midnight placement of laminaria, before surgical abortions among women at 13-20 weeks of gestation. The primary outcome was preoperative cervical dilation. Secondary outcomes were the need for further dilation, procedure duration and difficulty, immediate complications and side effects. Eighty-four women were randomized, with a median gestational age of 16.5 weeks. The mean time interval between misoprostol and laminaria placement and dilatation and evacuation initiation was 11.0±2.9 and 11.2±2.0h, respectively (p=.17). Cervical dilation was not greater in the laminaria group as compared to the misoprostol group (12.8 vs. 12.4mm, respectively; p=.32). No difference was demonstrated regarding the need for additional dilation or the difficulty of the procedure. Procedures performed after laminaria insertion were 1 min longer (median 11 vs. 10 min, p=.04). Participants found laminaria placement more uncomfortable than vaginal misoprostol placement. Other than pain, additional side effects occurred only in the misoprostol group, primarily nausea and vomiting. One participant in the misoprostol group experienced fetal expulsion during the night before the intended procedure. Either vaginal misoprostol or laminaria provides adequate dilation for second-trimester surgical abortion. Laminaria causes more pain at insertion and misoprostol causes more side effects. We found that cervical preparation in an inpatient setting for approximately 11h with misoprostol 600 mcg vaginally is comparable to 11h of laminaria. However, given the potential for spontaneous expulsion and more side effects with misoprostol, laminaria is likely a better general option in such a setting. Copyright © 2015 Elsevier Inc. All rights

  1. Instability of Misoprostol Tablets Stored Outside the Blister: A Potential Serious Concern for Clinical Outcome in Medical Abortion

    Science.gov (United States)

    Berard, Veronique; Fiala, Christian; Cameron, Sharon; Bombas, Teresa; Parachini, Mirella; Gemzell-Danielsson, Kristina

    2014-01-01

    Introduction Misoprostol (Cytotec) is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Misoprostol tablets are most often packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions. Objective To compare the pharmaco technical characteristics (weight, friability), water content, misoprostol content and decomposition product content (type A misoprostol, type B misoprostol and 8-epi misoprostol) of misoprostol tablets Cytotec (Pfizer) exposed to air for periods of 1 hour to 720 hours (30 days), to those of identical non exposed tablets. Methods Four hundred and twenty (420) tablets of Cytotec (Pfizer) were removed from their alveoli blister and stored at 25°C/60% relative humidity. Water content, and misoprostol degradation products were assayed in tablets exposed from 1 to 720 hours (30 days). Comparison was made with control tablets (N = 60) from the same batch stored in non-damaged blisters. Statistical analyses were carried out using Fisher’s exact test for small sample sizes. Results By 48 hours, exposed tablets demonstrated increased weight (+4.5%), friability (+1 300%), and water content (+80%) compared to controls. Exposed tablets also exhibited a decrease in Cytotec active ingredient dosage (−5.1% after 48 hours) and an increase in the inactive degradation products (+25% for type B, +50% for type A and +11% for 8-epi misoprostol after 48 hours) compared to controls. Conclusion Exposure of Cytotec tablets to ‘typical’ European levels of air and humidity results in significant time-dependent changes in physical and biological composition that could impact adversely upon clinical efficacy. Health professionals should

  2. Misoprostol exposure during the first trimester of pregnancy: Is the malformation risk varying depending on the indication?

    Science.gov (United States)

    Auffret, Marine; Bernard-Phalippon, Nathalie; Dekemp, Joëlle; Carlier, Patrick; Gervoise Boyer, Marie; Vial, Thierry; Gautier, Sophie

    2016-12-01

    To report the prospective follow-up of pregnancies exposed to misoprostol during the first trimester and analyse the teratogenic risk depending on the indication for use. Prospective observational study of 265 women exposed to misoprostol during the first 12 weeks of pregnancy and followed until the delivery. Women were included if they or their physician had contacted a French pharmacovigilance centre before 22 weeks of gestation (WG) to obtain information on the risk of misoprostol exposure, and if there had been misoprostol exposure before 13 WG. Data were collected at the time of the first contact, and the pregnancy outcome was recorded at follow-up. Women were prospectively enrolled from January 1988 to December 2013. The main indication for misoprostol was voluntary abortion (60.9%). Ten major malformations (5.5%) (95% CI 2.65-9.82%) were reported and five of them were consistent with the pattern of malformations attributed to misoprostol: Möbius sequence, hydrocephalus, terminal transverse limb reduction associated with a clubfoot, syndactyly, and complete posterior encephalocele. The rate of malformations was higher, but not significantly, in women exposed to misoprostol for voluntary abortion (7.9%) compared with women exposed to misoprostol for other or unknown indications (3.2%). Our results confirmed a specific pattern of malformations due to misoprostol use in early pregnancy, even with low dose of misoprostol. Despite the small number of cases, we observed a higher proportion of major malformations in fetuses born to women who continued their pregnancy after a failed voluntary abortion with misoprostol. Further studies should be conducted to evaluate other potential factors, such as combination treatment with mifepristone and the socio-environmental characteristics in this group of women. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortion.

    Directory of Open Access Journals (Sweden)

    Veronique Berard

    Full Text Available Misoprostol (Cytotec is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Misoprostol tablets are most often packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions.To compare the pharmaco technical characteristics (weight, friability, water content, misoprostol content and decomposition product content (type A misoprostol, type B misoprostol and 8-epi misoprostol of misoprostol tablets Cytotec (Pfizer exposed to air for periods of 1 hour to 720 hours (30 days, to those of identical non exposed tablets.Four hundred and twenty (420 tablets of Cytotec (Pfizer were removed from their alveoli blister and stored at 25°C/60% relative humidity. Water content, and misoprostol degradation products were assayed in tablets exposed from 1 to 720 hours (30 days. Comparison was made with control tablets (N=60 from the same batch stored in non-damaged blisters. Statistical analyses were carried out using Fisher's exact test for small sample sizes.By 48 hours, exposed tablets demonstrated increased weight (+4.5%, friability (+1 300%, and water content (+80% compared to controls. Exposed tablets also exhibited a decrease in Cytotec active ingredient dosage (-5.1% after 48 hours and an increase in the inactive degradation products (+25% for type B, +50% for type A and +11% for 8-epi misoprostol after 48 hours compared to controls.Exposure of Cytotec tablets to 'typical' European levels of air and humidity results in significant time-dependent changes in physical and biological composition that could impact adversely upon clinical efficacy. Health professionals should be made aware of the degradation of misoprostol with

  4. A COMPARATIVE STUDY OF OXYTOCIN/MISOPROSTOL/METHYLERGOMETRINE FOR ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOUR

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    Mundlapaty Sabitha

    2017-08-01

    Full Text Available BACKGROUND The third stage of labour is indeed the unforgiving stage of the labour and in it lurks more unheralded treachery than in both the other stages of labour combined. Many lifesaving drugs have been discovered and used for the management of this stage of labour. According to the WHO multicentric randomised trial using oral misoprostol with oxytocic, they concluded that oral misoprostol was associated with significantly high incidence of side effects like shivering and rise in body temperature and hence oxytocin is preferred to 600 mg of oral misoprostol in management of 3rd stage of labour in hospital settings, but still misoprostol has been suggested for the management of third stage of labour in developing countries, because it has strong uterotonic effects, can be given orally, inexpensive and does not need refrigeration. The aim of the study is to compare oxytocin, misoprostol, methylergometrine for active management of the third stage of labour. MATERIALS AND METHODS A total of 300 women of 37 weeks to 42 weeks of gestation delivering vaginally in Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh. 300 women allocated into 3 groups of 100 each to receive 10 IU I.M. oxytocin, 600 mcg sublingual misoprostol or 200 mcg I.M. methylergometrine, respectively. Primary outcome measure was blood loss in the third stage of labor; secondary measures were duration of the third stage, side effects and complications. RESULTS Subjects who received 600 mcg of misoprostol had the least blood loss (113 mL, followed by oxytocin and methylergometrine. The shortest mean duration of the third stage was with misoprostol (4.34 mins.. Shivering and pyrexia were observed in misoprostol group and raised blood pressure in methylergometrine group. CONCLUSION Misoprostol is as effective as oxytocin and both are more effective than methylergometrine in active management of the third stage of labour. Misoprostol therefore can be used in places

  5. Misoprostol for prevention and treatment of postpartum haemorrhage: A systematic review

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    Kabelo M. Olefile

    2013-04-01

    Full Text Available Background: Postpartum haemorrhage (PPH is a leading cause of maternal mortality especially in the developing world. Misoprostol, a highly effective drug is highly effective in inducing uterine contractions and has been proposed as a low-cost, easy-to-use intervention for PPH.Objective: This study assessed evidence of the effectiveness of misoprostol for the prevention and treatment of PPH.Method: Databases searched included MEDLINE, PUBMED, CINHAL, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL and EMBASE. Reference lists and conference proceedings were also searched for more studies. Three studies included in the meta-analysis were limited to randomised controlled trials (RCT. Two reviewers independently screened all articles for methodological quality using a standardised instrument adapted from the Cochrane Collaboration website. Data were entered in Review Manager 5.1 software for analysis.Results: Three trials (n = 2346 compared misoprostol to a placebo. Misoprostol was shown not to be effective in reducing PPH (risk ratios [RR] 0.65; 95% confidence interval [CI] 0.40–1.06. Only one trial reported on the need for a blood transfusion (RR 0.14; 95% CI 0.02–1.15. Shivering (RR 2.75; 95% CI 2.26–3.34 and pyrexia (RR 5.34; 95% CI 2.86–9.96 were significantly more common with misoprostol than with a placebo.Conclusion: The use of misoprostol was not associated with any significant reduction in the incidence of PPH. Therefore, in order to verify the efficacious use of misoprostol in the treatment of PPH, specialised investigations of its dose and routes of administration for clinically significant effects and acceptable side effects are warranted.

  6. Effect of misoprostol on patients with aspirin-exacerbated respiratory disease undergoing aspirin challenge and desensitization.

    Science.gov (United States)

    Walters, Kristen M; Simon, Ronald A; Woessner, Katharine M; Wineinger, Nathan E; White, Andrew A

    2017-07-01

    Prostaglandin E 2 (PGE 2 ) is an anti-inflammatory compound that inhibits 5-lipoxygenase activity. Diminished PGE 2 regulation in aspirin-exacerbated respiratory disease (AERD) leads to respiratory reactions on cyclooxygenase 1 inhibition. In vitro studies have found that exogenous PGE 2 stabilizes inflammatory mediator release. To examine whether misoprostol (oral prostaglandin E 1 analogue) use during aspirin challenge and desensitization might decrease the severity of aspirin-induced symptoms and make desensitization safer for patients with AERD. Forty-five patients undergoing aspirin challenge and/or desensitization were randomized to misoprostol (n = 30) or placebo (n = 15) and compared with a group of historical controls (n = 31). Misoprostol (200 μg) was administered at 30 minutes, 90 minutes, and 4 hours after the first dose of nasal ketorolac. Measured end points included change in forced expiratory volume in 1 second (FEV 1 ), peak nasal inspiratory flow rate (PNIF), number of treatments received for induced reactions, and adverse gastrointestinal effects. A difference in FEV 1 and PNIF reduction was detected between misoprostol and placebo (P = .03) and misoprostol and historical controls (P = .01), respectively, during nasal ketorolac challenge. No difference was detected among aspirin reactors. Among all reactors, no difference in magnitude was found for FEV 1 (P = .13) or PNIF (P = .07) reduction across all 3 groups. Total treatment requirement was similar (P = .14). Patients receiving misoprostol were more likely to report adverse gastrointestinal effects (P = .02). The addition of misoprostol to current aspirin challenge and/or desensitization protocols reveals no protective effect in reducing the intensity of nonsteroidal anti-inflammatory drug-induced symptoms and is not recommended based on the findings in this study. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. Second trimester medical abortion with mifepristone followed by unlimited dosing of buccal misoprostol in Armenia.

    Science.gov (United States)

    Louie, Karmen S; Chong, Erica; Tsereteli, Tamar; Avagyan, Gayane; Abrahamyan, Ruzanna; Winikoff, Beverly

    2017-02-01

    The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia. Women seeking to terminate 13-22 week pregnancies were enrolled in the study. Participants swallowed 200 mg mifepristone in the clinic and were instructed to return to the hospital for induction 24-48 h later. During induction, women were given 400 μg buccal misoprostol every 3 h until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery. A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24 h after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3 h (range 4-17.4) with a mean of 9.5 ± 2.5 h. A median of four misoprostol doses (range 2-6) with a mean of 4 ± 1 misoprostol doses were administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers. The medical abortion regimen of 200 mg mifepristone followed 24 h later by induction with 400 μg buccal misoprostol administered every 3 h, with no limit on the number of doses used for the termination of pregnancies of 13-22 weeks' gestation is an effective and acceptable option for women.

  8. Different Time Schedules of Mifepristone and Misoprostol in Second Trimester Medical Abortion: A Comparative Study

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    Nalini Sharma

    2017-07-01

    Full Text Available Background & aim: Recently, the use of mifepristone followed by misoprostol after 36-48 h has been demonstrated to be an effective and safe method for the second trimester medical abortion. However, this regimen entails long total abortion time, and consequently increases the financial burden and anxiety in the patients. We hypothesize that one day interval would be also effective and can be used to provide the abortion care. Regarding this, the present study aimed to compare the effectiveness and safety of 24- and 36-hour intervals between the administration of mifepristone and misoprstol for second trimester abortion. Methods: This prospective comparative study was conducted on 70 females who opted for second trimester medical abortion between 12-20 weeks. Mifepristone (200 mg was followed by sublingual misoprostol (800 mcg after one and two days in the first and second groups, respectively. Four hours after the administration of 800 mcg misoprostol, all patients received 400 mcg sublingual misoprostol every 4 h (maximum of four doses in 24 h. For the purpose of the study, such parameters as the rate of successful abortion 24 h after the first dose of misoprostol, abortion duration, and the associated side effect profile were examined. Results: According to the results of the present study, the two-day interval (100% was more effective than the one-day interval (91.4% (P=0.021. Furthermore, the mean induction abortion duration was significantly less in the two-day regimen. However, the side effect profiles were comparable in both groups. Conclusion: As the findings of the present study indicated, both schedules of mifepristone and misoprostol were safe and effective in second trimester abortion. The 36-hour interval between mifepristone and misoprostol was more effective than the 24-hour interval. Furthermore, it had shorter abortion duration. We can individualize the patient care by offering a one-day interval regimen since it is more

  9. Avaliação de riscos teratogênicos em gestações expostas ao misoprostol Evaluation of the teratogenic risks in gestations exposed to misoprostol

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    Emérita Sátiro Opaleye

    2010-01-01

    Full Text Available OBJETIVOS: a tentativa de aborto mal sucedida com o uso do misoprostol (Cytotec® sem indicação médica tem sido associada a malformações congênitas. Este estudo teve por objetivo identificar, em recém-nascidos malformados e controles normais, a frequência de exposição ao misoprostol e o espectro de malformações associadas. MÉTODOS: estudo de caso-controle desenvolvido em 2005 nas quatro principais maternidades públicas de Fortaleza (CE. Através de busca ativa diária, foram identificados recém-nascidos com diagnóstico de malformação fetal (caso e controles saudáveis de mesmo sexo nascidos em seguida na mesma maternidade (pareamento 1:1. A amostra foi de 252 parturientes entrevistadas por equipe treinada utilizando questionário estruturado com base no Estudo Colaborativo Latino-Americano de Malformações Congênitas (ECLAMC. Além de abordar questões sociodemográficas e histórico familiar de malformação, o questionário objetivou identificar exposições diversas durante a gestação, incluindo o misoprostol. A análise bivariada com teste do χ2 comparou os grupos quanto às características e fatores associados à malformação e foi calculada a Odds Ratio para verificar a razão de chances de o Grupo Caso apresentar malformação em relação ao Grupo Controle com relação à exposição ao misoprostol. RESULTADOS: não houve diferenças significativas entre os grupos caso e controle quanto à maioria dos fatores de riscos investigados para malformações. O relato de tentativa de aborto foi de 6,8%, havendo uma maior exposição ao misoprostol durante a gestação em neonatos malformados comparados a saudáveis, Odds Ratio (OR=3,65 (IC95%=0,74-17,91. O espectro de malformações encontradas entre os recém-nascidos expostos ao misoprostol foi compatível com a literatura, como os decorrentes de defeitos do tubo neural e disrupção vascular. CONCLUSÕES: os achados deste estudo, apesar de não apresentarem signific

  10. Effectiveness of Misoprostol for Induction of First-Trimester Miscarriages; Experience at a single tertiary care centre in Oman

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    Qamariya Ambusaidi

    2015-11-01

    Full Text Available Objectives: Non-invasive methods of inducing a miscarriage are now considered an effective alternative to surgical evacuation (dilatation and curettage. This study aimed to evaluate the effectiveness of misoprostol in the termination of first-trimester miscarriages. Methods: This prospective study was conducted between October 2009 and September 2010 and assessed all patients admitted to the Royal Hospital in Muscat, Oman, for the termination of first-trimester miscarriages during the study period. All patients received misoprostol and the rates of successful termination were measured. Patient satisfaction was assessed using a short questionnaire. Results: A total of 290 women were included in the study. Termination with misoprostol was successful in 61.38% of the subjects. Of the remaining subjects requiring additional surgical evacuation (n = 112, 58.93% required evacuation due to failed termination with misoprostol and 65.18% underwent early evacuation (≤24 hours since their last misoprostol dose. The majority of patients experienced no side-effects due to misoprostol (89.66%. Pain was controlled with simple analgesics in 70.00% of the subjects. A high satisfaction rate (94.83% with the misoprostol treatment was reported. Conclusion: Misoprostol was a well-tolerated drug which reduced the rate of surgical evacuation among the study subjects. This medication can therefore be used safely in the management of incomplete miscarriages.

  11. Double-balloon catheter and sequential oral misoprostol versus oral misoprostol alone for induction of labour at term: a retrospective cohort study.

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    Kehl, Sven; Weiss, Christel; Dammer, Ulf; Heimrich, Jutta; Beckmann, Matthias W; Faschingbauer, Florian; Sütterlin, Marc

    2016-09-01

    To evaluate the efficacy of induction of labour using a double-balloon catheter and, if necessary, sequential oral misoprostol without delay after removal of the catheter, in comparison with oral misoprostol alone. This retrospective cohort study included women undergoing induction of labour with oral misoprostol or double-balloon catheter with sequential oral misoprostol in singleton pregnancies at term. The catheter was placed in the evening and removed when there was no onset of labour within 12h. Then oral misoprostol was started within 3h. Primary outcome measure was the caesarean section rate. There were 13,082 deliveries during the study period with 3466 labour inductions out of which 1032 were eligible and analysed. The caesarean section rate was significantly lower in the double-balloon catheter group (26.1% vs. 17.3, p=0.021). Furthermore, in the combination group, the induction-to-delivery interval was shorter (median values 1144 vs. 1365min, p=0.001) and there were more deliveries within 24h (51.9 vs. 64.7%, p=0.003) and 48h (87.4 vs. 95.8%, p=0.002). When stratifying for parity, there were less caesarean sections in the combination group (37.2% vs. 24.2%, p=0.015) in nulliparous women, too. In both, nulliparous and parous women, the induction-to-delivery interval was shorter (1742 vs. 1400min, 0.005; 1020 vs. 912min, p=0.018). Especially in parous women, the rates of delivery within 24h (62.6% vs. 79.0%, p=0.007) and 48h (88.6% vs. 99.0%, p=0.007) were higher in the combination group. Double-balloon catheter and sequential oral misoprostol without long delay in absent onset of labour after removal of the catheter resulted in less caesarean section and shorter induction-to-delivery interval in comparison with oral misoprostol alone. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Misoprostol Inhibits Lipopolysaccharide-Induced Pro-inflammatory Cytokine Production by Equine Leukocytes

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    Martin, Emily Medlin; Messenger, Kristen M.; Sheats, Mary Katherine; Jones, Samuel L.

    2017-01-01

    Pro-inflammatory cytokines including tumor necrosis factor α (TNFα), IL-1β, IL-6, and IL-8 are potent immune mediators that exacerbate multiple equine diseases such as sepsis and laminitis. Unfortunately, safe and effective cytokine-targeting therapies are lacking in horses; therefore, novel mechanisms of inhibiting cytokine production are critically needed. One potential mechanism for inhibiting cytokine synthesis is elevation of intracellular cyclic AMP (cAMP). In human leukocytes, intracellular cAMP production is induced by activation of E-prostanoid (EP) receptors 2 and 4. These receptors can be targeted by the EP2/4 agonist and prostaglandin E1 analog, misoprostol. Misoprostol is currently used as a gastroprotectant in horses but has not been evaluated as a cytokine-targeting therapeutic. Thus, we hypothesized that misoprostol treatment would inhibit pro-inflammatory cytokine production by lipopolysaccharide (LPS)-stimulated equine leukocytes in an in vitro inflammation model. To test this hypothesis, equine leukocyte-rich plasma (LRP) was collected from 12 healthy adult horses and used to model LPS-mediated inflammatory signaling. LRP was treated with varying concentrations of misoprostol either before (pretreated) or following (posttreated) LPS stimulation. LRP supernatants were assayed for 23 cytokines using an equine-specific multiplex bead immunoassay. Leukocytes were isolated from LRP, and leukocyte mRNA levels of four important cytokines were evaluated via RT-PCR. Statistical differences between treatments were determined using one-way RM ANOVA (Holm–Sidak post hoc testing) or Friedman’s RM ANOVA on Ranks (SNK post hoc testing), where appropriate (p equine leukocytes but had no effect on IL-8 protein. Interestingly, misoprostol pretreatment enhanced IL-1β protein synthesis following 6 h of LPS stimulation, while misoprostol posttreatment inhibited IL-1β protein production after 24 h of LPS stimulation. At the mRNA level, misoprostol pre

  13. A randomized trial of misoprostol versus laminaria before dilation and evacuation in South Africa.

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    Grossman, Daniel; Constant, Deborah; Lince-Deroche, Naomi; Harries, Jane; Kluge, Judy

    2014-09-01

    To compare complication rates, efficacy and acceptability of buccal misoprostol to laminaria for cervical preparation before dilation and evacuation (D&E) in South Africa. We performed a randomized, single-blind trial comparing buccal misoprostol 400 mcg (1-2 doses, administered at least 3 h before D&E) to laminaria inserted the day before D&E among women at 13-19 weeks gestation. The primary outcome was expulsion of the fetus prior to surgery; secondary outcomes included other complications, need for mechanical dilation, procedure duration, side effects and satisfaction. Required sample size was 176 to detect a difference in expulsion of 20% to 5%, with a two-sided alpha of 0.05 and 80% power. Due to slow enrollment and low incidence of primary outcome, the study was stopped early. One hundred fifty-nine women were randomized, and 156 received treatment (78 in each group). Mean gestational age was 14.8 weeks (range, 13.0-18.6 weeks). Complications were rare and did not differ by group [three in each group; odds ratio (OR), 1; 95% confidence interval (CI), 0.20-5.11]; this included two expulsions in the misoprostol group (2.6%). Misoprostol participants were more likely to require mechanical dilation compared to those receiving laminaria (35% vs. 8%; OR, 6.4; 95% CI, 2.4-16.5). The proportion of women reporting each side effect was similar except for diarrhea (21.3% in misoprostol group vs. 5.2% in laminaria group, p=0.004). Procedure time and satisfaction did not differ between groups. Both misoprostol and laminaria are associated with a low complication rate in this setting, although misoprostol requires more mechanical dilation and causes more diarrhea. Cervical preparation using either laminaria or misoprostol can be safely used before D&E up to at least 19 weeks. Physicians using misoprostol must be skilled at mechanical dilation, since this is commonly required. Copyright © 2014. Published by Elsevier Inc.

  14. EVALUACIÓN DE PROGESTERONA INTRAVAGINAL POST INSEMINACIÓN ARTIFICIAL PARA REDUCIR LA MUERTE EMBRIONARIA EN VACAS

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    Jorge Ignacio Macias

    2014-06-01

    Full Text Available El objetivo de esta investigación fue evaluar el efecto de la administración de un dispositivo intravaginal de progesterona post IATF sobre la reducción de la muerte embrionaria, el cual se aplicó siete días después de la inseminación. Se utilizaron 40 vacas de aptitud cárnica de cruza mestiza Senangus x Brahman de dos-cuatro partos. Se realizó ecografía transrectal (Aquilla Vet 7.5 MHZ previo a la sincronización. Se efectuó el inicio de ésta con el dispositivo CIDR 1.38 g progesterona. Después de siete días de la inseminación se colocó el dispositivo usado a 20 animales tratamiento y se lo mantuvo durante 10 días. Se realizó tomas de muestras de sangre para medir los niveles de P4. Estas fueron tomadas a cinco animales del grupo tratamiento en el día que se reinsertó el dispositivo, 5 días después y al retiro. Las muestras revelaron niveles altos de progesterona que oscilaron entre 7.87 hasta 19.4 ng/mL. Se diagnosticó gestación a los 30 y 60 días. Se realizó un análisis costo beneficio al tratamiento. En los resultados se encontró una relación entre los tratamientos y la preñez a los 30 días (p=0.053; la relación del costo beneficio se manifestó económicamente viable con la aplicación de progesterona, ya que por cada dólar invertido se genera como ganancia 23 ctvs de dólar. Se concluye que la aplicación de progesterona reduce la muerte embrionaria hasta los 30 días post inseminación.

  15. Intra-vaginal Zinc Oxide Tetrapod Nanoparticles as Novel Immunoprotective Agents against Genital Herpes

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    Antoine, Thessicar E.; Hadigal, Satvik R.; Yakoub, Abraam; Mishra, Yogendra K.; Bhattacharya, Palash; Haddad, Christine; Valyi-Nagy, Tibor; Adelung, Rainer; Prabhakar, Bellur S.; Shukla, Deepak

    2016-01-01

    Virtually all efforts to generate an effective protection against the life-long, recurrent genital infections caused by Herpes simplex virus-2 (HSV-2) have failed. Apart from sexual transmission, the virus can also be transmitted from mothers to neonates, and is a key facilitator of HIV co-acquisition. Here, we uncover a nanoimmunotherapy using specially designed Zinc Oxide Tetrapod Nanoparticles (ZOTEN) with engineered oxygen vacancies. We demonstrate that ZOTEN, when used intravaginally as a microbicide, is an effective suppressor of HSV-2 genital infection in female BALB/c mice. The strong HSV-2 trapping ability of ZOTEN significantly reduced the clinical signs of vaginal infection and effectively decreased animal mortality. In parallel, ZOTEN promoted the presentation of bound HSV-2 virions to mucosal antigen presenting cells, enhancing T cell- mediated and antibody-mediated responses to the infection, and thereby, suppressing a re-infection. We also found that ZOTEN exhibits strong adjuvant-like properties, which is highly comparable to alum, a commonly used adjuvant. Overall, our study provides very first evidence for the protective efficacy of an intravaginal microbicide/vaccine or microbivac platform against primary and secondary female genital herpes infections. PMID:27183601

  16. Female urinary incontinence and intravaginal electrical stimulation: an observational prospective study.

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    Chêne, Gautier; Mansoor, Aslam; Jacquetin, Bernard; Mellier, Georges; Douvier, Serge; Sergent, Fabrice; Aubard, Yves; Seffert, Pierre

    2013-09-01

    To assess the efficacy of intravaginal electrical stimulation in the management of female urinary incontinence. 359 Women with urinary incontinence (207 with stress incontinence [group A], 33 with urge incontinence [group B] and 119 with mixed urinary incontinence [group C]) were included in this multicenter prospective observational study. Patients were managed by home intravaginal electrical stimulation of the pelvic floor for 20-30 min per day, 5 days a week, for a period of 10 weeks. Identical clinical assessments were performed before and after pelvic floor rehabilitation, comprising a voiding diary and validated symptom and quality of life scores. Objective assessment demonstrated an overall cure rate of 63.5% (228/359): 65.7% (136/207) for group A, 57.6% (19/33) for group B, and 61.3% (73/119) for group C. The overall significant improvement rate was 15.6% (56/359): 14.6% (30/207) for group A, 24.2% (8/33) for group B and 15.1% (18/119) for group C. All domains of quality of life were significantly improved after pelvic floor muscle training (pstimulation intensities. No significant difference was observed between the various types of electrodes used (pstimulators probably make this treatment modality one of the first-line treatments for female stress urinary incontinence. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Intravaginal testicular torsion in newborns. To fix or not to fix the contralateral testis?

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    G. Bordin

    2013-10-01

    Full Text Available Scrotal swelling suggesting testicular torsion is a rare urological emergency which requires a clinical urgent evaluation and most of the times must be managed surgically. In newborns it can occur in the postnatal period, usually within the twenty-eighth day of life, or more frequently in utero, during the descent of the testis into the scrotum. Usually its poor fixedness allows the testis an abnormal mobility inside the scrotum, configuring the framework of extravaginal torsion. On the contrary during the perinatal period a twist that takes place inside the tunica vaginalis, known as intravaginal torsion, is extremely uncommon and only few cases are well documented in the literature. Authors present a rare case of intravaginal testicular torsion occurred in perinatal period. In this situation only the early surgical exploration of the scrotum may allow the rescue of the gonad, although in rare cases. Timing of surgical treatment and need for contralateral testicular fixation remain controversial. However since the anatomical defect of the tunica vaginalis can be bilateral the surgical fixation even of the contralateral testis is important, now or later, in order to prevent any future torsion of this gonad. The authors also present a brief review of recent literature on the subject.

  18. Reaching women with instructions on misoprostol use in a Latin American country.

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    Cohen, Jessica; Ortiz, Olivia; Llaguno, Silvia Elena; Goodyear, Lorelei; Billings, Deborah; Martinez, Imelda

    2005-11-01

    In Latin America, where restrictive laws limit women's access to safe abortion services, misoprostol is being used to induce abortions, often without correct information on dosage or regimens. This study in an unnamed Latin American country aimed to identify appropriate channels through which instructions on misoprostol use could be disseminated to women. In-depth interviews were carried out with physicians, pharmacy staff, women who had had safe abortions and women from the community, as well as focus group discussions with advocates of safe abortion. Participants considered physicians to be the most appropriate source of information and for ensuring confidentiality for both women and provider. Participants considered midwives, pharmacists and women's groups as appropriate referral points, but not providers of information. Legal restrictions and professional risk were the primary reasons why pharmacists rejected this role, though many are selling misoprostol. There was a general lack of information about misoprostol for medical abortion among both health professionals and women. Accurate information about misoprostol use for a wide range of gynaecologic and obstetric purposes, including induced abortion, could be incorporated into training and educational materials for physicians, midwives and other appropriate mid-level providers, as well as pharmacists. Without these alternative information channels, access to information would be severely restricted, especially in rural areas.

  19. A randomized controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum hemorrhage.

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    Priya, G Prema; Veena, P; Chaturvedula, Latha; Subitha, L

    2015-12-01

    In India, two third of maternal deaths occur in rural areas where there is lack of transportation facilities, lack of refrigeration to store the injectable uterotonic drug such as oxytocin, lack of skilled personnel to administer them and lack of sterile syringes and needles. Hence, this study was conceived to evaluate misoprostol as a safe, effective, easily administered non-parenteral drug in the prevention of postpartum hemorrhage. This study was conducted during the period from August 2012 to July 2014. Low risk women with singleton pregnancy at term admitted for vaginal delivery were eligible for the study. A total of 500 women were randomized to two groups, 250 in each group, either to receive 400 mcg misoprostol sublingually or 10 units oxytocin intramuscularly at the delivery of anterior shoulder. Patient factors, labor parameters, blood loss and side effects were noted. The women in both the groups were well matched with respect to age, parity, gestational age and labor parameters. There was statistical significance in the blood loss (p = 0.04) between the two groups. The average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin group. Shivering was the statistically significant side effect (p = 0.004) in the misoprostol group and nausea was the statistically significant side effect (p = 0.003) in the oxytocin group. Sublingual misoprostol is as effective as intramuscular oxytocin as a prophylactic oxytocic in the active management of third stage of labor for prevention of postpartum hemorrhage.

  20. Vaginal misoprostol and cervical ripening balloon for induction of labor in late-term pregnancies.

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    Duro Gómez, Jorge; Garrido Oyarzún, María Fernanda; Rodríguez Marín, Ana Belén; de la Torre González, Antonio Jesús; Arjona Berral, José Eduardo; Castelo-Branco, Camil

    2017-01-01

    The aim of this study was to compare vaginal misoprostol with the Cook cervical ripening balloon (CCRB) for induction of labor in late-term nulliparous women. This open, quasi-experimental, prospective study included 109 nulliparous women with late-term pregnancies and Bishop scores misoprostol 25 mcg and 54 received the CCRB to induce labor. The primary outcome was the time until delivery. Secondary outcomes included time to the onset of labor and obstetric and perinatal outcomes. Women in the misoprostol group experienced shorter time until delivery (25.41 h vs 31.26 h; P misoprostol and the CCRB, respectively. There were no differences in the rates of cesarean section or post-partum anemia. Additionally, there were no differences in rates of tachysystolia, intrapartum fever, or meconium. Perinatal outcomes, post-partum pH, Apgar scores, and neonatal admissions were similar in the two groups. Misoprostol 25 mcg reduces labor induction time compared with the CCRB with similar safety in late-term pregnancies. © 2016 Japan Society of Obstetrics and Gynecology.

  1. Comparison of sublingual and vaginal misoprostol for second-trimester pregnancy terminations.

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    Forozan Milani

    2014-03-01

    Full Text Available Comparing sublingual and vaginal misoprostol in second trimester pregnancy termination.In this study 268 women at 12-24 weeks of gestation candidate for pregnancy termination were enrolled. Women were randomly divided in two groups. The first group received 400 µg sublingual misoprostol and vaginal placebo and the second group received 400 µg vaginal misoprostol and sublingual placebo every 4 hours for a maximum of five doses. The course of misoprostol was repeated if the women did not abort within 24 hours.The median induction-to-abortion interval was shorter in sublingual group (12/72 hours in sublingual and 14/67 hours in vaginal. There was no significant difference in the success rate at 24 and 48 hours and in side effects. The preference for the sublingual route of administration was higher.Both vaginal and sublingual misoprostol are effective for medical abortion in second trimester termination. But it appears from shorter induction interval in sublingual and higher acceptability that sublingual route is a better choice.

  2. Lack of evidence for neonatal misoprostol neurodevelopmental toxicity in C57BL6/J mice.

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    Claire M Koenig

    Full Text Available Misoprostol is a synthetic analogue of prostaglandin E1 that is administered to women at high doses to induce uterine contractions for early pregnancy termination and at low doses to aid in cervical priming during labor. Because of the known teratogenic effects of misoprostol when given during gestation and its effects on axonal growth in vitro, we examined misoprostol for its potential as a neurodevelopmental toxicant when administered to neonatal C57BL6/J mice. Mice were injected subcutaneously (s.c. with 0.4, 4 or 40 µg/kg misoprostol on postnatal day 7, the approximate developmental stage in mice of human birth, after which neonatal somatic growth, and sensory and motor system development were assessed. These doses were selected to span the range of human exposure used to induce labor. In addition, adult mice underwent a battery of behavioral tests relevant to neurodevelopmental disorders such as autism including tests for anxiety, stereotyped behaviors, social communication and interactions, and learning and memory. No significant effects of exposure were found for any measure of development or behavioral endpoints. In conclusion, the results of the present study in C57BL/6J mice do not provide support for neurodevelopmental toxicity after misoprostol administration approximating human doses and timed to coincide with the developmental stage of human birth.

  3. PGE2 receptor agonist misoprostol protects brain against intracerebral hemorrhage in mice

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    Wu, He; Wu, Tao; Hua, Wei; Dong, Xianghui; Gao, Yufeng; Zhao, Xiaochun; Chen, Wenwu; Cao, Wangsen; Yang, Qingwu; Qi, Jiping; Zhou, Jin; Wang, Jian

    2015-01-01

    Intracerebral hemorrhage (ICH) is a devastating form of stroke. Misoprostol, a synthetic PGE1 analog and PGE2 receptor agonist, has shown protection against cerebral ischemia. In this study, we tested the efficacy of misoprostol in 12-month-old mice subjected to one of two complementary ICH models, the collagenase model (primary study) and blood model (secondary study, performed in an independent laboratory). We also investigated its potential mechanism of action. Misoprostol post-treatment decreased brain lesion volume, edema, and brain atrophy and improved long-term functional outcomes. In the collagenase-induced ICH model, misoprostol decreased cellular inflammatory response; attenuated oxidative brain damage and gelatinolytic activity; and decreased HMGB1 expression, Src kinase activity, and interleukin-1β expression without affecting cyclooxygenase-2 expression. Further, HMGB1 inhibition with glycyrrhizin decreased Src kinase activity, gelatinolytic activity, neuronal death, and brain lesion volume. Src kinase inhibition with PP2 decreased gelatinolytic activity and brain edema and improved neurologic function, but did not decrease HMGB1 protein level. These results indicate that misoprostol protects brain against ICH injury through mechanisms that may involve the HMGB1, Src kinase, and MMP-2/9 pathway. PMID:25623334

  4. Comparison of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women.

    Science.gov (United States)

    Inal, Hasan Ali; Ozturk Inal, Zeynep Hafiza; Tonguc, Esra; Var, Turgut

    2015-05-01

    To compare the effectiveness of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women. Placebo-controlled, double blind, randomized trial. Teaching and research hospital. Ninety women of reproductive age eligible for diagnostic hysteroscopy. Randomly assignment to receive 400 μg of misoprostol (n = 30) or 10 mg of dinoprostone (n = 30) vaginally before diagnostic hysteroscopy, with a control group (n = 30) not receiving any cervical priming agent. the number of women requiring cervical dilatation; secondary outcomes: cervical width before surgery, duration of dilatation time, ease of dilatation, complications during surgical procedure, and side effects of the drugs. In the placebo group, 23 patients required cervical dilatation compared with 17 in the misoprostol group and 9 in the dinoprostone group. The mean (± standard deviation) cervical widths for the placebo, misoprostol, and dinoprostone groups were 4.23 ± 0.43 mm, 5.43 ± 0.5 mm, and 5.83 ± 0.64 mm, respectively. These widths were statistically significantly different. The duration of dilatation was also statistically significantly longer in the control group. Vaginally administered dinoprostone before diagnostic hysteroscopy is more effective than misoprostol for inducing cervical priming. Further studies are required to elucidate the most efficient option with the least side effects for cervical ripening. NCT01620814. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  5. Lack of Evidence for Neonatal Misoprostol Neurodevelopmental Toxicity in C57BL6/J Mice

    Science.gov (United States)

    Koenig, Claire M.; Walker, Cheryl K.; Qi, Lihong; Pessah, Isaac N.; Berman, Robert F.

    2012-01-01

    Misoprostol is a synthetic analogue of prostaglandin E1 that is administered to women at high doses to induce uterine contractions for early pregnancy termination and at low doses to aid in cervical priming during labor. Because of the known teratogenic effects of misoprostol when given during gestation and its effects on axonal growth in vitro, we examined misoprostol for its potential as a neurodevelopmental toxicant when administered to neonatal C57BL6/J mice. Mice were injected subcutaneously (s.c.) with 0.4, 4 or 40 µg/kg misoprostol on postnatal day 7, the approximate developmental stage in mice of human birth, after which neonatal somatic growth, and sensory and motor system development were assessed. These doses were selected to span the range of human exposure used to induce labor. In addition, adult mice underwent a battery of behavioral tests relevant to neurodevelopmental disorders such as autism including tests for anxiety, stereotyped behaviors, social communication and interactions, and learning and memory. No significant effects of exposure were found for any measure of development or behavioral endpoints. In conclusion, the results of the present study in C57BL/6J mice do not provide support for neurodevelopmental toxicity after misoprostol administration approximating human doses and timed to coincide with the developmental stage of human birth. PMID:22719983

  6. Comparison of manual vacuum aspiration and misoprostol in the management of incomplete abortion

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    Gabkika Bray Madoue

    2016-11-01

    Full Text Available Background: Incomplete abortions can be managed expectantly, surgically and medically (using misoprostol. Expectant management is safe in places where women have access to information, appropriate care and follow-up; however, in isolated and poor areas women who come for help need an intervention. Objective: To compare the efficiency of manual vacuum aspiration (MVA and misoprostol in the treatment of incomplete abortion. Patients and method: This was a prospective study over five months from March to August 2015. All patients admitted with a diagnosis of incomplete abortion were recruited into the study. Results: 308 patients with incomplete abortion were randomized into two treatment groups - MVA (done under local anaesthesia and misoprostol (400 micrograms by the vaginal route. MVA was successfully performed for all patients. Two patients presented with anaemia. In the misoprostol group, 23 patients had vaginal bleeding, and 10 persistence of incomplete abortion. Conclusion: MVA is more effective than misoprostol with less complications in the treatment of incomplete abortion when it is done by a trained person.

  7. Sublingual misoprostol is as effective as intravenous oxytocin to reduce intra-operative blood loss during cesarean delivery in women living at high altitude.

    Science.gov (United States)

    Gavilanes, Patricio; Morales, Maria Fernanda; Velasco, Stiward; Teran, Enrique

    2016-01-01

    To assess the effect of sublingual misoprostol compared to intravenous oxytocin for blood loss during cesarean delivery in women living at high altitude. In a randomized trial, conducted in Quito, Ecuador (2800 m above sea level), 100 women received either sublingual misoprostol (400 µg) or intravenous oxytocin (10 IU). Bleeding in the misoprostol was no different than in the oxytocin group. Shivering was reported in 66% of women in the misoprostol group. Sublingual misoprostol might be a valid alternative to oxytocin reduce intra-operative blood loss during cesarean section in women living at high altitude.

  8. Fescues of the Intravaginal group of Festuca L. section Festuca in the lowland and montane areas of the northeastern Iberian Peninsula

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    Pyke, S.

    2013-12-01

    Full Text Available Fescues of the Intravaginal group of Festuca L. section Festuca in the lowland and montane areas of the northeastern Iberian Peninsula.— Morphologically similar fescues occur across the study area (Mediterranean area of the northeastern Iberian Peninsula at low and middle elevations. With the exception of the high mountain or alpine species, these populations are reviewed here, with particular attention being paid to the Festuca inops (F. gracilior group, as well as to some other species, in particular F. lemanii, which are not easily understood and can complicate identification, especially where the taxa occur sympatrically. The application of the binomen F. inops De Not. to some of the Iberian populations constituting the F. inops group is discussed. New records for F. tarraconensis, F. occitanica, F. michaelis and F. heteroidea amplify the distribution range of these little-known taxa within the Iberian Peninsula.Diferentes especies de Festuca morfológicamente afines crecen en gran parte del territorio objeto de esta reseña (tierras mediterráneas del nordeste de la Península Ibérica, a baja y mediana altitud. Excluyendo las especies de alta montaña, estas poblaciones se han estudiado aquí haciendo hincapié en Festuca grupo inops (F. gracilior, y se han tratado otras especies (F. lemanii en especial que a veces complican la identificación de los miembros de dicho grupo, sobre todo cuando solapan sus distribuciones. Se comenta la aplicación del binomen F. inops De Not. a algunas poblaciones ibéricas del grupo F. inops. Nuevas citas de F. tarraconensis, F. occitanica, F. michaelis y F. heteroidea amplían la distribución de estos taxones dentro de la Península Ibérica.

  9. Community-based distribution of misoprostol to prevent postpartum haemorrhage at home births: results from operations research in rural Ghana.

    Science.gov (United States)

    Geller, S; Carnahan, L; Akosah, E; Asare, G; Agyemang, R; Dickson, R; Kapungu, C; Owusu-Ansah, L; Robinson, N; Mensah-Homiah, J

    2014-02-01

    To report on a rigorous distribution and monitoring plan to track misoprostol for community-based distribution to reduce postpartum haemorrhage (PPH) in rural Ghana. Operations research. Rural Ghana. Women in third trimester of pregnancy presenting to primary health centres (PHCs) for antenatal care (ANC). Ghana Health Service (GHS), Millennium Village Projects, and the University of Illinois at Chicago conducted an operations research study designed to assess the safety, feasibility, and acceptability of community-based distribution of misoprostol to prevent PPH at home deliveries in rural Ghana. One thousand doses (3000 tablets, 200 μg each) were obtained from the Family Health Division of GHS. Three 200-μg tablets of misoprostol (600 μg) in foil packets were packaged together in secured transparent plastic packets labelled with pictorial messages and distributed to midwives at seven PHCs for distribution to pregnant women. Correct use of misoprostol in home deliveries and retrieval of unused misoprostol doses, PPH rates and maternal mortality. Of the 999 doses distributed to midwives, 982 (98.3%) were successfully tracked, with a 1.7% lost to follow-up rate. Midwives distributed 654 doses to women at third-trimester ANC visits. Of women who had misoprostol to use at home, 81% had an institutional delivery and were able to return the misoprostol safely to the midwife. Of the women that used misoprostol, 99% used the misoprostol correctly. This study clearly demonstrates that misoprostol distributed antenatally to pregnant women can be used accurately and reliably by rural Ghanaian women, and should be considered for policy implementation across Ghana and other countries with high home birth rates and maternal mortality ratios. © 2013 Royal College of Obstetricians and Gynaecologists.

  10. Misoprostol-induced fever and genetic polymorphisms in drug transporters SLCO1B1 and ABCC4 in women of Latin American and European ancestry.

    Science.gov (United States)

    Alfirevic, Ana; Durocher, Jill; Elati, Anisa; León, Wilfrido; Dickens, David; Rädisch, Steffen; Box, Helen; Siccardi, Marco; Curley, Paul; Xinarianos, George; Ardeshana, Arjun; Owen, Andrew; Zhang, J Eunice; Pirmohamed, Munir; Alfirevic, Zarko; Weeks, Andrew; Winikoff, Beverly

    2015-01-01

    Misoprostol, a prostaglandin analogue used for the treatment of postpartum hemorrhage and termination of pregnancy, can cause high fevers. Genetic susceptibility may play a role in misoprostol-induced fever. Body temperature of women treated with misoprostol for termination of pregnancy in the UK (n = 107) and for postpartum hemorrhage in Ecuador (n = 50) was measured. Genotyping for 33 single nucleotide polymorphisms in 15 candidate genes was performed. Additionally, we investigated the transport of radiolabeled misoprostol acid across biological membranes in vitro. The ABCC4 single nucleotide polymorphism rs11568658 was associated with misoprostol-induced fever. Misoprostol acid was transported across a blood-brain barrier model by MRP4 and SLCO1B1. Genetic variability in ABCC4 may contribute to misoprostol-induced fever in pregnant women. Original submitted 21 January 2015; Revision submitted 24 April 2015.

  11. Comparison of gemeprost and vaginal misoprostol in first trimester mifepristone-induced abortion

    DEFF Research Database (Denmark)

    Svendsen, Pernille Fog; Rørbye, Christina; Vejborg, Thomas

    2005-01-01

    Abstract Background The aim of this study was to compare efficacy and side effects of gemeprost and vaginal misoprostol in mifepristone-induced abortions in women up to 63 days of gestation. Methods A retrospective study of 833 consecutive patients admitted for medical termination of first...... trimester pregnancy was conducted. Four-hundred ten patients received mifepristone 600 mg, followed 48 h later by gemeprost 1 mg (regimen I), and 423 patients received mifepristone 200 mg followed by vaginal misoprostol 800 µg (regimen II). Success rates were evaluated after 2 weeks and after 3 months......, gemeprost and vaginal misoprostol are equally effective for termination of first trimester abortion, but may be associated with varying intensity of side effects....

  12. Induction of labour: a comparison between controlled-release dinoprostone vaginal pessary (Cervidil) and dinoprostone intravaginal gel (Prostin E2).

    Science.gov (United States)

    Kho, Ee Min; Sadler, Lynn; McCowan, Lesley

    2008-10-01

    There are various prostaglandin preparations available for inducing labour. Controlled-release dinoprostone vaginal pessary is used in a number of centres in Australia and New Zealand. To compare the efficacy and safety of controlled-release dinoprostone vaginal pessary (Cervidil) with dinoprostone intravaginal gel (Prostin E2) for induction of labour. Retrospective cohort study of 969 women who were induced using either 10-mg controlled-released dinoprostone vaginal pessary (n=507) or intravaginal dinoprostone gel (n=462) at National Women's Health, Auckland City Hospital. Study outcomes included induction to delivery interval, mode of delivery, rate of oxytocin augmentation and incidence of uterine hyperstimulation. Induction to vaginal birth interval was longer among nullipara receiving the pessary compared to those receiving intravaginal gel (21.5 vs 17.8 h, P=0.004). There was no difference in rates of oxytocin augmentation or in mode of birth between pessary and gel groups. There was a trend to more uterine hyperstimulation among women induced with the pessary compared with those induced with intravaginal gel (22 (4.5%) vs 11 (2.4%) relative risk (RR) 1.9 (0.9-3.9)). Hyperstimulation associated with an abnormal fetal heart pattern (14 (2.9%) vs 2 (0.4%), RR 6.5 (1.5-28.9)) or treated with tocolytics (9 (1.8%) vs 1 (0.2%), RR 8.4 (1.1-66)) was more common in women who received the pessary. Use of dinoprostone vaginal pessaries did not shorten time to delivery or improve any other birth outcome measured compared to dinoprostone intravaginal gel. Clinically significant hyperstimulation appeared more common following use of the pessary. Large randomised controlled trials are needed to confirm or refute these findings.

  13. Intracervical versus vaginal misoprostol for cervical dilatation prior to operative hysteroscopy—a comparative study

    Science.gov (United States)

    Goyal, BK; Roy, Premansu; Bhat, PM; Das, NK; Paul, KG; Duggal, BS

    2012-01-01

    Background Hysteroscopic surgery requires pre-operative cervical ripening to facilitate adequate dilatation of the cervix for insertion of operative hysteroscope. This study was conducted to compare the efficacy of intracervical misoprostol with vaginal misoprostol in achieving cervical ripening before operative hysteroscopy. Methods In this randomised comparative study conducted at a tertiary care teaching hospital, 56 patients needing operative hysteroscopy were divided into two groups of 28 patients, one for intracervical misoprostol and the other for vaginal misoprostol. Four hundred microgram of misoprostol was inserted on the night before and in the morning of operative hysteroscopy intracervically in group I and vaginally in group II. Results Primary outcome measure was number of patients achieving 7 mm preoperative dilatation of cervix. Largest Hegar dilator that could be passed into the uterine cavity past the internal optic sheath without resistance was noted in each case. Mean cervical dilatation prior to operative hysteroscopy was calculated. In addition, incidence of slipping of vulsellum and cervical laceration was also noted. Time to achieve full cervical dilatation was recorded. In 23/28 cases of group I and 5/28 in group II, size 7 Hegar dilator could be passed without effort. Mean cervical dilatation was 7.5 mm in group I and 5.7 mm in group II. Slipping of the vulsellum and cervical lacerations were seen in significantly less patients in group I. Mean time to achieve cervical dilatation to 10 mm was 43.39 seconds in group I and 103.96 seconds in group II (PIntracervical administration of misoprostol is an effective method of achieving cervical ripening for easy cervical dilatation up to 10 mm prior to operative hysteroscopy. PMID:24669051

  14. Intracervical versus vaginal misoprostol for cervical dilatation prior to operative hysteroscopy-a comparative study.

    Science.gov (United States)

    Goyal, Bk; Roy, Premansu; Bhat, Pm; Das, Nk; Paul, Kg; Duggal, Bs

    2012-04-01

    Hysteroscopic surgery requires pre-operative cervical ripening to facilitate adequate dilatation of the cervix for insertion of operative hysteroscope. This study was conducted to compare the efficacy of intracervical misoprostol with vaginal misoprostol in achieving cervical ripening before operative hysteroscopy. In this randomised comparative study conducted at a tertiary care teaching hospital, 56 patients needing operative hysteroscopy were divided into two groups of 28 patients, one for intracervical misoprostol and the other for vaginal misoprostol. Four hundred microgram of misoprostol was inserted on the night before and in the morning of operative hysteroscopy intracervically in group I and vaginally in group II. Primary outcome measure was number of patients achieving 7 mm preoperative dilatation of cervix. Largest Hegar dilator that could be passed into the uterine cavity past the internal optic sheath without resistance was noted in each case. Mean cervical dilatation prior to operative hysteroscopy was calculated. In addition, incidence of slipping of vulsellum and cervical laceration was also noted. Time to achieve full cervical dilatation was recorded. In 23/28 cases of group I and 5/28 in group II, size 7 Hegar dilator could be passed without effort. Mean cervical dilatation was 7.5 mm in group I and 5.7 mm in group II. Slipping of the vulsellum and cervical lacerations were seen in significantly less patients in group I. Mean time to achieve cervical dilatation to 10 mm was 43.39 seconds in group I and 103.96 seconds in group II (PIntracervical administration of misoprostol is an effective method of achieving cervical ripening for easy cervical dilatation up to 10 mm prior to operative hysteroscopy.

  15. Misoprostol use under routine conditions for termination of pregnancies with intrauterine fetal death

    Directory of Open Access Journals (Sweden)

    Maria Isabel do Nascimento

    2013-08-01

    Full Text Available OBJECTIVE: To analyze the misoprostol use in pregnancies with intrauterine fetal death (IUFD, considering mode of delivery and induction-delivery interval. METHODS: Descriptive study including 171 pregnant women with IUFD, in the second or third trimester, submitted to labor induction with vaginal misoprostol and/or induction/augmentation with intravenous oxytocin, from 2005 to 2008, at a teaching-hospital of the Brazilian Unified Health System (Sistema Único de Saúde -SUS. RESULTS: Misoprostol alone (treatment A, misoprostol plus oxytocin (treatment B, and oxytocin alone (treatment C were administered in 9.3%, 19.9%, and 70.8% of the cases, respectively. One-third of pregnancies were less than 28 weeks, and 2.9% required a caesarean section. The percentage of vaginal delivery in treatments A and B combined (98.0% was similar to treatment C (96.7%. The mean induction-delivery interval was 15.4 hours. Comparing multiple groups, the mean induction-delivery interval was significantly shorter in treatment A (20.1 hours than in treatment B (33.3 hours, and was longer than in treatment C (9.7 hours. The majority (71% of cases required a single administration of misoprostol, and the total dosage was lower in treatment A (mean: 98.4 µg compared with treatment B (mean: 157.0 µg. CONCLUSION: Misoprostol effectively contributed to delivery of IUFD by vaginal route assisted under routine conditions of a public health service in Brazil, demonstrating its importance in cases resistant to usual induction methods, and its availability in Brazilian public health services is recommended.

  16. Misoprostol for treating postpartum haemorrhage: a randomized controlled trial [ISRCTN72263357

    Directory of Open Access Journals (Sweden)

    Maholwana Babalwa

    2004-08-01

    Full Text Available Abstract Background Postpartum haemorrhage remains an important cause of maternal death despite treatment with conventional therapy. Uncontrolled studies and one randomised comparison with conventional oxytocics have reported dramatic effects with high-dose misoprostol, usually given rectally, for treatment of postpartum haemorrhage, but this has not been evaluated in a placebo-controlled trial. Methods The study was conducted at East London Hospital Complex, Tembisa and Chris Hani Baragwanath Hospitals, South Africa. Routine active management of the third stage of labour was practised. Women with more than usual postpartum bleeding thought to be related to inadequate uterine contraction were invited to participate, and to sign informed consent. All routine treatment was given from a special 'Postpartum Haemorrhage Trolley'. In addition, participants who consented were enrolled by drawing the next in a series of randomised treatment packs containing either misoprostol 5 × 200 μg or similar placebo, which were given 1 orally, 2 sublingually and 2 rectally. Results With misoprostol there was a trend to reduced blood loss ≥500 ml in 1 hour after enrolment measured in a flat plastic 'fracture bedpan', the primary outcome (6/117 vs 11/120, relative risk 0.56; 95% confidence interval 0.21 to 1.46. There was no difference in mean blood loss or haemoglobin level on day 1 after birth 38.5°C (11/114 vs 2/118; 5.69, 1.29 to 25. In the misoprostol group 3 women underwent hysterectomy of whom 1 died, and there were 2 further maternal deaths. Conclusions Because of a lower than expected incidence of the primary outcome in the placebo group, the study was underpowered. We could not confirm the dramatic effect of misoprostol reported in several unblinded studies, but the results do not exclude a clinically important effect. Larger studies are needed to assess substantive outcomes and risks before misoprostol enters routine use.

  17. Serum biomarkers may help predict successful misoprostol management of early pregnancy failure.

    Science.gov (United States)

    Schreiber, Courtney A; Ratcliffe, Sarah J; Quinley, Kelly E; Miller, Carrie; Sammel, Mary D

    2015-06-01

    In order to simplify management of early pregnancy loss, our goal was to elucidate predictors of successful medical management of miscarriage with a single dose of misoprostol. In this secondary analysis of data from a multicenter randomized controlled trial, candidate biomarkers were compared between 49 women with missed abortion who succeeded in passing their pregnancy with a single dose of misoprostol and 46 women who did not pass their pregnancy with a misoprostol single dose. We computed the precision of trophoblastic protein and hormone concentrations to discriminate between women who succeed or fail single dose misoprostol management. We also included demographic factors in our analyses. We found overlap in the concentrations of the individual markers between women who succeeded and failed single-dose misoprostol. However, hCG levels ≥ 4000 mIU/mL and ADAM-12 levels ≥ 2500 pg/mL were independently associated with complete uterine expulsion after one dose of misoprostol in our population. A multivariable logistic model for success included non-Hispanic ethnicity and parity <2 in addition to hCG ≥ 4000 mIU/mL and ADAM-12 ≥ 2500 pg/mL and had an area under the receiver operating characteristic (ROC) of 0.81 (95% confidence interval: 72-90%). Categorizing women with a predicted probability of ≥ 0.65 resulted in a sensitivity of 75.0%, specificity 77.1% and positive predictive value of 81.8%. While preliminary, our data suggest that serum biomarkers, especially when combined with demographic characteristics, may be helpful in guiding patient decision-making regarding the management of early pregnancy failure (EPF). Further study is warranted. Copyright © 2015 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  18. Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda.

    Directory of Open Access Journals (Sweden)

    Solomon J Lubinga

    Full Text Available In settings where home birth rates are high, prenatal distribution of misoprostol has been advocated as a strategy to increase access to uterotonics during the third stage of labor to prevent postpartum hemorrhage (PPH. Our objective was to project the potential cost-effectiveness of this strategy in Uganda from both governmental (the relevant payer and modified societal perspectives.To compare prenatal misoprostol distribution to status quo (no misoprostol distribution, we developed a decision analytic model that tracked the delivery pathways of a cohort of pregnant women from the prenatal period, labor to delivery without complications or delivery with PPH, and successful treatment or death. Delivery pathway parameters were derived from the Uganda Demographic and Health Survey. Incidence of PPH, treatment efficacy, adverse event and case fatality rates, access to misoprostol, and health resource use and cost data were obtained from published literature and supplemented with expert opinion where necessary. We computed the expected incidence of PPH, mortality, disability adjusted life years (DALYs, costs and incremental cost effectiveness ratios (ICERs. We conducted univariate and probabilistic sensitivity analyses to examine robustness of our results. In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.2% (95% credibility interval (CrI: 0.55%, 1.95%, mortality by 0.08% (95% CrI: 0.04%, 0.13% and DALYs by 0.02 (95% CrI: 0.01, 0.03.” and “ICERs were US$181 (95% CrI: 81, 443 per DALY averted from a governmental perspective, and US$64 (95% CrI: -84, 260 per DALY averted from a modified societal perspective [corrected].Prenatal distribution of misoprostol is potentially cost-effective in Uganda and should be considered for national-level scale up for prevention of PPH.

  19. MEDICAL MANAGEMENT OF MISSED MISCARRIAGES USING VAGINAL MISOPROSTOL- A PROSPECTIVE OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Kala Bahuleyan Santha

    2017-03-01

    Full Text Available BACKGROUND Missed miscarriage is one of the common cases encountered by the practicing obstetricians all over the world. Diagnosis is made early due to increased use of ultrasound. Medical management is as effective as surgical management, but many still resort to surgical management due to concerns about adherence of products to uterine wall. This may result in complications like perforation, infection, cervical injury and may affect future fertility. Mifepristone followed by misoprostol is well accepted in medical abortion. Misoprostol alone is as efficient as the combination in missed miscarriage. In India, studies with misoprostol alone are limited. Hence, this study was conducted to evaluate the outcome of medical management in patients with first trimester miscarriage with misoprostol alone. MATERIALS AND METHODS After approval of Institutional Review Board, a total of 100 women with first trimester miscarriage were recruited for the study after satisfying inclusion and exclusion criteria. After necessary investigations and consent, they were treated with 800 micrograms of vaginal misoprostol followed by 600 micrograms after 3 hours. Main outcome measured was successful resolution without surgical intervention. Secondary outcomes measured were the induction delivery interval, incidence of pain, excess vaginal bleeding, infection, pyrexia and other gastrointestinal side effects. RESULTS Complete expulsion occurred in 89% patients and surgical evacuation needed in 11%. Mean induction delivery interval was 6- 12 hours. Incidence of complete expulsion was more among primigravida than multigravida. In multi, complete expulsion was observed in patients with previous normal delivery than caesarean. Majority of patients had bleeding for less than 7 days. None of them had major side effects like sepsis or heavy bleeding. Minor side effects were fever, nausea, diarrhoea and abdominal pain. CONCLUSION Medical management with misoprostol is efficient

  20. Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia

    Science.gov (United States)

    2014-01-01

    Background A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Methods Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. Results There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. Conclusions The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not

  1. Novel intravaginal nanomedicine for the targeted delivery of saquinavir to CD4+ immune cells

    Directory of Open Access Journals (Sweden)

    Yang S

    2013-08-01

    Full Text Available Sidi Yang,1,2 Yufei Chen,1,2 Kaien Gu,1,2 Alicia Dash,1,2 Casey L Sayre,1 Neal M Davies,1 Emmanuel A Ho1,2 1Faculty of Pharmacy, 2Laboratory for Drug Delivery and Biomaterials, University of Manitoba, Winnipeg, MB, Canada Abstract: The goal of this study was to develop and characterize an intravaginal nanomedicine for the active targeted delivery of saquinavir (SQV to CD4+ immune cells as a potential strategy to prevent or reduce HIV infection. The nanomedicine was formulated into a vaginal gel to provide ease in self-administration and to enhance retention within the vaginal tract. SQV-encapsulated nanoparticles (SQV-NPs were prepared from poly(lactic-co-glycolic acid(PLGA and conjugated to antihuman anti-CD4 antibody. Antibody-conjugated SQV-NPs (Ab-SQV-NPs had an encapsulation efficiency (EE% of 74.4% ± 3.7% and an antibody conjugation efficiency (ACE% of 80.95% ± 1.10%. Over 50% of total loaded SQV was released from NPs over 3 days. NPs were rapidly taken up by Sup-T1 cells, with more than a twofold increase in the intracellular levels of SQV when delivered by Ab-SQV-NPs in comparison to controls 1 hour post-treatment. No cytotoxicity was observed when vaginal epithelial cells were treated for 24 hours with drug-free Ab-NPs (1,000 µg/mL, 1% HEC placebo gel (200 mg/mL, or 1% HEC gel loaded with drug-free Ab-NPs (5 mg NPs/g gel, 200 mg/mL of gel mixture. Overall, we described an intravaginal nanomedicine that is nontoxic and can specifically deliver SQV into CD4+ immune cells. This platform may demonstrate potential utility in its application as postexposure prophylaxis for the treatment or reduction of HIV infection, but further studies are required. Keywords: nanoparticles, saquinavir, antibody conjugation, intravaginal gel, HIV/AIDS, microbicide

  2. Misoprostol for cervical ripening: a clinical trial in 60 pregnant women

    Directory of Open Access Journals (Sweden)

    Khazardoost S

    2011-01-01

    Full Text Available "n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Cervical ripening usually begins prior to the labor when there is an unripe cervix. Complications will increase significantly when the cervix is not ripped. Misoprostol is a pharmacologic agent available for cervical ripening and labor induction. The aim of this study was to compare the efficacy and safety of administration of a single dose of 25 mg vaginal Misoprostol (A with 100 mg Misoprostol (B for cervical ripening."n"nMethods: Sixty subjects with pregnancies of at least 40 gestation weeks, and an unfavorable cervix (Bishop Score <6 were randomly assigned to receive one dose oral misoprostol 100 mg or 25 mg vaginal misoprostol. The main dependent variables were mode of delivery, time interval from induction to cervical ripening, need for additional oxytocin, perinatal results and maternal side effects. "n"nResults: The mean time from the indication of induction to cervical ripening was the same in the two groups (3.63 h in oral group and 3.9 h in vaginal group. Two groups did not differ statistically in the percent of patients who were delivered vaginally or with cesarean section during 24 hours (20% in group A versus 10% in group B."n"nConclusion: Based on the results of our study, Misoprostol is an effective drug for the cervical ripening and labor induction in the term pregnancies. 25 mg vaginal tablet of Misoprostol is as effective as 100 mg oral misoprostol for cervical ripening.

  3. Changes in the prostacyctin sensitivity of thrombocytes after intravaginal radium irradiation of patients with corpus carcinoma

    International Nuclear Information System (INIS)

    Schneider, A.

    1987-01-01

    The goal of this work was to investigate, to what extent the platelet sensitivity in comparison to prostacyclin (PGI 2 ) should be seen as a responsible factor in the increase of the thrombosis rate. For this blood was examined from 22 patients with corpus carcinoma who had received an intravaginal Radium implant with a radiation dose of 960 mgeh to over 24 h. These patients were compared to a control group of 21 clinically healthy women. Even before the radiation therapy there was an increased aggregation rate of the thrombocytes in the carcinoma patients as well as a reduced sensitivity to PGI 2 . Under irradiation there was an even greater decrease in the sensitivity of the thrombocytes to PGI 2 . The aggregation speed increase statistically significantly and the number of thrombocytes decreased during the Radium irradiation. After the giving of heparin the sensitivity of the thrombocytes to PGI 2 sank strongly. (orig./MG) [de

  4. Home use of misoprostol for early medical abortion in a low resource setting: secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Iyengar, Kirti; Klingberg-Allvin, Marie; Iyengar, Sharad D; Paul, Mandira; Essén, Birgitta; Gemzell-Danielsson, Kristina

    2016-02-01

    Although home use of misoprostol for early medical abortion is considered to be safe, effective and feasible, it has not become standard service delivery practice. The aim of this study was to compare the efficacy, safety, and acceptability of home use of misoprostol with clinic misoprostol in a low-resource setting. This was a secondary analysis of a randomized controlled trial conducted in six primary care clinics in India. Women seeking medical abortion within up to nine gestational weeks (n = 731) received mifepristone in the clinic and were allocated either to home or clinic administration of misoprostol. Follow-up contact was after 10-15 days. Of 731 participants, 73% were from rural areas and 55% had no formal education. Complete abortion rates in the home and clinic misoprostol groups were 94.2 and 94.4%, respectively. The rate of adverse events was similar in both groups (0.3%). A greater proportion of home users (90.2%) said that they would opt for misoprostol at home in the event of a future abortion compared with clinic users (79.7%) who would opt for misoprostol at the clinic in a similar situation (p = 0.0002). Ninety-six percent women using misoprostol at home or in the clinic were satisfied with their abortion experience. Home-use of misoprostol for early medical abortion is as effective and acceptable as clinic use, in low resource settings. Women should be offered a choice of this option regardless of distance of their residence from the clinic and communication facilities. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Mifepristone and misoprostol for cervical ripening in surgical abortion between 12 and 14 weeks of gestation: a randomized controlled trial.

    Science.gov (United States)

    Ohannessian, Alexandra; Baumstarck, Karine; Maruani, Julia; Cohen-Solal, Emmanuelle; Auquier, Pascal; Agostini, Aubert

    2016-06-01

    Misoprostol and mifepristone are the two substances recommended for cervical preparation during first-trimester surgical abortions to decrease intraoperative bleeding and complications. The objective of the study was to evaluate whether the combination of mifepristone and misoprostol for cervical preparation in an elective surgical abortion between 12 and 14 weeks of gestation can reduce blood loss in comparison to misoprostol or mifepristone alone. A randomized controlled trial was performed in Marseille, France between May 2013 and May 2014. Women requesting a surgical abortion under general anesthesia between 12 and 14 weeks of gestation were 198, randomized into three groups: one received 400μg oral misoprostol 3h before surgery, one 200mg oral mifepristone 36h before surgery, and the other, both treatments. The main outcome was the quantity of intraoperative bleeding. The secondary outcomes were duration of intervention, ease of dilatation, and complications. The quantity of intraoperative bleeding differed significantly between the groups (p=0.001): 222±64mL in the combination group, 329±129mL in the misoprostol group, and 276±119mL in the mifepristone group. The combination was associated with a shorter operative duration (p=0.001): 5±2min in the combination group, 7±5min in the misoprostol group, and 7±3min in the mifepristone group. A hemorrhage was observed for 5 of 55 women (9%) in the combination group, 13 of 51 (25%) in the misoprostol group, and 9 of 56 (16%) in the mifepristone group (p=0.08). No cervical laceration or uterine perforation was reported. The combination of mifepristone and misoprostol in cervical preparation for elective surgical abortions between 12 and 14 weeks of gestation significantly reduced blood loss in comparison to misoprostol or mifepristone alone. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Immune response of heifers to vaginal submucosal or subcutaneous vaccination and intravaginal challenge with Ureaplasma diversum.

    Science.gov (United States)

    Mulira, G L; Saunders, J R

    1994-04-01

    Twenty beef heifers were randomly assigned to five equal groups and vaccinated: Group 1--in vaginal submucosa (VM) with Ureaplasma diversum ultrasonicated whole cells (WC) in complete Freund's adjuvant (CFA); Group 2--in VM with U. diversum cell membranes (CM) in CFA; Group 3--subcutaneously (SC) with CM in CFA; Group 4--in VM with CM alone; and Group 5--in VM with phosphate buffered saline (PBS) in CFA. A second vaccination with the same antigens in incomplete Freund's adjuvant was given after four weeks, and three weeks later, all heifers were challenged intravaginally with 3.6 x 10(7) colony-forming units (CFU) of U. diversum strain 2312. Immunoglobulins that reacted with U. diversum were measured in serum and cervicovaginal mucus (CVM) by an enzyme-linked-immunosorbent assay. In groups 1 and 2, vaccination by the VM route with WC or CM antigens, stimulated high levels of U. diversum-reactive IgG1 and IgG2 antibodies in serum as well as CVM, but a low IgA response only in CVM. In group 4, VM vaccination with CM (no adjuvant) elicited a minimal IgG1 and IgG2 response in serum and CVM. In group 3, SC vaccination with CM antigen stimulated high IgG1 and IgG2 reactivity in both serum and CVM, but no IgA reactivity. Very little IgM reactivity was detected in the four vaccinated groups. Intravaginal challenge resulted in characteristic granular vulvitis in all vaccinated and control heifers, with all animals remaining culture-positive for the 35 day observation period. The infection stimulated a marked increase in the specific IgA response in CVM of the three groups vaccinated with either, adjuvanted antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Intravaginal boric acid: is it an alternative therapeutic option for vaginal trichomoniasis?

    Science.gov (United States)

    Thorley, Nicola; Ross, Jonathan

    2017-12-09

    Trichomoniasis, caused by Trichomonas vaginalis (TV), is the most common curable sexually transmitted infection worldwide. Current guidance in the UK is to treat TV with a nitroimidazole antibiotic. The high prevalence of TV, high rate of antibiotic resistance and limited tolerability to nitroimidazoles suggest that alternative treatment regimens are needed. Intravaginal boric acid (BA) has been used safely for the treatment of candida vulvovaginitis and bacterial vaginosis, and in vitro studies suggest BA is active against TV. We review the evidence for the efficacy of BA in patients with TV. MEDLINE, EMBASE, CINAHL, AMED, HMIC and BNI and Grey literature databases, The Cochrane Library, Trial Registers, conference abstracts and proceedings were searched. Inclusion criteria were women aged 16 years or over with microbiological confirmation of TV infection and using BA as treatment. There were no restrictions on language, publication date or study design. The in vitro evidence for BA activity against TV was also reviewed. No randomised controlled trials or case series were found. Four case reports demonstrated TV clearance with BA using a variety of dose regimens (dose 600 mg alternate nights to 600 mg two times per day; duration 1-5 months). In vitro studies suggest that BA has activity against TV which is independent of its effect on pH. Further evaluation of BA for the treatment of uncomplicated TV is required, but it may be useful when therapeutic options are limited. If shown to be safe and effective, intravaginal BA might provide a well-tolerated alternative anti-infective treatment which reduces community exposure to systemic antibiotics. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Intravaginal probiotics modulated metabolic status and improved milk production and composition of transition dairy cows.

    Science.gov (United States)

    Deng, Q; Odhiambo, J F; Farooq, U; Lam, T; Dunn, S M; Ametaj, B N

    2016-02-01

    The objective of this investigation was to evaluate whether intravaginal infusion of probiotics (a lactic acid bacteria cocktail) around parturition would influence metabolic status and increase milk production of transition dairy cows. One hundred pregnant Holstein dairy cows were assigned to 1 of the 3 experimental groups receiving intravaginal infusion of probiotics or carrier (i.e., sterile skim milk) once a week at wk -2, -1, and +1 relative to calving as follows: 2 consecutive probiotics before parturition and 1 carrier dose after parturition (TRT1), 3 consecutive probiotics doses around parturition (TRT2), and 3 consecutive carrier doses around parturition (CTR). The probiotics were a lyophilized culture mixture composed of FUA3089 and FUA3138 and FUA3140 with a cell count of 10 to 10 cfu/dose. Blood was sampled from wk -2 to +3 and milk was sampled on the third day in milk (DIM) and from wk +1 to +5 on a weekly basis. Feed intake and milk production was monitored until wk +8. Results showed that the TRT2 group (366.12 ± 49.77 μmol/L) had a lower ( = 0.01) concentration of NEFA in the serum than the CTR group (550.85 ± 47.16 μmol/L). The concentrations of IgG in the milk were 32.71 ± 3.00 mg/mL in the TRT1 group, 17.47 ± 4.54 mg/mL in the TRT2 group, and 6.73 ± 3.43 mg/mL in the CTR group at 3 DIM ( dairy cows.

  9. Indução do Parto com Misoprostol: Comparação entre duas Doses Labor Induction with Misoprostol: Comparison of Two Dose Regimens

    OpenAIRE

    Dimas Augusto Carvalho de Araújo; Luiz Carlos Navarro de Oliveira; Isabel Cristina Navarro de Oliveira; Daniela Dias Paiva Porto; Sérgio Vilela de Oliveira; Frederico Henrique Oliveira Junqueira; Amaury Teixeira Leite Andrade

    1999-01-01

    Objetivo: comparar a eficácia e segurança entre duas doses de misoprostol administradas por via vaginal para amadurecimento cervical e indução do parto. Pacientes e Métodos: sessenta e uma pacientes com indicação médica para indução do parto e colo desfavorável foram incluídas neste estudo. Vinte e oito pacientes receberam 25 µg e trinta e três 50 µg de misoprostol, a intervalos de 4 horas, até um período máximo de 24 horas. Resultados: a rotura prematura de membranas, gestação prolongada e d...

  10. Severe morbidities associated with induced abortions among misoprostol users and non-users in a tertiary public hospital in Ghana

    Science.gov (United States)

    2014-01-01

    Background Misoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana. Methods This was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher’s exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks’ gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06). Conclusion Self-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication

  11. An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 microg for first-trimester legal medical abortion

    DEFF Research Database (Denmark)

    Ravn, Pernille; Rasmussen, Ase; Knudsen, Ulla Breth

    2005-01-01

    AIM: To evaluate the success rate of medical abortion using an outpatient regimen of oral mifepristone 400 mg and oral misoprostol 400 microg for legal abortion in women ... ultrasound and minimal vaginal bleeding at a control examination performed 14 days after administration of misoprostol. Over a 6-month period in 2003, a questionnaire (completion rate 70%) was used for a spot check of the patients' evaluation of the method. RESULTS: Six hundred and sixty women underwent...... abortion again in case of a future unwanted pregnancy, and 85% would prefer to abort at home again. CONCLUSION: A high acceptance and success rate was seen using this outpatient oral regimen of mifepristone and misoprostol....

  12. An Unreported Uterine Rupture in an Unscarred Uterus after Induction of Labour with 25 μg Misoprostol

    DEFF Research Database (Denmark)

    Rydahl, Eva; Clausen, Jette Aaroe

    2014-01-01

    Uterine rupture without a former history of cesarean delivery or uterine scarring is an exceedingly rare complication in pregnancy and labor. Misoprostol is widely used to induce labor but there is a lack of knowledge about serious adverse effects. It is especially challenging to collect reports...... on side effects because misoprostol is not a registered drug. We report a case of a woman induced by one dose 25 μg misoprostol vaginally. Her pregnancy was uncomplicated and she had an unscarred uterus. Her labor progressed rapidly and she experienced hyperstimulation, meconium stained amniotic fluid...

  13. Comparison of Efficacy and Side Effects of Different Administration Routes of Misoprostol (Oral, Vaginal, and Sublingual for Second-Trimester Abortion

    Directory of Open Access Journals (Sweden)

    Anisodowleh Nankali

    2017-10-01

    Full Text Available Background The current study was designed to compare the effectiveness and side effects of oral, vaginal, and sublingual misoprostol in termination of second-trimester pregnancy. Materials and Methods: In this clinical trial (2014 to 2015, 85 pregnant women in the second trimester of pregnancy were included in Imam Reza hospital, Kermanshah, Iran. They were randomly divided into three groups as follows: oral misoprostol (n=28, vaginal misoprostol (n=30, and sublingual misoprostol (n=27. Misoprostol was administered orally (oral misoprostol group, vaginally (vaginal misoprostol group, or sublingually (sublingual misoprostol group. The dosage was similar in three groups (400 micrograms every four hours up to a maximum of five doses. The mothers were followed and induction-abortion interval time, number of dosages required, and misoprostol side effects were documented. The data were analyzed by SPSS version 20.0 software. Results: The mean (standard deviation age of the sample was 28.27 (±4.97 years. Mean gestational age was 16.58 weeks and mean gravidity was 1.99. Mean number of administered misoprostol doses was 3.89 and most patients responded to three doses of misoprostol. Mean abortion time was 20.08 hours. No side effects were reported in 60% of the subjects. Others experienced side effects such as nausea (16.5%, fever and chills (12.9%, and vaginal bleeding (9.4%. The abortion duration in 35.3% of the subjects was within 18 hours. The most successful method was oral route (82.1%, followed by vaginal route (80%, and sublingual route (70.4%. The abortion duration was statistically different between the three groups (P= 0.001. Conclusion: Finding of the presented study showed that misoprostol is a safe medication to be used for medical abortion in the second trimester of pregnancy. Oral route of administration was superior to vaginal or rectal use of misoprostol.

  14. Is the Time of administration of misoprostol of value? The uterotonic effect of misoprostol given pre- and post-operative after elective cesarean section

    OpenAIRE

    Ahmed H. Abd-Ellah; Abdel Aziz E. Tamam; Mostafa Mohammed Khodry

    2014-01-01

    Objective: The aim of the current study was to compare blood loss in pre- and post-operatively rectally administered 600 μg of misoprostol in elective cesarean delivery, in order to determine the optimal time for drug administration (CS). Study design: A 30-month prospective, single-blind, randomized, clinical trial was done in the Qena University Hospital, Egypt, from January 2010 to October, 2012. Methods: Intervention consisted of pre and post-operative rectally administered misopros...

  15. Comparison of 25 and 50 microgram of misoprostol for induction of ...

    African Journals Online (AJOL)

    2014-09-03

    birth asphyxia) and birth ... APGAR scores were ≤6 at the 5th min following resuscitation were admitted into the special care ..... Med 2008;6:83‑7. 8. Ekele BA, Nnadi DC, Gana MA, Shehu CE, Ahmed Y, Nwobodo EI. Misoprostol.

  16. Intracervical misoprostol as an effective method of labor induction at term.

    Science.gov (United States)

    Liu, H S; Chu, T Y; Chang, Y K; Yu, M H; Chen, W H

    1999-01-01

    The purpose of this study was to evaluate the safety and effectiveness of intracervical misoprostol for the induction of labor at term. Eighty-nine term pregnancies requiring induction of labor were treated intracervically with 50 microg of misoprostol. The dose was repeated every 4 h until adequate uterine contraction and cervical dilatation were achieved. Status of cervical ripening, uterine contraction, cervical dilatation, labor course and side effects were recorded and analyzed. Among the 89 patients, 58 had an unfavorable cervix (Bishop score 4). Labor was successfully induced in all cases, most (93.3%) of which required a single dose of misoprostol. Seventy-two patients (81%) proceeded to spontaneous vaginal delivery, and 61 (85%) deliveries were achieved within 12 h. The other 17 cases received cesarean delivery with indications of fetopelvic disproportion (six cases), failure of induction (seven cases) and acute fetal distress (four cases). The mean duration from induction to regular uterine contraction and to delivery was 483+/-537 min and 79.2+/-38.2 min, respectively, with no significant difference between the two groups with differing status of cervical ripening. Complications of uterine contraction, including tachysystole (15 cases), hypertonus (one case) and hyperstimulation (10 cases) were more common in the group of unfavorable cervix (45%) than that of favorable cervix (23%) (P intracervical misoprostol at a single dose of 50 microg appears to be an effective method for induction of labor at term, but caution should be taken with cases with unfavorable cervix.

  17. Oral misoprostol and intracervical dinoprostone for cervical ripening and labor induction: a randomized comparison.

    Science.gov (United States)

    Bartha, J L; Comino-Delgado, R; Garcia-Benasach, F; Martinez-Del-Fresno, P; Moreno-Corral, L J

    2000-09-01

    To compare efficacy, safety, and tolerance of oral misoprostol with intracervical dinoprostone for cervical ripening and labor induction. Two hundred women were randomized to receive single doses of oral misoprostol 200 microg or 0.5 mg of dinoprostone intracervically every 6 hours for a maximum four doses. The intervals from administration of the drug to active phase of labor (11.1 hours [7-24] versus 15.8 hours [7.5-29.62], P =. 01), to delivery (14.0 hours [8.42-27.61] versus 20.2 hours [16.7-32. 8], P =.01), and to rupture of membranes (10.0 hours [4.95-24.7] versus 15.6 hours [8.2-29.2], P =.003) were significantly shorter in the misoprostol group. All those variables were not distributed normally, so results are presented as median and interquartile range. The rates of women who needed oxytocin (68% versus 52%, P =.03) and cesarean for failed induction (9% versus 1%, P =.01) were higher in the dinoprostone group. A single dose of 200 microg oral misoprostol was more effective for cervical ripening and labor induction than 0.5 mg of dinoprostone intracervically every 6 hours, with a maximum of four doses.

  18. Misoprostol Use For Cervical Ripening And Induction Of Labour In A ...

    African Journals Online (AJOL)

    Context: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. Objectives: To determine the efficacy and safety of misoprostol in cervical ripening and labour induction. Materials and Method: A prospective study spanning 2 years and involving 151 patients admitted for ...

  19. A novel misoprostol delivery system for induction of labor: clinical utility and patient considerations

    Directory of Open Access Journals (Sweden)

    Stephenson ML

    2015-04-01

    Full Text Available Megan L Stephenson, Deborah A WingDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USAAbstract: Induction of labor is one of the most commonly performed obstetric procedures and will likely become more common as the reproductive population in developed nations changes. As the proportion of women undergoing induction grows, there is a constant search for more efficacious ways to induce labor while maintaining fetal and maternal safety as well as patient satisfaction. With almost half of induced labors requiring cervical ripening, methods for achieving active labor and vaginal delivery are constantly being investigated. Prostaglandins have been shown to be effective induction agents, and specifically vaginal misoprostol, used off-label, have been widely utilized to initiate cervical ripening and active labor. The challenge is to administer this medication accurately while maintaining the ability to discontinue the medication when needed. The misoprostol vaginal insert initiates cervical ripening utilizing a delivery system that controls medication release and can be rapidly removed. This paper reviews the design, development, and clinical utility of the misoprostol vaginal insert for induction of labor as well as patient considerations related to the delivery system.Keywords: misoprostol, induction, cervical ripening, vaginal insert

  20. Experiences in the use of misoprostol in the management of first ...

    African Journals Online (AJOL)

    Objective: To determine the effectiveness and acceptability of misoprostol in the evacuation of the uterus in first trimester missed abortion. Study Design: This was a non‑randomized trial. Setting: This study was conducted in the Gynecologic Unit, Abubakar Tafawa Balewa University Teaching Hospital Bauchi,. Nigeria.

  1. Experiences in the use of misoprostol in the management of first ...

    African Journals Online (AJOL)

    Objective: To determine the effectiveness and acceptability of misoprostol in the evacuation of the uterus in first trimester missed abortion. Study Design: This was a non‑randomized trial. Setting: This study was conducted in the Gynecologic Unit, Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Nigeria.

  2. Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination

    NARCIS (Netherlands)

    Brouns, Joseph Franciscus Gertrudis Maria; van Wely, Madelon; Burger, Mattheus Petrus Maria; van Wijngaarden, Willem Jacobus

    2010-01-01

    Objective: The study was conducted to compare the efficacy of two different dose regimens of misoprostol administered vaginally in combination with mifepristone for second trimester termination of viable and non-viable pregnancies. Design: Double-blind randomized controlled trial conducted at the

  3. Clinical indicators for success of misoprostol treatment after early pregnancy failure.

    Science.gov (United States)

    Robledo, C; Zhang, J; Troendle, J; Barnhart, K; Creinin, M D; Westhoff, C; Huang, X; Frederick, M

    2007-10-01

    To identify clinical indicators for success of misoprostol treatment after early pregnancy failure. A total of 473 women with early pregnancy failure received 800 microg of vaginal misoprostol on treatment day 1. At the follow-up visit on day 3, a second dose was given if expulsion was incomplete. On day 8, vacuum aspiration was offered if expulsion had not occurred. Ultrasonography was used as gold standard for success. A Classification and Regression Tree analysis was undertaken to derive two decision trees for the success of misoprostol treatment on study days 3 and 8. Heavy bleeding after the first dose and an open cervical os were identified as clinical indicators of treatment success on day 3. Treatment success occurred in 84% of women with either or both indicators. Reporting passage of tissue after a second misoprostol dose and old blood in the vagina were potential indicators of treatment success or failure on day 8. A woman with either of these indicators has a 65% chance of treatment success after the second dose. Conversely, a woman with neither indicator on day 8 has a 94% chance of treatment failure. Standard clinical findings may be useful as indicators for success or failure of medical management of early pregnancy failure in settings with limited or no access to ultrasonography. More research to identify even better indicators is warranted.

  4. Differential radioprotective effects of misoprostol in DNA repair-proficient and -deficient or radiosensitive cell systems

    NARCIS (Netherlands)

    van Buul, P. P.; van Duyn-Goedhart, A.; de rooij, D. G.; Sankaranarayanan, K.

    1997-01-01

    The protective effects of misoprostol (MP), an analogue of prostaglandin E1, on X-ray-induced chromosomal aberrations, were studied in normal or mutant Chinese hamster cell lines grown as spheroids in vitro and on cell-killing in stem-cell spermatogonia of a mutant (acid) mouse strain or its

  5. Factors influencing the abortion interval of second trimester pregnancy termination using misoprostol

    Directory of Open Access Journals (Sweden)

    Wan-Hua Ting

    2015-08-01

    Conclusion: Higher parity, intrauterine fetal demise, and preterm premature rupture of membranes were associated with shorter AI. The regimen of 200 μg oral misoprostol at 6-hour intervals following a 200 μg or 400 μg priming vaginal dose is feasible and efficacious for second trimester pregnancy termination.

  6. Induction of Labor Using a Foley Catheter or Misoprostol : A Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    Ten Eikelder, Mieke L G; Mast, Kelly; van der Velden, Annemarie; Bloemenkamp, Kitty W M; Mol, Ben W

    2016-01-01

    Importance: Induction of labor is a widely used obstetric intervention, occurring in one in four pregnancies. When the cervix is unfavorable, still many different induction methods are used. Objective: We compared Foley catheter alone to different misoprostol dosages and administration routes, and

  7. Can the outcome of induction of labour with oral misoprostol be ...

    African Journals Online (AJOL)

    Objective. To determine predictors of outcome for induction of labour using oral misoprostol. Setting. Labour ward at Kalafong Hospital in Atteridgeville, Pretoria, that serves an indigent South African urban population. Methods. Data were collected prospectively on all women undergoing induction of labour with oral ...

  8. Progress of Labor in Women Induced with Misoprostol versus the Foley Catheter

    Science.gov (United States)

    TUULI, Methodius G.; KEEGAN, Mary B.; ODIBO, Anthony O.; ROEHL, Kimberly; MACONES, George A.; CAHILL, Alison G.

    2014-01-01

    Objective To estimate and compare the duration and progress of labor in women induced with misoprostol versus Foley catheter plus oxytocin. Study Design We performed a retrospective cohort study of labor progress among 617 consecutive term pregnancies induced with misoprostol (n=503) or Foley catheter plus oxytocin (n=114) who completed the first stage of labor. Labor duration and progress in the entire cohort, and stratified by parity, were compared in multivariable interval-censored regression models adjusting for maternal obesity and birth weight. Repeated-measures analysis with 9th degree polynomial modeling was used to construct average labor curves. Results Total duration of labor was not significantly different in women induced with misoprostol compared to the Foley catheter median (median duration from 1 to 10 cm: 12 versus 14.2 hours, p=0.19). Progress from 1 to 4 cm was more rapid with the Foley catheter (median: 3.4 versus 5.6 hours, pmisoprostol and at 6cm for the Foley catheter. Similar general patterns were noted for nulliparous and multiparous women, except for a shorter duration of labor with the Foley catheter among multiparous women. Conclusion Induction of labor with the Foley catheter is associated with more rapid initial cervical dilation, but transition to active labor occurs later compared to misoprostol. These differences should be considered in the management of induced labor. PMID:23659988

  9. [Termination of pregnancy in the 2nd trimester: mifepriston/misoprostol preferable to sulprostone

    NARCIS (Netherlands)

    Ebbers, S.; Creemers, J.W.T.; Lotgering, F.K.

    2009-01-01

    OBJECTIVE: To compare the efficacy of sulprostone and mifepristone/misoprostol when used for termination of pregnancy (TOP) in the 2nd trimester. DESIGN: Comparative retrospective cohort study. METHOD: Data were collected on all women whose pregnancies were terminated in the 2nd trimester, in the

  10. Misoprostol versus curettage in women with early pregnancy failure after initial expectant management : a randomized trial

    NARCIS (Netherlands)

    Graziosi, GCM; Mol, BWJ; Reuwer, PJH; Drogtrop, A; Bruinse, HW

    BACKGROUND: Little is known about the effectiveness of misoprostol treatment in women with early pregnancy failure who have been managed expectantly. We therefore performed a randomized trial on this subject. METHODS: Women with early pregnancy failure, who had been managed expectantly for at least

  11. Misoprostol versus curettage in women with early pregnancy failure after initial expectant management: a randomized trial

    NARCIS (Netherlands)

    Graziosi, G. C. M.; Mol, B. W. J.; Reuwer, P. J. H.; Drogtrop, A.; Bruinse, H. W.

    2004-01-01

    BACKGROUND: Little is known about the effectiveness of misoprostol treatment in women with early pregnancy failure who have been managed expectantly. We therefore performed a randomized trial on this subject. METHODS: Women with early pregnancy failure, who had been managed expectantly for at least

  12. Color Doppler Misoprostol Response Study (CDMRS: An Evaluation Tool for Patients Awaiting Myomectomy

    Directory of Open Access Journals (Sweden)

    Musarrat Hasan

    2014-06-01

    Conclusion: In conclusion, we suggest that all patients scheduled for myomectomy have prior CDMRS to evaluate the degree of vascularity and to assess if they have an appropriate response to misoprostol administered rectally, so that there is minimal or no blood loss during surgery. This preoperative assessment will decrease physician apprehension, with less intraoperative blood loss and morbidity.

  13. effectiveness and safety of 2-hourly 20 mcg oral misoprostol solution ...

    African Journals Online (AJOL)

    2014-09-01

    Sep 1, 2014 ... INTRAVENOUS OXYTOCIN IN LABOUR INDUCTION DUE TO PRE-LABOUR RUPTURE OF MEMBRANES AT. TERM: A RANDOMISED ..... Cervical ripening with oral misoprostol in premature rupture of membranes at term. Obstet Gynacol, 1996; 87: 923-926. 4. Adair DC, Weeks JW, Barrilleaux S, et al.

  14. Vaginal misoprostol for second-trimester pregnancy termination after one previous cesarean delivery.

    Science.gov (United States)

    Naguib, Ahmad H; Morsi, Hassan M; Borg, Tamer F; Fayed, Salah T; Hemeda, Hosam M

    2010-01-01

    To determine the safety and efficacy of using misoprostol vaginally for second-trimester abortion in women with a single previous cesarean delivery. This prospective observational study was carried out at a university hospital in Egypt with 50 pregnant women with 1 previous cesarean delivery; a gestation of at least 16 weeks but less than 20 weeks (group 1) or 20 or more weeks (group 2); and a need to terminate the pregnancy. The regimen was 4 doses of 200 microg of misoprostol applied vaginally every 4 hours daily, with a 12-hour nightly rest from misoprostol applications, until contractions appeared but not for more than 72 hours. The primary outcome was the induction-to-abortion interval. There were no cases of uterine rupture. Abortion within the study protocol occurred in 45 of the 50 women, for a 90% success rate. There was no significant difference in the induction-to-abortion interval between the 2 groups. Inducing abortion with lower misoprostol doses appear to be safe and effective throughout the second trimester in women with a single previous cesarean delivery. Larger randomized trials are needed to validate these results.

  15. Safety and Efficacy of Misoprostol versus Oxytocin for the Prevention of Postpartum Hemorrhage

    Directory of Open Access Journals (Sweden)

    Minoo Rajaei

    2014-01-01

    Full Text Available Postpartum hemorrhage (PPH is the commonest cause of maternal death worldwide. Studies suggest that the use of misoprostol may be beneficial in clinical settings where oxytocin is unavailable. The aim of this study was to compare the safety and efficacy of oxytocin and misoprostol when used in the prevention of PPH. In a double-blind randomized controlled trial, 400 pregnant women who had a vaginal delivery were assigned into two groups: to receive either 20 IU of oxytocin in 1000 mL Ringer’s solution and two placebo tablets or 400 mcg oral misoprostol (as two tablets and 2 mL normal saline in 1000 mL Ringer’s solution. The quantity of blood loss was higher in the oxytocin group in comparison to the misoprostol group. There was no significant difference in the decrease in hematocrit and hemoglobin between the two groups. Although there was no significant difference in the need for transfusions between the two groups, the patients in the oxytocin group had greater need for additional oxytocin. Results from this study indicate that it may be considered as an alternative for oxytocin in low resource clinical settings. This study is registered with ClinicalTrials.gov NCT01863706.

  16. Effect of Misoprostol on the Pharmacokinetics of Sustained Release Diclofenac in Myanmar Healthy Male Volunteers

    Directory of Open Access Journals (Sweden)

    Htet Htet Aung

    2017-03-01

    Full Text Available Background: Sustained release diclofenac (diclofenac SR is the commonly used non-steroidal anti-inflammatory drug for chronic inflammatory conditions such as rheumatoid arthritis. Misoprostol, prostaglandin analogue, is the agent that enhances gastrointestinal mucosal defense. Concomitant administration of misoprostol with diclofenac SR can prevent the gastrointestinal side effects of diclofenac SR. Objective: The purpose of the study was to explore the effect of misoprostol on the pharmacokinetics of diclofenac SR in healthy volunteers. Methods: Crossover study was evaluated in 14 male volunteers. Single oral dose of 100 mg diclofenac SR was concomitantly administered with 200 μg misoprostol with one-week wash out period. Plasma concentrations at 0, 0.5, 1, 1.5, 2, 3, 6 and 10 hrs were determined by high performance liquid chromatography (HPLC. Pharmacokinetic parameters such as area under concentration-time curve (AUC0-α, peak plasma concentration (Cmax, time to achieve peak plasma concentration (Tmax, absorption half-life (T½(ab, elimination half-life (T1/2(el, absorption rate constant (Kab, and elimination rate constant (Kel were determined. Results: With misoprostol, the mean AUC0-α of diclofenac SR was significantly reduced from 12.11±5.25μg/ mL×hr to 4.17±2.72μg/mL×hr (p0.05. The mean T½(ab was decreased from 0.56±0.23hr to 0.54±0.19hr (p>0.05. The mean Kab were almost the same 1.43±0.54hr-1 and 1.43±0.48hr-1. The mean T1/2(el was decreased from 3.68±1.64hr to 3.03±1.08hr (p>0.05. The mean Kel was increased from 0.21±0.09hr-1 to 0.25±0.09hr-1 (p>0.05. Conclusion: There was a significant reduction in the extent of absorption of diclofenac SR when concomitantly administered with misoprostol. Therefore, the dose of diclofenac SR may need to be increased to avoid therapeutic failure of diclofenac SR or concurrent use with misoprostol may need to be changed to other gastroprotective agents.

  17. Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda

    Science.gov (United States)

    Lubinga, Solomon J.; Atukunda, Esther C.; Wasswa-Ssalongo, George; Babigumira, Joseph B.

    2015-01-01

    Background In settings where home birth rates are high, prenatal distribution of misoprostol has been advocated as a strategy to increase access to uterotonics during the third stage of labor to prevent postpartum hemorrhage (PPH). Our objective was to project the potential cost-effectiveness of this strategy in Uganda from both governmental (the relevant payer) and modified societal perspectives. Methods and Findings To compare prenatal misoprostol distribution to status quo (no misoprostol distribution), we developed a decision analytic model that tracked the delivery pathways of a cohort of pregnant women from the prenatal period, labor to delivery without complications or delivery with PPH, and successful treatment or death. Delivery pathway parameters were derived from the Uganda Demographic and Health Survey. Incidence of PPH, treatment efficacy, adverse event and case fatality rates, access to misoprostol, and health resource use and cost data were obtained from published literature and supplemented with expert opinion where necessary. We computed the expected incidence of PPH, mortality, disability adjusted life years (DALYs), costs and incremental cost effectiveness ratios (ICERs). We conducted univariate and probabilistic sensitivity analyses to examine robustness of our results. In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.0% (95% credibility interval (CrI): 0.55%, 1.95%), mortality by 0.08% (95% CrI: 0.04%, 0.13%) and DALYs by 0.02 (95% CrI: 0.01, 0.03). Mean costs were higher with prenatal misoprostol distribution from governmental by US$3.3 (95% CrI: 2.1, 4.2) and modified societal (by US$1.3; 95% CrI: -1.6, 2.8) perspectives. ICERs were US$191 (95% CrI: 82, 443) per DALY averted from a governmental perspective, and US$73 (95% CI: -86, 256) per DALY averted from a modified societal perspective. Conclusions Prenatal distribution of misoprostol is potentially cost-effective in Uganda and should be

  18. Prevention of postpartum haemorrhage: cost consequences analysis of misoprostol in low-resource settings.

    Science.gov (United States)

    Lang, Danielle L; Zhao, Fei-Li; Robertson, Jane

    2015-11-23

    While inferior to oxytocin injection in both efficacy and safety, orally administered misoprostol has been included in the World Health Organization Model List of Essential Medicines for use in the prevention of postpartum haemorrhage (PPH) in low-resource settings. This study evaluates the costs and health outcomes of use of oral misoprostol to prevent PPH in settings where injectable uterotonics are not available. A cost-consequences analysis was conducted from the international health system perspective, using data from a recent Cochrane systematic review and WHO's Mother-Baby Package Costing Spreadsheet in a hypothetical cohort of 1000 births in a mixed hospital (40% births)/community setting (60% births). Costs were estimated based on 2012 US dollars. Using oxytocin in the hospital setting and misoprostol in the community setting in a cohort of 1000 births, instead of oxytocin (hospital setting) and no treatment (community setting), 22 cases of PPH could be prevented. Six fewer women would require additional uterotonics and four fewer women a blood transfusion. An additional 130 women would experience shivering and an extra 42 women fever. Oxytocin/misoprostol was found to be cost saving (US$320) compared to oxytocin/no treatment. If misoprostol is used in both the hospital and community setting compared with no treatment (i.e. oxytocin not available in the hospital setting), 37 cases of PPH could be prevented; ten fewer women would require additional uterotonics; and six fewer women a blood transfusion. An additional 217 women would experience shivering and 70 fever. The cost savings would be US$533. Sensitivity analyses indicate that the results are sensitive to the incidence of PPH-related outcomes, drug costs and the proportion of hospital births. Our findings confirm that, even though misoprostol is not the optimum choice in the prevention of PPH, misoprostol could be an effective and cost-saving choice where oxytocin is not or cannot be used due to a

  19. Misoprostol Reverse Hippocampal Neuron Cyclooxygenase-2 Downstream Signaling Imbalance in Aluminum-Overload Rats

    Science.gov (United States)

    Guo, Yuanxin; Lei, Wenjuan; Wang, Jianfeng; Hu, Xinyue; Wei, Yuling; Ji, Chaonan; Yang, Junqing

    2016-01-01

    Although COX-2 inhibition in animal models of neurodegenerative diseases has shown neuroprotection, recent studies have revealed some serious side effects (ulcers, bleeding, fatal cerebrovascular diseases etc.) and the limited benefits of COX-2 inhibitors. A more focused approach is necessary to explore the therapeutic effect of the COX downstream signaling pathway in neurological research. The aim of this study was to explore the alterations of the PGES-PGE2-EP signal pathway and the effect of misoprostol on neurodegeneration by chronic aluminum-overload in rats. Adult rats were treated by intragastric administration of aluminum gluconate. The PGE2 content and expression of PGES and EPs in the hippocampi of rats were detected using ELISA, q-PCR and Western blot analysis, respectively. The content of malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) in the rat hippocampi were also detected. The misoprostol treatment dose-dependently improved spatial learning and memory function as well as healing after hippocampal neuron damage induced by chronic aluminum-overload in rats. Meanwhile, the administration of misoprostol resulted in a decrease in the PGE2 level and down-regulation of the mPGES-1, EP2 and EP4 expression levels, while there was a dose-dependent up-regulation of EP3 expression. These results suggest that misoprostol possesses a neuroprotective property, and the mechanism involves affecting the EP3 level and reducing the endogenous production of PGE2 through a negative feedback mechanism, increasing the EP3 expression level, decreasing the EP2 and EP4 expression levels, and rebuilding the mPGES-1-PGE2-EP1-4 signal pathway balance. In this way, misoprostol has a counteractive effect on oxidant stress and inflammation in the central nervous system. The PGES-PGE2-EPs signaling pathway is a potential therapeutic strategy for treating neurodegeneration in patients. PMID:27033056

  20. Predictors of uterine evacuation following early medical abortion with mifepristone and misoprostol.

    Science.gov (United States)

    Reeves, Matthew F; Monmaney, Jessica A; Creinin, Mitchell D

    2016-02-01

    We sought to determine predictors of uterine evacuation for women undergoing medical abortion using mifepristone and vaginal misoprostol through 63 days' gestation. We pooled data from two prospective multicenter medical abortion trials. In one study, women received mifepristone 200 mg followed either 6-8 or 23-25 h later by misoprostol 800 mcg vaginally. In the second study, women received mifepristone 200 mg followed either misoprostol 800 mcg vaginally. We examined the absolute risk (AR) of uterine evacuation using Fisher's Exact Tests for categorical variables and Student t test and Wilcoxon rank-sum tests for continuous variables. We used logistic regression to calculate odds ratios (ORs) of uterine evacuation. Uterine evacuation was performed for 75 (3.5%) of 2160 women. In multivariable analysis, 5 or more prior deliveries (AR 11.9%, OR 4.6) and gestational age of 8 weeks or more (AR 4.1%, OR 2.1) were significantly associated with uterine evacuation, while age of 20 years or younger (AR 1.4%, OR 0.4) was significantly and inversely associated with uterine evacuation. Prior cesarean delivery, multiple gestations, smoking, weight, body surface area and body mass index were not predictive of uterine evacuation in univariate or multivariable analysis. Uterine evacuation is an uncommon outcome in medical abortion with mifepristone and vaginal misoprostol. Five or more deliveries are the only significant predictor that identifies a group with an AR of uterine evacuation of more than 6%. Uterine evacuation is uncommon in medical abortion with mifepristone and vaginal misoprostol. Parity of five or more is the only significant predictor of uterine evacuation exceeding 6%. Until additional research is completed, medical abortion should not be withheld from women with five or more deliveries. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Using Misoprostol for Primary versus Secondary Prevention of Postpartum Haemorrhage - Do Costs Matter?

    Science.gov (United States)

    Chatterjee, Susmita; Sarkar, Anupam; Rao, Krishna D

    2016-01-01

    Postpartum heammorrhage (PPH), defined as blood loss greater than or equal to 500 ml within 24 hours after birth, is the leading cause of maternal deaths globally and in India. Misoprostol is an important option for PPH management in setting where oxytocin (the gold standard for PPH prevention and treatment) in not available or not feasible to use. For the substantial number of deliveries which take place at home or at lower level heatlh facilities in India, misoprostol pills can be adminstered to prevent PPH. The standard approach using misoprostol is to administer it prophylactically as primary prevention (600 mcg). An alternative strategy could be to administer misoprostol only to those who are at high risk of having PPH i.e. as secondary prevention. This study reports on the relative cost per person of a strategy involving primary versus secondary prevention of PPH using misoprostol. It is based on a randomized cluster trial that was conducted in Bijapur district in Karnataka, India between December 2011 and March 2014 among pregnant women to compare two community-level strategies for the prevention of PPH: primary and secondary. The analysis was conducted from the government perspective using an ingredient approach. The cluster trial showed that there were no significant differences in clinical outcomes between the two study arms. However, the results of the cost analysis show that there is a difference of INR 6 (US$ 0.1) per birth for implementing the strategies primary versus secondary prevention. In India where 14.9 million births take place at sub-centres and at home, this additional cost of INR 6 per birth translates to an additional cost of INR 94 (US$ 1.6) million to the government to implement the primary prevention compared to the secondary prevention strategy. As clinical outcomes did not differ significantly between the two arms in the trial, taking into account the difference in costs and potential issues with sustainability, secondary prevention

  2. An Unreported Uterine Rupture in an Unscarred Uterus After Induced Labor With 25 μg Misoprostol Vaginally

    Directory of Open Access Journals (Sweden)

    Eva Rydahl

    2014-01-01

    Full Text Available Uterine rupture without a former history of cesarean delivery or uterine scarring is an exceedingly rare complication in pregnancy and labor. Misoprostol is widely used to induce labor but there is a lack of knowledge about serious adverse effects. It is especially challenging to collect reports on side effects because misoprostol is not a registered drug. We report a case of a woman induced by one dose 25 μg misoprostol vaginally. Her pregnancy was uncomplicated and she had an unscarred uterus. Her labor progressed rapidly and she experienced hyperstimulation, meconium stained amniotic fluid, uterine rupture, and excessive blood loss of approximately 14 l. The child survived but is diagnosed with cerebral palsy. The case was never reported as an adverse event. This case questions the safety of misoprostol even in low dosage. It also underlines the need to report side effects to national reporting systems.

  3. Misoprostol inhibits gastric mucosal release of endogenous prostaglandin E2 and thromboxane B2 in healthy volunteers

    DEFF Research Database (Denmark)

    Mertz-Nielsen, A; Eskerod, O; Bukhave, K

    1995-01-01

    antagonists in preventing ulcer relapse. It could be that prostaglandin analogues inhibit gastric mucosal synthesis or release of endogenous eicosanoids, thereby abrogating their own effects. This study, therefore, examined how a single therapeutic dose (200 micrograms) of misoprostol, a synthetic analogue...... blind, cross over design. In each subject misoprostol or placebo was instilled in randomised order into the stomach, which was subsequently perfused with isotonic mannitol. Misoprostol significantly decreased basal as well as acid stimulated output of PGE2 and TXB2, without affecting output of LTB4....... These data show that misoprostol inhibits gastric mucosal synthesis of prostanoids. Decreased concentrations, or even a changed profile, of native eicosanoids modulating the release of inflammatory mediators from immune cells might explain why prostaglandin analogues have a comparatively poor clinical...

  4. Size-fitting of Intravaginal Rings for Macaques and in vitro Release Kinetics of Zinc Finger Inhibitors

    OpenAIRE

    Malcolm, Karl; Smith, James M.; Appella, Ettore; Schito, Marco; Hayashi, Ryo; Lanier, Nattawan; Otten, Ronald; Butera, Sal; McConville, Christopher; Woolfson, David

    2008-01-01

    Background: Small molecule inhibitors of the zinc finger domain (ZFI) in the nucleocapsid protein (NCp7) of HIV-1 are potent inhibitors of HIV and SIVreplication and may have utility as topical products to prevent infection. Furthermore, intravaginal rings (IVRs) were developed as coitally-independent,sustained release devices which could be used for administration of HIV microbicides. The aims of these studies were to demonstrate that IVRs sized formacaques are practical and compatible with ...

  5. Rectal and bladder dose reduction with the addition of intravaginal balloons to vaginal packing in intracavitary brachytherapy for cervical cancer.

    Science.gov (United States)

    Eng, T Y; Patel, A J; Ha, C S

    2016-01-01

    The use of intravaginal Foley balloons in addition to conventional packing during high-dose-rate (HDR) tandem and ovoids intracavitary brachytherapy (ICBT) is a means to improve displacement of organs at risk, thus reducing dose-dependent complications. The goal of this project was to determine the reduction in dose achieved to the bladder and rectum with intravaginal Foley balloons with CT-based planning and to share our packing technique. One hundred and six HDR-ICBT procedures performed for 38 patients were analyzed for this report. An uninflated Foley balloon was inserted into the vagina above and below the tandem flange separately and secured in place with vaginal packing. CT images were then obtained with both inflated and deflated Foley balloons. Plan optimization occurred and dose volume histogram data were generated for the bladder and rectum. Maximum dose to 0.1, 1.0, and 2.0 cm(3) volumes for the rectum and bladder were analyzed and compared between inflated and deflated balloons using parametric statistical analysis. Inflation of intravaginal balloons allowed significant reduction of dose to the bladder and rectum. Amount of reduction was dependent on the anatomy of the patient and the placement of the balloons. Displacement of the organs at risk by the balloons allowed an average of 7.2% reduction in dose to the bladder (D0.1 cm(3)) and 9.3% to the rectum (D0.1 cm(3)) with a maximum reduction of 41% and 43%, respectively. For patients undergoing HDR-ICBT, a significant dose reduction to the bladder and rectum could be achieved with further displacement of these structures using intravaginal Foley balloons in addition to conventional vaginal packing. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  6. Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date

    Science.gov (United States)

    2013-01-01

    Background Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births. Methods We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events. Results Eighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal

  7. Pregnancy and conception rate after two intravaginal inseminations with dog semen frozen either with 5% glycerol or 5% ethylene glycol.

    Science.gov (United States)

    Rota, Ada; Milani, C; Romagnoli, S; Zucchini, P; Mollo, A

    2010-03-01

    The primary goal of this study was to compare the effects of 5% ethylene glycol (EG) and 5% glycerol (G) on fertility of frozen-thawed dog semen following intravaginal insemination. The sperm-rich fraction of the ejaculate of three male dogs was collected, pooled and divided into two aliquots, and then frozen with a Tris-glucose-egg yolk-citric acid extender containing either 5% G or 5% EG. A total of 10 bitches were inseminated twice, five with G-frozen-thawed semen and five with EG-frozen-thawed semen; intravaginal inseminations were performed the 4th and the 5th day after the estimated LH peak; four straws, thawed in a 37 degrees C water bath for 1 min and diluted in a Tris buffer, were used for insemination (200 x 10(6) spermatozoa); the insemination dose was introduced in the cranial vagina of the bitch using a sterile plastic catheter. Ovariohysterectomy was performed in all bitches between days 29 and 31 after the calculated LH surge, and pregnancy status, and the number of conceptuses and corpora lutea were recorded. All bitches were pregnant. Neither the number of conceptuses, nor the ratio of conceptuses to corpora lutea (conception rate) was significantly different between groups. In this first screening, with a limited number of bitches, EG-frozen semen did not show a higher fertility than G-frozen semen when used for two intravaginal inseminations. Irrespective of the semen used, conception rate was 0.50.

  8. Effect of intravaginal dehydroepiandrosterone (DHEA) on the female sexual function in postmenopausal women: ERC-230 open-label study.

    Science.gov (United States)

    Bouchard, Céline; Labrie, Fernand; Derogatis, Leonard; Girard, Ginette; Ayotte, Normand; Gallagher, John; Cusan, Leonello; Archer, David F; Portman, David; Lavoie, Lyne; Beauregard, Adam; Côté, Isabelle; Martel, Céline; Vaillancourt, Mario; Balser, John; Moyneur, Erick

    2016-03-01

    Intravaginal DHEA (dehydroepiandrosterone, prasterone), the exclusive precursor of androgens and estrogens in postmenopausal women, has previously been shown to improve all the domains of sexual function by a strictly local action in the vagina. The well recognized female sexual function index (FSFI) questionnaire was used in the present study. The long-term effect of 52-week treatment with daily intravaginal 0.50% (6.5 mg) DHEA was evaluated on the various domains of female sexual function using the FSFI questionnaire at baseline, Week 26 and Week 52. One hundred and fifty-four postmenopausal women with at least one mild to severe symptom of vulvovaginal atrophy (VVA) and who have completed the FSFI questionnaire at baseline and at least one post-baseline timepoint were included in the analysis. The FSFI domains desire, arousal, lubrication, orgasm, satisfaction and pain were increased by 28%, 49%, 115%, 51%, 41% and 108%, respectively (p<0.0001 for all parameters) at 52 weeks vs. baseline, while the total score was increased from 13.4±0.62 at baseline to 21.5±0.82 (+60%, p<0.0001) at 52 weeks. As the serum levels of DHEA and all its metabolites, including estradiol and testosterone, show no meaningful change, the present clinical data indicate a stimulatory effect of intravaginal DHEA through a strictly local action in agreement with the preclinical data showing that the androgens made locally from DHEA in the vagina induce an increase in local nerve density.

  9. Placement of laminaria tents does not improve time to delivery in patients undergoing second trimester labor induction with misoprostol.

    Science.gov (United States)

    Thornburg, Loralei L; Grace, Daniel; Gray, Angela L; Glantz, J Christopher; Pressman, Eva K

    2010-08-01

    We sought to determine whether placement of laminaria tents improve time to delivery compared with misoprostol alone in second trimester labor induction. We retrospectively reviewed all patients undergoing second trimester labor induction. Patients with ruptured membranes, abruption, cervical dilation and chorioamnionitis at presentation were excluded. Complications were defined as chorioamnionitis, retained placenta or other surgical procedures. Patients who received laminaria and vaginal misoprostol, 200 microg every 12 h, were compared to those who received misoprostol without laminaria. Forty-three patients met inclusion criteria, 19 underwent induction with misoprostol alone and 24 with laminaria and misoprostol. The median times to fetal and placenta deliveries were 16.4 and 0.0 h in the misoprostol group, and 20.6 and 0.2 h in the laminaria group. There was no difference in complications. Post-hoc power analysis revealed >80% power to detect a difference in time to delivery of >12 h, and >90% power to detect a difference in time to placental delivery of > or =30 min. Placement of laminaria does not improve fetal or placental delivery times in patients undergoing second trimester pregnancy termination by labor induction.

  10. Sublingual misoprostol plus laminaria for cervical preparation before surgical management of late first trimester missed abortions, a randomized controlled trial.

    Science.gov (United States)

    Khooshideh, Maryam; Yarmohammadi, Nasim; Shahriari, Ali; Sheikh, Mahdi

    2017-02-01

    Comparing the efficacy of low-dose sublingual misoprostol plus laminaria to medium-dose sublingual misoprostol alone for cervical dilation before surgical management of late first trimester missed abortions. Randomized, controlled trial evaluated 70 women with missed abortion, admitted for surgical termination of pregnancy. The patients were randomly assigned to receive 200 μg sublingual misoprostol with cervical laminaria (intervention group) or 400 μg sublingual misoprostol without laminaria (control group), four hours before surgical process. The study is registered at www.irct.ir (IRCT2014070711020N4). More patients in the intervention group achieved the desired cervical dilation (≥Hegar7) before surgical process than the control group (91.4% versus 17.1%, p misoprostol alone, using a combination of cervical laminaria plus low-dose sublingual misoprostol before surgical process is associated with significantly more effective and rapid cervical dilation, lower requirement for mechanical dilation, lower abdominal pain and discomfort during the waiting period and higher patients' satisfaction.

  11. Comparison of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion.

    Science.gov (United States)

    Huang, Ming-Chao; Hsieh, Ching-Hung; Huang, Jian-Pei; Tsai, Hsiu-Ting; Lee, Maw-Sheng

    2017-06-01

    To evaluate the effects of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion. From January 2006 to December 2011, 173 women received an 800-μg vaginal loading dose of misoprostol. After the loading dose, 103 patients received 800 mg of misoprostol vaginally and 70 patients received 400 mg of misoprostol sublingually every 12 h until the delivery of the fetus. In the vaginal group, the average abortion time was 1.07 ± 1.29 days; that was 0.82 ± 0.66 days in the sublingual group. Sequential sublingual misoprostol after a vaginal loading dose of 800 mg with an administration interval of 12 h had a similar abortion rate and time to abortion. In addition, this protocol reduced unnecessary digital pelvic examinations and speculum examinations. This sequential sublingual misoprostol regimen might be a suitable regimen for mid-trimester abortion. Copyright © 2017. Published by Elsevier B.V.

  12. Randomized controlled trial comparing carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following an elective cesarean delivery.

    Science.gov (United States)

    Elbohoty, Ahmed E H; Mohammed, Walid E; Sweed, Mohamed; Bahaa Eldin, Ahmed M; Nabhan, Ashraf; Abd-El-Maeboud, Karim H I

    2016-09-01

    To compare the effectiveness and safety of carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following cesarean deliveries. A double-blind randomized controlled trial enrolled patients with a singleton pregnancy scheduled for an elective cesarean delivery at a maternity hospital in Cairo, Egypt, between October 1, 2012 and June 30, 2013. Participants were randomized using a computer-generated sequence to receive treatment with carbetocin, misoprostol, or oxytocin. The primary outcome was the occurrence of uterine atony necessitating additional uterotonics. Per-protocol analyses were performed. Patients, investigators, and data analysts were masked to treatment assignments. The present study enrolled 263 patients; data were analyzed from 88 patients treated with carbetocin, 89 treated with misoprostol, and 86 women treated with oxytocin. Further uterotonics were needed for the treatment of 5 (6%) patients who were treated with carbetocin, 20 (22%) patients treated with misoprostol, and 11 (13%) patients treated with oxytocin. In the prevention of uterine atony, carbetocin was comparable with oxytocin (RR 0.41, 95%CI 0.14-1.25) and superior to misoprostol (RR 0.21, 95%CI 0.07-0.58). Additional uterotonics were needed less frequently by patients treated with carbetocin. Carbetocin was comparable to oxytocin and superior to misoprostol in the prevention of uterine atony following an elective cesarean delivery. ClinicalTrials.gov: NCT02053922. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Buccal or sublingual misoprostol for cervical ripening and induction of labour.

    Science.gov (United States)

    Muzonzini, G; Hofmeyr, G J

    2004-10-18

    This is one of a series of reviews of cervical ripening and labour induction using standardised methodology. Misoprostol administered by the oral and sublingual routes have the advantage of rapid onset of action, while the sublingual and vaginal routes have the advantage of prolonged activity and greatest bioavailability. To determine the effectiveness and safety of misoprostol administered buccally or sublingually for third trimester cervical ripening and induction of labour. We searched the Cochrane Pregnancy and Childbirth Group trials register (8 December 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), and bibliographies of relevant papers. Randomised controlled trials comparing buccal or sublingual misoprostol used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. A generic strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. Data were extracted onto standardized forms, checked for accuracy, and analysed using RevMan software. Three studies (502 participants) compared buccal/sublingual misoprostol respectively with a vaginal regimen (200 microg versus 50 microg) and with oral administration (50 versus 50 microg and 50 versus 100microg).The buccal route was associated with a trend to fewer caesarean sections than with the vaginal route (18/73 versus 28/79; relative risk (RR) 0.70; 95% confidence interval (CI) 0.42 to 1.15). There were no significant differences in any other outcomes. When the same dosage was used sublingually versus orally, the sublingual route was associated with less failures to achieve vaginal delivery within 24 hours (12/50 versus 19/50; RR 0.63, 95% CI 0.34 to 1.16), reduced oxytocin augmentation (17/50 versus 23/50; RR 0.74, 95% CI 0.45 to 1.21) and reduced caesarean section (8/50 versus 15/50; RR 0.53, 95% CI 0.25 to

  14. Oral misoprostol for preventing postpartum haemorrhage in home births in rural Bangladesh: how effective is it?

    Science.gov (United States)

    Nasreen, Hashima-E-; Nahar, Shamsun; Al Mamun, Mahfuz; Afsana, Kaosar; Byass, Peter

    2011-01-01

    Aims Evidence exists about prevention of postpartum haemorrhage (PPH) by oral administration of misoprostol in low-income countries, but effectiveness of prevention by lay community health workers (CHW) is not sufficient. This study aimed to investigate whether a single dose (400 µg) of oral misoprostol could prevent PPH in a community home-birth setting and to assess its acceptability and feasibility among rural Bangladeshi women. Methods This quasi-experimental trial was conducted among 2,017 rural women who had home deliveries between November 2009 and February 2010 in two rural districts of northern Bangladesh. In the intervention district 1,009 women received 400 µg of misoprostol immediately after giving birth by the lay CHWs, and in the control district 1,008 women were followed after giving birth with no specific intervention against PPH. Primary PPH (within 24 hours) was measured by women's self-reported subjective measures of the normality of blood loss using the ‘cultural consensus model.’ Baseline data provided socio-economic, reproductive, obstetric, and bleeding disorder information. Findings The incidence of primary PPH was found to be lower in the intervention group (1.6%) than the control group (6.2%) (pMisoprostol provided 81% protection (RR: 0.19; 95% CI: 0.08–0.48) against developing primary PPH. The proportion of retained and manually removed placentae was found to be higher in the control group compared to the intervention group. Women in the control group were more likely to need an emergency referral to a higher level facility and blood transfusion than the intervention group. Unexpectedly few women experienced transient side effects of misoprostol. Eighty-seven percent of the women were willing to use the drug in future pregnancy and would recommend to other pregnant women. Conclusion Community-based distribution of oral misoprostol (400 µg) by CHW appeared to be effective, safe, acceptable, and feasible in reducing the incidence

  15. Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence.

    Science.gov (United States)

    Castellani, Daniele; Saldutto, Pietro; Galica, Vikiela; Pace, Gianna; Biferi, Daniela; Paradiso Galatioto, Giuseppe; Vicentini, Carlo

    2015-01-01

    Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative models of therapy for treating female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advances the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women. Sixty-two women with SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6 months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire-Short Form. Two patients were lost at follow-up and one discontinued the study. Mean urine leakage at the 24-hour pad test dropped from 42.3 ± 20.2 g/die to 31.5 ± 14.2 g/die in Group 1 and from 48.3 ± 19.8 g/die to 22.3 ± 10.1 g/die in Group 2. Symptoms scores and incontinence status were statistically significant better in Group 2 when compared to Group 1. IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI. © 2015 S. Karger AG, Basel.

  16. Chlamydial Type III Secretion System Needle Protein Induces Protective Immunity against Chlamydia muridarum Intravaginal Infection

    Directory of Open Access Journals (Sweden)

    Ekaterina A. Koroleva

    2017-01-01

    Full Text Available Chlamydia trachomatis imposes serious health problems and causes infertility. Because of asymptomatic onset, it often escapes antibiotic treatment. Therefore, vaccines offer a better option for the prevention of unwanted inflammatory sequelae. The existence of serologically distinct serovars of C. trachomatis suggests that a vaccine will need to provide protection against multiple serovars. Chlamydia spp. use a highly conserved type III secretion system (T3SS composed of structural and effector proteins which is an essential virulence factor. In this study, we expressed the T3SS needle protein of Chlamydia muridarum, TC_0037, an ortholog of C. trachomatis CdsF, in a replication-defective adenoviral vector (AdTC_0037 and evaluated its protective efficacy in an intravaginal Chlamydia muridarum model. For better immune responses, we employed a heterologous prime-boost immunization protocol in which mice were intranasally primed with AdTC_0037 and subcutaneously boosted with recombinant TC_0037 and Toll-like receptor 4 agonist monophosphoryl lipid A mixed in a squalene nanoscale emulsion. We found that immunization with TC_0037 antigen induced specific humoral and T cell responses, decreased Chlamydia loads in the genital tract, and abrogated pathology of upper genital organs. Together, our results suggest that TC_0037, a highly conserved chlamydial T3SS protein, is a good candidate for inclusion in a Chlamydia vaccine.

  17. [Intravaginal culture and embryo transfer. A new method for the fertilization of human oocytes].

    Science.gov (United States)

    Ranoux, C; Dubuisson, J B; Foulot, H; Aubriot, F X

    1987-12-01

    This technique was developed at the University Clinic of Port-Royal. It corresponds to the intravaginal culture of embryos and their transfer into the uterus. After ovocyte stimulation, most often by Clomid HMG, the follicles are aspirated under laparoscopic or sonographic control 34 to 36 hours after HCG. After being collected, the ovocytes are placed, whatever their stage of maturity, in one or several 3 ml tubes completely filled with culture medium (B2 of pure Menezo). Up to 4 ovocytes per tube are thus fertilized with 10 to 20,000 mobile spermatozoids/ml, prepared in the usual dilution, centrifugation and migration. Then the tube(s) are placed in the posterior vaginal cul-de-sac, kept in place with a diaphragm where they will remain during the 44 to 48 hours of culture time. Following that time, the contents of the tube are examined in order to evaluate the occurrence and the stage of embryonic division. A first series of 100 aspirations has enabled to obtain 15 pregnancies, still evolving, including two births of healthy children. A randomized series is currently in progress to determine a possible difference in the rates of pregnancy between CIVETE and the classic technique. Beside its new psychological contribution, this technique has demonstrated that it was possible to culture human embryos in the absence of CO2; its extreme simplicity should lead to a broader expansion of this technique.

  18. Static and dynamic MRI of a urinary control intra-vaginal device

    Energy Technology Data Exchange (ETDEWEB)

    Maubon, A.J. [Department of Medical Imaging, C. M. C. Beausoleil, Montpellier (France); Department of Radiology, CHU Dupuytren, Limoges (France); Boncoeur-Martel, M.P. [Department of Radiology, CHU Dupuytren, Limoges (France); Juhan, V.; Rouanet, J.P. [Department of Medical Imaging, C. M. C. Beausoleil, Montpellier (France); Courtieu, C.R. [Department of Gynecology, C. M. C. Beausoleil, Montpellier (France); Department of Obstetrics and Gynecology, C. H. U., F-30029 Nimes (France); Thurmond, A.S. [Women' s Imaging, Meridian Park Hospital, Portland, OR (United States); Aubas, P. [Department of Medical Information, Hopital Arnaud de Villeneuve, F-34295 Montpellier (France); Mares, P. [Department of Obstetrics and Gynecology, C. H. U., F-30029 Nimes (France)

    2000-06-01

    The aim of this study was to describe by MRI, in dynamic conditions at rest and straining, the anatomical modifications induced by a commercially available intravaginal device (IVD) aimed at relieving female stress urinary incontinence. Ten female patients complaining of stress urinary incontinence (SUI) had pelvic MRI with static and dynamic sequences, without and with a self-inserted IVD. We studied positions and angulations of the IVD in the pelvis. Paired t-test allowed comparisons of: position of the bladder neck; urethral angulation with the pubis axis; position of the urethra; and posterior urethro-vesical angle (PUVA) without and with IVD. At rest, in ten of ten cases IVD laid cranial to the pubo-rectal muscle; with an average angulation of 95 {+-} 10 with the pubis axis, laterally tilted in three of ten cases. In maximum straining with IVD bladder neck descent was lower by an average of 5.2 {+-} 3.1 mm (p = 0.001), pubo-urethral angle opening was smaller by an average of 22 {+-} 20 (p = 0.015), and bladder neck to pubis distance was shorter by an average of 5.7 {+-} 4 mm. Posterior urethro-vesical angle was not significantly modified. Dynamic MRI allowed a non-invasive assessment of the mode of action of an IVD. The main modifications were a support of the bladder base and bladder neck, with a superior displacement of the urethra toward the pubis. (orig.)

  19. Static and dynamic MRI of a urinary control intra-vaginal device

    International Nuclear Information System (INIS)

    Maubon, A.J.; Boncoeur-Martel, M.P.; Juhan, V.; Rouanet, J.P.; Courtieu, C.R.; Thurmond, A.S.; Aubas, P.; Mares, P.

    2000-01-01

    The aim of this study was to describe by MRI, in dynamic conditions at rest and straining, the anatomical modifications induced by a commercially available intravaginal device (IVD) aimed at relieving female stress urinary incontinence. Ten female patients complaining of stress urinary incontinence (SUI) had pelvic MRI with static and dynamic sequences, without and with a self-inserted IVD. We studied positions and angulations of the IVD in the pelvis. Paired t-test allowed comparisons of: position of the bladder neck; urethral angulation with the pubis axis; position of the urethra; and posterior urethro-vesical angle (PUVA) without and with IVD. At rest, in ten of ten cases IVD laid cranial to the pubo-rectal muscle; with an average angulation of 95 ± 10 with the pubis axis, laterally tilted in three of ten cases. In maximum straining with IVD bladder neck descent was lower by an average of 5.2 ± 3.1 mm (p = 0.001), pubo-urethral angle opening was smaller by an average of 22 ± 20 (p = 0.015), and bladder neck to pubis distance was shorter by an average of 5.7 ± 4 mm. Posterior urethro-vesical angle was not significantly modified. Dynamic MRI allowed a non-invasive assessment of the mode of action of an IVD. The main modifications were a support of the bladder base and bladder neck, with a superior displacement of the urethra toward the pubis. (orig.)

  20. Examining targets for HIV prevention: intravaginal practices in Urban Lusaka, Zambia.

    Science.gov (United States)

    Alcaide, Maria L; Chisembele, Maureen; Mumbi, Miriam; Malupande, Emeria; Jones, Deborah

    2014-03-01

    Intravaginal practices (IVP) are the introduction of products inside the vagina for hygienic, health, or sexuality reasons. The influence of men and Alengizis, traditional marriage counselors for girls, in promoting IVP has not been explored. We conducted gender-concordant focus groups and key informant interviews with Alengizis. The responses were conducted grouped into three themes: (1) cultural norms, (2) types and reasons for IVP, and (3) health consequences. We found that IVP were used by all participants in our sample and were taught from generation to generation by friends, relatives, or Alengizis. The reasons for women to engage in IVP were hygienic, though men expect women to engage in IVP to enhance sexual pleasure. Approximately 40% of women are aware that IVP can facilitate genital infections, but felt they would not feel clean discontinuing IVP. All men were unaware of the vaginal damage caused by IVP, and were concerned about the loss of sexual pleasure if women discontinued IVP. Despite the health risks of IVP, IVP continue to be widespread in Zambia and an integral component of hygiene and sexuality. The frequency of IVP mandates exploration into methods to decrease or ameliorate their use as an essential component of HIV prevention.

  1. Regulatory T Cells Are Locally Induced during Intravaginal Infection of Mice with Neisseria gonorrhoeae▿

    Science.gov (United States)

    Imarai, Mónica; Candia, Enzo; Rodriguez-Tirado, Carolina; Tognarelli, Javier; Pardo, Mirka; Pérez, Tomas; Valdés, Daniel; Reyes-Cerpa, Sebastián; Nelson, Pablo; Acuna-Castillo, Claudio; Maisey, Kevin

    2008-01-01

    Neisseria gonorrhoeae is a gram-negative diplococcus that in human beings produces gonorrhea. Much clinical evidence has led to the conclusion that gonococcus has important mechanisms to evade host immune functions; however, these mechanisms are only now beginning to be elucidated. In this study, we determined that the BALB/c mouse is a good animal model to study gonococcus infection and examined the immune response against the bacteria. We determined that after intravaginal inoculation of mice with Neisseria gonorrhoeae, the bacteria reached and invaded the upper female reproductive tissues and elicited a T-cell-specific immune response associated with a very weak humoral response, altogether resembling gonococcus infection and disease in women. Remarkably, in the draining lymph nodes of the genital tracts of infected mice, we found an increase of regulatory T lymphocytes, namely, transforming growth factor β1-positive CD4+ T cells and CD4+ CD25+ Foxp3+ T cells. Altogether, results indicate that N. gonorrhoeae induces regulatory T cells, which might be related to the local survival of the pathogen and the establishment of a chronic asymptomatic infection. PMID:18824531

  2. Segmented polyurethane intravaginal rings for the sustained combined delivery of antiretroviral agents dapivirine and tenofovir.

    Science.gov (United States)

    Johnson, Todd J; Gupta, Kavita M; Fabian, Judit; Albright, Theodore H; Kiser, Patrick F

    2010-02-19

    Dual segment polyurethane intravaginal rings (IVRs) were fabricated to enable sustained release of antiretroviral agents dapivirine and tenofovir to prevent the male to female sexual transmission of the human immunodeficiency virus. Due to the contrasting hydrophilicity of the two drugs, dapivirine and tenofovir were separately formulated into polymers with matching hydrophilicity via solvent casting and hot melt extrusion. The resultant drug loaded rods were then joined together to form dual segment IVRs. Compression testing of the IVRs revealed that they are mechanically comparable to the widely accepted NuvaRing IVR. Physical characterization of the individual IVR segments using wide angle X-ray scattering and differential scanning calorimetry determined that dapivirine and tenofovir are amorphous and crystalline within their polymeric segments, respectively. In vitro release of tenofovir from the dual segment IVR was sustained over 30 days while dapivirine exhibited linear release over the time period. A 90 day accelerated stability study confirmed that dapivirine and tenofovir are stable in the IVR formulation. Altogether, these results suggest that multisegment polyurethane IVRs are an attractive formulation for the sustained vaginal delivery of drugs with contrasting hydrophilicity such as dapivirine and tenofovir. 2009 Elsevier B.V. All rights reserved.

  3. Optimal timing of misoprostol administration in nulliparous women undergoing office hysteroscopy: a randomized double-blind placebo-controlled study.

    Science.gov (United States)

    Fouda, Usama M; Gad Allah, Sherine H; Elshaer, Hesham S

    2016-07-01

    To determine the optimal timing of vaginal misoprostol administration in nulliparous women undergoing office hysteroscopy. Randomized double-blind placebo-controlled study. University teaching hospital. One hundred twenty nulliparous patients were randomly allocated in a 1:1 ratio to the long-interval misoprostol group or the short-interval misoprostol group. In the long-interval misoprostol group, two misoprostol tablets (400 μg) and two placebo tablets were administered vaginally at 12 and 3 hours, respectively, before office hysteroscopy. In the short-interval misoprostol group, two placebo tablets and two misoprostol tablets (400 μg) were administered vaginally 12 and 3 hours, respectively, before office hysteroscopy. The severity of pain was assessed by the patients with the use of a 100-mm visual analog scale (VAS). The operators assessed the ease of the passage of the hysteroscope through the cervical canal with the use of a 100-mm VAS as well. Pain scores during the procedure were significantly lower in the long-interval misoprostol group (37.98 ± 13.13 vs. 51.98 ± 20.68). In contrast, the pain scores 30 minutes after the procedure were similar between the two groups (11.92 ± 7.22 vs. 13.3 ± 6.73). Moreover, the passage of the hysteroscope through the cervical canal was easier in the long-interval misoprostol group (48.9 ± 17.79 vs. 58.28 ± 21.85). Vaginal misoprostol administration 12 hours before office hysteroscopy was more effective than vaginal misoprostol administration 3 hours before office hysteroscopy in relieving pain experienced by nulliparous patients undergoing office hysteroscopy. NCT02316301. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Misoprostol na Indução do Trabalho de Parto: Oral ou Vaginal?

    OpenAIRE

    Godinho, C; Santos, L; Palma, F; Campos, A

    2004-01-01

    Algumas complicações maternas ou fetais no decorrer da gravidez tornam necessária a indução do trabalho de parto. O misoprostol é um análogo sintético da prostaglandina Eı que mimetiza a acção endógena destas substâncias na maturação do colo do útero. A dose ideal, via e frequência de administração continuam sob investigação. O objectivo deste trabalho foi avaliar a eficácia do misoprostol na indução do trabalho de parto e a morbilidade associada à sua administração oral e vaginal. Foi efectu...

  5. The biomedicalisation of illegal abortion: the double life of misoprostol in Brazil

    Directory of Open Access Journals (Sweden)

    Silvia De Zordo

    Full Text Available Abstract This paper examines the double life of misoprostol in Brazil, where it is illegally used by women as an abortifacient and legally used in obstetric hospital wards. Based on my doctoral and post-doctoral anthropological research on contraception and abortion in Salvador, Bahia, this paper initially traces the “conversion” of misoprostol from a drug to treat ulcers to a self-administered abortifacient in Latin America, and its later conversion to aneclectic global obstetric tool. It then shows how, while reducing maternal mortality, its use as an illegal abortifacient has reinforced the double reproductive citizenship regime existing in countries with restrictive abortion laws and poor post-abortion care services, where poor women using it illegally are stigmatised, discriminated against and exposed to potentially severe health risks.

  6. Ulcerating and stenosing enteropathy treated with misoprostol: a case report with analysis of prostaglandin metabolism.

    Science.gov (United States)

    Havelund, Troels; Jensen, Boye L; Vinholt, Pernille J; Engvad, Birte; Stubbe, Jane

    2012-10-01

    A case of a 40-year-old man with chronic anaemia because of nonspecific ulcerating and stenosing enteropathy is presented. The diagnosis was made on the basis of capsule endoscopy, histology of resected ileum and no use of NSAIDs. He showed a clinical response to treatment with misoprostol, and therefore, he was investigated for a possible impairment in eicosanoid biosynthesis compared with healthy controls. No deficient synthesis of prostacyclin, prostaglandin E2 and thromboxane was found on examination of metabolites in blood and urine. This suggests a normal release of arachidonic acid from phospholipids. Ex-vivo cyclooxygenase (COX) assays showed normal COX-1 and COX-2 activities. The clinical response to treatment with the prostaglandin E1 analogue misoprostol suggests a defective prostaglandin E synthesis in the intestinal mucosa.

  7. Comparison of gemeprost and vaginal misoprostol in first trimester mifepristone-induced abortion

    DEFF Research Database (Denmark)

    Svendsen, Pernille Fog; Rørbye, Christina; Vejborg, Thomas

    2005-01-01

    Abstract Background The aim of this study was to compare efficacy and side effects of gemeprost and vaginal misoprostol in mifepristone-induced abortions in women up to 63 days of gestation. Methods A retrospective study of 833 consecutive patients admitted for medical termination of first......, gemeprost and vaginal misoprostol are equally effective for termination of first trimester abortion, but may be associated with varying intensity of side effects........ The severity of bleeding and side effects (pain, nausea, vomiting and diarrhea) was scored by the patients, and requests for supplementary analgesic treatment were recorded by the attending nurse. Results Success rates were 99% in both groups after 2 weeks of follow-up. At 3 months of follow-up, success rates...

  8. Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

    Directory of Open Access Journals (Sweden)

    Shochet Tara

    2012-11-01

    Full Text Available Abstract Background In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. Methods A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. Results Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%. Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92. Both tolerability of side effects and women’s satisfaction were similar in the two study arms. Conclusion Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. Trial

  9. Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: A randomized clinical trial.

    Science.gov (United States)

    Othman, Essam Rashad; Fayez, Margaret Fathy; El Aal, Diaa Eldeen Mohamed Abd; El-Dine Mohamed, Hazem Saad; Abbas, Ahmed Mohammed; Ali, Mohammed Khairy

    2016-12-01

    This study compares the efficacy of sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery. A randomized clinical trial conducted on 120 pregnant women at term (37-40 weeks) gestation scheduled for elective cesarean delivery, who were assigned to either sublingual misoprostol 400 μg or intravenous infusion of 20 units of oxytocin after delivery of the neonate. The main outcome measures were blood loss at and 2 hours after cesarean delivery, change in hematocrit value, need for any additional oxytocic drugs, and drug-related side effects. The overall mean blood loss was significantly lower in the misoprostol group compared to the oxytocin group (490.75 ± 159.90 mL vs. 601.08 ± 299.49 mL; p = 0.025). However, changes in hematocrit level (pre- and postpartum) was comparable between both groups. There was a need for additional oxytocic therapy in 16.7% and 23.3% after use of misoprostol and oxytocin, respectively (p = 0.361). Incidence of side effects such as shivering and metallic taste were significantly higher in the misoprostol group compared to the oxytocin group (p misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss during and after cesarean delivery. However, occurrence of temporary side effects such as shivering and metallic taste was more frequent with the use of misoprostol. Copyright © 2016. Published by Elsevier B.V.

  10. Cervical Priming by Vaginal or Oral Misoprostol Before Operative Hysteroscopy: A Double-Blind, Randomized Controlled Trial.

    Science.gov (United States)

    Nada, Adel M; Elzayat, Ahmed R; Awad, Mohamed H; Metwally, Ahmed A; Taher, Ayman M; Ogila, Asmaa I; Askalany, Ahmed N; Mohsen, Reham A; Mostafa, Mona; Abdelaal, Hoda

    To evaluate whether misoprostol oral is as effective as vaginal tablets for cervical ripening. Randomized controlled trial involving a parallel, double-blinded study (Canadian Task Force Classification IB). Department of Obstetrics and Gynecology, Cairo University Hospital, between January 2014 and January 2016. Patients undergoing operative hysteroscopy for various indications. At 12 hours before hysteroscopy, the oral group received a 400-μg misoprostol tablet and 2 vaginal starch tablets. The vaginal group received 400 μg of misoprostol and 2 oral starch tablets. The control group received 2 oral starch and 2 vaginal starch tablets as placebo. Preoperative preparation was the same in all patients. The main outcome measures were width of the endocervical canal, ease of dilatation, time to dilatation, and adverse effects. All subjects eligible for operative hysteroscopy (n = 430) were invited to participate. Twenty subjects refused, and 20 subjects were excluded. The enrolled subjects (n = 390) were randomized to oral misoprostol, vaginal misoprostol, or placebo. The differences in mean width of the endocervical canal between the oral and the control groups (4.79 ± 1.07 mm vs 3.92 ± 0.92 mm), and also between the vaginal and the control groups (4.25 ± 0.71 mm vs 3.92 ± 0.92 mm) were significant (p  .05). We found no statistically significant difference in the efficacy of cervical priming between oral misoprostol and vaginal misoprostol. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  11. Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

    Science.gov (United States)

    2012-01-01

    Background In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. Methods A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. Results Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%). Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92). Both tolerability of side effects and women’s satisfaction were similar in the two study arms. Conclusion Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. Trial registration This study has

  12. side-effects of oral misoprostol in the third stage of labour

    African Journals Online (AJOL)

    9.7%,. RR 0.93, a 0.56 - 1.53). Possible effects on blood loss may have been obscured by the lesser use of additional oxytocics ir1 the misoprostol group (14% v. 18%, RR 0.78, CI 0.54 - 1.13). Department of Obstetrics and Gynaecology, Coronation Hospital and Effective Care. Research Unit, University of the Witwatersrand, ...

  13. Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy.

    Science.gov (United States)

    Wang, Xiu; Yang, Aijun; Ma, Qingyong; Li, Xuelan; Qin, Li; He, Tongqiang

    2016-09-01

    To evaluate effectiveness and safety of titrated oral misoprostol solution (OMS) in comparison with vaginal dinoprostone for cervix ripening and labor induction in term pregnant women. A multicenter randomized controlled trial of women with term singleton pregnancy with indications for labor induction; 481 participants were allocated to receive titrated OMS with different doses by hourly administration according to the procedure or insert vaginal dinoprostone for cervix ripening and labor induction to compare maternal outcomes including indication of labor induction, mode of outcome of delivery, maternal morbidity, and neonatal outcomes between two groups for evaluating the efficacy and safety of titrated oral misoprostol induction. Proportion of delivery within 12 h of titrated oral misoprostol is significantly less than vaginal dinoprostone (p = 0.03), but no difference of total vaginal delivery rate (p = 0.93); the mean time of first treatment to vaginal delivery was longer in OMS group (21.3 ± 14.5 h) compared with the vaginal dinoprostone group (15.7 ± 9.6 h). Although the proportion of cesarean section between the two groups showed no statistically significant difference, OMS group showed significantly lower frequency of uterine hyperstimulation, hypertonus, partus precipitatus and non-reassuring fetal heart rate than dinoprostone group. Neonatal outcomes were similar evaluating from Apgar score and NICU admission. Our study also showed that labor induction of women with cervix Bishop score ≤3 needed increased dosage of misoprostol solution. Titrated OMS is as effective as vaginal dinoprostone in labor induction for term pregnant women, with safer effect for its lower rate of adverse effect for women.

  14. Different routes of misoprostol for cervical priming in first trimester surgical abortions: a randomized blind trial.

    Science.gov (United States)

    Ganer Herman, Hadas; Kerner, Ram; Gluck, Ohad; Feit, Hagit; Keidar, Ran; Bar, Jacob; Sagiv, Ron

    2017-04-01

    To compare effectiveness and patient satisfaction of different routes of misoprostol for short-term (same day) cervical priming in first trimester surgical abortions. In a blind randomized trial, patients undergoing surgical abortion at a gestational age of 6 + 0-14 + 6 were administered oral, vaginal, or sub-lingual 400 mcg misoprostol, 1.5 to 4 h prior to procedure. Surgeons blinded to patient allocation evaluated cervical priming. The primary outcome was initial cervical dilatation. Secondary outcomes were cervical consistency, ease of dilation, patient discomfort, and side effects. From July 2015 through May 2016, 120 patients were randomized as follows: 40 to oral, 40 to vaginal, and 40 to sublingual misoprostol administration. No differences were noted in patient age, gestational age, curettage indication (termination/delayed miscarriage), past vaginal delivery, and administration to procedure interval. Initial cervical dilatation was similar between the groups, as were cervical consistency and ease of dilation. Patients noted the greatest discomfort and side effects with sublingual administration. The followings were found to be independently associated with cervical dilatation in a linear regression analysis: sublingual administration, gestational age, missed abortion, and previous vaginal delivery. Side effects and administration to procedure interval were found non-significant. The same day cervical priming for first trimester surgical abortion is similarly achieved with all routes of misoprostol administration. In cases of termination of pregnancy with no prior vaginal delivery, sublingual administration may be considered, but entails a higher rate of side effects and patient discomfort.

  15. One or two day mifepristone-misoprostol interval for second trimester abortion

    DEFF Research Database (Denmark)

    Nilas, Lisbeth; Glavind-Kristensen, Marianne; Vejborg, Thomas

    2007-01-01

    METHODS: A retrospective 2-year cohort study of 127 women, with gestation between 13 and 24 weeks and a live fetus, seeking induced abortion. The aim was to compare the effect of a 1-day and a 2-day interval between oral mifepristone (200 mg) and vaginal misoprostol (400 microg) every 3 h. RESULTS...... with lower gestation (10.2 versus 6.8 h; pmisoprostol is effective in the second trimester, and the interval between the drugs can be reduced allowing individualised...

  16. ROLE OF 400 MCG INTRAOPERATIVE SUBLINGUAL MISOPROSTOL FOR REDUCTION OF CAESAREAN BLOOD LOSS

    Directory of Open Access Journals (Sweden)

    Lalmohan Nayak

    2017-02-01

    Full Text Available BACKGROUND Lower segment caesarean section is a common surgical procedure. Postpartum haemorrhage incidence after LSCS is 4%. Misoprostol is a prostaglandin E1 analogue with good uterotonic properties, easy availability, low cost, thermostability, long shelf life, easy administration and few adverse effects at therapeutic dose. It is readily absorbed by oral, sublingual, buccal, vaginal or rectal route. Sublingual route attains quickest concentration. Dose of 400 mcg was chosen in this study to minimise adverse effects with optimal therapeutic benefit. The aim of the study is to determine the efficacy of sublingual misoprostol in reducing caesarean blood loss. MATERIALS AND METHODS It is a prospective experimental study done in VSSIMSAR, Burla. Women undergoing LSCS were randomly assigned to study and control groups of equal strength of 100 each. In all cases, preoperative Hb%, haematocrit, pulse, BP was noted. Study group were given 400 mcg misoprostol at the time of cord clamping. In control group, nothing was given. In all patients, active management of third stage of labour was done by using oxytocin 10 IU (IV along with uterine massage. Blood loss soaked by tetra was calculated using formula, blood loss = wet weight-dry weight/1.05 (1.05 is constant. Amount of blood loss, postoperative Hb%, haematocrit, pulse rate, BP was noted in both groups and compared. BP and pulse were noted after 1 hour and Hb%, haematocrit were noted after 24 hours. RESULTS Study group showed significant decrease in total blood loss (around 117.9 mL as compared to control group. There was significant decrease in the postoperative fall in Hb in the study group as compared to control, the mean difference being 0.631 gm%. Study group also showed decrease in postoperative fall in haematocrit as compared to control, the mean difference being 0.055. CONCLUSION Misoprostol significantly reduced caesarean blood loss and doesn’t affect foetal outcome without significant

  17. Effectiveness of Per Rectal Misoprostol Versus Intramuscular Oxytocin for Prevention of Primary Postpartum Haemorrhage.

    Science.gov (United States)

    Asmat, Raheela; Ashraf, Tasneem; Asmat, Fazila; Asmat, Shakila; Asmat, Nagina

    2017-01-01

    To compare the effectiveness of per rectal misoprostol over oxytocin in primary postpartum haemorrhage (PPH). Randomised controlled trial study. Gynaecology and Obstetrics Department, Unit IV, Bolan Medical Complex Hospital, Quetta, from September 2013 to February 2014. Emergency obstetric patients receiving per rectal misoprostol (800 µgm) were named as group 'A' and those receiving 10 units oxytocin intramuscularly were labelled as group 'B'. The patients were followed within 24 hours of spontaneous vaginal deliveries. Pads soaked were used to assess the amount of blood loss. A total of 1,678 patients were included in the study. The mean age of patients in group-A was 29.11 years while the mean age of patients in group-B was 29.16 years. One hundred and twenty-three (14.66%) patients in group-A and 120 (14.31%) patients in group-B had PPH. Among the total 1,678 patients, 243 (14.49%) had postpartum haemorrhage among whom 24 (9.88%) had major haemorrhage with a blood loss ≥1000 mL. Among the sub-group (839 patients) administered misoprostol had 123 (14.66%) patients with blood loss greater than 500 mL and the rest 716 patients (85.34%) had blood loss less than 500 mL. The sub-group administered oxytocin have 120 (14.31%) out of 839 patients with postpartum haemorrhage while 719 (85.69%) had blood loss less than 500 mL. Active management of 3rd stage of labour with per rectal misoprostol administration was as effective as intramuscular oxytocin. Both were equally effective to reduce PPH and the subsequent need for surgical interventions.

  18. Effect of misoprostol, a prostaglandin E1 analog, on orthodontic tooth movement in rats.

    Science.gov (United States)

    Sekhavat, Ali Reza; Mousavizadeh, Kazem; Pakshir, Hamid Reza; Aslani, Fatemeh Sari

    2002-11-01

    The purpose of this study was to investigate the effects of oral administration of misoprostol, a prostaglandin E1 analog, on orthodontic tooth movement and root resorption in rats. Sixty-four male Sprague-Dawley rats that initially weighed 250 +/- 20 g were used in this study. The animals were randomly assigned to 1 of 6 experimental and 2 control (nonappliance and appliance) groups. The experimental groups received 2.5, 5.0, 10.0, 25.0, 50.0, and 100.0 microg/kg misoprostol by gastric lavage every 24 hours for 2 weeks. A fixed orthodontic appliance consisting of a nickel-titanium closed-coil spring, 5.0 mm long was ligated between the maxillary right incisor and the maxillary right first molar. The initial activating force was 60 g. For analysis of root resorption, 99 maxillary right and left first molars from 61 animals were chosen. Serial histologic sections of the mesial root of the maxillary first molars were made, and histologic analysis of root resorption on the mesial and distal surfaces was performed. The results showed that oral misoprostol did increase the amount of orthodontic tooth movement in all the experimental groups compared with the appliance control group. This increase was statistically significant in doses of 10.0, 25.0, 50.0, and 100.0 microg/kg (P orthodontic tooth movement with minimal root resorption.

  19. What is the optimal duration of oral misoprostol treatment for cervical ripening?

    Science.gov (United States)

    Drakopoulos, Panagiotis; Duyck, Céline; Gayet-Ageron, Angèle; Fernandez, Sonia; Irion, Olivier; Martinez de Tejada, Begoña

    2017-06-01

    To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) ≥ 6 or a significant cervical change (≥2 points in BS) during cervical ripening. Retrospective study of women with term singleton pregnancies and a BS misoprostol (20 μg first 2 doses followed by 40 μg every 2 h) for cervical ripening. We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS ≤ 2. During cervical ripening, 61 (15.3%) achieved a BS ≥ 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS ≥ 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age misoprostol tablets (14 h) during cervical ripening is very low.

  20. Effects of misoprostol on cell migration and transit in the dog stomach

    International Nuclear Information System (INIS)

    Goodlad, R.A.; Madgwick, A.J.; Moffatt, M.R.; Levin, S.; Allen, J.L.; Wright, N.A.

    1990-01-01

    Prostaglandins of the E series increase stomach mucosal mass by inducing hyperplasia, which could be the result either of increased cell production or of decreased cell loss. This report describes an investigation of the effect of the prostaglandin E1 analogue, misoprostol, on cell migration and transit. 3H-thymidine was used to label those cells synthesizing deoxyribonucleic acid in dogs that had been given an oral dose of 300 micrograms/kg per day misoprostol for 11 weeks. The animals were killed at timed intervals, and tissue from the gastric fundus was prepared for autoradiography. The distribution of labeled cells at various times after labeling was used to follow the movement of the wave of label and to calculate median cell migration rates and transit times. The migration rate of cells toward the gastric lumen was significantly increased from 1.4 +/- 0.3 to 3.6 +/- 0.6 cell positions per day in the misoprostol-treated group (p less than 0.001); however, the gland length (from the most basal mucous neck cell to the luminal surface) was also increased (from 52.1 +/- 1.1 to 74.0 +/- 1.6; p less than 0.001), thus there was no significant difference in the (transit) time taken for cells to reach the top of the gland (control, 17.5 +/- 9.8 days; test, 12.2 +/- 7.1 days)

  1. Assessment of pain during medical abortion with home use of misoprostol.

    Science.gov (United States)

    Cavet, Sandra; Fiala, Christian; Scemama, Agathe; Partouche, Henri

    2017-06-01

    Although medical abortion with home use of misoprostol has been shown to be safe and acceptable, there are few data about the experience of pain during the procedure. The aims of this study were to assess the intensity of pain associated with home use of misoprostol for medical abortion and to identify variables associated with severe pain. This was an observational study using an anonymous web-based questionnaire in patients having a medical abortion at home in France between 1 December 2013 and 30 April 2014. The questionnaire was completed by 232 women and the results of 193 were retained for analysis. The average pain score was 5.6 on a 10 point scale. A pain score ≥6 was rated as severe and was reported by 105 patients (54%). Nulliparity (odds ratio [OR] 4.10; 95% confidence interval [CI] 2.04, 8.22; p misoprostol at home for medical abortion, in order to improve their care and improve evidence-based guidelines.

  2. Effects of misoprostol on cell migration and transit in the dog stomach

    Energy Technology Data Exchange (ETDEWEB)

    Goodlad, R.A.; Madgwick, A.J.; Moffatt, M.R.; Levin, S.; Allen, J.L.; Wright, N.A. (Imperial Cancer Research Fund, London (England))

    1990-01-01

    Prostaglandins of the E series increase stomach mucosal mass by inducing hyperplasia, which could be the result either of increased cell production or of decreased cell loss. This report describes an investigation of the effect of the prostaglandin E1 analogue, misoprostol, on cell migration and transit. 3H-thymidine was used to label those cells synthesizing deoxyribonucleic acid in dogs that had been given an oral dose of 300 micrograms/kg per day misoprostol for 11 weeks. The animals were killed at timed intervals, and tissue from the gastric fundus was prepared for autoradiography. The distribution of labeled cells at various times after labeling was used to follow the movement of the wave of label and to calculate median cell migration rates and transit times. The migration rate of cells toward the gastric lumen was significantly increased from 1.4 +/- 0.3 to 3.6 +/- 0.6 cell positions per day in the misoprostol-treated group (p less than 0.001); however, the gland length (from the most basal mucous neck cell to the luminal surface) was also increased (from 52.1 +/- 1.1 to 74.0 +/- 1.6; p less than 0.001), thus there was no significant difference in the (transit) time taken for cells to reach the top of the gland (control, 17.5 +/- 9.8 days; test, 12.2 +/- 7.1 days).

  3. A novel misoprostol delivery system for induction of labor: clinical utility and patient considerations

    Science.gov (United States)

    Stephenson, Megan L; Wing, Deborah A

    2015-01-01

    Induction of labor is one of the most commonly performed obstetric procedures and will likely become more common as the reproductive population in developed nations changes. As the proportion of women undergoing induction grows, there is a constant search for more efficacious ways to induce labor while maintaining fetal and maternal safety as well as patient satisfaction. With almost half of induced labors requiring cervical ripening, methods for achieving active labor and vaginal delivery are constantly being investigated. Prostaglandins have been shown to be effective induction agents, and specifically vaginal misoprostol, used off-label, have been widely utilized to initiate cervical ripening and active labor. The challenge is to administer this medication accurately while maintaining the ability to discontinue the medication when needed. The misoprostol vaginal insert initiates cervical ripening utilizing a delivery system that controls medication release and can be rapidly removed. This paper reviews the design, development, and clinical utility of the misoprostol vaginal insert for induction of labor as well as patient considerations related to the delivery system. PMID:25960635

  4. Eficácia de dinoprostone e misoprostol para indução do trabalho de parto em nulíparas Efficacy of dinoprostone and misoprostol for labor induction in nulliparous women

    Directory of Open Access Journals (Sweden)

    Tenilson Amaral Oliveira

    2011-03-01

    Full Text Available OBJETIVO: verificar a eficácia e a segurança de dinoprostone e misoprostol para indução do parto vaginal, com ou sem o uso de ocitocina em nulíparas. MÉTODOS: realizou-se estudo retrospectivo, observacional, envolvendo 238 pacientes que foram submetidas à indução do parto de janeiro de 2008 a fevereiro de 2010 com uso de misoprostol 25 mcg via vaginal ou pessário contendo 10 mg de dinoprostone. Desse grupo, foram selecionadas 184 pacientes, que apresentavam as seguintes características: nulíparas, gestação entre 37 e 42 semanas, feto único, apresentação cefálica, membranas íntegras e índice de Bishop PURPOSE: to determine the efficacy and safety of dinoprostone and misoprostol for the induction of vaginal childbirth, with or without the use of oxytocin in nulliparous women. METHODS: in this retrospective observational study, 238 patients were subjected to the induction of delivery from January 2008 to February 2010 with the use of misoprostol 25 mcg by the vaginal route or a pessary containing 10 mg of dinoprostone. A total of 184 patients were selected, with the following characteristics: nulliparous, gestational age of 37-42 weeks, singleton pregnancies, cephalic presentation, intact membranes, and Bishop score < 3. Obstetric and neonatal data were analyzed and compared between groups. The Student t-test, chi-square test and Fisher's exact test were used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the rate of vaginal childbirth did not differ significantly in patients who used misoprostol and dinoprostone (43.2% versus 50%; p = 0.35, respectively. The ripening of cervix was higher in the group treated with misoprostol (87.3% versus 75.6%, p=0.04. The use of oxytocin was necessary in 58.8% of the misoprostol group and 57.3% in the dinoprostone group after the ripening of cervix. Failed induction was the primary indication of caesarean section delivery in both groups, with no significant

  5. Buccal misoprostol plus laminaria for cervical preparation before dilation and evacuation at 21-23 weeks of gestation: a randomized controlled trial.

    Science.gov (United States)

    Drey, Eleanor A; Benson, Lyndsey S; Sokoloff, Abby; Steinauer, Jody E; Roy, Geneviève; Jackson, Rebecca A

    2014-04-01

    To describe the effectiveness of buccal misoprostol as an adjunct to laminaria for cervical ripening before later second-trimester abortion by dilation and evacuation (D&E). A randomized, double-blinded, placebo-controlled trial of 196 women undergoing D&E between 21 and 23 weeks of gestation. Subjects had overnight laminaria and 400 mcg buccal misoprostol or placebo 3-4 h before the abortion. We used logarithmic transformation of the primary outcome--D&E procedure duration--to achieve a normal distribution. Mean D&E duration was 1.7 min shorter with misoprostol (p=.02). The median duration was 9.7 versus 10.4 min in the misoprostol and placebo groups, respectively (p=.09). Cervical dilation was slightly greater with misoprostol (median 75 mm vs. 73 mm, p=.04); however, physicians did not find the misoprostol D&Es easier to complete. Half of subjects reported severe pain after misoprostol vs. 11% with placebo (p<.001). Adjuvant buccal misoprostol results in slightly shorter D&Es at the cost of more side effects. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. The prostaglandin E1 analog, misoprostol, a normal tissue protector, does not protect four murine tumors in vivo from radiation injury

    International Nuclear Information System (INIS)

    Hanson, W.R.; Zhen, W.; Geng, L.

    1995-01-01

    The clinical development of radioprotectors, such as misoprostol, to protect normal tissue during cancer treatment must proceed with the assurance that tumors are not protected similarly or significantly. To provide data on this critical question, radiation-induced growth delay with or without the presence of misoprostol was measured in four murine tumors grown in the flanks of mice: the Lewis lung carcinoma, M-5076 ovarian sarcoma, FSA and NFSA. The effect of misoprostol on the tumor control dose (TCD 50 ) of radiation was measured in FSA-bearing mice with or without prior treatment with the nonsteroidal anti-inflammatory agent, indomethacin. Misoprostol did not influence the in vivo growth of any of the four tumors, nor did it protect any of the tumors from radiation-induced growth delay. Likewise, there was no increase in the radiation TCD 50 to treat the FSA in vivo in control or indomethacin-treated tumor-bearing mice. To measure any possible influence of tumor burden on the protective effect of miso-prostol on normal tissue in mice, the protective effect of misoprostol on the survival of intestinal clonogenic cells was measured in M-5076-bearing mice and found to be the same as in non-tumor-bearing mice. These data suggest that misoprostol protects normal tissue in mice without protecting at least four experimental murine tumors. The data support the contention that misoprostol can achieve therapeutic gain by protecting normal tissues without protecting tumors. 44 refs., 5 figs., 1 tab

  7. Cervical Priming Before Diagnostic Operative Hysteroscopy in Infertile Women: A Randomized, Double-Blind, Controlled Comparison of 2 Vaginal Misoprostol Doses

    Science.gov (United States)

    Bastu, Ercan; Celik, Cem; Nehir, Asli; Dogan, Murat; Yuksel, Bahar; Ergun, Bulent

    2013-01-01

    The aim of this study was to evaluate the efficacy of vaginal misoprostol for cervical priming at doses of 200 mcg and 400 mcg, 12 to 15 hours before diagnostic office hysteroscopy (OH) without anesthesia in patients with infertility. Sixty infertile patients requiring a diagnostic office hysteroscopy for investigation of infertility were included in the study. The patients were randomly allocated into 3 vaginally administered misoprostol groups: (1) control group, (2) 200-mcg dose group, and (3) 400-mcg dose group. Misoprostol significantly facilitated the procedure of OH: cervical entry was easier; procedural time was shorter; baseline cervical width was larger; and pain scoring was lower in the misoprostol groups compared with the control group. Increasing the dose of misoprostol from 200 mcg to 400 mcg did not improve the effect on cervical dilation. Misoprostol is a promising analog to use for cervical priming before OH. Since doses of 200 mcg and 400 mcg vaginal misoprostol 12 hours before the OH both have proven to be effective regimens, 200 mcg may be preferred. However, before routine clinical usage, further research is needed through large, randomized, controlled trials powered to detect a difference in complications to determine whether misoprostol reduces complications in OH. PMID:23701149

  8. The prostaglandin E{sub 1} analog, misoprostol, a normal tissue protector, does not protect four murine tumors in vivo from radiation injury

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, W.R.; Zhen, W.; Geng, L. [Loyola Univ. Chicago and Hines Veterans Administration Medical Centers, Hines, IL (United States)] [and others

    1995-06-01

    The clinical development of radioprotectors, such as misoprostol, to protect normal tissue during cancer treatment must proceed with the assurance that tumors are not protected similarly or significantly. To provide data on this critical question, radiation-induced growth delay with or without the presence of misoprostol was measured in four murine tumors grown in the flanks of mice: the Lewis lung carcinoma, M-5076 ovarian sarcoma, FSA and NFSA. The effect of misoprostol on the tumor control dose (TCD{sub 50}) of radiation was measured in FSA-bearing mice with or without prior treatment with the nonsteroidal anti-inflammatory agent, indomethacin. Misoprostol did not influence the in vivo growth of any of the four tumors, nor did it protect any of the tumors from radiation-induced growth delay. Likewise, there was no increase in the radiation TCD{sub 50} to treat the FSA in vivo in control or indomethacin-treated tumor-bearing mice. To measure any possible influence of tumor burden on the protective effect of miso-prostol on normal tissue in mice, the protective effect of misoprostol on the survival of intestinal clonogenic cells was measured in M-5076-bearing mice and found to be the same as in non-tumor-bearing mice. These data suggest that misoprostol protects normal tissue in mice without protecting at least four experimental murine tumors. The data support the contention that misoprostol can achieve therapeutic gain by protecting normal tissues without protecting tumors. 44 refs., 5 figs., 1 tab.

  9. Oviduct infection and hydrosalpinx in DBA1/j mice is induced by intracervical but not intravaginal inoculation with Chlamydia muridarum.

    Directory of Open Access Journals (Sweden)

    Lingli Tang

    Full Text Available Intravaginal infection with C. muridarum in mice often results in hydrosalpinx similar to that found in women urogenitally infected with C. trachomatis, making the C. muridarum lower genital tract infection murine model suitable for studying C. trachomatis pathogenesis. To our surprise, DBA1/j mice were highly resistant to hydrosalpinx following an intravaginal infection with C. muridarum although these mice were as susceptible to lower genital tract infection as other mouse strains. A significantly lower level of C. muridarum organisms was recovered from the oviduct of DBA1/j mice, correlating the resistance to hydrosalpinx with reduced ascension of C. muridarum to the oviduct. The DBA1/j resistance to hydrosalpinx was effectively overcome by intracervical inoculation with C. muridarum. The intracervically inoculated DBA1/j mice developed severe hydrosalpinx with the highest levels of live C. muridarum organisms recovered from uterine tissue on day 3 and oviduct tissue on day 7 post inoculation while in intravaginally inoculated DBA1/j mice, the peak of live organism recovery from uterine tissue was delayed to day 7 with no rise in the amount of live organisms recovered from the oviduct. These observations have not only validated the correlation between hydrosalpinx and live organism invasion in the oviduct but also demonstrated that the intracervical inoculation, by promoting rapid chlamydial replication in the uterine epithelial cells and ascension to the oviduct of DBA1/j mice, may be used for further understanding chlamydial pathogenic mechanisms. The above findings also suggest that strategies aimed at reducing tubal infection may be most effective in blocking tubal pathology.

  10. Oviduct infection and hydrosalpinx in DBA1/j mice is induced by intracervical but not intravaginal inoculation with Chlamydia muridarum.

    Science.gov (United States)

    Tang, Lingli; Zhang, Hongbo; Lei, Lei; Gong, Siqi; Zhou, Zhiguang; Baseman, Joel; Zhong, Guangming

    2013-01-01

    Intravaginal infection with C. muridarum in mice often results in hydrosalpinx similar to that found in women urogenitally infected with C. trachomatis, making the C. muridarum lower genital tract infection murine model suitable for studying C. trachomatis pathogenesis. To our surprise, DBA1/j mice were highly resistant to hydrosalpinx following an intravaginal infection with C. muridarum although these mice were as susceptible to lower genital tract infection as other mouse strains. A significantly lower level of C. muridarum organisms was recovered from the oviduct of DBA1/j mice, correlating the resistance to hydrosalpinx with reduced ascension of C. muridarum to the oviduct. The DBA1/j resistance to hydrosalpinx was effectively overcome by intracervical inoculation with C. muridarum. The intracervically inoculated DBA1/j mice developed severe hydrosalpinx with the highest levels of live C. muridarum organisms recovered from uterine tissue on day 3 and oviduct tissue on day 7 post inoculation while in intravaginally inoculated DBA1/j mice, the peak of live organism recovery from uterine tissue was delayed to day 7 with no rise in the amount of live organisms recovered from the oviduct. These observations have not only validated the correlation between hydrosalpinx and live organism invasion in the oviduct but also demonstrated that the intracervical inoculation, by promoting rapid chlamydial replication in the uterine epithelial cells and ascension to the oviduct of DBA1/j mice, may be used for further understanding chlamydial pathogenic mechanisms. The above findings also suggest that strategies aimed at reducing tubal infection may be most effective in blocking tubal pathology.

  11. Effects of surface and intravaginal electrical stimulation in the treatment of women with stress urinary incontinence: randomized controlled trial.

    Science.gov (United States)

    Correia, Grasiéla N; Pereira, Vanessa S; Hirakawa, Humberto S; Driusso, Patricia

    2014-02-01

    To evaluate the effects of surface electrical stimulation (SES) and to compare them with the effects of the intravaginal electrical stimulation (IVES) in women with stress urinary incontinence (SUI). This randomized controlled study included 48 women aged over 50 years, who complained of SUI evaluated according to two structured questions of King's Health Questionnaire (KHQ) and who had not previously undergone physical therapy for SUI. The calculation of the sample size estimated a sample of 45 volunteers with a significance level of 5% and statistical power of 90%. The women were randomized to: Surface Electrical Stimulation Group (SESG) (n=15), Intravaginal Electrical Stimulation Group (IVESG) (n=15) and Control Group (CG) (n=15). Subjects in the intervention groups were treated with the same parameters of electrical stimulation for 12 sessions. The SESG had four silicone electrodes fixed in the suprapubic and ischial tuberosity regions. The IVES group used an intravaginal electrode. The CG did not receive any treatment during the corresponding time. They were evaluated before and after treatment by a physical therapist who was blind to group allocation. The primary outcomes were urinary leakage, pressure and strength of pelvic floor muscle (PFM) contraction. The secondary outcome was quality of life (QOL) evaluated by KHQ. Forty-five women completed the study and were included in the analysis. Statistical analysis was performed using the Wilcoxon test for intragroup analysis and Kruskal-Wallis and Mann-Whitney tests for intergroup analysis (purinary loss and pressure of contraction in the SESG and IVESG. PFM strength increased only in the IVESG. Intergroup analysis found differences after the treatment in: urinary leakage between the SESG and CG (pincontinence impact, limitations of daily activities, physical limitation, emotion, sleep and disposition and severity domains in the SESG (all purinary leakage, and strength and pressure of PFM contraction. Copyright

  12. Short communication: Drug residues in goat milk after prophylactic use of antibiotics in intravaginal sponges for estrus synchronization.

    Science.gov (United States)

    Romero, T; Balado, J; Althaus, R L; Beltrán, M C; Molina, M P

    2016-01-01

    The aim of this study was to determine whether the prophylactic use of antibiotics in intravaginal sponges used for estrus synchronization in goats may result in the presence of inhibitors in milk and, therefore, of positive results by microbial screening tests. Ninety-eight Murciano-Granadina goats were used, divided into 7 groups of 14 animals. Intravaginal sponges were placed in 6 groups using 2 concentrations of 3 different antibiotics: doxycycline, oxytetracycline, and sulfathiazole-framycetin. The sponges of the control group were placed without antibiotics. Milk samples were collected daily until 7 d posttreatment and analyzed using 3 microbial tests. Positive samples were retested by specific receptor-binding assays to confirm the positive results. Vaginal status was evaluated by visual assessment of the external aspect of the sponges after removal. The microbial test response was not affected by either day posttreatment or dose of antibiotic used, except for oxytetracycline at the higher concentration. Moreover, no positive results were obtained using receptor-binding assays, suggesting that residues, if present in milk, did not exceed the regulatory (safety) levels established for these drugs. The occurrence of soiled sponges was higher in the control group. With respect to the dose of antibiotics used, no significant differences were found for the lower dose administered. However, a significant increase in the percentage of clean sponges was observed for the higher dose of doxycycline. We conclude that the prophylactic use of low doses of doxycycline, oxytetracycline, or sulfathiazole in intravaginal sponges used for synchronization of estrus helps to reduce clinical vaginitis in dairy goats and does not seem to be the cause of positive results in microbial inhibitor tests used to detect antibiotics in goat milk. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  13. Intravaginal electrical stimulation: a randomized, double-blind study on the treatment of mixed urinary incontinence.

    Science.gov (United States)

    Amaro, João L; Gameiro, Mônica O; Kawano, Paulo R; Padovani, Carlos R

    2006-01-01

    The aim of this study was to compare effective and sham intravaginal electrical stimulation (IES) in treating mixed urinary incontinence. Between January 2001 and February 2002, 40 women were randomly distributed, in a double-blind study, into two groups: group G1 (n=20), effective IES, and group G2 (n = 20), sham IES, with follow up at one month. Different parameters was studied: 1. clinical questionnaire; 2. body mass index; 3. 60-min pad test; 4. urodynamic study. The protocol of IES consisted of three 20-min sessions per week over a seven-week period. The Dualpex Uro 996 used a frequency of 4 Hz. There was no statistically significant difference in the demographic data of both groups. The number of micturitions per 24 h after treatment was reduced significantly in both groups. Urge incontinence was reduced to 15% in G1 and 31.5% in G2; there was no significant difference between the groups. In the analog wetness and discomfort sensation evaluations were reduced significantly in both groups. The pretreatment urodynamic study showed no statistical difference in urodynamic parameters between the groups. Ten percent of the women presented involuntary detrusor contractions. In the 60-min pad test, there was a significant reduction in both groups. In regards to satisfaction level, after treatment, 80% of G1 patients and 65% of G2 patients were satisfied. There was no statistically significant difference between the groups. Significant improvement was provided by effective and sham electrostimulation, questioning the effectiveness of electrostimulation as a monotherapy.

  14. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women.

    Science.gov (United States)

    Labrie, Fernand; Archer, David; Bouchard, Céline; Fortier, Michel; Cusan, Leonello; Gomez, José-Luis; Girard, Ginette; Baron, Mira; Ayotte, Normand; Moreau, Michèle; Dubé, Robert; Côté, Isabelle; Labrie, Claude; Lavoie, Lyne; Berger, Louise; Gilbert, Lucy; Martel, Céline; Balser, John

    2009-01-01

    The objective of this study was to provide evidence that the transformation of DHEA into both androgens and/or estrogens locally in cells of the three layers of the vagina (epithelium, lamina propria, and muscularis) would have effects of greater impact, including effects on sexual function, than only effects on superficial epithelial cells as achieved with estrogens. This prospective, randomized, double-blind, and placebo-controlled phase III clinical trial has evaluated the effect of daily local intravaginal application of Prasterone (dehydroepiandrosterone; DHEA) for 12 weeks on the domains of sexual dysfunction, namely, desire/interest, arousal, orgasm, and pain at sexual activity, in 216 postmenopausal women with moderate to severe symptoms of vaginal atrophy. A time- and dose-dependent improvement of the four domains of sexual function was observed. At the 12-week time interval, the 1.0% DHEA dose led, compared with placebo, to 49% (P = 0.0061) and 23% (P = 0.0257) improvements of the desire domains in the Menopause Specific Quality of Life and Abbreviated Sex Function questionnaires, respectively. Compared with placebo, the Abbreviated Sex Function arousal/sensation domain was improved by 68% (P = 0.006), the arousal/lubrication domain by 39% (P = 0.0014), orgasm by 75% (P = 0.047), and dryness during intercourse by 57% (P = 0.0001). By a local action in the vagina, DHEA applied daily at doses at which serum steroids remain well within normal postmenopausal values exerts relatively potent beneficial effects on all four aspects of sexual dysfunction. Such data indicate that combined androgenic/estrogenic stimulation in the three layers of the vagina exerts important beneficial effects on sexual function in women without systemic action on the brain and other extravaginal tissues.

  15. Safe and sustained vaginal delivery of pyrimidinedione HIV-1 inhibitors from polyurethane intravaginal rings.

    Science.gov (United States)

    Johnson, Todd J; Srinivasan, Priya; Albright, Theodore H; Watson-Buckheit, Karen; Rabe, Lorna; Martin, Amy; Pau, Chou-Pong; Hendry, R Michael; Otten, Ron; McNicholl, Janet; Buckheit, Robert; Smith, James; Kiser, Patrick F

    2012-03-01

    The potent antiretroviral pyrimidinediones IQP-0528 (PYD1) and IQP-0532 (PYD2) were formulated in polyurethane intravaginal rings (IVRs) as prophylactic drug delivery systems to prevent the sexual transmission of HIV-1. To aid in the selection of a pyrimidinedione candidate and the optimal loading of the drug in the IVR delivery system, four pyrimidinedione IVR formulations (PYD1 at 0.5 wt% [PYD1(0.5 wt%)], PYD1(1 wt%), PYD2(4 wt%), and PYD2(14 wt%)) were evaluated in pigtail macaques over 28 days for safety and pyrimidinedione vaginal biodistribution. Kinetic analysis of vaginal proinflammatory cytokines, native microflora, and drug levels suggested that all formulations were safe, but only the high-loaded PYD2(14 wt%) IVR demonstrated consistently high pyrimidinedione vaginal fluid and tissue levels over the 28-day study. This formulation delivered drug in excess of 10 μg/ml to vaginal fluid and 1 μg/g to vaginal tissue, a level over 1,000 times the in vitro 50% effective concentration. The in vitro release of PYD1 and PYD2 under nonsink conditions correlated well with in vivo release, both in amount and in kinetic profile, and therefore may serve as a more biologically relevant means of evaluating release in vitro than typically employed sink conditions. Lastly, the pyrimidinediones in the IVR formulation were chemically stable after 90 days of storage at elevated temperature, and the potent nanomolar-level antiviral activity of both molecules was retained after in vitro release. Altogether, these results point to the successful IVR formulation and vaginal biodistribution of the pyrimidinediones and demonstrate the usefulness of the pigtail macaque model in evaluating and screening antiretroviral IVR formulations prior to preclinical and clinical evaluation.

  16. Using Misoprostol for Primary versus Secondary Prevention of Postpartum Haemorrhage - Do Costs Matter?

    Directory of Open Access Journals (Sweden)

    Susmita Chatterjee

    Full Text Available Postpartum heammorrhage (PPH, defined as blood loss greater than or equal to 500 ml within 24 hours after birth, is the leading cause of maternal deaths globally and in India. Misoprostol is an important option for PPH management in setting where oxytocin (the gold standard for PPH prevention and treatment in not available or not feasible to use. For the substantial number of deliveries which take place at home or at lower level heatlh facilities in India, misoprostol pills can be adminstered to prevent PPH. The standard approach using misoprostol is to administer it prophylactically as primary prevention (600 mcg. An alternative strategy could be to administer misoprostol only to those who are at high risk of having PPH i.e. as secondary prevention.This study reports on the relative cost per person of a strategy involving primary versus secondary prevention of PPH using misoprostol. It is based on a randomized cluster trial that was conducted in Bijapur district in Karnataka, India between December 2011 and March 2014 among pregnant women to compare two community-level strategies for the prevention of PPH: primary and secondary. The analysis was conducted from the government perspective using an ingredient approach.The cluster trial showed that there were no significant differences in clinical outcomes between the two study arms. However, the results of the cost analysis show that there is a difference of INR 6 (US$ 0.1 per birth for implementing the strategies primary versus secondary prevention. In India where 14.9 million births take place at sub-centres and at home, this additional cost of INR 6 per birth translates to an additional cost of INR 94 (US$ 1.6 million to the government to implement the primary prevention compared to the secondary prevention strategy.As clinical outcomes did not differ significantly between the two arms in the trial, taking into account the difference in costs and potential issues with sustainability, secondary

  17. Using Misoprostol for Primary versus Secondary Prevention of Postpartum Haemorrhage – Do Costs Matter?

    Science.gov (United States)

    Chatterjee, Susmita; Sarkar, Anupam; Rao, Krishna D.

    2016-01-01

    Background Postpartum heammorrhage (PPH), defined as blood loss greater than or equal to 500 ml within 24 hours after birth, is the leading cause of maternal deaths globally and in India. Misoprostol is an important option for PPH management in setting where oxytocin (the gold standard for PPH prevention and treatment) in not available or not feasible to use. For the substantial number of deliveries which take place at home or at lower level heatlh facilities in India, misoprostol pills can be adminstered to prevent PPH. The standard approach using misoprostol is to administer it prophylactically as primary prevention (600 mcg). An alternative strategy could be to administer misoprostol only to those who are at high risk of having PPH i.e. as secondary prevention. Methods This study reports on the relative cost per person of a strategy involving primary versus secondary prevention of PPH using misoprostol. It is based on a randomized cluster trial that was conducted in Bijapur district in Karnataka, India between December 2011 and March 2014 among pregnant women to compare two community-level strategies for the prevention of PPH: primary and secondary. The analysis was conducted from the government perspective using an ingredient approach. Results The cluster trial showed that there were no significant differences in clinical outcomes between the two study arms. However, the results of the cost analysis show that there is a difference of INR 6 (US$ 0.1) per birth for implementing the strategies primary versus secondary prevention. In India where 14.9 million births take place at sub-centres and at home, this additional cost of INR 6 per birth translates to an additional cost of INR 94 (US$ 1.6) million to the government to implement the primary prevention compared to the secondary prevention strategy. Conclusion As clinical outcomes did not differ significantly between the two arms in the trial, taking into account the difference in costs and potential issues with

  18. Misoprostol for Prevention of Postpartum Hemorrhage at Home Birth in Afghanistan: Program Expansion Experience.

    Science.gov (United States)

    Haver, Jaime; Ansari, Nasratullah; Zainullah, Partamin; Kim, Young-Mi; Tappis, Hannah

    2016-01-01

    Afghanistan has a maternal mortality ratio of 400 per 100,000 live births. Hemorrhage is the leading cause of maternal death. Two-thirds of births occur at home. A pilot program conducted from 2005 to 2007 demonstrated the effectiveness of using community health workers for advance distribution of misoprostol to pregnant women for self-administration immediately following birth to prevent postpartum hemorrhage. The Ministry of Public Health requested an expansion of the pilot to study implementation on a larger scale before adopting the intervention as national policy. The purpose of this before-and-after study was to determine the effectiveness of advance distribution of misoprostol for self-administration across 20 districts in Afghanistan and identify any adverse events that occurred during expansion. Cross-sectional household surveys were conducted pre- (n = 408) and postintervention (n = 408) to assess the effect of the program on uterotonic use among women who had recently given birth. Maternal death audits and verbal autopsies were conducted to investigate peripartum maternal deaths that occurred during implementation in the 20 districts. Uterotonic use among women in the sample increased from 50.3% preintervention to 74.3% postintervention. Because of a large-scale investment in Afghanistan in training and deployment of community midwives, it was assumed that all women who gave birth in facilities received a uterotonic. A significant difference in uterotonic use at home births was observed among women who lived farthest from a health facility (> 90 minutes self-reported travel time) compared to women who lived closer (88.5% vs 38.9%; P women who accepted misoprostol and gave birth at home used the drug. No maternal deaths were identified among those women who used misoprostol. The results of this study build on the findings of the pilot program and provide evidence on the effectiveness, primarily measured by uterotonic use, of an expansion of advance

  19. Analysis of misoprostol and chlorhexidine policy gains in Pakistan: the advocacy experience of Mercy Corps Pakistan.

    Science.gov (United States)

    Sarwar, Zahida; Cutherell, Andrea; Noor, Arif; Naureen, Farah; Norman, Jennifer

    2015-11-25

    While Pakistan has made progress toward achieving Millennium Development Goal 5 for maternal health, it is unlikely to achieve the target; further, it is also not on track for Millennium Development Goal 4 regarding child health. Two low-cost, temperature stable and life-saving drugs, misoprostol and chlorhexidine, can respectively avert maternal and newborn deaths, and are particularly pertinent for poor and marginalized areas which bear the brunt of maternal and newborn deaths in Pakistan. In response, Mercy Corps led focused advocacy efforts to promote changes in policies, protocols, and regulatory environments for misoprostol (2012-2014) and for chlorhexidine (2014). These short-duration advocacy projects facilitated significant policy gains, such as inclusion of misoprostol and chlorhexidine into province-specific essential drug lists, development and endorsement of clinical protocols for the two drugs by provincial health departments, inclusion of misoprostol into pre-service training curriculum for several health cadres, and application for registration of chlorhexidine (at the concentration required for newborn care) by two pharmaceutical companies. These results were achieved by a consultative and evidence-based process which generated feedback from community members, program implementers, and policymakers, and ultimately put the government in the driver's seat to facilitate change. Community Action Dialogue forums were linked with provincial-level Technical Working Groups and Provincial Steering Committees, who passed on endorsed recommendations to the Health Secretary. The key factors which facilitated change were the identification of champions within the provincial health departments, prioritization of relationship building and follow-up, focus on concrete advocacy aims rather than broad objectives, and the use of multi-stakeholder forums to secure an enabling environment for the policy changes to take root. While these advocacy initiatives resulted in

  20. Feasibility, Acceptability, and Programme Effectiveness of Misoprostol for Prevention of Postpartum Haemorrhage in Rural Bangladesh: A Quasiexperimental Study

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    Abdul Quaiyum

    2014-01-01

    Full Text Available We explored the feasibility of distributing misoprostol tablets using two strategies in prevention of postpartum haemorrhage (PPH among women residing in the Abhoynagar subdistrict of Bangladesh. We conducted a quasiexperimental study with a posttest design and nonequivalent comparison and intervention groups. Paramedics distributed three misoprostol tablets, one delivery mat (Quaiyum’s delivery mat, a packet of five standardized sanitary pads, and one lidded plastic container with detailed counseling on their use. All materials except misoprostol were also provided with counseling sessions to the control group participants. Postpartum blood loss was measured by paramedics using standardized method. This study has demonstrated community acceptability to misoprostol tablets for the prevention of PPH that reduced overall volume of blood loss after childbirth. Likewise, the delivery mat and pad were found to be useful to mothers as tools for assessing the amount of blood loss after delivery and informing care-seeking decisions. Further studies should be undertaken to explore whether government outreach health workers can be trained to effectively distribute misoprostol tablets among rural women of Bangladesh. Such a study should explore and identify the programmatic requirements to integrate this within the existing reproductive health program of the Government of Bangladesh.

  1. Efficacy and acceptability of a mifepristone-misoprostol combined regimen for early induced abortion among women in Mexico City.

    Science.gov (United States)

    Peña, Melanie; Dzuba, Ilana G; Smith, Patricio Sanhueza; Mendoza, Luis Jorge Arellano; Bousiéguez, Manuel; Martínez, María Laura García; Polanco, Ranulfo Ríos; Villalón, Antonio Eduardo Flores; Winikoff, Beverly

    2014-10-01

    To evaluate the experience of women receiving mifepristone-misoprostol for early induced abortion in public sector facilities in the Federal District of Mexico City. An open-label prospective study was conducted with 1000 pregnant women who sought induced abortion with a pregnancy of up to 63days of gestation, as measured from the date of their last menstrual period. The study was conducted in three public sector healthcare facilities: two secondary level hospitals and one primary care clinic. Women ingested 200mg mifepristone on day 1, followed by 800μg buccal misoprostol 24hours later, and they returned for follow-up on day 8. The primary outcome was complete abortion without recourse to surgical intervention. A total of 971 women received mifepristone-misoprostol and were included in the analysis for efficacy of treatment. The overall efficacy of the combined medical abortion regimen studied was 97.3% (n=945); the success rate did not vary significantly by gestational age (95.9%-100%; P=0.449). Most women (n=922, 95.0%) had a successful induced abortion with only one dose of misoprostol. The combined mifepristone and buccal misoprostol regimen was found to be highly effective and acceptable among Mexican women. www.ClinicalTrials.gov: NCT00386282. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Availability and provision of misoprostol and other medicines for menstrual regulation among pharmacies in Bangladesh via mystery client survey.

    Science.gov (United States)

    Huda, Fauzia A; Ngo, Thoai D; Ahmed, Anisuddin; Alam, Anadil; Reichenbach, Laura

    2014-02-01

    To explore the availability and provision of misoprostol and other medicines for menstrual regulation (MR) among pharmacies in Bangladesh. Between March and November 2011, a cross-sectional study using mystery client visits was conducted among pharmacy workers in Dhaka and Gazipur Districts, Bangladesh. Mystery clients were trained to present 1 of 4 pre-developed situations to pharmacy workers to elicit information on the regimen, adverse effects, and complications of misoprostol use. Mystery clients visited 331 pharmacies. Among the 331 pharmacy workers, 45.8% offered the mystery clients misoprostol and/or other medicines for MR; 25.7% referred them to private clinics or hospitals. Only 7% recommended an effective regimen of misoprostol for MR; 65% suggested administering vaginal and oral misoprostol together. Overall, 72.4% did not provide any advice on complications; the remainder suggested visiting trained providers for complications. Counseling on excessive bleeding as a danger sign was provided by 46% of pharmacy workers. Most (94%) did not provide or refer for post-MR family planning. Pharmacy workers in urban Bangladesh are providing ineffective drugs and regimens for MR. A training package is needed to strengthen service delivery by providing accurate information, high-quality products, and referral mechanisms for women seeking MR through pharmacies. © 2013.

  3. Misoprostol-induced radioprotection of Syrian hamster embryo cells in utero from cell death and oncogenic transformation

    Energy Technology Data Exchange (ETDEWEB)

    Miller, R.C.; LaNasa, P.; Hanson, W.R. [Loyola Univ., Maywood, IL (United States)

    1994-07-01

    Misoprostol, a PGE analog, is an effective radioprotector of murine intestine and hematopoietic and hair cell renewal systems. The radioprotective nature of misoprostol was extended to examine its ability to influence clonogenic cell survival and induction of oncogenic transformation in Syrian hamster embryo cells exposed to X rays in utero and assayed in vitro. Hamsters in their 12th day of pregnancy were injected subcutaneously with misoprostal, and 2 h later the pregnant hamsters were exposed to graded doses of X rays. Immediately after irradiation, hamsters were euthanized and embryonic tissue was explanted into culture dishes containing complete growth medium. After a 2-week incubation period, clongenic cell survival and morphologically transformed foci were determined. Survival of misoprostol-treated SHE cells was increased and yielded a dose reduction factor of 1.5 compared to SHE cells treated with X rays alone. In contrast, radiation-induced oncogenic transformation of misoprostol-treated cells was reduced by a factor of 20 compared to cells treated with X rays alone. These studies suggest that misoprostol not only protects normal tissues in vivo from acute radiation injury, but also protects cells, to a large extent, from injury leading to transforming events. 26 refs., 6 figs., 2 tabs.

  4. Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation.

    Science.gov (United States)

    Smith, Helen J; Colvin, Christopher J; Richards, Esther; Roberson, Jeffrey; Sharma, Geeta; Thapa, Kusum; Gülmezoglu, A Metin

    2016-02-01

    Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  5. Misoprostol-induced radioprotection of Syrian hamster embryo cells in utero from cell death and oncogenic transformation

    International Nuclear Information System (INIS)

    Miller, R.C.; LaNasa, P.; Hanson, W.R.

    1994-01-01

    Misoprostol, a PGE analog, is an effective radioprotector of murine intestine and hematopoietic and hair cell renewal systems. The radioprotective nature of misoprostol was extended to examine its ability to influence clonogenic cell survival and induction of oncogenic transformation in Syrian hamster embryo cells exposed to X rays in utero and assayed in vitro. Hamsters in their 12th day of pregnancy were injected subcutaneously with misoprostal, and 2 h later the pregnant hamsters were exposed to graded doses of X rays. Immediately after irradiation, hamsters were euthanized and embryonic tissue was explanted into culture dishes containing complete growth medium. After a 2-week incubation period, clongenic cell survival and morphologically transformed foci were determined. Survival of misoprostol-treated SHE cells was increased and yielded a dose reduction factor of 1.5 compared to SHE cells treated with X rays alone. In contrast, radiation-induced oncogenic transformation of misoprostol-treated cells was reduced by a factor of 20 compared to cells treated with X rays alone. These studies suggest that misoprostol not only protects normal tissues in vivo from acute radiation injury, but also protects cells, to a large extent, from injury leading to transforming events. 26 refs., 6 figs., 2 tabs

  6. Comparing intravenous oxytocin Vs. rectal misoprostol for third-stage management after second-trimester medically induced abortion

    Directory of Open Access Journals (Sweden)

    Amirabi A

    2012-09-01

    Full Text Available Background: Induction of medical abortion during the second trimester of pregnancy is considered under certain medical conditions. Abortion in the second trimester of pregnancy could be accompanied by several side effects including hemorrhage and placenta retention. Several types of medications including oxytocin, ergots, and prostaglandins are used to control and optimize the third stage of labor and condition of delivery. The aim of this study was to compare the efficacy of intravenous oxytocin versus rectal misoprostol for the management of the third stage of labor during pregnancy termination. Methods: In this randomized clinical trial, 80 pregnant women between 14 to 24 weeks of gestational age were randomly assigned into two intervention groups. Twenty units of intravenous oxytocin was used as the standard regimen and it was compared with 400 µg of rectal misoprostol to manage the third stage of labor.Results: In this study, the frequency of placenta retention was significantly (P=0.034 lower in the misoprostol group (n=3, 7.5% compared with oxytocin group (n=10, 25%. The average duration of placenta delivery was significantly lower in the misoprostol group (7.95 min Vs. 19.22 min, respectively P=0.015. Decreases in hemoglobin concentration was not significantly different between the two groups. Conclusion: Generally, management of the third stage of labor in second-trimester abortions could reach a better outcome, regarding lower risks of placenta retention and duration of delivery, if rectal misoprostol is administered instead of intravenous oxytocin.

  7. Misoprostol versus prostaglandin E2 gel for labor induction in premature rupture of membranes after 34 weeks of pregnancy.

    Science.gov (United States)

    Zhang, Yan; Wang, Jun; Yu, Yan; Xie, Cui; Xiao, Meiqun; Ren, Lirong

    2015-09-01

    Both misoprostol and prostaglandin E2 (PGE2) gel are used for labor induction in women with premature rupture of membranes (PROM). To evaluate studies comparing the effects of misoprostol and PGE2 gel in labor induction. Databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant papers. Randomized controlled trials comparing the use of misoprostol and PGE2 gel for labor induction in women with PROM were included. For meta-analyses, the Mantel-Haenszel method was used for dichotomous data, and the inverse variance method was used for continuous data. Four randomized controlled studies (n=615) were included. There were no significant differences between the two groups in the induction-to-delivery interval (mean difference -4.44 hours; 95% confidence interval [CI] -9.35 to 0.48), rate of cesarean delivery (odds ratio [OR] 0.90; 95% CI 0.44-1.85), and rate of neonatal intensive care unit admission (OR 0.89; 95% CI 0.57-1.38). Women receiving misoprostol had a significantly higher rate of tachysystole than did those receiving PGE2 gel (OR 4.84; 95% CI 2.46-9.54). Misoprostol is as efficacious and safe as PGE2 gel for labor induction in women with PROM. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Sublingual versus vaginal misoprostol for cervical dilatation 1 or 3 h prior to surgical abortion: a double-blinded RCT.

    Science.gov (United States)

    Sääv, Ingrid; Kopp Kallner, Helena; Fiala, Christian; Gemzell-Danielsson, Kristina

    2015-06-01

    Can sublingual administration of misoprostol 1 h prior to vacuum aspiration be more effective than vaginal administration and as effective as either route three 3 h prior to surgery? Sublingually administered misoprostol is superior to vaginally administered misoprostol when given 1 h pre operatively, and it is as effective as after a three 3 h priming interval with either route of administration. Misoprostol reduces complications and morbidity when used for cervical priming prior to surgical dilatation and vacuum aspiration in first trimester pregnancy. Despite the widespread use and extensive studies, the optimal route of administration of misoprostol before surgical abortion remains to be defined. The optimal priming interval after vaginal and sublingual administration of 400 mcg misoprostol has been reported to be 3 h. A longer interval will not improve dilatation but will increase the risk for bleeding and expulsion of the uterine contents before surgical evacuation. The pharmacokinetic properties of misoprostol indicate that sublingual compared with vaginal administration of misoprostol may result in a more rapid cervical priming effect. Women were randomized to four treatment groups and received 400 mcg misoprostol sublingually, or vaginally, 1 or 3 h prior to surgery. The study was a double-blinded RCT with regard to route of misoprostol administration but not the timing interval. The primary outcome was baseline cervical dilatation after misoprostol priming. The study was conducted between June 2007 and March 2014 and 184 women aged 18 years or older were recruited. Women were recruited among nulliparous women undergoing elective surgical first trimester abortion. Exclusion criteria were any contraindication for misoprostol, untreated genital infection, previous history of surgery to the cervix, or abnormal pregnancy. Gestational age was established by endovaginal ultrasound examination. The trial was conducted in a university hospital outpatient clinic

  9. Oral misoprostol versus intracervical prostaglandin E2 gel for active management of premature rupture of membranes at term.

    Science.gov (United States)

    Nagpal, Monika B; Raghunandan, Chitra; Saili, Arvind

    2009-07-01

    To compare the efficacy and safety of oral misoprostol with intracervical prostaglandin E2 (PGE2) gel for the active management of premature rupture of membranes (PROM) at term. Women with pregnancies between 37 and 42 weeks presenting with PROM at term and a Bishop score of 5 or less were randomly assigned to receive either a 4-hourly oral dose of 50 microg of misoprostol up to a maximum of 3 doses or 2 applications of intracervical PGE2 gel at a 6-hour interval. Oxytocin was given if labor had not started after 12 hours. Twenty women in the misoprostol group (n=31) delivered within 12 hours compared with 5 in the PGE2 group (n=30) (Pintracervical PGE2 gel in the active management of PROM at term.

  10. Aborto e misoprostol: usos médicos, práticas de saúde e controvérsia científica Abortion and misoprostol: health practices and scientific controversy

    Directory of Open Access Journals (Sweden)

    Marilena Cordeiro Dias Villela Corrêa

    2012-07-01

    Full Text Available Este artigo coloca em perspectiva a controvérsia entre a associação do uso de misoprostol para aborto e teratogenicidade, encontrada em estudos do tipo relato de caso, e a consagração do uso de medicamentos à base do fármaco na área médico-obstétrica e em documentos normativos nacionais e internacionais que regulam o registro e a circulação de produtos farmacêuticos. Através do método monográfico, foram revisados, sistematizados e analisados documentos oficiais da Anvisa, Ministério da Saúde e Organização Mundial da Saúde sobre o uso do misoprostol, bem como 68 artigos do tipo relato de casos clínicos, publicados em periódicos científicos nacionais, que associam aborto, misoprostol e teratogenicidade. A interdição legal do aborto impede a prescrição e o uso adequados de uma droga que produz efeitos eficazes e seguros como o misoprostol. Assim, o grande malefício à saúde de mulheres está ligado não a características intrínsecas ao fármaco, mas a argumentos morais que representam descaso e desrespeito aos direitos fundamentais de mulheres.This article puts into perspective the controversy between the association of the use of misoprostol for abortion and teratogenicity studies of the type found in a case report. The use of herbal medicinal drugs and the medical-obstetric and national and international norms governing the registration and circulation of pharmaceutical products were examined. Official documents of ANVISA, the Ministry of Health and the World Health Organization on the use of misoprostol, as well as 68 articles such as case reports published in national journals, linking abortion, misoprostol and teratogenicity were reviewed, systematically filed and analyzed using the monographic method. The legal prohibition of abortion prevents the proper prescription and use of a drug such as misoprostol that is both safe and effective. Thus, the danger for the health of women is linked not to the intrinsic

  11. Qualitative and quantitative analysis of bacteria from vaginitis associated with intravaginal implants in ewes following estrus synchronization

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    Carlos Otávio de Paula Vasconcelos

    2016-04-01

    Full Text Available ABSTRACT: This study evaluated the presence of vaginitis and the bacterial load associated with different intravaginal implants in ewes. Twenty-four Dorper and crossbred ewes were allocated into three groups and received intravaginal implant containing 0.3g progesterone (CIDR(r, 60mg MAP or sponges without progesterone (CONTROL for six days. Then, CIDR and MAP treated-ewes received 12.5mg dinoprost and 300IU eCG. Vaginal mucus samples were collected at four times: before device insertion, at the day of its removal, 24 and 48 hours after. The samples were cultured and the colonies were counted (CFU/mL and identified. The results obtained from the counting of CFU mL-1 were submitted to Kruskal-Wallis H test, with P0.05 in comparison with MAP and CIDR-treated ewes. During the occurrence of vaginitis, the predominant isolates belonged to the coliform group, mainly Escherichia coli (72.7%. Such infection was not determined by the members of the vaginal microbiota that were present before implant insertion and normal microbiota was restored between 24 to 48 hours after insert removal.

  12. Misoprostol prior to hysteroscopy in premenopausal and post-menopausal women. A systematic review and meta-analysis.

    Science.gov (United States)

    Polyzos, N P; Zavos, A; Valachis, A; Dragamestianos, C; Blockeel, C; Stoop, D; Papanikolaou, E G; Tournaye, H; Devroey, P; Messinis, I E

    2012-07-01

    Although several randomized controlled trials (RCTs) have examined the effect of misoprostol prior to hysteroscopy for cervical dilatation, no solid conclusion has been reached. We therefore set out to perform a meta-analysis of RCTs. We searched MEDLINE, the ISI Web of Science and the Cochrane Library to identify RCTs comparing misoprostol versus placebo or control prior to hysteroscopy. No restrictions on language or time were applied. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for all dichotomous outcomes, whereas mean differences (MDs) and 95% CIs were calculated for continuous outcomes using the Mantel-Haenszel or DerSimonian-Laird model according to the heterogeneity. Of the initial 141 potentially relevant articles that were retrieved, 21 RCTs involving 1786 patients were included in the meta-analysis. Subgroup analyses were performed according to menopausal status and according to whether diagnostic or operative hysteroscopy was performed. Premenopausal women treated with misoprostol had a significantly lower risk for further cervical dilatation in the diagnostic setting [RR (95% CI): 0.56 (0.34-0.92)] and a significantly lower risk for cervical laceration in the operative setting [RR (95% CI): 0.22 (0.09-0.54)], compared with placebo. In contrast, post-menopausal patients did not experience any clear benefit from misoprostol compared with placebo regarding the need for further cervical dilatation [RR (95% CI): 0.99 (0.76-1.30)] and the cervical laceration rate [RR (95% CI): 1.15 (0.40-3.29)]. In addition, the mean cervical width prior to hysteroscopy was significantly higher in premenopausal women treated with misoprostol compared with placebo [MD (95% CI): 2.47 mm (1.81-3.13)] but did not differ among post-menopausal patients [MD (95% CI): 0.39 mm (-0.42 to 1.21)]. Misoprostol prior to hysteroscopy appears to facilitate an easier and uncomplicated procedure only in premenopausal women.

  13. Misoprostol 1 to 3 h preprocedure vs. overnight osmotic dilators prior to early second-trimester surgical abortion.

    Science.gov (United States)

    Ramesh, Shanthi; Roston, Alicia; Zimmerman, Lindsay; Patel, Ashlesha; Lichtenberg, E Steve; Chor, Julie

    2015-09-01

    We sought to compare the effectiveness of at least 1 h of 400 mcg of buccal misoprostol to overnight osmotic dilators for early second-trimester surgical abortion cervical preparation. We conducted a retrospective cohort study, reviewing 145 consecutive charts to compare procedure duration for women who received 400 mcg of buccal misoprostol at least 1 h preprocedure vs. overnight osmotic dilators before dilation and evacuation between 14 weeks, 0 days and 15 weeks, 6 days' gestation. Primary outcome was procedure duration and secondary outcomes included maximum mechanical dilator size, estimated blood loss and side effects. Sixty-four women (44.1%) received buccal misoprostol (mean 1.6 h), and 81 women (55.9%) received overnight osmotic dilators. Groups did not differ regarding mean gestational age or gynecologic history. All procedures in both groups were completed. Procedure duration was not significantly different between the misoprostol and osmotic dilator groups (median 11.0 min vs. 10.0 min, p=.22), even after multivariable linear regression (p=.17). The mean total cervical preparation duration was 1.6 h for women in the misoprostol group compared to 20.3 h in the osmotic dilator group (pmisoprostol decreased the duration of cervical preparation for early second-trimester procedures performed by an experienced surgeon. In this small, retrospective review, at least 1 h of preprocedure buccal misoprostol decreased the duration from cervical preparation initiation to procedure completion in early second-trimester procedures performed by an experienced surgeon. These results should be considered as a pilot evaluation, and further prospective study is needed to further clarify whether this short interval could be applied in general practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Dose and side effects of sublingual misoprostol for treatment of postpartum hemorrhage: what difference do they make?

    Science.gov (United States)

    2012-01-01

    Background Shivering and fever are common side effects of misoprostol. An unexpectedly high rate of fever above 40°C was documented among Ecuadorian women given treatment with 800mcg of sublingual misoprostol to manage postpartum hemorrhage (PPH) (36%). Much lower rates have been reported elsewhere (0-9%). Methods From February to July 2010, an open-label pilot study was conducted in Quito, Ecuador to determine whether a lower dose--600mcg sublingual misoprostol--would result in a lower incidence of high fever (≥40°C). Rates of shivering and fever with 600mcg sublingual regimen were compared to previously documented rates in Ecuador following PPH treatment with 800mcg sublingual misoprostol. Results The 600mcg dose resulted in a 55% lower rate of high fever compared with the 800mcg regimen (8/50; 16% vs. 58/163; 36%; relative risk 0.45 95% CI 0.23-0.88). Only one woman had severe shivering following the 600mcg dose compared with 19 women in the 800mcg cohort (2% vs. 12%; relative risk 0.17 (0.02-1.25)). No cases of delirium/altered sensorium were reported with the 600mcg dose and women’s assessment of severity/tolerability of shivering and fever was better with the lower dose. Conclusions 600mcg sublingual misoprostol was found to decrease the occurrence of high fever among Ecuadorian women when given to treat PPH. This study however was not powered to examine the efficacy of this treatment regimen and cannot be recommended at this time. Future research is needed to confirm whether other populations, outside of Quito, Ecuador, experience unusually high rates of elevated body temperature following sublingual administration of misoprostol for treatment of PPH. If indeed similar trends are found elsewhere, larger trials to confirm the efficacy of lower dosages may be justified. Trial Registration Clinical trials.gov, Registry No. NCT01080846 PMID:22769055

  15. Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster-randomised non-inferiority community trial.

    Science.gov (United States)

    Raghavan, S; Geller, S; Miller, S; Goudar, S S; Anger, H; Yadavannavar, M C; Dabash, R; Bidri, S R; Gudadinni, M R; Udgiri, R; Koch, A R; Bellad, M B; Winikoff, B

    2016-01-01

    To assess whether secondary prevention, which preemptively treats women with above-average postpartum bleeding, is non-inferior to universal prophylaxis. A cluster-randomised non-inferiority community trial. Health sub-centres and home deliveries in the Bijapur district of Karnataka, India. Women with low-risk pregnancies who were eligible for delivery with an Auxiliary Nurse Midwife at home or sub-centre and who consented to be part of the study. Auxiliary Nurse Midwifes were randomised to secondary prevention using 800 mcg sublingual misoprostol administered to women with postpartum blood loss ≥350 ml or to universal prophylaxis using 600 mcg oral misoprostol administered to all women during the third stage of labour. Postpartum haemoglobin ≤7.8 g/dl, mean postpartum blood loss and postpartum haemoglobin, postpartum haemorrhage rate, transfer to higher-level facilities, acceptability and feasibility of the intervention. Misoprostol was administered to 99.7% of women as primary prevention. In secondary prevention, 92 (4.7%) women had postpartum bleeding ≥350 ml, of which 90 (97.8%) received misoprostol. The proportion of women with postpartum haemoglobin ≤7.8 g/dl was 5.9 and 8.8% in secondary and primary prevention clusters, respectively [difference -2.9%, one-sided 95% confidence interval (CI) misoprostol is non-inferior to universal prophylaxis based on the primary outcome of postpartum haemoglobin. Secondary prevention could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level. Secondary prevention of postpartum haemorrhage with misoprostol is non-inferior to universal prophylaxis. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  16. Initial clinical experience with a misoprostol vaginal insert in comparison with a dinoprostone insert for inducing labor.

    Science.gov (United States)

    Mayer, Richard Bernhard; Oppelt, Peter; Shebl, Omar; Pömer, Joachim; Allerstorfer, Christina; Weiss, Christoph

    2016-05-01

    Only one phase III trial has been published to date on the efficacy and safety of misoprostol vaginal inserts for inducing labor. The aim of this study was to compare misoprostol inserts with dinoprostone inserts. This retrospective cohort study evaluated the reduction in time to vaginal delivery and delivery within 24h, in routine clinical work, in 119 labor inductions using a 200-μg misoprostol vaginal insert (Misodel(®); June-October 2014) in comparison with 124 inductions using a 10-mg dinoprostone insert (Propess(®); December 2013-April 2014). Vaginal delivery within 24h occurred in 77.3% (n=92) of the misoprostol cohort and 74.2% (n=92) of the dinoprostone cohort (P=0.654). Time from insert application to vaginal delivery (min) was 761.76 (±409.44, cohort M) versus 805.17 (±473.00, cohort D) (P=0.817). Cesarean delivery was performed in 10.1% (n=12) versus 10.5% (n=13) in the misoprostol and dinoprostone cohorts, respectively (P≥0.999). The modified Bishop scores were 2.0 versus 3.0 (P=0.001), mean body mass index (BMI) was 24.72 versus 23.95 (P=0.033), and fetal scalp blood testing was required in 12.6% (n=15) versus 3.2% (n=4; P=0.008). No differences were observed with regard to the rates of transfer to the neonatal unit or any type of fetal acidosis. The groups thus had similar results for rates of vaginal delivery within 24h, cesarean delivery and fetal outcomes. The misoprostol group had lower modified Bishop scores, higher BMIs, and a higher rate of fetal scalp blood testing. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Umbilical vein injection of misoprostol versus normal saline for the treatment of retained placenta: intrapartum placebo-controlled trial

    Science.gov (United States)

    2014-01-01

    Background The third stage of labour may be complicated by retained placenta, which should be managed promptly because it may cause severe bleeding and infection, with a potentially fatal outcome. This study evaluated the effectiveness of umbilical vein injection of misoprostol for the treatment of retained placenta in a hospital setting. Methods This hospital-based placebo-controlled trial was conducted at the Maternity Teaching Hospital, Erbil City, Kurdistan region, Northern Iraq from April 2011 to February 2012. The inclusion criteria were: gestational age of at least 28 weeks, vaginal delivery, and failure of the placenta to separate within 30 minutes after delivery of the infant despite active management of the third stage of labour. Forty-six women with retained placentas were eligible for inclusion. After informed consent was obtained, the women were alternately allocated to receive umbilical vein injection of either 800 mcg misoprostol dissolved in 20 mL of normal saline (misoprostol group) or 20 mL of normal saline only (saline group). The women were blinded to the group allocation, but the investigator who administered the injection was not. The trial was registered by the Research Ethics Committee of Hawler Medical University. Results After umbilical vein injection, delivery of the placenta occurred in 91.3% of women in the misoprostol group and 69.5% of women in the saline group, which was not a significant difference between the two groups. The median vaginal blood loss from the time of injection until delivery of the placenta was significantly less in the misoprostol group (100 mL) than in the saline group (210 mL) (p value misoprostol is an effective treatment for retained placenta, and reduces the volume of vaginal blood loss with few adverse effects. Clinical Trial Registration Current Controlled Trial HMU: N252.1.2011 PMID:24444360

  18. Advanced preformulation investigations for the development of a lead intravaginal bioadhesive polymeric device.

    Science.gov (United States)

    Ndesendo, Valence M K; Pillay, Viness; Choonara, Yahya E; du Toit, Lisa C; Buchmann, Eckhart; Kumar, Pradeep; Khan, Riaz A; Meyer, Leith C R

    2012-03-01

    To screen various polymers through extensive preformulation investigations to ultimately obtain a lead polymer combination for designing a desirable Intravaginal Bioadhesive Polymeric Device (IBPD). Hydrophilic and hydrophobic polymers (18) at different combinations were blended and compressed into 62 caplet-shaped devices at 5 tons, one of the hydrophilic polymers being a modified synthetic product of polyamide 6,10 ((m)PA 6,10). Two sets of crosslinked PAA-based caplets comprising either allyl-sucrose (AS-PAA) or allyl-penta-erythritol (APE-PAA) were explored. The devices were subjected to in-process validation tests and thereafter to preformulation investigational screening {equilibrium swelling ratio (ESR) being a screening parameter}, using a One Variable at a Time (OVAT) approach. Molecular mechanics force field simulations in both vacuum and solvated systems were conducted to investigate the influence of addition and subsequent replacement of a polymer(s) on the spatial disposition and energetic profile of the sterically constrained and geometrically optimized multi-polymeric complex, IBPD. The developed devices were sufficiently strong (longitudinal crushing force:286 ± 0.01 N; mean weight:600 ± 0.48 mg; mean friability:0.31 ± 0.04%). Through OVAT approach, 15 lead formulations with minimal swelling tendencies (ESRs ranging from 0.011 to 0.084) were obtained out of 62 formulations. F62 {i.e. (m)PA 6,10, (150 mg), PLGA (400 mg), EC (200 mg), PVA (25 mg) and PAA (25 mg)} displayed minimal swelling tendency and therefore the highest stability. The highly stabilized conformation of the final in silico IBPD polymeric assembly PLGA-(m)PA6,10-PVA-PAA-EC corroborated the experimental results in terms of preformulation investigational screening using the OVAT approach. The results obtained suggest that (m)PA 6,10, PLGA, EC, PVA and PAA at an appropriate weight ratio may be suitable for development of an IBPD.

  19. Thermoplastic polyurethane-based intravaginal rings for prophylaxis and treatment of (recurrent) bacterial vaginosis.

    Science.gov (United States)

    Verstraete, G; Vandenbussche, L; Kasmi, S; Nuhn, L; Brouckaert, D; Van Renterghem, J; Grymonpré, W; Vanhoorne, V; Coenye, T; De Geest, B G; De Beer, T; Remon, J P; Vervaet, C

    2017-08-30

    The aim of the present study was to develop thermoplastic polyurethane (TPU)-based intravaginal rings (IVRs) for prophylaxis and treatment of bacterial vaginosis via hot melt extrusion/injection molding. Therefore, different TPU grades were processed in combination with lactic acid or metronidazole, targeting a sustained lactic acid release over a 28day-period and sustained metronidazole release over 4-7days. Hot melt extrusion of lactic acid/TPU combinations required a lower extrusion temperature due to the plasticizing properties of lactic acid, evidenced by the lower glass transition temperature (T g ) and cross-over point (T tanδ = 1 ) values. NIR-chemical imaging data showed a homogenous distribution of lactic acid in TPU matrices at drug loads up to 30% (w/w). The addition of metronidazole did not lower processing temperatures, as the active pharmaceutical ingredient remained crystalline in the TPU matrix. Hydrophobic TPUs with a low ratio between the soft and hard segments (SS/HS ratio) in the polymer structure were suitable carriers for the lactic acid-eluting device over a 28-day period, while hydrophilic TPUs were needed to achieve the required release rate of metronidazole-eluting IVRs. IVRs manufactured with a TPU grade having a higher SS/HS ratio and lactic acid/TPU ratio exhibited a more elastic behavior. The addition of 25% (w/w) metronidazole did not affect the mechanical properties of the IVRs. Hydrophilic TPUs were most prone to biofilm formation by Candida albicans and Staphylococcus aureus, but the incorporation of metronidazole in the device prevented biofilm formation. Based on the drug eluting performance and mechanical tests, a mixture of lactic acid and Tecoflex™ EG-93A (20/80, w/w) and a combination of metronidazole and Tecophilic™ SP-93A-100 (25/75, w/w) were selected to design IVRs for the prophylaxis and treatment of bacterial vaginosis, respectively. Slug mucosal irritation tests predicted low irritation potency for both devices

  20. Intravaginal rings as delivery systems for microbicides and multipurpose prevention technologies

    Directory of Open Access Journals (Sweden)

    Thurman AR

    2013-10-01

    Full Text Available Andrea Ries Thurman, Meredith R Clark, Jennifer Hurlburt, Gustavo F Doncel CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA Abstract: There is a renewed interest in delivering pharmaceutical products via intravaginal rings (IVRs. IVRs are flexible torus-shaped drug delivery systems that can be easily inserted and removed by the woman and that provide both sustained and controlled drug release, lasting for several weeks to several months. In terms of women's health care products, it has been established that IVRs effectively deliver contraceptive steroids and steroids for the treatment of postmenopausal vaginal atrophy. A novel application for IVRs is the delivery of antiretroviral drugs for the prevention of human immunodeficiency virus (HIV genital infection. Microbicides are antiviral drugs delivered topically for HIV prevention. Recent reviews of microbicide IVRs have focused on technologies in development and optimizing ring design. IVRs have several advantages, including the ability to deliver sustained drug doses for long periods of time while bypassing first pass metabolism in the gut. IVRs are discreet, woman-controlled, and do not require a trained provider for placement or fitting. Previous data support that women and their male sexual partners find IVRs highly acceptable. Multipurpose prevention technology (MPT products provide protection against unintended/mistimed pregnancy and reproductive tract infections, including HIV. Several MPT IVRs are currently in development. Early clinical testing of new microbicide and MPT IVRs will require a focus on safety, pharmacokinetics and pharmacodynamics. Specifically, IVRs will have to deliver tissue concentrations of drugs that are pharmacodynamically active, do not cause mucosal alterations or inflammation, and do not change the resident microbiota. The emergence of resistance to antiretrovirals will need to be investigated. IVRs should not

  1. Radioimmunoassay of serum d-Norgestrel in women following oral and intravaginal administration

    International Nuclear Information System (INIS)

    Stanczyk, F.Z.; Hiroi, M.; Goebelsmann, U.; Brenner, P.F.; Lumkin, M.E.; Mishell, D.R. Jr.

    1975-01-01

    A radioimmunoassay (RIA) method for measuring d-Norgestrel (d-Ng) in serum has been developed utilizing petroleum ether extraction, an antiserum raised against d-Norgestrel-3-(0-carboxymethyl) oxime-epsilon-aminocaproic acid--boxine serum albumin, d-Norgestrel-3-(0-carboxymethyl) imino-[ 125 I]-iodohistamine, and dextran-coated charcoal separation. Control serum blanks were undetectable, 6 pg of d-Ng was measurable in 0.1 ml of serum with a high reliability, and intra- and interassay coefficients of variation were 4.4 and 4.9 percent, respectively. d-Ng added to control serum was quantitatively recovered. This RIA proved to be highly specific for d-Ng, cross-reacting less than 0.01 percent with 1-Ng and some 4 to 8 percent with 5α- and 5β-tetrahydro-d-Ng. Serum d-Ng levels measured in 3 women after ingestion of 75 μg of dl-Ng rose to 1.5 to 2 ng/ml within 1/2 to 2-3 hours after oral intake and fell rapidly thereafter to 0.2 to 0.4 ng/ml within 24 hours. Insertion of Silastic intravaginal rings (IVRs), containing 50 or 100 mg of dl-Ng, into 3 women for periods of 3 weeks resulted in a rapid rise of serum d-Ng after insertion. Serum d-Ng levels were highest 24 to 48 hours after the first insertion of each IVR, reaching peak levels of about 5 and 7 to 11 ng/ml, respectively, and declined gradually during the ensuing 15 to 20 days to some 30 to 40 percent of the peak serum d-Ng concentration. Serum d-Ng levels attained after IVR reinsertion remained relatively constant at 1 to 3 ng/ml during each subsequent cycle in all subjects and fell rapidly after each IVR removal. Serum estradiol and progesterone concentrations, measured about 3 times a week in these patients, indicated that ovulation was consistently inhibited

  2. Intravaginal administration of lactic acid bacteria modulated the incidence of purulent vaginal discharges, plasma haptoglobin concentrations, and milk production in dairy cows.

    Science.gov (United States)

    Ametaj, B N; Iqbal, S; Selami, F; Odhiambo, J F; Wang, Y; Gänzle, M G; Dunn, S M; Zebeli, Q

    2014-04-01

    This investigation studied the effects of intravaginal administration of a mixture of lactic acid bacteria (LAB) on the incidence of purulent vaginal discharges (PVD), plasma haptoglobin concentrations, and milk production in dairy cows. A total of 82 pregnant primiparous and multiparous Holstein dairy cows were used in this study. Half of the cows received intravaginally 1mL of LAB at 10(10)-10(12)cfu/mL and the other half 1mL of reconstituted skim milk (i.e., carrier) (controls). Administration of LAB was conducted once per wk during 2 and 1wk before the expected day of calving and at 1, 2, 3, and 4wk postpartum. Data demonstrated that intravaginal administration of LAB decreased the occurrence of PVD at 3wk postpartum (Pmilk than their control counterparts (Pmilk yield (P>0.05). Overall, this is the first study demonstrating that intravaginal LAB administration lowers the incidence of PVD and enhances milk production in dairy cows. Further research is warranted to evaluate the effects of LAB on reproductive performance in a larger cohort of cows. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model.

    Science.gov (United States)

    Kaya, Cihan; Sever, Nurten; Cengiz, Hüseyin; Yıldız, Şükrü; Ekin, Murat; Yaşar, Levent

    2014-05-01

    To investigate the effect of misoprostol in the reduction of adhesion formation after gynecological surgery. A double blind, randomized controlled experimental study was designed. Twenty-one female Wistar Hannover rats were divided into three groups as control, misoprostol and Hyalobarrier(®) groups. A uterine horn adhesion model was created. After anesthesia induction, 1.5-2cm injuries were made to the each uterine horn by cautery. The control group received no special medications except for the standard surgical procedure. The misoprostol group received 10μcg/kg misoprostol in addition to the standard surgical procedure, and the Hyalobarrier(®) group received 1cm(3) ready-for-use Hyalobarrier(®) gel intraperitoneally in addition to the standard surgical procedure. After 14 days from the first surgical procedure, adhesion scores were evaluated. The extent (p<0.001), severity (p<0.001), degree (p<0.001) and total adhesion score (p<0.001) values of the control group were statistically higher than the values of misoprostol and Hyalobarrier(®) groups. The inflammation score value of misoprostol group was statistically lower than control and Hyalobarrier(®) groups (p<0.001). In this study, we have found a new therapeutic potential of misoprostol that may be useful in preventing pelvic adhesion and reducing inflammation scores. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Evaluating misoprostol content in pregnant women with hourly oral administration during labor induction by microElution solid phase extraction combined with liquid chromatography tandem mass spectrometry.

    Science.gov (United States)

    Hung, Cheng-Han; Cheng, Shi-Yann; Chan, Tzu-Min; Lee, Maw-Rong

    2015-09-01

    Misoprostol is a widely used alternative of prostaglandin for labor induction. Based on previous studies, we envision that small and frequent oral dosage of misoprostol is an effective method for labor induction. To monitor the misoprostol content during labor induction, a rapid, sensitive, and selective microElution solid phase extraction (μElution SPE) combined with liquid chromatography tandem mass spectrometry (LC-MS/MS) was developed. Using μElution SPE could minimize the sample consumption and elution volume in order to maximize the sample enrichment and throughput. The misoprostol acid, a metabolite of misoprostol, was gradient separated in a Bidentate C18 column, then quantified by highly-selective reaction monitoring (H-SRM) in a total run time of 6min. The developed method was optimized and validated in human plasma, and showed linear range of 0.01-10ng/mL. The limit of detection (LOD) was 0.001ng/mL. The recovery ranged from 89.0 to 96.0%, and no significant matrix effect or carryover was observed. The precision, accuracy and stability were met with the criteria of U.S. FDA guidance. The developed method was successfully applied to evaluate misoprostol concentration during labor induction in pregnant women. The concentration-time profiles approves that hourly oral administration of misoprostol is a safe and effective method without drug accumulation for labor induction. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. A systematic review and meta-analysis of randomized controlled trials on the effectiveness of cervical ripening with misoprostol administration before hysteroscopy.

    Science.gov (United States)

    Zhuo, Zhihong; Yu, Huimin; Jiang, Xingzhi

    2016-03-01

    Misoprostol is an effective cervical ripening agent. To determine the effect of misoprostol on cervical ripening before hysteroscopy. Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for pertinent studies published before November 2014, using the search terms "hysteroscopy," "ripening," and "misoprostol." Randomized controlled trials published in English were included that compared the effects of misoprostol versus placebo on cervical dilatation before diagnostic or operative hysteroscopy. Random-effects models were used to calculate odds ratios or mean differences (MDs) with 95% confidence intervals (CIs). The analysis included 32 trials. Misoprostol had significant effects on the need for further cervical dilatation (odds ratio 0.29, 95% CI 0.17-0.50), the cervical width (MD 1.53, 95% CI 0.92-2.13), and the time taken for cervical dilatation (MD -0.35, 95% CI -0.50 to -0.20). Corresponding observations were made in the subgroup of premenopausal women, but not in the subgroup of postmenopausal women. Adverse effects were significantly more common with misoprostol than with placebo (risk difference 0.07, 95% CI 0.01-0.12). Misoprostol had a significant effect on cervical ripening before hysteroscopy, except in the postmenopausal population. However, it also resulted in more adverse effects. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  6. Randomized Trial of Oral Misoprostol Treatment for Cervical Ripening Before Tandem Application in Cervix Cancer

    International Nuclear Information System (INIS)

    Cepni, Kimia; Gul, Sule; Cepni, Ismail; Gueralp, Onur; Sal, Veysel; Mayadagli, Alpaslan

    2011-01-01

    Purpose: To investigate the efficacy of oral misoprostol administered to facilitate tandem application to the cervix as a part of brachytherapy in patients with cervical cancer. Methods and Materials: Eighty patients with cervical cancer who had been planned to undergo brachytherapy at Dr. Luetfi Kirdar Kartal Training and Research Hospital were evaluated in a double-blind, prospective, randomized trial. Patients were divided randomly into two groups of 40 patients. The first and second groups received 400 μg of misoprostol orally and placebo, respectively, 3 h before tandem application. The two groups were compared in terms of age, diameter of tumor, parity, age at first intercourse, amount of bleeding and pain at first tandem application, length of endometrial cavity measured by hysterometer, and size of Hegar dilators used for cervical dilatation. Results: Of all cases, 63.6%, 16.3%, 10%, 6.3%, 2.5%, and 1.3% were Stage IIB, IIIB, IIIA, IVA, IIA and IIC, respectively. Mean (±SD) age (range) was 49.3 ± 13.1 (25-83) years and 56.6 ± 13.2 (30-78) years in the study and control groups, respectively (p = 0.015). Age at first intercourse, diameter of tumor, parity, amount of bleeding at first tandem application, and length of endometrial cavity measured by hysterometer were not significantly different between the two groups. Pain score was significantly higher in the control group (p < 0.001). Application was significantly easier in the study group compared with controls (p < 0.001). Average size of initial Hegar dilators used for cervical dilatation was significantly higher in the study group compared with controls (p = 0.017). Conclusion: Administration of misoprostol 400 μg orally for cervical ripening before tandem application facilitates the procedure, increases patient tolerability and comfort, and may decrease complication rates.

  7. Implementation of misoprostol for postabortion care in Kenya and Uganda: a qualitative evaluation

    Science.gov (United States)

    Osur, Joachim; Baird, Traci L.; Levandowski, Brooke A.; Jackson, Emily; Murokora, Daniel

    2013-01-01

    Objective Evaluate implementation of misoprostol for postabortion care (MPAC) in two African countries. Design Qualitative, program evaluation. Setting Twenty-five public and private health facilities in Rift Valley Province, Kenya, and Kampala Province, Uganda. Sample Forty-five MPAC providers, health facility managers, Ministry of Health officials, and non-governmental (NGO) staff involved in program implementation. Methods and main outcome measures In both countries, the Ministry of Health, local health centers and hospitals, and NGO staff developed evidence-based service delivery protocols to introduce MPAC in selected facilities; implementation extended from January 2009 to October 2010. Semi-structured, in-depth interviews evaluated the implementation process, identified supportive and inhibitive policies for implementation, elicited lessons learned during the process, and assessed provider satisfaction and providers’ impressions of client satisfaction with MPAC. Project reports were also reviewed. Results In both countries, MPAC was easy to use, and freed up provider time and health facility resources traditionally necessary for provision of PAC with uterine aspiration. On-going support of providers following training ensured high quality of care. Providers perceived that many women preferred MPAC, as they avoided instrumentation of the uterus, hospital admission, cost, and stigma associated with abortion. Appropriate registration of misoprostol for use in the pilot, and maintaining supplies of misoprostol, were significant challenges to service provision. Support from the Ministry of Health was necessary for successful implementation; lack of country-based standards and guidelines for MPAC created challenges. Conclusions MPAC is simple, cost-effective and can be readily implemented in settings with high rates of abortion-related mortality. PMID:23618341

  8. Implementation of misoprostol for postabortion care in Kenya and Uganda: a qualitative evaluation

    Directory of Open Access Journals (Sweden)

    Joachim Osur

    2013-04-01

    Full Text Available Objective: Evaluate implementation of misoprostol for postabortion care (MPAC in two African countries. Design: Qualitative, program evaluation. Setting: Twenty-five public and private health facilities in Rift Valley Province, Kenya, and Kampala Province, Uganda. Sample: Forty-five MPAC providers, health facility managers, Ministry of Health officials, and non-governmental (NGO staff involved in program implementation. Methods and main outcome measures: In both countries, the Ministry of Health, local health centers and hospitals, and NGO staff developed evidence-based service delivery protocols to introduce MPAC in selected facilities; implementation extended from January 2009 to October 2010. Semi-structured, in-depth interviews evaluated the implementation process, identified supportive and inhibitive policies for implementation, elicited lessons learned during the process, and assessed provider satisfaction and providers’ impressions of client satisfaction with MPAC. Project reports were also reviewed. Results: In both countries, MPAC was easy to use, and freed up provider time and health facility resources traditionally necessary for provision of PAC with uterine aspiration. On-going support of providers following training ensured high quality of care. Providers perceived that many women preferred MPAC, as they avoided instrumentation of the uterus, hospital admission, cost, and stigma associated with abortion. Appropriate registration of misoprostol for use in the pilot, and maintaining supplies of misoprostol, were significant challenges to service provision. Support from the Ministry of Health was necessary for successful implementation; lack of country-based standards and guidelines for MPAC created challenges. Conclusions: MPAC is simple, cost-effective and can be readily implemented in settings with high rates of abortion-related mortality.

  9. Low Dose Vaginal Misoprostol in the Management of Women with Intrauterine Fetal Death

    Directory of Open Access Journals (Sweden)

    M.N. El-Gharib

    2010-01-01

    Full Text Available Objectives The study was conducted to assess the effectiveness and side effects of vaginal misoprostol (Vagiprost® tablet in termination of second and third trimester pregnancy complicated with intrauterine fetal death. Design A prospective observational cohort study. Setting Tanta University Hospital. Patients The study was carried out on 324 women with fetal demise in the second and third trimesters. Cases were collected during the period from January 2008 to December 2009. Intervention All patients were subjected to history taking, physical examination, Bishop Scoring. Application of 25 μg misoprostol in the posterior fornix of the vagina, this will be repeated every 4 hours over 24 hours. The adverse effects, progress, and outcomes were assessed. Results the success rate was 90% and 45% in women with third and second trimesters respectively. The mean induction-termination interval was 8.95 ± 2.63 and 15.3 ± 5.37 hours for women with third and second trimesters respectively. The induction termination interval correlated negatively with the duration of gestation. Approximately, 90% of second trimester and 55% of third trimester women required oxytocin augmentation. The mean value of total required dose of misoprostol was 166.3 ± 7.5 and 120 ± 28.79 μg for women with second and third trimesters respectively. Conclusion Vagiprost appears to be a safe, effective, practical, and inexpensive method for termination of third trimester pregnancy complicated with of intrauterine fetal death (IUFD, its effects increase with parity and duration of gestation.

  10. One or two day mifepristone-misoprostol interval for second trimester abortion

    DEFF Research Database (Denmark)

    Nilas, Lisbeth; Glavind-Kristensen, M; Vejborg, Thomas

    2007-01-01

    METHODS: A retrospective 2-year cohort study of 127 women, with gestation between 13 and 24 weeks and a live fetus, seeking induced abortion. The aim was to compare the effect of a 1-day and a 2-day interval between oral mifepristone (200 mg) and vaginal misoprostol (400 microg) every 3 h. RESULTS......: The time to fetal expulsion was longer (9.8 versus 7.5 h; pabortion occurred in 98% within 24 h in both groups The time to abortion was longer in women with a gestation of 17-22 weeks compared to women...

  11. Déclenchement du travail à terme par le misoprostol: expérience d ...

    African Journals Online (AJOL)

    Evaluer l'efficacité et l'innocuité de l'utilisation du misoprostol par voie vaginale pour le déclenchement du travail à terme. Etude prospective réalisée au service de gynécologie obstétrique B de l'hôpital Charles Nicolle de Tunis sur une durée de 4 mois. La population sélectionnée concernait les patientes à terme devant ...

  12. Practice of self-medication of mifepristone-misoprostol drug combination for medical abortion

    OpenAIRE

    Sushila Godara; Jyoti Kaushal

    2014-01-01

    Most medical abortion protocols require women to take mifepristone in the hospital setting. The rate of complete abortion up to 63 days' gestation with mifepristone and misoprostol was reported to be 92-95% using the Food and Drug Administration-approved regimen.1,2 In a recent study, the completion rates of 96-97% was reported in early pregnancy, including pregnancies up to 63 days' gestation.3 Women choosing medical abortion must consent to undergo vacuum aspiration or dilatation and curett...

  13. VACTERL association and Moebius syndrome in a newborn girl prenatally exposed to misoprostol = Asociación VACTERL y síndrome de Moebius en un recién nacido expuesto prenatalmente a misoprostol

    Directory of Open Access Journals (Sweden)

    Ramírez Cheyne, Julián

    2014-04-01

    Full Text Available Misoprostol, a synthetic analogue of prostaglandin E1, has been associated with an increased risk of occurrence of the Moebius syndrome (congenital paralysis of the seventh cranial nerve that may be associated with involvement of other cranial nerves or of other systems and cross-terminal limb defects in pregnancies in which mothers used this drug during the first trimester of pregnancy. Vascular disruption has been proposed as a teratogenic mechanism of misoprostol. The VACTERL association is the statistically non-random co-occurrence of vertebral defects, vascular anomalies, anal atresia, cardiac abnormalities, tracheo-esophageal fistula with esophageal atresia, radial and renal dysplasia, and other limb anomalies. There is no evidence for a unifying cause for the co-occurrence of VACTERL malformations, so this condition is still called an association and not a syndrome. We report the case of a newborn girl with VACTERL association and Moebius syndrome associated with prenatal exposure to misoprostol in the first trimester of pregnancy. Given the teratogenic mechanism of misoprostol, we propose a vascular origin for VACTERL association.

  14. Demonstration of specific E-type prostaglandin receptors using enriched preparations of canine parietal cells and [3H]misoprostol free acid

    International Nuclear Information System (INIS)

    Tsai, B.S.; Kessler, L.K.; Schoenhard, G.; Collins, P.W.; Bauer, R.F.

    1987-01-01

    High-affinity, E-type prostaglandin binding sites in enriched canine parietal cell preparations were identified with [ 3 H] misoprostol free acid, a prostaglandin E1 analogue. Saturable, reversible, and highly stereospecific binding was identified, with approximately 8000 binding sites per cell. Prostaglandin I and F bound weakly, and cimetidine and histamine did not bind. The results indicate that [ 3 H] misoprostol free acid binds to E-type prostaglandin receptors, which suggests that the ulcer-healing inhibition of gastric acid secretion by misoprostol results from its interaction with a specific E-type prostaglandin receptor

  15. Demonstration of specific E-type prostaglandin receptors using enriched preparations of canine parietal cells and (/sup 3/H)misoprostol free acid

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, B.S.; Kessler, L.K.; Schoenhard, G.; Collins, P.W.; Bauer, R.F.

    1987-07-27

    High-affinity, E-type prostaglandin binding sites in enriched canine parietal cell preparations were identified with (/sup 3/H) misoprostol free acid, a prostaglandin E1 analogue. Saturable, reversible, and highly stereospecific binding was identified, with approximately 8000 binding sites per cell. Prostaglandin I and F bound weakly, and cimetidine and histamine did not bind. The results indicate that (/sup 3/H) misoprostol free acid binds to E-type prostaglandin receptors, which suggests that the ulcer-healing inhibition of gastric acid secretion by misoprostol results from its interaction with a specific E-type prostaglandin receptor.

  16. Intracervical sodium nitroprusside versus vaginal misoprostol in first trimester surgical termination of pregnancy: a randomized double-blinded controlled trial.

    Science.gov (United States)

    Chan, C C W; Tang, O S; Ng, E H Y; Li, C F; Ho, P C

    2005-03-01

    Results from small-scale randomized studies on the effectiveness of different preparations of nitric oxide donors in cervical priming before first trimester termination of pregnancies are not consistent. We compared sodium nitroprusside gel to misoprostol, the standard agent for cervical priming in this randomized double-blinded controlled trial. Two hundred pregnant patients between 8 to 12 weeks admitted for surgical termination of pregnancy were recruited. They were randomized into either 400 microg vaginal misoprostol and intracervical placebo gel, or 10 mg intracervical sodium nitroprusside gel and placebo tablets 3 h before the procedure. The baseline cervical dilatation and cumulative force required to dilate the cervix from 4 to 9 mm were measured with a tonometer. Blood pressure was measured and side effects were assessed. The cumulative force to dilate the cervix from 4 to 9 mm was significantly higher in the sodium nitroprusside group, and the difference remained when a sub-group analysis was performed according to parity. Baseline cervical dilatation, duration of operation and operative blood loss were all in favour of misoprostol. Transient drop in blood pressure was observed after sodium nitroprusside treatment. Intracervical sodium nitroprusside is not as effective as misoprostol in cervical priming.

  17. COMPARISON OF SIDE EFFECTS OF MISOPROSTOL BY ORAL AND RECTAL ROUTES IN ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR

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    Ratna Bulusu

    2017-01-01

    Full Text Available BACKGROUND Every year, there are 14 million cases of PPH. It accounts for about 25% of maternal deaths worldwide. This can be reduced by active management of third stage of labour. Administration of misoprostol after delivery of neonate has been shown to be effective in reducing amount of blood loss during delivery. The aim of the study is to compare the side effects of misoprostol in terms of distribution, frequency and severity by oral and rectal route for active management of third stage of labour. MATERIALS AND METHODS A prospective randomised study conducted on 100 women in labour in Department of OBG in MVJMC and RH. They were divided into 2 groups of 50 parturient mothers each group receiving misoprostol (600 µg by oral route (Group 1 and rectal route (Group 2. Outcome of these women were noted in terms of blood loss, duration of 3 rd stage of labour and side effects like shivering, fever, diarrhoea, nausea and vomiting. RESULTS There was not much difference in amount of blood loss and duration of third stage among the two groups. However, side effects were more in the group receiving misoprostol orally (32% as compared to that receiving by rectal route (14%. CONCLUSION In the present study, both oral and rectal routes are effective in active management of third stage of labour. However, rectal route has lesser side effects.

  18. Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management

    NARCIS (Netherlands)

    Graziosi, GCM; van der Steeg, JW; Reuwer, PHW; Drogtrop, AP; Bruinse, HW; Mol, BWJ

    BACKGROUND: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is

  19. Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management

    NARCIS (Netherlands)

    Graziosi, G. C. M.; van der Steeg, J. W.; Reuwer, P. H. W.; Drogtrop, A. P.; Bruinse, H. W.; Mol, B. W. J.

    2005-01-01

    BACKGROUND: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is

  20. Induction of labor in twin pregnancies with oral misoprostol versus vaginal dinoprostone--is it effective and safe?

    Science.gov (United States)

    Huber, Georgine; Schütz, Heike; Seelbach-Göbel, Birgit

    2015-06-01

    To compare the effectiveness and safety of oral misoprostol versus vaginal dinoprostone for the induction of labor in twin pregnancies. All twin pregnancies ≥ 34 weeks 0 days that were induced with either misoprostol or dinoprostone in St. Hedwig Hospital between 2002 and 2013 were included in this retrospective study. Length of induction, mode of delivery, maternal and neonatal outcomes were compared between the two groups. After identifying 186 twin mothers matching the inclusion criteria, 154 women were induced with misoprostol (group A) and 32 with dinoprostone (group B). There were no differences in demographic data between the groups. Rates of successful vaginal delivery (53.9% versus 56.3%) and length of induction to delivery (30.2 h versus 26.9 h) were also similar. There were slightly higher rates of postpartum hemorrhage in group B (16.6% versus 10.8%), but without reaching statistical significance. Neonatal outcomes regarding umbilical artery pH misoprostol and vaginal dinoprostone are similarly effective and safe for the induction of labor in twin gestations. Further trials with larger series are needed to confirm these results.

  1. A randomized trial of sublingual misoprostol to augment routine third-stage management among women at risk of postpartum hemorrhage.

    Science.gov (United States)

    Chaudhuri, Picklu; Majumdar, Arindam

    2016-02-01

    To assess whether a combination of misoprostol and oxytocin is more beneficial than oxytocin alone in reducing blood loss after vaginal delivery among women with known risk factors for postpartum hemorrhage (PPH). A randomized, double-blind trial was conducted in a medical college in eastern India among women aged at least 18 years who had known high-risk factors for PPH. Using a computer-generated random number sequence (block size 6-8), participants were randomly assigned to receive 400 μg misoprostol or matched placebo tablets sublingually, in addition to 10 units of oxytocin, after vaginal delivery. The primary outcomes were postpartum blood loss at 1 hour and frequency of PPH. Analyses were by intention to treat. Both groups contained 144 participants. Postpartum blood loss at 1 hour after delivery was significantly lower among women who received misoprostol than among those who received placebo (225.8±156.7 mL vs 302.4±230.3 mL; Pmisoprostol than in the placebo group (5 [3.5%] vs 15 [10.4%] participants; P=0.03). As compared with oxytocin alone, misoprostol with oxytocin more effectively reduced blood loss after vaginal delivery among women at risk of PPH. Clinical Trial Registry India:CTRI/2014/03/004491. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Efficacy and safety of mifepristone-buccal misoprostol for early medical abortion in an Australian clinical setting.

    Science.gov (United States)

    Goldstone, Philip; Walker, Clara; Hawtin, Katherine

    2017-06-01

    In 2014, a composite pack containing mifepristone-buccal misoprostol, indicated for use to 63 days gestation replaced the existing regimen for early medical abortion (EMA) in Australia. To provide updated efficacy and safety information for the use of mifepristone-buccal misoprostol for EMA in Australia, and assess the effect of patient age and gestational age on efficacy. Observational cohort study of 15 008 women attending one of 16 Marie Stopes International clinics in Australia for an EMA (gestational age ≤ 63 days) between 1 March 2013 and 30 September 2015. Administration of 200 mg oral mifepristone in-clinic was followed 24-48 h later by 800 μg buccal misoprostol self-administered at home. Method success was defined as complete abortion not requiring surgical intervention. Follow-up information was available for 87.14% (13 078/15 008) of women. Likelihood of follow-up was significantly lower for women from rural or remote locations (adjusted odds ratio, 0.47; P misoprostol is an effective and safe alternative to surgical termination of pregnancy up to 63 days gestation. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  3. Does sublingual misoprostol reduce pain and facilitate IUD insertion in women with no previous vaginal delivery? A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Amr Adel Mansy

    2018-03-01

    Conclusion: Although misoprostol is used in cervical ripening in labour induction and medical evacuation of missed abortion, its use to facilitate IUD insertion in women with tight cervix or in whom vaginal delivery was not experienced, has no role in pain reduction or increase the ease of IUD insertion.

  4. Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Blum Jennifer

    2008-08-01

    Full Text Available Abstract Background Postpartum hemorrhage (PPH remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment. Methods A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants. Results Due to a much lower rate of PPH than expected (1.2%, only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or

  5. A comparison of oral misoprostol and vaginal prostaglandin e2 tablets for induction of labour at term

    International Nuclear Information System (INIS)

    Munzar, Z.

    2015-01-01

    To compare the efficacy and safety of oral misoprostol with prostaglandin E2 vaginal tablets for ripening of cervix and induction of labour at term. Study Design: A non blinded, randomised, controlled trial. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pakistan Air Force Hospital, Air Headquarters Islamabad from July 2005 to January 2006. Patients and Methods: Hundred pregnant women with a singleton live pregnancy, at term (37-42 weeks) with cephalic presentation were selected for induction of labour for various indications having a Bishop's score of < or =5. These women were randomly allocated to receive either 100 micro gm of misoprostol rally repeated four hourly to a maximum of four doses or a 3mg PGE2 tablet vaginally repeated six hourly to a maximum of two doses. Main outcomes measured: Cervical score before and after oral misoprostol and prostaglandin E2 vaginal tablets, vaginal birth within 24 hours of first prostaglandin dose, no of patients having failed induction, caesarean sections (all), caesarean section for fetal distress and uterine hyperstimulation with associated changes in fetal heart rate. Results: Over the period of one year 100 women were recruited for the study, 50 to the misoprostol group and 50 to the vaginal prostaglandin E2 group. There was no significant differences between the two treatment groups in the primary outcomes: improvement in bishops score in both the groups, no of patients with failed induction in both the groups misoprostol 2/50 (4%) v PGE2 3/50 (6%) , vaginal birth achieved in 24 hours (misoprostol 27/50 (54%) v PGE2 29/50 (58%), caesarean sections 14/50 (28%) v 12/50(24%) caesarean section for fetal distress 4/50((8%) v 5/50(9%); uterine hyperstimulation with fetal heart rate changes 2/50 ((4%) v none in the PGE2 group.). Neonatal outcomes were not significantly different in the two groups. Conclusion: Oral misoprostol in strength of 100 micro gm has similar efficacy to vaginal PGE2 tablets

  6. EVALUACIÓN DE PROGESTERONA INTRAVAGINAL POST INSEMINACIÓN ARTIFICIAL PARA REDUCIR LA MUERTE EMBRIONARIA EN VACAS

    OpenAIRE

    Jorge Ignacio Macias; Jofre Andrés Vera Cedeño

    2014-01-01

    El objetivo de esta investigación fue evaluar el efecto de la administración de un dispositivo intravaginal de progesterona post IATF sobre la reducción de la muerte embrionaria, el cual se aplicó siete días después de la inseminación. Se utilizaron 40 vacas de aptitud cárnica de cruza mestiza Senangus x Brahman de dos-cuatro partos. Se realizó ecografía transrectal (Aquilla Vet 7.5 MHZ) previo a la sincronización. Se efectuó el inicio de ésta con el dispositivo CIDR 1.38 g progesterona. Desp...

  7. Acute intestinal injury induced by acetic acid and casein: prevention by intraluminal misoprostol

    International Nuclear Information System (INIS)

    Miller, M.J.; Zhang, x.J.; Gu, x.A.; Clark, D.A.

    1991-01-01

    Acute injury was established in anesthetized rabbits by intraluminal administration of acetic acid with and without bovine casein, into loops of distal small intestine. Damage was quantified after 45 minutes by the blood-to-lumen movement of 51 Cr-labeled ethylenediaminetetraacetic acid (EDTA) and fluorescein isothiocyanate-tagged bovine serum albumin as well as luminal fluid histamine levels. The amount of titratable acetic acid used to lower the pH of the treatment solutions to pH 4.0 was increased by the addition of calcium gluconate. Luminal acetic acid caused a 19-fold increase in 51 Cr-EDTA accumulation over saline controls; casein did not modify this effect. In saline controls, loop fluid histamine levels bordered on the limits of detection (1 ng/g) but were elevated 19-fold by acetic acid exposure and markedly increased (118-fold) by the combination of acid and casein. Intraluminal misoprostol (3 or 30 micrograms/mL), administered 30 minutes before acetic acid, significantly attenuated the increase in epithelial permeability (luminal 51 Cr-EDTA, fluorescein isothiocyanate-bovine serum albumin accumulation) and histamine release (P less than 0.05). Diphenhydramine, alone or in combination with cimetidine, and indomethacin (5 mg/kg IV) were not protective. It is concluded that exposure of the epithelium to acetic acid promotes the transepithelial movement of casein leading to enhanced mast cell activation and mucosal injury. Damage to the epithelial barrier can be prevented by misoprostol

  8. Acute intestinal injury induced by acetic acid and casein: prevention by intraluminal misoprostol

    Energy Technology Data Exchange (ETDEWEB)

    Miller, M.J.; Zhang, x.J.; Gu, x.A.; Clark, D.A. (Department of Pediatrics, Louisiana State University School of Medicine, New Orleans (USA))

    1991-07-01

    Acute injury was established in anesthetized rabbits by intraluminal administration of acetic acid with and without bovine casein, into loops of distal small intestine. Damage was quantified after 45 minutes by the blood-to-lumen movement of {sup 51}Cr-labeled ethylenediaminetetraacetic acid (EDTA) and fluorescein isothiocyanate-tagged bovine serum albumin as well as luminal fluid histamine levels. The amount of titratable acetic acid used to lower the pH of the treatment solutions to pH 4.0 was increased by the addition of calcium gluconate. Luminal acetic acid caused a 19-fold increase in {sup 51}Cr-EDTA accumulation over saline controls; casein did not modify this effect. In saline controls, loop fluid histamine levels bordered on the limits of detection (1 ng/g) but were elevated 19-fold by acetic acid exposure and markedly increased (118-fold) by the combination of acid and casein. Intraluminal misoprostol (3 or 30 micrograms/mL), administered 30 minutes before acetic acid, significantly attenuated the increase in epithelial permeability (luminal {sup 51}Cr-EDTA, fluorescein isothiocyanate-bovine serum albumin accumulation) and histamine release (P less than 0.05). Diphenhydramine, alone or in combination with cimetidine, and indomethacin (5 mg/kg IV) were not protective. It is concluded that exposure of the epithelium to acetic acid promotes the transepithelial movement of casein leading to enhanced mast cell activation and mucosal injury. Damage to the epithelial barrier can be prevented by misoprostol.

  9. Receptor binding characteristics of tritiated misoprostol free acid in enriched canine parietal cells

    International Nuclear Information System (INIS)

    Tsai, B.S.; Kessler, L.K.; Conway, R.G.; Schoenhard, G.; Stolzenbach, J.; Collins, P.; Kramer, S.; Butchko, G.M.; Bauer, R.F.

    1986-01-01

    Misoprostol (MISO) is a synthetic prostaglandin (PG) E 1 methyl ester with gastric antisecretory and mucosal protective properties. MISO is rapidly de-esterified to misoprostol free acid (MISO-FA) in enriched (65-80%) canine parietal cell preparations. Both forms appear to possess equivalent antisecretory potency and [ 3 H] MISO-FA is stable in these preparations. [ 3 H] MISO-FA binding was reversible and saturable with a maximal number of binding sites estimated at 8138 +/- 1893 per cell. The scatchard plot was linear, indicating a single, high affinity receptor population with a dissociation constant of 11 +/- 2.6 x 10 -9 M. Unlabeled MISO-FA and MISO were equally potent inhibitors [IC 50 , approx. 10 -8 M] of [ 3 H] MISO-FA binding. At 10 -5 M, the dinor and tetranor β-oxidation metabolites of MISO were weak binding inhibitors. Strict stereospecific binding was shown by MISO stereoisomers, and the 11R, 16S isomer was most active. Both PGE 1 and 16,16 dimethyl PGE 2 were potent binding inhibitors, but PGF 1 α (10 -6 M) and Hoe 892 (10 -5 M), a stable PGI 2 analog, were weak inhibitors. Neither histamine or cimetidine competed for binding sites. These data indicate the presence of stereospecific E-type prostaglandin receptors in enriched canine parietal cell preparations

  10. Receptor binding characteristics of tritiated misoprostol free acid in enriched canine parietal cells

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, B.S.; Kessler, L.K.; Conway, R.G.; Schoenhard, G.; Stolzenbach, J.; Collins, P.; Kramer, S.; Butchko, G.M.; Bauer, R.F.

    1986-03-01

    Misoprostol (MISO) is a synthetic prostaglandin (PG) E/sub 1/ methyl ester with gastric antisecretory and mucosal protective properties. MISO is rapidly de-esterified to misoprostol free acid (MISO-FA) in enriched (65-80%) canine parietal cell preparations. Both forms appear to possess equivalent antisecretory potency and (/sup 3/H) MISO-FA is stable in these preparations. (/sup 3/H) MISO-FA binding was reversible and saturable with a maximal number of binding sites estimated at 8138 +/- 1893 per cell. The scatchard plot was linear, indicating a single, high affinity receptor population with a dissociation constant of 11 +/- 2.6 x 10/sup -9/ M. Unlabeled MISO-FA and MISO were equally potent inhibitors (IC/sub 50/, approx. 10/sup -8/M) of (/sup 3/H) MISO-FA binding. At 10/sup -5/ M, the dinor and tetranor ..beta..-oxidation metabolites of MISO were weak binding inhibitors. Strict stereospecific binding was shown by MISO stereoisomers, and the 11R, 16S isomer was most active. Both PGE/sub 1/ and 16,16 dimethyl PGE/sub 2/ were potent binding inhibitors, but PGF/sub 1/..cap alpha.. (10/sup -6/ M) and Hoe 892 (10/sup -5/ M), a stable PGI/sub 2/ analog, were weak inhibitors. Neither histamine or cimetidine competed for binding sites. These data indicate the presence of stereospecific E-type prostaglandin receptors in enriched canine parietal cell preparations.

  11. A randomized clinical trial of preoperative versus postoperative misoprostol in elective cesarean delivery.

    Science.gov (United States)

    Ragab, Ahmed; Barakat, Rafik; Alsammani, Mohamed A

    2016-01-01

    To determine the optimum time for misoprostol administration to minimize blood loss during and after elective cesarean delivery. A randomized clinical trial was conducted at Mansoura University Hospital, Egypt, between January 1, 2013, and December 31, 2014. Eligible participants had full-term pregnancies, were scheduled to have a cesarean, and had normal fetal heart tracing. Patients were randomly allocated into two equal groups using computer-generated tables and sealed opaque envelopes. Misoprostol (400μg, given rectally) was given either before (group 1) or after (group 2) surgery. Patients, investigators, and data analysts were not masked to group assignment. The primary outcome was blood loss. A total of 348 women were included (174 in each group). Blood loss was significantly lower in group 1 than in group 2 (570±240 vs 844±270mL; Pcesarean delivery. The frequency of complications was not affected by time of administration. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. Analytical Method Validation of High-Performance Liquid Chromatography and Stability-Indicating Study of Medroxyprogesterone Acetate Intravaginal Sponges

    Directory of Open Access Journals (Sweden)

    Nidal Batrawi

    2017-02-01

    Full Text Available Medroxyprogesterone acetate is widely used in veterinary medicine as intravaginal dosage for the synchronization of breeding cycle in ewes and goats. The main goal of this study was to develop reverse-phase high-performance liquid chromatography method for the quantification of medroxyprogesterone acetate in veterinary vaginal sponges. A single high-performance liquid chromatography/UV isocratic run was used for the analytical assay of the active ingredient medroxyprogesterone. The chromatographic system consisted of a reverse-phase C18 column as the stationary phase and a mixture of 60% acetonitrile and 40% potassium dihydrogen phosphate buffer as the mobile phase; the pH was adjusted to 5.6. The method was validated according to the International Council for Harmonisation (ICH guidelines. Forced degradation studies were also performed to evaluate the stability-indicating properties and specificity of the method. Medroxyprogesterone was eluted at 5.9 minutes. The linearity of the method was confirmed in the range of 0.0576 to 0.1134 mg/mL ( R 2 > 0.999. The limit of quantification was shown to be 3.9 µg/mL. Precision and accuracy ranges were found to be %RSD <0.2 and 98% to 102%, respectively. Medroxyprogesterone capacity factor value of 2.1, tailing factor value of 1.03, and resolution value of 3.9 were obtained in accordance with ICH guidelines. Based on the obtained results, a rapid, precise, accurate, sensitive, and cost-effective analysis procedure was proposed for quantitative determination of medroxyprogesterone in vaginal sponges. This analytical method is the only available method to analyse medroxyprogesterone in veterinary intravaginal dosage form.

  13. Engineering a segmented dual-reservoir polyurethane intravaginal ring for simultaneous prevention of HIV transmission and unwanted pregnancy.

    Directory of Open Access Journals (Sweden)

    Justin T Clark

    Full Text Available The HIV/AIDS pandemic and its impact on women prompt the investigation of prevention strategies to interrupt sexual transmission of HIV. Long-acting drug delivery systems that simultaneously protect womenfrom sexual transmission of HIV and unwanted pregnancy could be important tools in combating the pandemic. We describe the design, in silico, in vitro and in vivo evaluation of a dual-reservoir intravaginal ring that delivers the HIV-1 reverse transcriptase inhibitor tenofovir and the contraceptive levonorgestrel for 90 days. Two polyether urethanes with two different hard segment volume fractions were used to make coaxial extruded reservoir segments with a 100 µm thick rate controlling membrane and a diameter of 5.5 mm that contain 1.3 wt% levonorgestrel. A new mechanistic diffusion model accurately described the levonorgestrel burst release in early time points and pseudo-steady state behavior at later time points. As previously described, tenofovir was formulated as a glycerol paste and filled into a hydrophilic polyurethane, hollow tube reservoir that was melt-sealed by induction welding. These tenofovir-eluting segments and 2 cm long coaxially extruded levonorgestrel eluting segments were joined by induction welding to form rings that released an average of 7.5 mg tenofovir and 21 µg levonorgestrel per day in vitro for 90 days. Levonorgestrel segments placed intravaginally in rabbits resulted in sustained, dose-dependent levels of levonorgestrel in plasma and cervical tissue for 90 days. Polyurethane caps placed between segments successfully prevented diffusion of levonorgestrel into the tenofovir-releasing segment during storage.Hydrated rings endured between 152 N and 354 N tensile load before failure during uniaxial extension testing. In summary, this system represents a significant advance in vaginal drug delivery technology, and is the first in a new class of long-acting multipurpose prevention drug delivery systems.

  14. Engineering a Segmented Dual-Reservoir Polyurethane Intravaginal Ring for Simultaneous Prevention of HIV Transmission and Unwanted Pregnancy

    Science.gov (United States)

    Clark, Justin T.; Clark, Meredith R.; Shelke, Namdev B.; Johnson, Todd J.; Smith, Eric M.; Andreasen, Andrew K.; Nebeker, Joel S.; Fabian, Judit; Friend, David R.; Kiser, Patrick F.

    2014-01-01

    The HIV/AIDS pandemic and its impact on women prompt the investigation of prevention strategies to interrupt sexual transmission of HIV. Long-acting drug delivery systems that simultaneously protect womenfrom sexual transmission of HIV and unwanted pregnancy could be important tools in combating the pandemic. We describe the design, in silico, in vitro and in vivo evaluation of a dual-reservoir intravaginal ring that delivers the HIV-1 reverse transcriptase inhibitor tenofovir and the contraceptive levonorgestrel for 90 days. Two polyether urethanes with two different hard segment volume fractions were used to make coaxial extruded reservoir segments with a 100 µm thick rate controlling membrane and a diameter of 5.5 mm that contain 1.3 wt% levonorgestrel. A new mechanistic diffusion model accurately described the levonorgestrel burst release in early time points and pseudo-steady state behavior at later time points. As previously described, tenofovir was formulated as a glycerol paste and filled into a hydrophilic polyurethane, hollow tube reservoir that was melt-sealed by induction welding. These tenofovir-eluting segments and 2 cm long coaxially extruded levonorgestrel eluting segments were joined by induction welding to form rings that released an average of 7.5 mg tenofovir and 21 µg levonorgestrel per day in vitro for 90 days. Levonorgestrel segments placed intravaginally in rabbits resulted in sustained, dose-dependent levels of levonorgestrel in plasma and cervical tissue for 90 days. Polyurethane caps placed between segments successfully prevented diffusion of levonorgestrel into the tenofovir-releasing segment during storage.Hydrated rings endured between 152 N and 354 N tensile load before failure during uniaxial extension testing. In summary, this system represents a significant advance in vaginal drug delivery technology, and is the first in a new class of long-acting multipurpose prevention drug delivery systems. PMID:24599325

  15. Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

    Directory of Open Access Journals (Sweden)

    AlSaad D

    2017-05-01

    Full Text Available Doua AlSaad,1,2 Sawsan Alobaidly,3 Palli Abdulrouf,1 Binny Thomas,4,5 Afif Ahmed,1 Moza AlHail1 1Department of Pharmacy, Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; 2Public Health Program, London School of Hygiene and Tropical Medicine, University of London, UK; 3Department of Obstetrics and Gynecology, Women’s Hospital, 4Clinical Support Service Unit, Hamad Medical Corporation, Doha, Qatar; 5Pharmacy and Life Sciences Research Institute, Robert Gordon University, Aberdeen, Scotland Background: Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited.Case presentation: We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 µg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed.Conclusion: We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results. Keywords: cesarean section, uterine rupture, prostaglandin E1, misoprostol, second trimester, miscarriage, abortion

  16. The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial

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    Elham Naghshineh

    2015-01-01

    Full Text Available Background: In developing countries it is important to the exploration of available and safe regimens for medical abortion. The present study was designed to assess the effect of letrozole compared to placebo pretreatment followed by sublingual misoprostol for therapeutic abortion in eligible women with gestational age less than 17 weeks. Materials and Methods: In this randomized control trail, 130 women eligible for legal abortions were randomly divided into two groups of case and controls. Cases received daily oral dose of 10 mg letrozole 10 mg letrozole for three days followed by sublingual misoprostol. Controls received daily oral dose of placebo followed by sublingual misoprostol. The dose of misoprostol was administrated according to ACOG guidelines based on patients′ gestational age. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed as main outcomes. Results: Complete abortion was observed in 46 (76.7% letrozole group and 26 (42.6% controls (P < 0.0001. Also, in 14 subjects of letrozole group and 35 subjects in placebo group, the placenta was not delivered during follow-up and curettage was performed. The mean interval induction-to-abortion was 5.1 h in letrozole group and 8.9 h in control (P < 0.0001. The cumulative rates of the induction-of-abortion time were a significant difference between the two groups (P < 0.0001. The incidence and severity of side-effects was comparable for the two groups (P = 0.9. Conclusion: Letrozole could be a quite beneficial adjuvant to misoprostol for induction of complete abortion in those who are candidates for legal medical abortion.

  17. Is induced abortion with misoprostol a risk factor for late abortion or preterm delivery in subsequent pregnancies?

    Science.gov (United States)

    Winer, Norbert; Resche-Rigon, Mathieu; Morin, Christine; Ville, Yves; Rozenberg, Patrick

    2009-07-01

    To examine whether a first or second trimester induced abortion with misoprostol influences the risk of late abortion or preterm delivery in subsequent pregnancies. Case-control study in a teaching hospital from January 2005 to June 2006. The cases had singleton pregnancies delivered at 16-36 weeks of gestation after spontaneous late abortions, preterm labor or preterm premature rupture of membrane, or induction of labor for preterm premature rupture of membrane before 37 weeks. The control group was composed of the two consecutive spontaneous singleton deliveries at >or=37 weeks of gestation after each new case (ratio 2/1). The principal outcome measure was late abortion or preterm delivery. The association between late abortion or preterm delivery and a previous induced abortion with misoprostol was first assessed with the Cochran-Mantel-Haenszel chi-square test. Conditional logistic regression models adapted for clustered data were then further used to quantify the effect size, measured by estimated odds ratios (ORs) with their 95% confidence intervals (95% CI). The study included 245 cases and 490 controls. There was no significant difference in mean maternal age, number of pregnancies, parity, smoking, or history of first trimester miscarriage between cases and controls. However, a history of late abortion or previous preterm delivery was significantly more frequent among cases than controls. Forty (16.3%) cases and 56 (11.5%) controls had a history of cervical ripening with misoprostol before vacuum curettage or evacuation, or of medical abortion by misoprostol alone or with mifepristone (OR 1.51, 95% CI: 0.95-2.39; p=0.08). After adjustment for maternal age and number of pregnancies with a multivariable conditional regression model, the adjusted OR was estimated at 1.33 (95% CI: 0.81-2.17; p=0.25). Despite the need for prudence, these results provide some reassurance that induced abortion with misoprostol during the first or second trimester of pregnancy is

  18. Treatment of retained placenta with misoprostol: a randomised controlled trial in a low-resource setting (Tanzania

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    Fauteck Heiner

    2009-10-01

    Full Text Available Abstract Background Retained placenta is one of the common causes of maternal mortality in developing countries where access to appropriate obstetrical care is limited. Current treatment of retained placenta is manual removal of the placenta under anaesthesia, which can only take place in larger health care facilities. Medical treatment of retained placenta with prostaglandins E1 (misoprostol could be cost-effective and easy-to-use and could be a life-saving option in many low-resource settings. The aim of this study is to assess the efficacy and safety of sublingually administered misoprostol in women with retained placenta in a low resource setting. Methods Design: Multicentered randomised, double-blind, placebo-controlled trial, to be conducted in 5 hospitals in Tanzania, Africa. Inclusion criteria: Women with retained placenta, at a gestational age of 28 weeks or more and blood loss less than 750 ml, 30 minutes after delivery of the newborn despite active management of third stage of labour. Trial Entry & Randomisation & Study Medication: After obtaining informed consent, eligible women will be allocated randomly to the treatment groups using numbered envelopes that will be randomized in variable blocks containing identical capsules with either 800 microgram of misoprostol or placebo. The drugs will be given sublingually. The women, maternal care providers and researchers will be blinded to treatment allocation. Sample Size: 117 women, to show a 40% reduction in manual removals of the placenta (p = 0.05, 80% power. The randomization will be misoprostol: placebo = 2:1 Primary Study Outcome: Expulsion of the placenta without manual removal. Secondary outcome is the number of blood transfusions. Discussion This is a protocol for a randomized trial in a low resource setting to assess if medical treatment of women with retained placenta with misoprostol reduces the incidence of manual removal of the placenta. Clinical Trial Registration Current

  19. Uso do misoprostol em substituição à curetagem uterina em gestações interrompidas precocemente Misoprostol in substitution at uterine curettage in early pregnancy failure

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    Francisco Carlos Nogueira Arcanjo

    2011-06-01

    Full Text Available OBJETIVOS: Avaliar a eficácia do misoprostol administrado via vaginal para esvaziamento uterino em gestações interrompidas precocemente, bem como o tempo entre a administração e o esvaziamento, correlacionando-os com a idade gestacional. MÉTODOS: Ensaio clínico com 41 pacientes com gestações interrompidas entre a 7ª e a 12ª semanas gestacionais, com média de idade de 27,3 (±6,1 anos. A paridade média foi de 2,2 (±1,2 partos; o número médio de abortamentos prévios foi 0,2 (±0,5. Foram administrados 800 µg de misoprostol via vaginal, em dose única; após 24 horas, foi realizado ultrassom transvaginal. Considerou-se abortamento completo quando o diâmetro anteroposterior da cavidade endometrial media 8 semanas de idade gestacional em relação aos desfechos: frequência de abortamento completo e intervalo entre administração de misoprostol e o abortamento (em minutos. O nível de significância utilizado foi de 5%. RESULTADOS: A idade gestacional, no momento do diagnóstico, foi de 8,5 semanas em média (DP=1,5. Os intervalos entre a administração de misoprostol e as contrações uterinas, e entre a administração e o abortamento, foram de 322,5±97,0 min e 772,5±201,0 min, respectivamente. Houve abortamento completo em 80,3%. No primeiro grupo, a taxa de sucesso foi de 96,2% e no segundo, de 53,3% (pPURPOSE: To evaluate the effectiveness of misoprostol administered vaginally for uterine evacuation in interrupted early pregnancies and the time between the administration and emptying correlated with gestational age. METHODS: Clinical trial with 41 patients with pregnancies interrupted between the 7th and the 12th gestational weeks. The mean age was 27.3 (±6.1 years. Mean parity was 2.2 (±1.2 deliveries. The average number of previous abortions was 0.2 (± 0.5. Misoprostol was administered vaginally in a single 800 µg dose and transvaginal ultrasound was performed after 24 hours. Abortion was considered complete when the

  20. Sublingual misoprostol for management of empty sac or missed miscarriage: The first two years' experience at a metropolitan Australian hospital.

    Science.gov (United States)

    Mcgee, Therese M; Diplock, Hayley; Lucewicz, Ania

    2016-08-01

    Misoprostol management of miscarriage is only now becoming widely used in Australia. To review the efficacy, safety and the popularity of outpatient sublingual misoprostol in empty sac/missed miscarriage management over its first two years of availability in a metropolitan Australian hospital. A retrospective cohort review was undertaken of women choosing sublingual misoprostol 600 μg (three tablets) × three doses for miscarriage management. Principal outcomes assessed were miscarriage resolution without the need for curettage and complications. Additionally, the relative popularity of misoprostol versus surgery by place of birth and over time, and the return of pregnancy tissue for histology were analysed. Between 1 December 2012 and 30 November 2014, 279 women chose sublingual misoprostol for nonurgent miscarriage management, while 420 chose surgery (40 and 60%, respectively). Of the misoprostol cohort, 269 had complete data; 239 of 269 (88.8%) had resolution without curettage, nine (3.3%) had acute curettage, 21 (7.8%) had nonacute curettage, 30 (11.15%) had unplanned emergency department presentation, 11 (4.1%) had unplanned admission, three (1.1%) had blood transfusion and one (0.4%) had an infection requiring admission. Misoprostol was as popular with Australian-born as overseas-born women; 53.5% of patients returned histopathology specimens; one (0.7%) demonstrated partial hydatidiform mole. Outpatient management of missed/empty gestational sac miscarriage using sublingual misoprostol is associated with a high rate of avoiding curettage and the low rate of complication. It is equally popular with Australian-born and overseas-born women. Just over 50% returned pregnancy tissue for analysis. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  1. A phase III randomized, placebo-controlled, double-blind study of misoprostol rectal suppositories to prevent acute radiation proctitis in patients with prostate cancer

    International Nuclear Information System (INIS)

    Hille, Andrea; Schmidberger, Heinz; Hermann, Robert M.; Christiansen, Hans; Saile, Bernhard; Pradier, Olivier; Hess, Clemens F.

    2005-01-01

    Purpose: Acute radiation proctitis is the most relevant complication of pelvic radiation and is still mainly treated supportively. Considering the negative impact of acute proctitis symptoms on patients' daily activities and the potential relationship between the severity of acute radiation injury and late damage, misoprostol was tested in the prevention of acute radiation-induced proctitis. Methods and Materials: A total of 100 patients who underwent radiotherapy for prostate cancer were entered into this phase III randomized, placebo-controlled, double-blind study with misoprostol or placebo suppositories. Radiation-induced toxicity was evaluated weekly during radiotherapy using the Common Toxicity Criteria. Results: Between the placebo and the misoprostol groups, no significant differences in proctitis symptoms occurred: 76% of patients in each group had Grade 1 toxicity, and 26% in the placebo group and 36% in the misoprostol group had Grade 2 toxicity. No differences were found in onset or symptom duration. Comparing the peak incidence of patients' toxicity symptoms, significantly more patients experienced rectal bleeding in the misoprostol group (p = 0.03). Conclusion: Misoprostol given as a once-daily suppository did not decrease the incidence and severity of radiation-induced acute proctitis and may increase the incidence of acute bleeding

  2. [Misoprostol: off-label use in the first trimester of pregnancy (spontaneous abortion, and voluntary medical termination of pregnancy)].

    Science.gov (United States)

    Beucher, G; Dolley, P; Carles, G; Salaun, F; Asselin, I; Dreyfus, M

    2014-02-01

    State of knowledge about misoprostol's use out of its marketing authorization during the first trimester of pregnancy, in early miscarriage or to induce abortion or medical termination of pregnancy. French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. Cervical ripening prior to surgical uterine evacuation during the first trimester of pregnancy facilitates cervical dilatation and reduces operative time and uterine retention risk. Misoprostol, mifepristone and osmotic cervical dilators are equally efficient. Concerning first trimester miscarriage, surgical uterine evacuation remains the most effective and the quickest method of treatment (EL 1). Depending on the clinical situation, medical treatment using misoprostol (missed miscarriage) or expectative attitude (incomplete miscarriage) does not increase the risk of complications, neither haemorrhagic nor infectious (EL 1). However, these alternatives generally require longer outpatient follow-up, which leads to more consultations, prolonged bleeding and not planned surgical procedures (EL 1). Concerning missed miscarriage, a vaginal dose of 800 μg of misoprostol, possibly repeated 24 to 48 hours later, seems to offer the best efficiency/tolerance ratio (EL 2). Concerning early abortion, medical method is a safe and efficient alternative to surgery (EL 2). Success rates are inversely proportional to gestational age (EL 2). According to the modalities of its marketing authorization, 400 μg of misoprostol can only be given by oral route, for less than 7 weeks of amenorrhea (WA) pregnancies and after 36 to 48 hours following 600 mg of mifepristone (EL 1). However, 200mg of mifepristone is as efficient as 600 mg (EL 1). Beyond 7WA, misoprostol buccal dissolution (sublingual or prejugal) or vaginal administration are more efficient and better tolerated than oral ingestion (EL 1). Between 7 and 9WA, the best protocol in terms of efficiency and

  3. Safety and efficacy of oral versus vaginal misoprostol use for induction of labor at term

    International Nuclear Information System (INIS)

    Abbasi, R.M.; Rivi, S.

    2008-01-01

    To compare the safety and efficacy of Misoprostol through oral and vaginal routes for induction of labour at term. Quasi-experimental study. Eighty term patients who met the inclusion criteria were selected for induction of labour with (50 macro g) Misoprostol, either by oral or vaginal route. The patients were allocated in two groups-A and B, using non-probability convenient sampling technique. The dose was repeated at an interval of 6 hours upto maximum dose of 150 macro g. Improvement in Bishop's score, analgesic requirements, route of delivery, maternal complications, neonatal outcomes were noted. The commonest indication in group-A was premature rupture of membranes in 16 patients (40%) and in 8 (20%) patients of group-B. Mean improvement in Bishop's score after 6 hours was greater in group-A (3.6 + 3.09) than group-B (3.3 + 3.45, p=0.70). Induction to delivery interval was less in group-A (6.7 + 4.4 hours) than group-B (7.5 + 4.3 hours, p=0.41). Oxytocin augmentation was required more in group-B as compared to group-A. Normal vaginal deliveries were achieved in 95% of group-A and in 80% of group-B. The dose of 50 macro g was effective in 31(77.5%) patients of group-A as compared to 24 (60.0%) patients of group-B, while 100 macro g was needed in 6 (15.0%) patients of group-A as compared to 13 (32.5%) patients in group-B. There was no significant difference between both the groups with regard to analgesic requirement, instrumental delivery, maternal complications and neonatal outcome. Safety and efficacy was comparable between low-dose vaginal and oral Misoprostol uses for induction of labour. However, oral route was better with respect to treatment interval, number of doses required and route of delivery. Both routes of administration can alternatively be used for induction of labour in developing countries where cost of drug does matter. (author)

  4. Comparison of misoprostol (pge1) analogue with dinoprostone (pge2) for induction of labour

    International Nuclear Information System (INIS)

    Tahir, N.; Afzal, B.; Chohan, S.

    2013-01-01

    Objective: To compare the results of induction of labour with misoprostol (PGE1 analogue) with dinoprostone (PGE2 analogue) in terms of induction delivery interval, mode of delivery, and the need for oxytocin augmentation. Setting: Department of Obstetrics and Gynaecology, Combined Military Hospital, Rawalpindi. Duration of Study: Six months Study Design: Randomized controlled trial. Subject and Method: Total 100 subjects were included in this study. These patients were divided in groups-A and B. Group-A was induced with prostin tablet i.e. dinoprostone PGE2 3 mg tablets maximum of 2 doses, 6 hours apart. Group-B induced with prosotec 50 mu gm 4 hourly, 4 doses. The subjects were full term pregnant women who were either primigravida, 2nd or 3rd gravid and had bishop score less than 5. Results: The patients included in the study were between the ages of 19 to 37 years. The mean age of group-A was 26.72 +- 4.62 years and of group-B was 28.4 +- 4.94 years (p value > 0.05). All the patients in both groups were between 37 to 42 weeks of gestation. The mean gestational age of group-A was 39.74 +- 2.09 weeks and in group-B it was 39.62 +- 1.55 weeks (p > 0.05). Oxytocin augmentation was required in late 1st stage and 2nd stage in group-A in 68% cases but it was required in only 30% cases in group-B cases. The maximum duration of labour was more than 11 hours in 24% cases in group-A but only 6% in group-B. Conclusion: Misoprostol (PGE1 analogue) is a useful drug for labour induction. There is short induction delivery interval and reduced need for the use of oxytocin augmentation. There are also less failure rates of induction with misoprostol. Rate of instrumental delivery and caesarean section is also less. (author)

  5. Complications of first-trimester abortion by vacuum aspiration after cervical preparation with and without misoprostol: a multicentre randomised trial.

    Science.gov (United States)

    Meirik, Olav; My Huong, Nguyen Thi; Piaggio, Gilda; Bergel, Eduardo; von Hertzen, Helena

    2012-05-12

    Little information is available about the incidence of complications from vacuum aspiration for first-trimester abortion after cervical preparation with prostaglandin analogues. We compared incidence of complications from vacuum aspiration in women who had had cervical preparation with misoprostol and those who had not. We did a randomised parallel-group trial at 14 centres in nine countries between Oct 22, 2002, and Sept 24, 2005. Healthy women seeking first-trimester abortion were randomly assigned via a computer-generated randomisation sequence stratified by centre, to receive vaginal administration of either two 200 μg tablets of misoprostol or two placebo tablets 3 h before abortion by vacuum aspiration. Participants and health-care personnel other than staff administering the treatment were masked to group assignment. Follow-up was up to 2 weeks. The primary outcome was one or more complications of vacuum aspiration (cervical tear, uterine perforation, incomplete abortion, uterine re-evacuation, pelvic inflammatory disease, or any other serious adverse event). We included women undergoing treatment and vacuum aspiration in the analysis of immediate complications; whereas, in the analysis of delayed complications, we included only those followed-up. In the analysis of any immediate or delayed complication, we excluded women lost to follow-up. This trial is registered, number ISRCTN85366519. We randomly assigned 2485 women to the misoprostol group and 2487 to the placebo group. Two women in the misoprostol group did not have vacuum aspiration. 56 women in each group were lost to follow-up. 50 (2%) of 2427 women in the misoprostol group and 74 (3%) of 2431 in the placebo group had one or more complication of vacuum aspiration (relative risk [RR] 0·68, 95% CI 0·47-0·96). No women in the misoprostol group had cervical tears and three had uterine perforations compared with two women in the placebo group who had cervical tears and one who had perforation. 19

  6. Unexpected Inflammatory Effects of Intravaginal Gels (Universal Placebo Gel and Nonoxynol-9 on the Upper Female Reproductive Tract: A Randomized Crossover Study.

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    Karen Smith-McCune

    Full Text Available Intravaginal anti-HIV microbicides could provide women with a self-controlled means for HIV prevention, but results from clinical trials have been largely disappointing. We postulated that unrecognized effects of intravaginal gels on the upper female reproductive tract might contribute to the lower-than-expected efficacy of HIV microbicides. Our objective was to study the effects of intravaginal gels on the immune microenvironment of the cervix and uterus. In this randomized crossover study, 27 healthy female volunteers used a nightly application of intravaginal nonoxynol-9 (N9 gel as a "failed" microbicide or the universal placebo gel (UPG as a "safe" gel (intervention cycles, or nothing (control cycle from the end of menses to the mid-luteal phase. At a specific time-point following ovulation, all participants underwent sample collection for measurements of T-cell phenotypes, gene expression, and cytokine/chemokine protein concentrations from 3 anatomic sites above the vagina: the cervical transformation zone, the endocervix and the endometrium. We used hierarchical statistical models to estimate mean (95% CI intervention effects, for N9 and UPG relative to control. Exposure to N9 gel and UPG generated a common "harm signal" that included transcriptional up-regulation of inflammatory genes chemokine (C-C motif ligand 20 (macrophage inflammatory factor-3alpha and interleukin 8 in the cervix, decreased protein concentrations of secretory leukocyte protease inhibitor, and transcriptional up-regulation of inflammatory mediators glycodelin-A and osteopontin in the endometrium. These results need to be replicated with a larger sample, but underscore the need to consider the effects of microbicide agents and gel excipients on the upper female reproductive tract in studies of vaginal microbicides.

  7. Meaning-making matters in product design: users' sensory perceptions and experience evaluations of long-acting vaginal gels and intravaginal rings.

    Science.gov (United States)

    Rosen, Rochelle K; van den Berg, Jacob J; Vargas, Sara E; Senocak, Natali; Shaw, Julia G; Buckheit, Robert W; Smith, Kelley Alison; Guthrie, Kate Morrow

    2015-12-01

    Users' sensory perceptions and experiences of intravaginal products can inform acceptability and adherence. Focusing on the meanings women derive from formulation/device characteristics facilitates developers' design iterations toward optimizing user experience. We investigated how users of long-acting gels and intravaginal rings (IVRs) impute meaning to characteristics that may affect future product use. Focus groups were conducted with contraceptive IVR and vaginal lubricant users. Current perceptibility science and historical theory on the cultural acceptability of fertility regulating methods informed the analysis. A total of 21 IVR users and 29 lubricant users attended focus groups in which they manipulated products in their hands and discussed reactions to product characteristics. Participants used prior product experiences and sensory perceptions of prototype manipulations to inform meanings about product properties and performance for pregnancy, disease prevention, comfort, and perceived efficacy. The meanings derived from product characteristics depended on why the product would be used; a characteristic deemed problematic in one risk context may be considered preferable in another. Intravaginal product users create narratives that ascribe influence or causality to product characteristics. These meanings, whether correct or incorrect biologically, will shape vaginal product acceptability, use, and effectiveness. Long-acting and sustained-release drug delivery systems will be part of the multipurpose prevention continuum. Developers must consider how sensory experiences and culturally salient assumptions shape the meanings users make of product design characteristics. Those meanings will ultimately impact use and effectiveness. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Efficacy of Combination Therapy with Methotrexate and Misoprostol in Termination of Pregnancy in the First Trimester

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Shakeri

    2009-06-01

    Full Text Available Background: Induced abortion is the medical or surgical terminationof pregnancy before fetal viability. It has maternal orfetal indications. The aim of the present study was to evaluatethe efficacy of the combination of methotrexate and misoprostolfor termination of the pregnancy in the first trimester.Methods: This analytic study was performed on 100 women atthe first trimester of pregnancy (9 weeksand 24 has gestational age9 weeks and22 patients with gestational age <9 weeks had complete abortion.Failure rate was higher in missed abortion. Required doseof misoprostol and duration of conceptus expulsion werehigher in pregnancies with missed abortion.Conclusion: Combination therapy with methotrexate and misoprostolrepresents a safe and effective alternative to invasivemethods for termination of the pregnancy in the first trimester.

  9. A randomized trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women

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    Anita Kant

    2011-01-01

    Observations: The study showed a significant difference between the study group (7.7 ± 1.7 mm and the control group (4.5 ± 1.8 mm in terms of pre-procedural cervical width and the number of women requiring a dditional dilatation (7 / 25 versus 22 / 25, and hence, the time required for dilatation (4.7 ± 8 seconds versus 20.6 ± 9.3 seconds. Conclusion: The pre-procedural cervical width was significantly more in the study group as compared to that in the control group. We found significant differences between the study and control groups with respect to the number of women who required cervical dilatation. To conclude, this study helps derive a conclusion that vaginal misoprostol as a cervical priming agent in postmenopausal women appears to be safe, effective, and inexpensive, with mild side effects.

  10. Exposure to misoprostol and hormones during pregnancy and risk of congenital anomalies Exposição ao misoprostol e hormônios durante a gravidez e risco de anomalia congênita

    Directory of Open Access Journals (Sweden)

    Tatiane da Silva Dal Pizzol

    2008-06-01

    Full Text Available This study evaluated the association between use of misoprostol and other drugs to induce menstruation, and congenital anomalies. A sample of 4,856 pregnant women 20 years and older were enrolled consecutively in prenatal services in the Unified National Health System, in six Brazilian State capitals. Data on socio-demographics and use of medicines were obtained using an interview from the 21st to 28th week of pregnancy. Other data, including information on delivery and diagnosis of congenital anomalies by the attending neonatal physician were obtained from patient charts. Potential confounders were adjusted by logistic regression. Use of drugs to induce menstruation was reported by 707 women (14.6%, of whom 120 (17% reported use of misoprostol. After adjusting for the study center, a positive association was observed between misoprostol and congenital anomalies (OR = 2.64; 95%CI: 1.03-6.75; a positive association was also observed for sex hormones (OR = 2.24; 95%CI: 1.06-4.74. The results suggest that the use of misoprostol or sex hormones during pregnancy increases the risk of congenital anomalies.Este estudo avalia a associação do uso do misoprostol e de outros produtos utilizados para induzir a menstruação com anomalia congênita. Foram arroladas consecutivamente 4.856 mulheres com vinte anos de idade ou mais, procedentes de serviços de pré-natal do Sistema Único de Saúde em seis capitais brasileiras. Dados sócio-demográficos e o uso de medicamentos foram obtidos por meio de entrevista, entre a 21ª e a 28ª semanas de gestação. Outros dados, incluindo informações sobre o parto e o diagnóstico de anomalia congênita, realizado pelo médico que assistiu o recém-nascido, foram obtidos no prontuário. Potenciais confundidores foram ajustados por meio de regressão logística. O uso de produtos para induzir a menstruação foi relatado por 707 gestantes (14,6%, das quais 120 (17% referiram-se ao misoprostol. Após ajustamento

  11. Association of misoprostol, moebius syndrome and congenital central alveolar hypoventilation: case report Associação de misoprostol, síndrome de Moebius e hipoventilação central congênita: relato de caso

    Directory of Open Access Journals (Sweden)

    MAGDA LAHORGUE NUNES

    1999-03-01

    Full Text Available We report a case showing the association of Moebius syndrome, the use of misoprostol during pregnancy and the development of central congenital alveolar hypoventilation. Pathophysiological aspects of these three diseases are discussed and also the unfavorable prognosis of this association.Descrevemos o caso de um paciente com Síndrome de Moebius associada ao uso de misoprostol durante a gestação. A criança necessitou de suporte ventilatório desde o primeiro dia de vida e evoluiu com quadro de hipoventilação alveolar central congênita, persistindo dependente de ventilação mecânica. São discutidos aspectos fisiopatológicos que poderiam justificar a comorbidade destes três eventos, assim como o prognóstico reservado desta associação.

  12. Intravaginal Administration of Interleukin 12 during Genital Gonococcal Infection in Mice Induces Immunity to Heterologous Strains ofNeisseria gonorrhoeae.

    Science.gov (United States)

    Liu, Yingru; Perez, Julianny; Hammer, Laura A; Gallagher, Heather C; De Jesus, Magdia; Egilmez, Nejat K; Russell, Michael W

    2018-01-01

    It has previously been shown that genital tract infection with Neisseria gonorrhoeae in mice does not induce a state of protective immunity against reinfection but instead suppresses the development of adaptive immune responses against N. gonorrhoeae dependent on transforming growth factor beta (TGF-β) and interleukin 10 (IL-10). Intravaginal administration during gonococcal infection of IL-12 encapsulated in biodegradable microspheres (IL-12/ms) reverses the immunosuppression and promotes the production of gamma interferon (IFN-γ) and of specific antibodies in serum and genital secretions and accelerates clearance of the infection. In this study, microspheres were shown to remain largely within the genital tract lumen and to release IL-12 over the course of 4 days. Antigonococcal IgA and IgG antibodies induced by IL-12/ms treatment reacted with antigenically different strains of N. gonorrhoeae and led to resistance to reinfection with heterologous and homologous strains. Immune resistance to reinfection persisted for at least 6 months after clearance of the primary infection. Experiments performed with immunodeficient strains of mice lacking either IFN-γ or B cells demonstrated that both IFN-γ and B cells were necessary for the IL-12-induced generation of immune responses to N. gonorrhoeae and the resulting accelerated clearance of the infection. It is therefore concluded that intravaginally administered IL-12/ms achieves its effect by the sustained release of IL-12 that promotes Th1-driven adaptive immune responses, including the production of specific antigonococcal antibodies that cross-react with multiple strains of N. gonorrhoeae . IL-12-enhanced immunity to N. gonorrhoeae can be recalled against reinfection after prolonged intervals and is dependent upon both IFN-γ and antibody production by B cells. IMPORTANCE Genital infection with Neisseria gonorrhoeae (gonorrhea) is a significant cause of reproductive tract morbidity in women, leading to

  13. Efficacy of Sublingual Misoprostol versus Intramuscular Methylergometrine in Prevention of Primary Postpartum Hemorrhage

    International Nuclear Information System (INIS)

    Anwar, R.; Ambreen, A.; Khuram, A.; Mushtaq, M.

    2013-01-01

    Post partum hemorrhage still remains a major cause of maternal morbidity and mortality in developing countries. Most of oxytocics like methylergometrine require parenteral administration, which requires special storage. Misoprostol is thermo stable, has a long shelf life and is widely recommended for prevention of postpartum hemorrhage. This can be a choice of oxytocic in developing countries like ours, where storage facilities and resources are limited. Objectives: To compare efficacy of sublingual Misoprostol versus intramuscular Methylergometrine in prevention of primary postpartum hemorrhage after delivery. Study Design: Quasi experimental study Place and Duration of Study: Department of Gynae/Obs, Military Hospital and Combined Military Hospital Rawalpindi cantt. December 2007 to July 2008. Material and Methods: One hundred and thirty six pregnant ladies were selected. On arrival each patient was examined thoroughly along with baseline investigations. Therapeutic option was allocated to the patients simply by using a table of random numbers and dividing them in two equal groups. Informed written consent was taken. Each patient was observed for blood loss estimation and hematocrit drop. All the data was analyzed using SPSS version 10.0. Mean +- SD for age, pre-delivery and post-delivery hematocrit, percentage of drop in hematocrit and blood loss during labour was calculated. Results: Mean drop of hematocrit and blood loss were compared among two groups. At the end, it was revealed that there was no significant difference among two groups in blood loss (p=0.49) and hematocrit drop (p=0.14). Conclusion: There is no significant better effect in preventing post partum hemorrhage among the two drugs. (author)

  14. Social networks and health policy: the case of misoprostol and the WHO model essential medicine list.

    Science.gov (United States)

    Millard, Colin; Brhlikova, Petra; Pollock, Allyson

    2015-05-01

    The WHO Essential Medicines List (EML) was established to help countries prioritise medicines according to their health care needs. Selection for the List is based on rigorous scrutiny of public health relevance, evidence on efficacy and safety, and comparative cost effectiveness. The WHO ideal is that a medicine and its efficacy are based on science, but in reality a medicine has a social life and the acceptance of a pharmaceutical intervention involves the interaction of a wide array of governmental and civil society organisations, and industry. Misoprostol is a medicine widely used for both abortion and prevention of postpartum haemorrhage in low income countries. Although the evidence for the latter is highly contested it was nevertheless added to the WHO EML in 2011. We use social network analysis to examine the social, political and economic field surrounding the WHO EML applications and health policy. We describe a chronology of the drug's use and of the applications to the WHO EML and carry out a social network analysis of the organisations and individuals involved in the applications, research and dissemination. The research identified a network of 238 organisations and individuals involved in the promotion of misoprostol for postpartum haemorrhage and present at the time of the WHO EML applications. There is a strong interdependency between the funding bodies, civil society organisations, researchers and clinician organisations. The research was part of an EU FP7 funded project on Accessing Medicines in Africa and South Asia (2010-2013). Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  15. Indução do Parto com Misoprostol: Comparação entre duas Doses

    OpenAIRE

    Araújo,Dimas Augusto Carvalho de; Oliveira,Luiz Carlos Navarro de; Oliveira,Isabel Cristina Navarro de; Porto,Daniela Dias Paiva; Oliveira,Sérgio Vilela de; Junqueira,Frederico Henrique Oliveira; Andrade,Amaury Teixeira Leite

    1999-01-01

    Objetivo: comparar a eficácia e segurança entre duas doses de misoprostol administradas por via vaginal para amadurecimento cervical e indução do parto. Pacientes e Métodos: sessenta e uma pacientes com indicação médica para indução do parto e colo desfavorável foram incluídas neste estudo. Vinte e oito pacientes receberam 25 µg e trinta e três 50 µg de misoprostol, a intervalos de 4 horas, até um período máximo de 24 horas. Resultados: a rotura prematura de membranas, gestação prolongada e d...

  16. Misoprostol versus uterine straightening by bladder distension for pain relief in postmenopausal patients undergoing diagnostic office hysteroscopy: a randomised controlled non-inferiority trial.

    Science.gov (United States)

    Fouda, Usama M; Elshaer, Hesham S; Elsetohy, Khaled A; Youssef, Mohamed A

    2016-08-01

    To compare the effectiveness of misoprostol with uterine straightening by bladder distension in minimising the pain experienced by postmenopausal patients during diagnostic office hysteroscopy. Seventy-six postmenopausal patients were randomly allocated in a 1:1 ratio to the misoprostol group or to the bladder distension group. Patients in the misoprostol group were instructed to insert two misoprostol tablets (400μg) in the vagina 12h before office hysteroscopy. Patients in the bladder distension group were instructed to drink one litre of water and to avoid urination during a period of 2h before office hysteroscopy. The severity of pain experienced by the patients during and at 30min after the procedure was measured using a 100-mm visual analogue scale (VAS). The ease of passing the hysteroscope through the cervical canal was assessed by the hysteroscopists using a 100-mm VAS. The passage of the hysteroscope through the cervical canal was easier in the misoprostol group [60.37±15.78 vs. 50.05±19.88, p=0.015]. The mean VAS pain score during the procedure was significantly lower in the misoprostol group [39.47±13.96 vs. 50.18±15.44, p=0.002]. The mean VAS pain score 30min post-procedure was comparable between both groups [11.82±3.71 vs. 12.61±4.06, p=0.379]. Vaginal misoprostol is more effective than uterine straightening by bladder distension in relieving the pain experienced by postmenopausal patients during office hysteroscopy. Clinicaltrials.gov [NCT02328495]. https://clinicaltrials.gov/ct2/show/NCT02328495. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Vaginal misoprostol versus intravenous oxytocin for the management of second-trimester pregnancies with intrauterine fetal death: A randomized clinical trial.

    Science.gov (United States)

    Abediasl, Zhila; Sheikh, Mahdi; Pooransari, Parichehr; Farahani, Zahra; Kalani, Farah

    2016-03-01

    The aim of this study was to compare vaginal misoprostol versus intravenous (i.v.) oxytocin in the management of pregnancies with second-trimester intrauterine fetal death (IUFD). This randomized clinical trial was conducted on 85 pregnant women with IUFD and unripe cervix who were admitted for labor induction. Forty were randomly allocated to receive 200 mcg vaginal misoprostol every 12 h, and 45 were randomly assigned to receive high-dose i.v. oxytocin (starting from 6 mU/min to reach the maximum dose of 40 mU/min). This study is registered at www.irct.ir (IRCT201307159568N5). The induction-to-delivery interval in the misoprostol group (10.5 ± 5.3 [range 4-27] h) was significantly lower than that in the oxytocin group (14 ± 6.8 [range 4-30] h) (P = 0.009). The total hospital stay in the misoprostol group (22.6 ± 9.5 [range 12-48] h) was significantly lower than that in the oxytocin group (35.3 ± 16.4 [range 12-72] h) (P = 0.000). Although the successful induction rate was higher in the misoprostol group, this was not significant (95% vs 86.7%, P = 0.1). Placenta retention occurred more in the oxytocin group (20% vs 5%, P = 0.03). Both vaginal misoprostol and high-dose i.v. oxytocin are highly effective in labor induction in second-trimester pregnancies with IUFD and an unripe cervix. However, vaginal misoprostol seems to be superior to i.v. oxytocin. © 2015 Japan Society of Obstetrics and Gynecology.

  18. Induction of labour at term with oral misoprostol versus a Foley catheter (PROBAAT-II): a multicentre randomised controlled non-inferiority trial.

    Science.gov (United States)

    Ten Eikelder, Mieke L G; Oude Rengerink, Katrien; Jozwiak, Marta; de Leeuw, Jan W; de Graaf, Irene M; van Pampus, Mariëlle G; Holswilder, Marloes; Oudijk, Martijn A; van Baaren, Gert-Jan; Pernet, Paula J M; Bax, Caroline; van Unnik, Gijs A; Martens, Gratia; Porath, Martina; van Vliet, Huib; Rijnders, Robbert J P; Feitsma, A Hanneke; Roumen, Frans J M E; van Loon, Aren J; Versendaal, Hans; Weinans, Martin J N; Woiski, Mallory; van Beek, Erik; Hermsen, Brenda; Mol, Ben Willem; Bloemenkamp, Kitty W M

    2016-04-16

    Labour is induced in 20-30% of all pregnancies. In women with an unfavourable cervix, both oral misoprostol and Foley catheter are equally effective compared with dinoprostone in establishing vaginal birth, but each has a better safety profile. We did a trial to directly compare oral misoprostol with Foley catheter alone. We did an open-label randomised non-inferiority trial in 29 hospitals in the Netherlands. Women with a term singleton pregnancy in cephalic presentation, an unfavourable cervix, intact membranes, and without a previous caesarean section who were scheduled for induction of labour were randomly allocated to cervical ripening with 50 μg oral misoprostol once every 4 h or to a 30 mL transcervical Foley catheter. The primary outcome was a composite of asphyxia (pH ≤7·05 or 5-min Apgar score misoprostol and 927 women to Foley catheter. The composite primary outcome occurred in 113 (12·2%) of 924 participants in the misoprostol group versus 106 (11·5%) of 921 in the Foley catheter group (adjusted relative risk 1·06, 90% CI 0·86-1·31). Caesarean section occurred in 155 (16·8%) women versus 185 (20·1%; relative risk 0·84, 95% CI 0·69-1·02, p=0·067). 27 adverse events were reported in the misoprostol group versus 25 in the Foley catheter group. None were directly related to the study procedure. In women with an unfavourable cervix at term, induction of labour with oral misoprostol and Foley catheter has similar safety and effectiveness. FondsNutsOhra. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Double-blind randomized controlled trial comparing misoprostol and oxytocin for management of the third stage of labor in a Nigerian hospital.

    Science.gov (United States)

    Musa, Abdulkarim O; Ijaiya, Munir'deen A; Saidu, Rakiya; Aboyeji, Abiodun P; Jimoh, Abiodun A; Adesina, Kikelomo T; Abdul, Ishaq F

    2015-06-01

    To compare the efficacy of oral misoprostol with that of oxytocin for active management of the third stage of labor (AMTSL). A double-blind randomized control trial was undertaken at a center in Ilorin, Nigeria, between January and June 2013. Every other eligible patient (in the first stage of labor at term, to have a spontaneous vaginal delivery, and no/low risk of postpartum hemorrhage [PPH]) were randomly assigned with computer-generated random numbers to receive oral misoprostol (600μg) plus placebo injection or oral placebo plus oxytocin injection (1mL of 10IU) in the third stage of labor. The primary outcome was amount of blood loss during delivery. Mean postpartum blood loss was 325.85±164.72mL in the 100 patients given misoprostol and 303.95±163.33mL in the 100 patients given oxytocin (P=0.391). PPH (≥500mL blood loss) was recorded in 15 (15.0%) patients given misoprostol and 14 (14.0%) given oxytocin (P=0.841). Shivering, pyrexia, and diarrhea were all significantly more common in the misoprostol group (Pmisoprostol was similar to that of intramuscular oxytocin. Adverse effects associated with misoprostol were transient and self-limiting. Thus, oral misoprostol is efficacious and a good alternative to oxytocin for AMTSL. Pan African Clinical Trials Registry:PACTR201407000825227. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section: a randomized double-blind clinical trial.

    Science.gov (United States)

    Abdellah, Mohamed S; Abbas, Ahmed M; Hegazy, Aml M; El-Nashar, Ihab M

    2017-06-01

    The current study aims to evaluate if vaginal misoprostol (400 mcg) administered prior to intrauterine device (IUD) insertion increases the ease and success of insertion among women who had delivered only by elective cesarean delivery (CD). The current study was a randomized, double-blind, placebo-controlled trial conducted in Assiut Women's Health Hospital, Egypt, between the 1st of April 2015 and the 31st of March 2016 and included women who delivered only by elective CD. One hundred forty women were randomized into two groups; misoprostol group received two misoprostol 400-mcg tablets vaginally, and placebo group received two placebo tablets 3 h before a copper T380A IUD insertion. The primary outcome measure was the difference in the ease of insertion score using a 10-cm visual analog scale between both groups with 0=very easy insertion, and 10=terribly difficult insertion. The ease of insertion score was lower in the misoprostol group (2.2±0.5 vs. 4.2±0.5, p=.0001) with higher number of successful IUD insertions than the placebo group (69 [98.6%] vs. 61 [87.1%], p=.009). The mean pain score reported by the women was lower in misoprostol group (2.7±0.6 vs. 4.3±0.8) with higher level of satisfaction from the whole procedure (8.9±0.4 vs. 7.9±0.2) with p=.001 for both. Misoprostol 400 mcg vaginally prior to IUD insertion eases and increase the success of insertion with reduction of pain among women who had delivered only by elective CD. The use of vaginal misoprostol before IUD insertion in women who had never delivered vaginally before may increase the ease and success of insertion. Moreover, it may reduce the pain felt by women during the procedure. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Women's Experiences with and Preference for Induction of Labor with Oral Misoprostol or Foley Catheter at Term

    OpenAIRE

    Ten Eikelder, Mieke L G; van de Meent, Marieke M; Mast, Kelly; Rengerink, Katrien Oude; Jozwiak, Marta; de Graaf, Irene M; Scholtenhuis, Marloes A G Holswilder-Olde; Roumen, Frans J M E; Porath, Martina M; van Loon, Aren J; van den Akker, Eline S; Rijnders, Robbert J P; Feitsma, A Hanneke; Adriaanse, Albert H; Muller, Moira A

    2017-01-01

    Objective We assessed experience and preferences among term women undergoing induction of labor with oral misoprostol or Foley catheter.  Study Design In 18 of the 29 participating hospitals in the PROBAAT-II trial, women were asked to complete a questionnaire within 24 hours after delivery. We adapted a validated questionnaire about expectancy and experience of labor and asked women whether they would prefer the same method again in a future pregnancy. Results The questionnaire was completed...

  2. Topical Delivery of Tenofovir Disoproxil Fumarate and Emtricitabine from Pod-Intravaginal Rings Protects Macaques from Multiple SHIV Exposures.

    Directory of Open Access Journals (Sweden)

    Priya Srinivasan

    Full Text Available Topical preexposure prophylaxis (PrEP against HIV has been marginally successful in recent clinical trials with low adherence rates being a primary factor for failure. Controlled, sustained release of antiretroviral (ARV drugs may help overcome these low adherence rates if the product is protective for extended periods of time. The oral combination of tenofovir disoproxil fumarate (TDF and emtricitabine (FTC is currently the only FDA-approved ARV drug for HIV PrEP. A novel pod-intravaginal ring (IVR delivering TDF and FTC at independently controlled rates was evaluated for efficacy at preventing SHIV162p3 infection in a rigorous, repeat low-dose vaginal exposure model using normally cycling female pigtailed macaques. Six macaques received pod-IVRs containing TDF (65 mg and FTC (68 mg every two weeks, and weekly vaginal exposures to 50 TCID50 of SHIV162p3 began one week after the first pod-IVR insertion. All pod-IVR-treated macaques were fully protected throughout the study (P = 0.0002, Log-rank test, whereas all control animals became infected with a median of 4 exposures to infection. The topical, sustained release of TDF and FTC from the pod-IVR maintained protective drug levels in macaques over four months of virus exposures. This novel and versatile delivery system has the capacity to deliver and maintain protective levels of multiple drugs and the protection observed here warrants clinical evaluation of this pod-IVR design.

  3. Local and Systemic Functional Responses of Mouse Macrophages to Intravaginal Infection with Type 2 Herpes Simplex Virus and Vaccination.

    Science.gov (United States)

    Zaitseva, L G; Bekhalo, V A; Kireeva, I V; Shaposhnikova, G M; Nagurskaya, E V; Barinskii, I F; Nesterenko, V G

    2017-05-01

    Activity of cathepsin D and phagocytosis of macrophages from vaginal lavage fluid, peritoneal exudation, and spleen were studied in mice of sensitive (DBA/2) and resistant (BALB/c) lines after intravaginal infection with type 2 herpes simplex virus and vaccination. Activity of cathepsin D and intensity of phagocytosis (irrespective of the macrophage source) and their ratio in BALB/c mice in early terms after infection were close to the control levels taken as a unit. In DBA/2 mice, these parameters and their balance were shifted and changes in cathepsin D activity depended on the time after challenge. Activities of cellular and extracellular cathepsin D increased sharply on day 1 postinfection under conditions of local virus interaction with the vaginal mucosa and activation of the pathological process. Later, after generalization of the infection, activity of cathepsin D decreased, while phagocytosis increased in all the studied macrophage populations. Vaccination corrected the cathepsin D/phagocytosis imbalance and created conditions for rapid elimination of the virus.

  4. Qualitative and quantitative intravaginal targeting: key to anti-HIV-1 microbicide delivery from test tube to in vivo success.

    Science.gov (United States)

    Pillay, Viness; Mashingaidze, Felix; Choonara, Yahya E; Du Toit, Lisa C; Buchmann, Eckhart; Maharaj, Vinesh; Ndesendo, Valence M K; Kumar, Pradeep

    2012-06-01

    The past decade has seen several effective anti-HIV-1 agent discoveries, yet microbicides continue to disappoint clinically. Our review expounds the view that unsatisfactory microbicide failures may be a result of inefficient delivery systems employed. We hereby propose a thorough scientific qualitative and quantitative investigation of important aspects involved in HIV-1 transmission as a prerequisite for microbicide delivery. Intravaginal targeting of HIV-1 increases the chances of microbicide success, wherein vaginal microenvironmental factors including pH should be maintained at HIV-1 prohibitive acidic levels simultaneously to ward off other sexually transmitted diseases, which compromise vaginal epithelial barrier properties. Furthermore, choice of receptors to target both on HIV-1 and on target cells is vital in deterring transmission. Appropriate modeling of virus-target cell interactions as well as targeting early stages of the HIV-1 infection accompanied by computation and delivery of appropriate microbicide quantities could revolutionize microbicide research, ultimately delivering a female-controlled HIV-1 prevention modality appropriately. Copyright © 2012 Wiley Periodicals, Inc.

  5. Incidence of fetal distress in 6 hourly vaginally administered 3 doses, of misoprostol versus dinoprostone for labour induction: a comparative study

    International Nuclear Information System (INIS)

    Rashid, N.; Hanif, A.

    2013-01-01

    Background: Artificial labor pain always poses the risk of fetal distress and is more painful than spontaneous labour. The pharmacological agents that are involved in stimulating uterine contraction may initiate a chain of processes that may lead the baby to suffocate, being deficient of essential oxygen and suffer from distress. The accelerated efforts to adapt safe and advanced measures are inevitable to make the labour induction easier and more secure for both lives involved. Objective: The objective of this study was to compare the incidence of fetal distress in 6 hourly vaginally administered 3 doses, of misoprostol versus dinoprostone for labour induction. Methods: This observational type of comparative study was conducted in Obstetrics Ward Lady Aitchison Hospital Lahore. A total of 200 postdate primigravidas undergoing induction of labour at 41 weeks were selected for this study. They were randomly divided into misoprostol and dinoprostone group, each containing 100 patients. The dose of misoprostol was 50 microgram each time up to a maximum of 150 microgram (3 doses) and dose of dinoprostone was 2 mg and only 2 doses of dinoprostone were used with an interval of 6 hours. Continuous fetal heart rate monitoring was done after induction. Signs of fetal distress like meconium staining of liquor after rupture of membranes and CTG changes were noted. After delivery of baby Apgar score at 5 minutes was taken and any resuscitation required or need for keeping the baby in nursery was noted. Results: The mean age of the patients in misoprostol group was 25.4+-4.5 years and in dinoprostone group was 23.3+-3.4 years. The mean duration of induction to delivery interval in misoprostol group was 16.4+-6.4 hours and in dinoprostone group was 13.1+-4.6 hours. In misoprostol group, 40 (40%) patients delivered with LSCS and 60 (60%) patients delivered with spontaneous vaginal delivery. In dinoprostone group, 36 (36%) patients delivered with LSCS and 64 (64%) patients

  6. The combination route versus sublingual and vaginal misoprostol for the termination of 13 to 24 week pregnancies: A randomized clinical trial.

    Science.gov (United States)

    Rahimi-Sharbaf, Fatemeh; Adabi, Khadijeh; Valadan, Mehrnaz; Shirazi, Mahboobeh; Nekuie, Sepideh; Ghaffari, Parisa; Khansari, Narges

    2015-12-01

    The goal of this study was to compare the effectiveness of misoprostol via sublingual and vaginal administration versus the combination route in the termination of 13 to 24 week pregnancies. One hundred and ninety-five patients, divided into three groups, were enrolled in this study. In the vaginal group, two 200-μg misoprostol tablets were inserted into the posterior fornix every 4 hours for 48 hours. In the sublingual group, patients took two 200-μg misoprostol tablets every 4 hours for up to 48 hours. In the combination group, two 200-μg misoprostol tablets were inserted within the posterior fornix followed by the administration of 400 μg misoprostol sublingually every 4 hours for a period of 48 hours. Efficacy was defined as a successful termination without the need for any interventions. The success rate, after 24-48 hours, was not significantly different among the three groups. It was significantly higher within the first 12 hours of misoprostol administration within the sublingual group (p = 0.031). Nonetheless, the overall failure rate was not significantly different between three groups. The mean duration of abortion was shortest among the sublingual group (655 ± 46 minutes), p = 0.005, and the number of misoprostol tablets administered was lower when compared to the other groups (5.9 ± 0.3), p = 0.001. The duration of abortion and the number of misoprostol tablets used significantly varied in the cases in which the patient had a history of a previous normal vaginal delivery (NVD; p = 0.007). The average number of tablets administered was the lowest in the sublingual group. The prevalence of fever among the NVD cases were significantly higher in the combination group (p = 0.008). Overall, of all the methods, patients preferred the sublingual route (p = 0.001). Sublingual misoprostol has a higher efficacy when compared to the vaginal and combination methods. Copyright © 2015. Published by Elsevier B.V.

  7. Bioequivalence of two misoprostol tablets in healthy Chinese female volunteers: a single-dose, two-period, double crossover study.

    Science.gov (United States)

    Huang, J; Chen, R; Li, R; Wei, C-M; Yuan, G-Y; Liu, X-Y; Wang, B-J; Guo, R-C

    2012-01-01

    To assess the bioequivalence of a new generic formulation of misoprostol (CAS 59122-46-2) 0.2 mg tablets (test) and the available branded tablet (reference) for the requirement of state regulatory criteria and the marketing of the test product in China. A randomized-sequence, 2-period crossover study was conducted in 20 healthy Chinese female volunteers in the fasted state. Blood samples were collected at baseline and 0.083, 0.17, 0.25, 0.33, 0.5, 0.75, 1, 1.25, 1.5, 2, 3, 4 and 6 h after a single oral dose of 0.6 mg misoprostol test or reference, followed by a 7-day washout period. Misoprostol acid, the active metabolite of misoprostol, was determined by an HPLC-MS/MS method. Drug And Statistics 2.0 was used to calculate the pharmacokinetics parameters and assess bioequivalence of the 2 formulations. It was considered bioequivalent if the 90% CIs of the mean ratios (test: reference) for Tmax, Cmax and AUC0-t were all within the range from 80% to 125%. Adverse events were monitored throughout the study based on clinical parameters and patient reports. The main pharmacokinetics parameters for the test and reference were as follows: t1/2 was (0.680 ± 0.371) h and (0.650 ± 0.264) h; Tmax was (0.415 ± 0.087) h and (0.399 ± 0.097) h; Cmax was (1.941 ± 0.417) ng/mL and (2.047 ± 0.397) ng/mL; AUC0-t was (1.535 ± 0.419) ng·h/mL and (1.652 ± 0.400)ng·h/mL, and the AUC0-∞ was (1.576 ± 0.465) ng·h/mL and (1.686 ± 0.396) ng·h/mL. The mean ratios (test: reference) for Cmax, AUC0-t, and AUC0-∞ were 95.3% ±13.2%, 92.65% ± 17.31%, and 93.61%±18.97%, respectively. No significant (p>0.05) differences in pharmacokinetic parameters were found between preparations, treatments and periods. This single-dose study in healthy Chinese fasted volunteers was shown that the misoprostol test and reference met the requirement of US and China regulatory criterion, and the test and reference were bioequivalent. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Single versus repeat doses of misoprostol for treatment of early pregnancy loss-a randomized clinical trial.

    Science.gov (United States)

    Mizrachi, Yossi; Dekalo, Ann; Gluck, Ohad; Miremberg, Hadas; Dafna, Lotem; Feldstein, Ohad; Weiner, Eran; Bar, Jacob; Sagiv, Ron

    2017-06-01

    Does repeat administration of misoprostol for early pregnancy loss increase the treatment success rate? Repeat administration of misoprostol does not increase the treatment success rate, and is associated with more analgesics use. Misoprostol reduces the need for surgical evacuation and shortens the time to complete expulsion in patients with early pregnancy loss. However, the impact of repeat doses of misoprostol is not clear. A randomized clinical trial was conducted in a single tertiary hospital, recruiting women with early pregnancy loss (misoprostol vaginally on Day 1, and were then randomly assigned into two groups: Patients in the single-dose group were evaluated on Day 8. Patients in the repeat-dose group were evaluated on Day 4, when they were given a repeat dose if required, and scheduled for re-evaluation on Day 8. If complete expulsion was not achieved on Day 8 (endometrial thickness >15 mm or the presence of gestational sac on transvaginal sonography), participants underwent surgical evacuation. The primary outcome was treatment success, defined as no need for surgical intervention up to Day 8. Final analysis included 87 participants in the single-dose group and 84 participants in the repeat-dose group, out of whom 41 (48.8%) received a second dose. Treatment succeeded in 67 (77%) patients in the single-dose group and 64 (76%) patients in the repeat-dose group (RR 0.98; 95% CI 0.83-1.16; P = 0.89). Patients in the repeat-dose group reported more use of over the counter analgesics (82.1% versus 69.0%, P = 0.04). The study was not blinded and our definition of complete expulsion may be debated. Follow-up time was not equal in all participants, since some had a complete expulsion on Day 4 and some underwent emergent D&C before Day 8. This, however, should not affect the primary outcome. Our results suggest that a single-dose protocol is superior to a repeat-dose protocol due to a comparable success rate and more favorable outcomes regarding the need for

  9. Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea.

    Science.gov (United States)

    Vallely, Lisa M; Homiehombo, Primrose; Walep, Elizabeth; Moses, Michael; Tom, Marynne; Kelly-Hanku, Angela; Vallely, Andrew; Nataraye, Eluo; Ninnes, Caroline; Mola, Glen D; Morgan, Chris; Kaldor, John M; Wand, Handan; Whittaker, Andrea; Homer, Caroline S E

    2016-06-01

    To determine the feasibility and acceptability of providing clean birth kits (CBKs) containing misoprostol for self-administration in a rural setting in Papua New Guinea. A prospective intervention study was conducted between April 8, 2013, and October 24, 2014. Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena. Participants received individual instruction and were then given a CBK containing 600μg misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their understanding of correct use of items in the CBK. Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up. Among 200 participants, 106 (53.0%) had an unsupervised birth, and 99 (93.4%) of these women used the CBK. All would use the CBK again and would recommend it to others. Among these 99 women, misoprostol was self-administered by 98 (99.0%), all of whom would take the drug again and would recommend it to others. The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities. Large-scale interventions should be planned to further evaluate impact and acceptability. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  10. A double-blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14-21 weeks of pregnancy.

    Science.gov (United States)

    Dabash, Rasha; Chelli, Héla; Hajri, Selma; Shochet, Tara; Raghavan, Sheila; Winikoff, Beverly

    2015-07-01

    To assess differences in outcomes of misoprostol with or without mifepristone for second-trimester abortion. A randomized, double-blind, placebo-controlled trial of buccal misoprostol following placebo or 200mg mifepristone was done in Tunisia among women presenting for abortions at 14-21 weeks of pregnancy between August 2009 and December 2011. Women with a live fetus, a closed cervical os, no cervical bleeding, and no contraindications to study drugs were eligible and underwent randomization (block size 10). Participants returned 24 hours later to receive 400 μg buccal misoprostol every 3 hours until complete fetal and placental expulsion (maximum 10 doses, five per 24-hour period). The primary outcomes were rates of complete uterine evacuation at 48 hours and time to expulsion. A total of 120 women were evenly randomized to treatment. Complete uterine evacuation at 48 hours was recorded in 55 (91.7%) women in the combined group versus 43 (71.7%) in the misoprostol alone group (relative risk 1.28; 95% confidence interval 1.07-1.53). Mean time to complete abortion was 10.4±6.6 hours in the group who received mifepristone versus 20.6±9.7 hours in the misoprostol alone group (Pmisoprostol can improve the quality of second-trimester abortion care by making the process faster. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  11. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Silverstein, F E; Graham, D Y; Senior, J R; Davies, H W; Struthers, B J; Bittman, R M; Geis, G S

    1995-08-15

    To investigate whether concurrent administration of misoprostol reduces the occurrence of serious upper gastrointestinal complications, such as perforation, gastric outlet obstruction, or bleeding, in patients with rheumatoid arthritis who are receiving nonsteroidal anti-inflammatory drugs (NSAIDs). 6-month randomized, double-blind, placebo-controlled trial. 664 clinical practices of family medicine, internal medicine, or rheumatology in the United States and Canada. 8843 men and women (mean age, 68 years) receiving continuous therapy with any of 10 specified NSAIDs for control of symptoms of rheumatoid arthritis. Patients were enrolled between July 1991 and August 1993. Patients were randomly assigned to receive 200 micrograms of misoprostol or placebo four times a day. Development of serious upper gastrointestinal complications detected by clinical symptoms or findings (not by scheduled endoscopy). Serious upper gastrointestinal complications were reduced by 40% (odds ratio, 0.598 [95% CI, 0.364 to 0.982; P = 0.049]) among patients receiving misoprostol (25 of 4404 patients) compared with those receiving placebo (42 of 4439 patients). During the first month, more patients receiving misoprostol (20%) than placebo (15%) withdrew from the study, primarily because of diarrhea and related problems (P rheumatoid arthritis, misoprostol reduced serious NSAID-induced upper gastrointestinal complications by 40% compared with placebo.

  12. Randomized double-blind placebo-controlled trial of buccal misoprostol to reduce the need for additional uterotonic drugs during cesarean delivery.

    Science.gov (United States)

    Hernández-Castro, Flavio; López-Serna, Norberto; Treviño-Salinas, Emilio M; Soria-López, Juan A; Sordia-Hernández, Luis H; Cárdenas-Estrada, Eloy

    2016-02-01

    To determine whether buccal misoprostol during cesarean delivery in conjunction with active management of the third stage of labor reduces the need for additional uterotonic drugs. A double-blind, randomized, placebo-controlled trial was performed in Monterrey, Mexico, between February 2008 and December 2013. Eligible women had risk factors for uterine atony and were to undergo cesarean delivery under epidural block. Using a computer-generated sequence and blocks of six, patients were randomly assigned to receive 400μg misoprostol or 800μg placebo buccally after cord clamping. Both groups received an intravenous oxytocin infusion. The primary outcome was the need for additional uterotonic drugs. Analyses were performed per protocol. Patients, investigators, and data analysts were masked to group assignment. A total of 120 women were included in analyses (60 in each group). At least one additional uterotonic drug was required in 24 (40%) women in the placebo group versus 6 (10%) women in the misoprostol group (relative risk 0.16; 95% confidence interval 0.06-0.44). No adverse effects due to misoprostol were recorded. Buccal misoprostol during cesarean delivery reduced the need for additional uterotonic drugs to treat uterine atony. ClinicalTrials.gov:NCT01733329. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. COMPORTAMIENTO REPRODUCTIVO DE VACAS CRIOLLAS CON AMAMANTAMIENTO RESTRINGIDO Y SINCRONIZACIÓN DEL ESTRO

    Directory of Open Access Journals (Sweden)

    Juan Prisciliano Z\\u00E1rate-Mart\\u00EDnez

    2010-01-01

    Full Text Available Los objetivos fueron conocer el comportamie nto reproductivo posparto de vacas criollas de rodeo con amamantamie nto restringido, la respuesta a la sincronización del estro con protocolos hormonales, los niveles séricos de progesterona y estradiol, la actividad ovárica y la tasa de concepción, con el empleo de inseminación artificial a tiempo fijo. En el Municipi o de Soto Maynes, Chihuahua, México durante el verano de 2008, se observó el comportamie nto de 27 vacas amamantando durante 95 días y se determinó el inicio de su actividad ovárica posparto por detección de estros, ultrasonografía y niveles séricos de progesterona. En el primer tratamie nto, once vacas recibie ron un dispositivo intravaginal con 1,9 g de progesterona, inyección intramuscular con 1 mg de ¿-estradiol + 50 mg de P4. Se retiró el dispositivo intravaginal el día sie te más inyección intramuscular de 30 mg de prostaglandina. A las 24 h se aplicó 1 mg de ¿- estradiol y la IA TF se realizó a las 54 h posteriores al retiro del dispositivo intravaginal. El segundo tratamie nto con once vacas fue similar, pero la inyección intramuscular al recibir el dispositivo intravaginal sólo contenía ¿-estradiol. Se observó un comportamie nto agresivo durante el amamantamie nto restringido. El reinicio de actividad ovárica, fue a los 11,66 días de haber expuesto a vacas criollas a amamantamiento restringido, 11,11% mostraron estro durante este periodo, todas presentaron estro después de los protocolos hormonales. Hubo interacción T*DS (P=0,06 para niveles séricos de progesterona y estradiol. La tasa de concepción fue de 18,8%. Adicionar progesterona con un dispositivo intravaginal no incrementaron los niveles séricos de progesterona.

  14. Comparison of home-based and outpatient clinic-based intravaginal electrical stimulation for the treatment of urinary incontinence.

    Science.gov (United States)

    Gungor Ugurlucan, F; Alper, N; Ayvacikli, G; Nehir, A; Celik, R; Yalcin, O

    2014-08-01

    Aim of the study was to compare the effects of outpatient clinic-based versus home-based intravaginal electrical stimulation (ES) for the treatment of urinary incontinence. Women applying with the complaint of urinary incontinence and offered ES treatment were divided into outpatient clinic-based or home-based ES. Patients were instructed about home-based ES at the outpatient clinic by certified physiotherapy nurses. Bladder diary, 1-hour pad test, and King's-Health-Questionnaire (KHQ) were performed before and after treatment. ES was applied for 20 minutes, 6-8 weeks with pulses of 10-50 Hz square waves at a 300 μs or 1 ms pulse duration and a maximal output current of 24 to 60 mA with 5-10 Hz frequency, three times/week. Twenty-four patients received outpatient clinic-based, 22 patients received home-based ES. Pad test, bladder diary and pelvic floor muscle strength parameters in both groups improved significantly after treatment, with no significant difference between the two groups. Seven patients (31.8%) were cured, six patients (27.3%) were much improved, and seven patients (31.8%) were improved in the home-based ES group. Nine patients (37.5%) were cured, six patients (25%) were much improved, and six patients (25%) were improved and in the outpatient clinic-based ES group. There was an improvement in quality of life in all domains in both groups when the pretreatment and post-treatment KHQ results were compared, with no significant difference between the two groups. Home-based ES is as effective in the treatment of urinary incontinence as outpatient clinic-based ES with significant improvement in objective and subjective parameters.

  15. Combination Pod-Intravaginal Ring Delivers Antiretroviral Agents for HIV Prophylaxis: Pharmacokinetic Evaluation in an Ovine Model

    Science.gov (United States)

    Moss, John A.; Butkyavichene, Irina; Churchman, Scott A.; Gunawardana, Manjula; Fanter, Rob; Miller, Christine S.; Yang, Flora; Easley, Jeremiah T.; Marzinke, Mark A.; Hendrix, Craig W.; Smith, Thomas J.

    2016-01-01

    Preexposure prophylaxis (PrEP) against HIV using oral regimens based on the nucleoside reverse transcriptase inhibitor tenofovir disoproxil fumarate (TDF) has been effective to various degrees in multiple clinical trials, and the CCR5 receptor antagonist maraviroc (MVC) holds potential for complementary efficacy. The effectiveness of HIV PrEP is highly dependent on adherence. Incorporation of the TDF-MVC combination into intravaginal rings (IVRs) for sustained mucosal delivery could increase product adherence and efficacy compared with oral and vaginal gel formulations. A novel pod-IVR technology capable of delivering multiple drugs is described. The pharmacokinetics and preliminary local safety characteristics of a novel pod-IVR delivering a combination of TDF and MVC were evaluated in the ovine model. The device exhibited sustained release at controlled rates over the 28-day study and maintained steady-state drug levels in cervicovaginal fluids (CVFs). Dilution of CVFs during lavage sample collection was measured by ion chromatography using an inert tracer, allowing corrected drug concentrations to be measured for the first time. Median, steady-state drug levels in vaginal tissue homogenate were as follows: for tenofovir (TFV; in vivo hydrolysis product of TDF), 7.3 × 102 ng g−1 (interquartile range [IQR], 3.0 × 102, 4.0 × 103); for TFV diphosphate (TFV-DP; active metabolite of TFV), 1.8 × 104 fmol g−1 (IQR, 1.5 × 104, 4.8 × 104); and for MVC, 8.2 × 102 ng g−1 (IQR, 4.7 × 102, 2.0 × 103). No adverse events were observed. These findings, together with previous pod-IVR studies, have allowed several lead candidates to advance into clinical evaluation. PMID:27067321

  16. Intravaginal cytomegalovirus (CMV challenge elicits maternal viremia and results in congenital transmission in a guinea pig model

    Directory of Open Access Journals (Sweden)

    Schleiss Mark R

    2011-03-01

    Full Text Available Abstract Background The objective of this study was to compare intravaginal (ivg and subcutaneous (sc administration of the guinea pig cytomegalovirus (GPCMV in pregnant and non-pregnant guinea pigs. These studies tested the hypotheses that ivg infection would elicit immune responses, produce maternal viremia, and lead to vertical transmission, with an efficiency similar to the traditionally employed sc route. Results Four groups of age- and size-matched guinea pigs were studied. Two groups were pregnant, and two groups were not pregnant. Animals received 5x105 plaque-forming units (PFU of a GPCMV reconstituted from an infectious bacterial artificial chromosome (BAC construct containing the full-length GPCMV genome. Seroconversion was compared by IgG ELISA, and viremia (DNAemia was monitored by PCR. In both pregnant and non-pregnant animals, sc inoculation resulted in significantly higher serum ELISA titers than ivg inoculation at 8 and 12 weeks post-infection. Patterns of viremia (DNAemia were similar in animals inoculated by either sc or ivg route. However, in pregnant guinea pigs, animals inoculated by both routes experienced an earlier onset of DNAemia than did non-pregnant animals. Neither the percentage of dead pups nor the percentage of GPCMV positive placentas differed by inoculation route. Conclusions In the guinea pig model of congenital CMV infection, the ivg route is as efficient at causing congenital infection as the conventional but non-physiologic sc route. This finding could facilitate future experimental evaluation of vaccines and antiviral interventions in this highly relevant animal model.

  17. A Novel Microbicide/Contraceptive Intravaginal Ring Protects Macaque Genital Mucosa against SHIV-RT Infection Ex Vivo.

    Science.gov (United States)

    Villegas, Guillermo; Calenda, Giulia; Ugaonkar, Shweta; Zhang, Shimin; Kizima, Larisa; Mizenina, Olga; Gettie, Agegnehu; Blanchard, James; Cooney, Michael L; Robbiani, Melissa; Fernández-Romero, José A; Zydowsky, Thomas M; Teleshova, Natalia

    2016-01-01

    Women need multipurpose prevention products (MPTs) that protect against sexually transmitted infections (STIs) and provide contraception. The Population Council has developed a prototype intravaginal ring (IVR) releasing the non-nucleoside reverse transcriptase inhibitor (NNRTI) MIV-150 (M), zinc acetate (ZA), carrageenan (CG) and levonorgestrel (LNG) (MZCL IVR) to protect against HIV, HSV-2, HPV and unintended pregnancy. Our objective was to evaluate the anti-SHIV-RT activity of MZCL IVR in genital mucosa. First, macaque vaginal tissues were challenged with SHIV-RT in the presence of (i) MIV-150 ± LNG or (ii) vaginal fluids (VF); available from studies completed earlier) collected at various time points post insertion of MZCL and MZC IVRs. Then, (iii) MZCL IVRs (vs. LNG IVRs) were inserted in non-Depo Provera-treated macaques for 24h and VF, genital biopsies, and blood were collected and tissues were challenged with SHIV-RT. Infection was monitored with one step SIV gag qRT-PCR or p27 ELISA. MIV-150 (LCMS/MS, RIA), LNG (RIA) and CG (ELISA) were measured in different compartments. Log-normal generalized mixed linear models were used for analysis. LNG did not affect the anti-SHIV-RT activity of MIV-150 in vitro. MIV-150 in VF from MZC/MZCL IVR-treated macaques inhibited SHIV-RT in vaginal mucosa in a dose-dependent manner (pex vivo infection relative to baseline (96%; ppost LNG IVR group (90%, p<0.001). No MIV-150 dose-dependent protection was observed, likely because of high MIV-150 concentrations in all vaginal tissue samples. In cervical tissue, MIV-150 inhibited infection vs. baseline (99%; p<0.05). No cervical tissue was available for MIV-150 measurement. Exposure to LNG IVR did not change tissue infection level. These observations support further development of MZCL IVR as a multipurpose prevention technology to improve women's sexual and reproductive health.

  18. Embryo yield in llamas synchronized with two different intravaginal progesterone-releasing devices and superovulated with eCG

    Energy Technology Data Exchange (ETDEWEB)

    Aller, J.F.; Abalos, M.C.; Acuña, F.A.; Virgili, R.; Requena, F.; Cancino, A.K.

    2015-07-01

    The objectives of this study were to compare the effects of two intravaginal devices (ID) containing the same dose (0.5 g) of progesterone (P4) on subsequent ovarian response, embryo production and circulating P4 concentration profile in llamas (Lama glama) treated with equine chorionic gonadotropin (eCG) for ovarian superstimulation. Female llamas were randomly assigned (n = 10 llamas per group) to one of the following groups and treated (Day 0) with an ID containing 0.5 g of vegetal P4 to synchronize the emergence of a new follicular wave: i) DIB 0.5® and ii) Cronipres M15®. On Day 3 llamas were intramuscularly treated with 1000 IU of eCG. The IDs were removed on Day 7. Llamas were naturally mated (Day 9) and treated with GnRH analogue to induce ovulation. A second mating was allowed 24 h later. Embryos were collected between 7 and 8 days after the first mating. Blood samples were taken every day from Day 0 to Day 7 to measure circulating P4 concentrations. The results indicated that DIB device maintained greater plasma P4 levels as compared to Cronipres until Day 2. However, the mean (± SD) number of corpora lutea and recovered embryos was not affected (p < 0.05) by the type of ID (5.3 ± 2.6 vs 4.2 ± 2.2 and 3.5 ± 2.7 vs 2.6 ± 3.0 for DIB and Cronipres, respectively). In conclusion, both DIB and Cronipres devices can be successfully used to synchronize the emergence of follicular wave prior to a single dose of eCG in superovulation protocol in llamas. (Author)

  19. Embryo yield in llamas synchronized with two different intravaginal progesterone-releasing devices and superovulated with eCG

    Directory of Open Access Journals (Sweden)

    Juan F. Aller

    2015-09-01

    Full Text Available The objectives of this study were to compare the effects of two intravaginal devices (ID containing the same dose (0.5 g of progesterone (P4 on subsequent ovarian response, embryo production and circulating P4 concentration profile in llamas (Lama glama treated with equine chorionic gonadotropin (eCG for ovarian superstimulation. Female llamas were randomly assigned (n = 10 llamas per group to one of the following groups and treated (Day 0 with an ID containing 0.5 g of vegetal P4 to synchronize the emergence of a new follicular wave: i DIB 0.5® and ii Cronipres M15®. On Day 3 llamas were intramuscularly treated with 1000 IU of eCG. The IDs were removed on Day 7. Llamas were naturally mated (Day 9 and treated with GnRH analogue to induce ovulation. A second mating was allowed 24 h later. Embryos were collected between 7 and 8 days after the first mating. Blood samples were taken every day from Day 0 to Day 7 to measure circulating P4 concentrations. The results indicated that DIB device maintained greater plasma P4 levels as compared to Cronipres until Day 2. However, the mean (± SD number of corpora lutea and recovered embryos was not affected (p < 0.05 by the type of ID (5.3 ± 2.6 vs 4.2 ± 2.2 and 3.5 ± 2.7 vs 2.6 ± 3.0 for DIB and Cronipres, respectively. In conclusion, both DIB and Cronipres devices can be successfully used to synchronize the emergence of follicular wave prior to a single dose of eCG in superovulation protocol in llamas.

  20. A harm-reduction model of abortion counseling about misoprostol use in Peru with telephone and in-person follow-up: A cohort study

    Science.gov (United States)

    Baum, Sarah E.; Andjelic, Denitza; Tatum, Carrie; Torres, Guadalupe; Fuentes, Liza; Friedman, Jennifer

    2018-01-01

    Background In Peru, abortion is legal only to preserve the life and health of the woman. A non-profit clinic system in Peru implemented a harm-reduction model for women with unwanted pregnancy that included pre-abortion care with instructions about misoprostol use and post-abortion care; they started offering telephone follow-up for clients in 2011. This study aimed to evaluate the effectiveness and safety of the harm-reduction model, and to compare outcomes by type of follow-up obtained. Methods Between January 2012 and March 2013, 500 adult women seeking harm-reduction services were recruited into the study. Telephone surveys were conducted approximately four weeks after their initial harm-reduction counseling session with 262 women (response rate 52%); 9 participants were excluded. The survey focused on whether women pursued an abortion, and if so, what their experience was. Demographic and clinical data were also extracted from clinic records. Results Eighty-six percent of participants took misoprostol; among those taking misoprostol, 89% reported a complete abortion at the time of the survey. Twenty-two percent obtained an aspiration after taking misoprostol and 8% self-reported adverse events including hemorrhage without transfusion, infection, or severe pain. Among women who took misoprostol, 46% reported receiving in-person follow-up (in some cases both telephone and in-person), 34% received telephone only, and 20% did not report receiving any form of follow-up. Those who had in-person follow-up with the counselor were most likely to report a complete abortion (abortion laws is associated with improvements in health outcomes, but the process of legal reform is often lengthy. In the interim, giving women information about evidence-based regimens of misoprostol, as well as offering a range of follow-up options to ensure high quality post-abortion care, may reduce the risks associated with unsafe abortion. PMID:29320513

  1. High Levels of Inflammatory Cytokines in the Reproductive Tract of Women with BV and Engaging in Intravaginal Douching: A Cross-Sectional Study of Participants in the Women Interagency HIV Study.

    Science.gov (United States)

    Alcaide, Maria L; Rodriguez, Violeta J; Brown, Megan R; Pallikkuth, Suresh; Arheart, Kristopher; Martinez, Octavio; Roach, Margaret; Fichorova, Raina N; Jones, Deborah L; Pahwa, Savita; Fischl, Margaret A

    2017-04-01

    High levels of inflammatory cytokines in the genital tract suggest mucosal vulnerability and increased risk of HIV and sexually transmitted infection (STI) acquisition. Intravaginal douching is associated with bacterial vaginosis (BV) in women in the United States, and both douching and BV are linked to HIV and STI acquisition. This study evaluates inflammatory cytokines in the genital tract to increase understanding of the effects of both BV and intravaginal douching to the vaginal mucosa. A cross-sectional study of participants in the Miami WIHS investigated 72 reproductive age women (45 HIV + and 27 high-risk HIV - ) who completed intravaginal douching questionnaires and underwent collection of vaginal swabs and cervicovaginal lavages (CVLs). BV was assessed using the Nugent score. Inflammatory cytokines in the CVLs (interleukin [IL]-6, IL-8, IL-1α, IL-1β, soluble intracellular adhesion molecule-1 [sICAM-1], interferon [IFN]α2, chemokine C ligand 5 (CCL5), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP1), tumor necrosis factor alpha (TNFα), and secretory leukocyte protease inhibitor [SLPI]) were measured. Fourteen (19%) women reported intravaginal douching; 24 (33%) had BV. BV, intravaginal douching, and HIV were associated with higher levels of inflammatory cytokines. After controlling for demographic and risk factors and HIV status, women who had BV and douched had higher levels of inflammatory cytokines than those without BV and who did not douche, or who only had BV or only douched. These findings suggest that BV and douching are associated with greater mucosal inflammation and may facilitate HIV acquisition and transmission. Although longitudinal studies are needed to determine temporal associations and causality, interventions to decrease rates of intravaginal douching and BV could significantly decrease women's risks of acquiring STIs and HIV and limit the spread of HIV.

  2. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause.

    Science.gov (United States)

    Labrie, Fernand; Archer, David F; Koltun, William; Vachon, Andrée; Young, Douglas; Frenette, Louise; Portman, David; Montesino, Marlene; Côté, Isabelle; Parent, Julie; Lavoie, Lyne; Beauregard, Adam; Martel, Céline; Vaillancourt, Mario; Balser, John; Moyneur, Érick

    2016-03-01

    The aim of this study is to confirm the local beneficial effects of intravaginal dehydroepiandrosterone (DHEA, Prasterone) on moderate to severe dyspareunia or pain at sexual activity, the most frequent symptom of vulvovaginal atrophy due to menopause or genitourinary syndrome of menopause (GSM). In a prospective, randomized, double-blind, and placebo-controlled phase III clinical trial, the effect of daily intravaginal 0.50% DHEA (6.5 mg) (Prasterone, EndoCeutics) was examined on four coprimary objectives, namely percentage of parabasal cells, percentage or superficial cells, vaginal pH, and moderate to severe pain at sexual activity (dyspareunia) identified by the women as their most bothersome vulvovaginal atrophy symptom. The intent-to-treat population included 157 and 325 women in the placebo and DHEA-treated groups, respectively. After daily intravaginal administration of 0.50% DHEA for 12 weeks, when compared to baseline by the analysis of covariance test, the percentage of parabasal cells decreased by 27.7% over placebo (P < 0.0001), whereas the percentage of superficial cells increased by 8.44% over placebo (P < 0.0001), vaginal pH decreased by 0.66 pH unit over placebo (P < 0.0001), and pain at sexual activity decreased by 1.42 severity score unit from baseline or 0.36 unit over placebo (P = 0.0002). On the other hand, moderate to severe vaginal dryness present in 84.0% of women improved at 12 weeks by 1.44 severity score unit compared to baseline, or 0.27 unit over placebo (P = 0.004). At gynecological evaluation, vaginal secretions, epithelial integrity, epithelial surface thickness, and color all improved by 86% to 121% over the placebo effect (P < 0.0001 for all comparisons with placebo). Serum steroid levels remained well within the normal postmenopausal values according to the involved mechanisms of intracrinology. The only side effect reasonably related to treatment is vaginal discharge due to melting of the vehicle at

  3. Photoacoustic methods for in vitro study of kinetics progesterone release from the biodegradation of polyhydroxybutyrate/polycaprolactone used as intravaginal devices

    Energy Technology Data Exchange (ETDEWEB)

    Souza Filho, N. E. [Universidade Estadual de Maringá, Departamento de Física, Grupo de Estudos dos Fenômenos Fototérmicos-GEFF/DFI/UEM, Av. Colombo 5790, Maringá-PR (Brazil); Universidade Federal de Santa Maria, Departamento de Eng. Acústica, Av. Roraima 1000, CEP 97105–900, Santa Maria-RS (Brazil); Mariucci, V. V. G.; Dias, G. S.; Szpak, W.; Medina, A. N.; Baesso, M. L.; Bento, A. C. [Universidade Estadual de Maringá, Departamento de Física, Grupo de Estudos dos Fenômenos Fototérmicos-GEFF/DFI/UEM, Av. Colombo 5790, Maringá-PR (Brazil); Miguez, P. H. P.; Madureira, E. H. [Universidade de São Paulo, Departamento de Reprodução Animal–VRA/USP, Av. Prof. Dr. Orlando Marques Paiva 87, São Paulo–SP (Brazil)

    2013-09-30

    Intravaginal devices composed of polyhydroxybutyrate/polycaprolactone blends incorporating progesterone were used over eight days in crossbred cow ovariectomized, and then analyzed with photoacoustic methods, measuring the absorption spectra, thermal diffusivity, and inspecting its degradation by means of scanning electron microscopy. The characteristic time found for progesterone release was TR ∼ 53 h, and the typical time found for biodegradation was TB ∼ 30 h. Morphological analysis complements the study showing that release of progesterone and biodegradation of the blend occurs on sample surface.

  4. Photoacoustic methods for in vitro study of kinetics progesterone release from the biodegradation of polyhydroxybutyrate/polycaprolactone used as intravaginal devices

    Science.gov (United States)

    Souza Filho, N. E.; Mariucci, V. V. G.; Dias, G. S.; Szpak, W.; Miguez, P. H. P.; Madureira, E. H.; Medina, A. N.; Baesso, M. L.; Bento, A. C.

    2013-09-01

    Intravaginal devices composed of polyhydroxybutyrate/polycaprolactone blends incorporating progesterone were used over eight days in crossbred cow ovariectomized, and then analyzed with photoacoustic methods, measuring the absorption spectra, thermal diffusivity, and inspecting its degradation by means of scanning electron microscopy. The characteristic time found for progesterone release was TR ˜ 53 h, and the typical time found for biodegradation was TB ˜ 30 h. Morphological analysis complements the study showing that release of progesterone and biodegradation of the blend occurs on sample surface.

  5. Morphological Findings in Trophozoites during Amoebic Abscess Development in Misoprostol-Treated BALB/c Mice

    Science.gov (United States)

    Aceves-Cano, Andrés; Gaytán-Ochoa, Rocío; Ramos-Martínez, Ernesto; Erosa de la Vega, Gilberto; González-Horta, Carmen; Talamás-Rohana, Patricia; Sánchez-Ramírez, Blanca

    2015-01-01

    During amoebic liver abscess (ALA) formation in susceptible animals, immune response is regulated by prostaglandin E2 (PGE2) dependent mechanisms. The aim of this study was to analyze the effect of misoprostol (MPL), a PGE1 analogue, on ALA formation in BALB/c mice. Male mice from BALB/c strain were intrahepatically infected with 7.5 × 105 trophozoites of E. histolytica strain HM1:IMSS and treated with 10−4 M of MPL daily until sacrifice at 2, 4, and 7 days postinfection (p.i.). ALA formation was evaluated at 2, 4, and 7 days postinfection; trophozoite morphology was analyzed using immunohistochemistry and image analysis. Results showed an increase in frequency of ALA formation in infected and MPL-treated mice only at 2 days p.i. (P = 0.03). A significant diminution in the size of trophozoites was detected in abscesses from mice independently of MPL treatment (from 5.8 ± 1.1 µm at 2 days p.i. to 2.7 ± 1.9 µm at 7 days p.i.) compared with trophozoites dimensions observed in susceptible hamsters (9.6 ± 2.7 µm) (P < 0.01). These results suggest that MPL treatment may modify the adequate control of inflammatory process to allow the persistence of trophozoites in the liver; however, natural resistance mechanisms cannot be discarded. PMID:26090455

  6. Morphological Findings in Trophozoites during Amoebic Abscess Development in Misoprostol-Treated BALB/c Mice

    Directory of Open Access Journals (Sweden)

    Andrés Aceves-Cano

    2015-01-01

    Full Text Available During amoebic liver abscess (ALA formation in susceptible animals, immune response is regulated by prostaglandin E2 (PGE2 dependent mechanisms. The aim of this study was to analyze the effect of misoprostol (MPL, a PGE1 analogue, on ALA formation in BALB/c mice. Male mice from BALB/c strain were intrahepatically infected with 7.5×105 trophozoites of E. histolytica strain HM1:IMSS and treated with 10−4 M of MPL daily until sacrifice at 2, 4, and 7 days postinfection (p.i.. ALA formation was evaluated at 2, 4, and 7 days postinfection; trophozoite morphology was analyzed using immunohistochemistry and image analysis. Results showed an increase in frequency of ALA formation in infected and MPL-treated mice only at 2 days p.i. (P=0.03. A significant diminution in the size of trophozoites was detected in abscesses from mice independently of MPL treatment (from 5.8±1.1 µm at 2 days p.i. to 2.7±1.9 µm at 7 days p.i. compared with trophozoites dimensions observed in susceptible hamsters (9.6±2.7 µm (P<0.01. These results suggest that MPL treatment may modify the adequate control of inflammatory process to allow the persistence of trophozoites in the liver; however, natural resistance mechanisms cannot be discarded.

  7. Providing mifepristone-misoprostol medical abortion: the view from the clinic.

    Science.gov (United States)

    Ellertson, C; Simonds, W; Winikoff, B; Springer, K; Bagchi, D

    1999-01-01

    In order to gather information about the practical aspects of offering medical abortion, we conducted focus group discussions at each of 17 sites participating in the first large-scale, multi-center trial of mifepristone-misoprostol abortion in the United States. The sites were chosen to represent diverse practice settings (Planned Parenthood affiliates, university research clinics, private practices, and feminist health centers) and geographical regions. Seventy-seven clinic staff members (including counselors, administrators, physicians and other health workers) participated. They discussed the impact of adding a medical method to their clinic structure, their own preferences about offering the method, and their perceptions of women's preferences. Staffing a medical abortion service requires different skills and temperament than those needed for a surgical service. Nearly all participants were eager to begin offering the medical method, and they perceived a strong demand for it on the part of women. They had mixed feelings about the type of provider who should offer the method, but nearly all felt that the regimen could be greatly simplified from the three-visit regimen tested in the trial.

  8. Síndrome de Moebius relacionada ao uso do misoprostol (CYTOTEC®) como abortivo - doi:10.5020/18061230.2005.p140

    OpenAIRE

    Renata Cavalcante Barbosa; Marcelo Bezerra Nogueira; Célia Maria Giacheti

    2012-01-01

    A síndrome de Moebius constitui uma doença congênita caracterizada por paralisia dos nervos facial e abducente associada a malformações de membros. Além da etiologia genética, fatores causais de origem ambiental foram propostos devido ao aumento do número de casos da síndrome associados ao emprego de misoprostol durante a gravidez. O misoprostol é o princípio ativo do Cytotec®, uma droga utilizada para o tratamento da úlcera péptica que atua na contratilidade uterina quando empregada durante ...

  9. Associação de misoprostol, síndrome de Moebius e hipoventilação central congênita: relato de caso

    OpenAIRE

    NUNES, MAGDA LAHORGUE; FRIENDRICH, MAURÍCIO A. G.; LOCH, LUIZ FERNANDO

    1999-01-01

    We report a case showing the association of Moebius syndrome, the use of misoprostol during pregnancy and the development of central congenital alveolar hypoventilation. Pathophysiological aspects of these three diseases are discussed and also the unfavorable prognosis of this association.Descrevemos o caso de um paciente com Síndrome de Moebius associada ao uso de misoprostol durante a gestação. A criança necessitou de suporte ventilatório desde o primeiro dia de vida e evoluiu com quadro de...

  10. Efficacy of sublingual misoprostol for induction of labor at term and post term according to parity and membrane integrity: a prospective observational study.

    Science.gov (United States)

    Brusati, Valentina; Brembilla, Gloria; Cirillo, Federico; Mastricci, Luciana; Rossi, Samantha; Paganelli, Andrea Michele; Ferrazzi, Enrico

    2017-03-01

    To evaluate the effectiveness and safety of 25 mcg sublingual misoprostol for induction of Labor at term according to parity and membrane integrity. We conducted a prospective observational study on singleton pregnancies undergoing induction of Labor at term. Twenty-five mcg of misoprostol were administered sublingually every 4 h. Main outcomes were vaginal deliveries within 24 h, time-to-vaginal-delivery, hyper-stimulation syndrome, cesarean section rate, arterial pHmisoprostol is an effective and safe method for induction of Labor at term. Parity, status of membranes and BMI significantly affect time to delivery.

  11. A Novel Microbicide/Contraceptive Intravaginal Ring Protects Macaque Genital Mucosa against SHIV-RT Infection Ex Vivo.

    Directory of Open Access Journals (Sweden)

    Guillermo Villegas

    Full Text Available Women need multipurpose prevention products (MPTs that protect against sexually transmitted infections (STIs and provide contraception. The Population Council has developed a prototype intravaginal ring (IVR releasing the non-nucleoside reverse transcriptase inhibitor (NNRTI MIV-150 (M, zinc acetate (ZA, carrageenan (CG and levonorgestrel (LNG (MZCL IVR to protect against HIV, HSV-2, HPV and unintended pregnancy. Our objective was to evaluate the anti-SHIV-RT activity of MZCL IVR in genital mucosa. First, macaque vaginal tissues were challenged with SHIV-RT in the presence of (i MIV-150 ± LNG or (ii vaginal fluids (VF; available from studies completed earlier collected at various time points post insertion of MZCL and MZC IVRs. Then, (iii MZCL IVRs (vs. LNG IVRs were inserted in non-Depo Provera-treated macaques for 24h and VF, genital biopsies, and blood were collected and tissues were challenged with SHIV-RT. Infection was monitored with one step SIV gag qRT-PCR or p27 ELISA. MIV-150 (LCMS/MS, RIA, LNG (RIA and CG (ELISA were measured in different compartments. Log-normal generalized mixed linear models were used for analysis. LNG did not affect the anti-SHIV-RT activity of MIV-150 in vitro. MIV-150 in VF from MZC/MZCL IVR-treated macaques inhibited SHIV-RT in vaginal mucosa in a dose-dependent manner (p<0.05. MIV-150 in vaginal tissue from MZCL IVR-treated animals inhibited ex vivo infection relative to baseline (96%; p<0.0001 and post LNG IVR group (90%, p<0.001. No MIV-150 dose-dependent protection was observed, likely because of high MIV-150 concentrations in all vaginal tissue samples. In cervical tissue, MIV-150 inhibited infection vs. baseline (99%; p<0.05. No cervical tissue was available for MIV-150 measurement. Exposure to LNG IVR did not change tissue infection level. These observations support further development of MZCL IVR as a multipurpose prevention technology to improve women's sexual and reproductive health.

  12. Improvement of abnormal vaginal flora in Ugandan women by self-testing and short use of intravaginal antimicrobials.

    Science.gov (United States)

    Donders, G; Bellen, G; Donders, F; Pinget, J; Vandevelde, I; Michiels, T; Byamughisa, J

    2017-04-01

    The vaginal composition of African women is more often lactobacillus-deficient compared to that of women from other areas around the world. Lactobacillus-deficient microflora is a known risk factor for serious health problems, such as preterm birth, cervix cancer, and entrapment of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). The aim of this study was to assess the effect of local vaginal antibiotic or antiseptic treatment on abnormal vaginal flora (AVF), aerobic vaginitis (AV), and bacterial vaginosis (BV) among women in rural, semi-urban, and urban areas in Uganda, as compared to placebo. In a double-blind, placebo-controlled, randomized trial, 300 women presenting for outpatient routine, follow-up, or medical care at Mulago Hospital in Kampala, Uganda, were enrolled to receive 6 days of treatment with vaginal rifaximin (RFX), dequalinium chloride (DQC), or placebo if they had an increased vaginal pH of >4.5 as determined by self-testing. At initial visit and at control visit after 4 weeks, a smear was taken for blinded wet mount microscopy to determine AVF, BV, AV, and Candida severity scores. As compared to placebo, both RFX or DQC treatments dramatically diminished BV prevalence and severity from the initial to follow-up visit: the BV score declined from 2.5 to 1.6 (p improvements in the AV score were seen in both treatment regimens: moderate and severe AV declined from AV scores of 6.3 to 3.6 (p = 0.003) and from 6.6 to 4.1 (p improvements when compared with placebo. Women with normal flora and Candida at the initial visit showed less Candida after 4 weeks in the group treated with DQC (p = 0.014). Even after a short duration of intravaginal treatment with local non-absorbable antiseptics or antibiotics produced significant, lasting improvements in the vaginal microbiome composition of women with disturbed vaginal microflora. As African women have high prevalences of BV, AV, and AVF, this approach could

  13. Factors influencing women's preferences for subsequent management in the event of incomplete evacuation of the uterus after misoprostol treatment for miscarriage

    NARCIS (Netherlands)

    Hentzen, Judith E. K. R.; Verschoor, Marianne A.; Lemmers, Marike; Ankum, Willem M.; Mol, Ben Willem J.; van Wely, Madelon

    2017-01-01

    STUDY QUESTION: What affects women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for a first-trimester miscarriage? SUMMARY ANSWER: Women's treatment preferences in the management of an incomplete evacuation of the uterus after

  14. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curacao

    NARCIS (Netherlands)

    Boersma, Adriana A.; Jong, Betty Meyboom-de; Kleiverda, Gunilla

    Objective To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curacao, where induced abortion is severely restricted by law. Methods In a prospective study 330 women received 200 mg

  15. Comparing induction of labour with oral misoprostol or Foley catheter at term: cost-effectiveness analysis of a randomised controlled multi-centre non-inferiority trial

    NARCIS (Netherlands)

    ten Eikelder, Mlg; van Baaren, G.-J.; Oude Rengerink, K.; Jozwiak, M.; de Leeuw, J. W.; Kleiverda, G.; Evers, I.; de Boer, K.; Brons, J.; Bloemenkamp, Kwm; Mol, B. W.

    2018-01-01

    To assess the costs of labour induction with oral misoprostol versus Foley catheter. Economic evaluation alongside a randomised controlled trial. Obstetric departments of six tertiary and 23 secondary care hospitals in the Netherlands. Women with a viable term singleton pregnancy in cephalic

  16. The role of prostaglandins E1 and E2, dinoprostone, and misoprostol in cervical ripening and the induction of labor: a mechanistic approach.

    Science.gov (United States)

    Bakker, Ronan; Pierce, Stephanie; Myers, Dean

    2017-08-01

    Prostaglandins play a critical role in cervical ripening by increasing inflammatory mediators in the cervix and inducing cervical remodeling. Prostaglandin E1 (PGE1) and prostaglandin E2 (PGE2) exert different effects on these processes and on myometrial contractility. These mechanistic differences may affect outcomes in women treated with dinoprostone, a formulation identical to endogenous PGE2, compared with misoprostol, a PGE1 analog. The objective of this review is to evaluate existing evidence regarding mechanistic differences between PGE1 and PGE2, and consider the clinical implications of these differences in patients requiring cervical ripening for labor induction. We conducted a critical narrative review of peer-reviewed articles identified using PubMed and other online databases. While both dinoprostone and misoprostol are effective in cervical ripening and labor induction, they differ in their clinical and pharmacological profiles. PGE2 has been shown to stimulate interleukin-8, an inflammatory cytokine that promotes the influx of neutrophils and induces remodeling of the cervical extracellular matrix, and to induce functional progesterone withdrawal. Misoprostol has been shown to elicit a dose-dependent effect on myometrial contractility, which may affect rates of uterine tachysystole in clinical practice. Differences in the mechanism of action between misoprostol and PGE2 may contribute to their variable effects in the cervix and myometrium, and should be considered to optimize outcomes.

  17. Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality of life. A randomized controlled trial

    NARCIS (Netherlands)

    Graziosi, G. C. M.; Bruinse, H. W.; Reuwer, P. J. H.; van Kessel, P. H.; Westerweel, P. E.; Mol, B. W.

    2005-01-01

    BACKGROUND: We aimed to compare patients' health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management. METHODS: A multicentre randomized clinical trial was performed in The Netherlands. In all, 154 women with

  18. MisoREST : Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study

    NARCIS (Netherlands)

    Lemmers, Marilee; Verschoor, Marianne A. C.; Rengerink, Katrien Oude; Naaktgeboren, Christiana; Bossuyt, Patrick M.; Huirne, Judith A. F.; Janssen, Ineke A. H.; Radder, Celine; Klinkert, Ellen. R.; Langenveld, Josje; van der Voet, Lucet; Siemens, E. Frederike; Bongers, Marlies Y.; van Hooff, Marcel H.; van der Ploeg, Marinus; Sjors, F. P. J.; Coppus, S. F. P. J.; Ankum, W. M.; Mol, Ben Willem J.

    Objective: To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. Study design: We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between

  19. Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage

    NARCIS (Netherlands)

    Lemmers, M.; Verschoor, M. A. C.; Overwater, K.; Bossuyt, P. M.; Hendriks, D.; Hemelaar, M.; Schutte, J. M.; Adriaanse, A. H.; Ankum, W. M.; Huirne, J. A. F.; Mol, B. W. J.

    2017-01-01

    To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for

  20. MisoREST : surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial

    NARCIS (Netherlands)

    Lemmers, M.; Verschoor, M. A. C.; Rengerink, K. Oude; Naaktgeboren, C.; Opmeer, B. C.; Bossuyt, P. M.; Huirne, J. A. F.; Janssen, C. A. H.; Radder, C.; Klinkert, E. R.; Langenveld, J.; Catshoek, R.; Van der Voet, L.; Siemens, F.; Geomini, P.; Van Hooff, M. H.; Van der Ploeg, J. M.; Coppus, S. F. P. J.; Ankum, W. M.; Mol, B. W. J.

    2016-01-01

    Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of women with an incomplete

  1. MisoREST : surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial

    NARCIS (Netherlands)

    Lemmers, M; Verschoor, M A C; Oude Rengerink, K; Naaktgeboren, C; Opmeer, B C; Bossuyt, P M; Huirne, J A F; Janssen, C A H; Radder, C; Klinkert, E R; Langenveld, J; Catshoek, R; Van der Voet, L; Siemens, F; Geomini, P; Van Hooff, M H; Van der Ploeg, J M; Coppus, S F P J; Ankum, W M; Mol, B W J

    2016-01-01

    STUDY QUESTION: Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? SUMMARY ANSWER: Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of

  2. Use of topical misoprostol to reduce radiation-induced mucositis: results of a randomized, double-blind, placebo-controlled trial

    International Nuclear Information System (INIS)

    Veness, M. J.; Foroudi, F.; Gebski, V.; Timms, I.; Sathiyaseelan, Y.; Cakir, B.; Tiver, K. W.

    2006-01-01

    Radiation-induced mucositis is an acute reaction of the mucosa of patients undergoing head and neck radiotherapy. It can have debilitating and dose-limiting consequences. There is no consensus on an accepted intervention that significantly reduces its severity. Misoprostol is a synthetic prostaglandin Ei analogue, with properties of a mucosal cytoprotectant. We designed a randomized, double-blind, placebo-controlled trial of misoprostol in patients with head and neck cancer. The aim of this study was to determine if topical misoprostol was effective in reducing the severity of radiation-induced mucositis in patients receiving radical dose radiotherapy. The effect of this intervention on a patient's general well-being was also investigated. The primary end-point of the study was the incidence of Radiation Therapy Oncology Group grade 3 mucositis. Between 1999 and 2002, 83 patients were recruited into the study at Westmead and Nepean Hospitals, Sydney. Forty-two patients were randomized to receive misoprostol and 41 to receive a placebo. Most patients received radiotherapy in the adjuvant setting (52 of the 83) and had either an oral cavity (42 of the 83) or an oropharyngeal (16 of the 83) cancer. We could not identify any significant difference in the incidence of severe mucositis based on whether patients were allocated to receive misoprostol or placebo. There was no significant difference in the mean area under the mucositis curve (13.2 vs 16.6; P 0.1). Patients allocated to misoprostol did report slightly increased soreness (7.6 vs 6.9; P = 0.04) and a greater use of analgesics. However, this difference did not translate into a worse feeling of general well-being as measured by a simple visual analogue scale (5.8 vs 5.2; P = 0.3). In conclusion, we were unable to identify a reduction in radiation-induced mucositis in patients receiving misoprostol. There is a paucity of high-level evidence on potentially useful interventions and a continued need for new and

  3. A Comparative Study to Evaluate the Efficacy of Vaginal vs Oral Prostaglandin E1 Analogue (Misoprostol) in Management of First Trimester Missed Abortion

    Science.gov (United States)

    Gupta, Supriya; Batra, Neera Parothi; Bhasin, Vidhu; Sarna, Veena; Kaur, Nirlep

    2016-01-01

    Introduction Missed miscarriages, occurring in upto 15% of all clinically recognized pregnancies are a cause of concern for the patients. Though many researchers in the past have compared the surgical and medical approaches in management of such patients, only a few have executed an appraisal of two routes of misoprostol at equal dosages in treatment of first trimester missed miscarriages. Aim To compare the efficacy of misoprostol by vaginal and oral route, for the management of first trimester missed abortion; and to recognize the utility of misoprostol for cervical dilation prior to any surgical termination of pregnancy. Materials and Methods A randomized prospective trial, comparing the efficacy of misoprostol, by vaginal and oral routes, for termination of first trimester missed abortion was conducted in the Department of Obstetrics and Gynecology, Government Multi-Specialty Hospital, Chandigarh over one year. Hundred subjects satisfying the inclusion criteria from 213 consecutive women presenting to the institute with first trimester missed abortion were hospitalized. The study participants were randomly assigned to one of the two treatment groups, using sequentially numbered envelopes, to receive 400mcg misoprostol vaginally or orally to a maximum of three doses six hours apart, and outcome documented. Patients were followed up on Day 14 and 6 weeks after discharge. Primary outcome evaluated was drug-induced complete expulsion of Products of Conception (POCs). Secondary outcomes measured were induction expulsion interval, number of doses required, classification of failures, cervical canal permeability in women requiring surgical evacuation, side effects, hemoglobin drop, duration and amount of post-abortal bleeding, time of resumption of menses, experience with side effects, patient satisfaction and acceptability to treatment. Results Both routes were highly effective (vaginal=92%, oral= 74%, p=0.032), safe and acceptable with tolerable side effects. The

  4. Misoprostol use for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries.

    Science.gov (United States)

    Cuellar Torriente, Martin; Steinberg, Wilhelm J; Joubert, Gina

    2017-07-01

    To establish the safety and efficacy of misoprostol for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries. In a retrospective study, data were reviewed from women attending a reproductive health clinic in Bloemfontein, South Africa, for second-trimester termination between 2010 and 2013. The study group, comprising women with one or more previous cesareans, was compared with a control group, comprising women with no previous cesarean or uterine scarring. Procedure-specific information was compared, including misoprostol use, termination duration, need for other methods (e.g. oxytocin), placenta delivery, termination outcome, and bleeding. The study group comprised 268 women: 231 (86.2%) with one and 37 (13.8%) with two previous cesareans. The control group comprised 266 women. Incomplete abortion was recorded in 223 (85.4%) of 261 women in the study group and 213 (80.4%) of 265 in the control group. The number of women with retained placenta was higher in the study than in the control group (158/261 [60.5%] vs 146/265 [55.1%]; PMisoprostol was safe for second-trimester termination among women with previous cesareans; however, the efficacy of the local regimen was reduced owing to high placental retention. © 2017 International Federation of Gynecology and Obstetrics.

  5. Abortion after deliberate Arthrotec® addition to food. Mass spectrometric detection of diclofenac, misoprostol acid, and their urinary metabolites.

    Science.gov (United States)

    Watzer, Bernhard; Lusthof, Klaas J; Schweer, Horst

    2015-07-01

    Arthrotec(®) (AT) is a combination of diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), and misoprostol (MP), a synthetic analogue of prostaglandin E1 (PGE1). MP is a lipophilic methyl ester prodrug. It is readily metabolized to the biologically active misoprostol acid (MPA). During the last few years, medical studies exhibited MP to be an excellent abortive. In this paper, we describe a rare criminal case of MP abortion, initiated by the expectant father. After the abortion, samples of vomit and urine were collected. Systemic exposure to MP is difficult to prove, because both MP and the active metabolite MPA are hardly excreted in urine. Therefore, in addition to routine toxicological analysis, we used slightly modified, well-established liquid and gas chromatographic/tandem mass spectrometric (LC/MS/MS and GC/MS/MS) methods, for the direct and the indirect detection of MPA and its metabolites. In this case, we were able to demonstrate the presence of the major MP metabolites 2,3-dinor-MPA and 2,3,4,5-tetranor-MPA in the urine of the victim. We also detected paracetamol, 3-methoxyparacetamol and diclofenac-glucuronide in the urine. In the vomit of the victim, we detected diclofenac and MPA. These results, combined with the criminal investigations, showed that the accused had mixed MP into the food of his pregnant girlfriend. Finally, these investigations contributed to a confession of the accused.

  6. Improving manual vacuum aspiration service delivery, introducing misoprostol for cases of incomplete abortion, and strengthening postabortion contraception in Bangladesh.

    Science.gov (United States)

    Begum, Ferdousi; Zaidi, Shahida; Fatima, Parveen; Shamsuddin, Latifa; Anowar-ul-Azim, A K M; Begum, Rowshan Ara

    2014-07-01

    The Obstetrical and Gynaecological Society of Bangladesh was an important advocate in mobilizing government authorities to adopt new techniques for postabortion care and provide long-acting contraceptives post abortion. With the support of the International Federation of Gynecology and Obstetrics (FIGO), the Society provided commodities and training to increase the use of these techniques in 7 private and public hospitals and clinics. Data from two of these institutes for the January 2012 to June 2013 period showed a rapid decrease in the use of dilation and curettage, an increase in the use of manual vacuum aspiration (MVA) and misoprostol, and the progressive adoption of long-acting reversible contraceptives, permanent contraception, and injectable contraceptives in one of these two hospitals. The Directorates General of Health and Family Planning incorporated training in the use of MVA and misoprostol in their national operation plans. The success in these hospitals shows that the proposed changes have been well accepted by providers and clients. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Induction of labor with titrated oral misoprostol solution versus oxytocin in term pregnancy: randomized controlled trial Indução do trabalho de parto por meio de solução oral titulada de misoprostol versus oxitocina em gestação a termo: estudo controlado randomizado

    Directory of Open Access Journals (Sweden)

    Rezvan Aalami-Harandi

    2013-02-01

    Full Text Available PURPOSE: To evaluate the effectiveness and the safety of orally administered misoprostol in comparison to intravenously infused oxytocin for labor induction in term pregnant women. METHODS: Between 2008 and 2010, a total of 285 term pregnant women whom were candidate for vaginal delivery were assessed for eligibility to enter the study. Twenty five patients were excluded for different reasons; and 260 included women were randomly assigned to one of the two groups according to the method of treatment, misoprostol or oxytocin. The misoprostol group received 25 µg every 2 hours for up to 24 hours for induction. The oxytocin group received an infusion of 10 IU which was gradually increased. The time from induction to delivery and induction to the beginning of the active phase and successful inductions within 12, 18, and 24 hours were recorded. The trial is registered at irct.ir, number IRCT2012061910068N1. RESULTS: Failure of induction, leading to caesarean section was around 38.3% in the oxytocin group and significantly higher than that of the misoprostol group (20.3% (pOBJETIVO: Avaliar a eficácia e segurança do misoprostol administrado por via oral em comparação à infusão de oxitocina para a indução do trabalho de parto em gestantes a termo. MÉTODOS: Entre 2008 e 2010, um total de 285 gestantes a termo candidatas para parto vaginal foram avaliadas quanto à eligibilidade para inclusão no estudo. Vinte e cinco pacientes foram excluídas por várias razões, e as 260 mulheres incluídas foram divididas aleatoriamente em dois grupos de acordo com o método de tratamento, misoprostol ou oxitocina. O grupo tratado com o misoprostol recebeu 25 µg cada 2 horas durante um máximo de 24 horas para indução. O grupo tratado com oxitocina recebeu infusão de 10 UI, que foi aumentada gradativamente. O tempo a partir da indução até o início da fase ativa e as induções bem-sucedidas dentro de 12, 18 e 24 horas foram registrados. O ensaio foi

  8. Feasibility and effectiveness of unintended pregnancy prevention with low-dose mifepristone combined with misoprostol before expected menstruation.

    Science.gov (United States)

    Li, Cui-Lan; Chen, Dun-Jin; Deng, Yi-Fan; Song, Li-Ping; Mo, Xue-Tang; Liu, Kai-Jie

    2015-12-01

    What is the efficacy of maintaining or restoring non-pregnant status with low-dose mifepristone combined with misoprostol administered before expected menstruation? Low-dose mifepristone and misoprostol administered at the time of expected menstruation was effective and safe in maintaining or restoring non-pregnant status, with no obvious menstrual disturbance. Menstrual regulation involves the medical or mechanical stimulation of uterine sloughing in women with up to 2-3 weeks of menstrual delay. Low-dose mifepristone plus misoprostol is efficacious for termination of ultra-early pregnancy (≤ 35 days of amenorrhoea) with no obvious menstrual disturbance. A total of 678 women fulfilled all criteria and were recruited. Seventeen women dropped out after deciding to remain pregnant and 11 others were lost to follow-up. Thus, data from 650 women who completed the procedure were included in analyses. Participants were enrolled at any time during their menstrual cycle and administered medication 1 day before expected menstruation. The end of the study was defined on a per-patient basis as the date of completion of the post-treatment menstrual cycle. The primary outcome was the efficacy of abortion induction (for pregnant women) or menstrual regulation (for non-pregnant women). Women with regular menstrual cycles (25-35 days) were voluntarily recruited for this study between February 2012 and December 2014. Serum β-hCG was measured before mifepristone intake. Mifepristone (50 mg) was administered orally 1 day before expected menstruation and 200 µg misoprostol was administered orally on the day of expected menstruation. Efficacy, disturbance in bleeding patterns in the treatment and post-treatment cycles, satisfaction with the treatment, and subsequent contraception preference were analysed. Retrospective analysis of serum β-hCG levels at admission indicated that 23.3% (158/678) of the women were pregnant. The success rate for pregnancy termination was 98.6% (136

  9. A systematic review and network meta-analysis comparing the use of Foley catheters, misoprostol, and dinoprostone for cervical ripening in the induction of labour.

    Science.gov (United States)

    Chen, W; Xue, J; Peprah, M K; Wen, S W; Walker, M; Gao, Y; Tang, Y

    2016-02-01

    Various methods are used for cervical ripening during the induction of labour. It is still debatable which of these methods of treatment is optimal. To compare treatment techniques for cervical ripening in the induction of labour. Medline, Embase, and the Cochrane Collaboration databases were searched using the keywords 'cervical ripening', 'labour induced', 'misoprostol', 'dinoprostone', and 'Foley catheter'. Randomised controlled trials (RCTs) of cervical ripening during the induction of labour, evaluating rates of failure to achieve vaginal delivery within 24 hours, incidence of uterine hyperstimulation with fetal heart rate (FHR) changes, and rates of caesarean section. Studies including women with prelabour rupture of membranes were excluded. Outcome data were collected and analysed through pairwise meta-analysis and network meta-analysis within a Bayesian framework. A total of 96 RCTs (17,387 women) were included in the meta-analysis. Vaginal misoprostol was the most effective cervical ripening method to achieve vaginal delivery within 24 hours, but had the highest incidence of uterine hyperstimulation with FHR changes. The use of a Foley catheter to induce labour was associated with the lowest rate of uterine hyperstimulation accompanied by FHR changes. The caesarean section rate was lowest using oral misoprostol for the induction of labour. No method of labour induction demonstrated overall superiority when considering all three clinical outcomes. Decisions regarding the choice of induction method will depend upon the relative preference for effecting vaginal delivery within 24 hours, minimising the incidence of uterine hyperstimulation with adverse FHR changes and avoiding caesarean section. Oral misoprostol for the induction of labour is safer than vaginal misoprostol and has the lowest rate of caesarean section. © 2015 Royal College of Obstetricians and Gynaecologists.

  10. Misoprostol: percursos, mediações e redes sociais para o acesso ao aborto medicamentoso em contextos de ilegalidade no Estado de São Paulo Misoprostol: pathways, mediation and social networks for access to abortion using medication in the context of illegality in the State of Sao Paulo

    Directory of Open Access Journals (Sweden)

    Margareth Martha Arilha

    2012-07-01

    Full Text Available O objetivo é problematizar a comercialização e o uso abortivo do misoprostol em contextos de ilegalidade que ainda persistem no Brasil. As informações apresentadas foram coletadas através de estudo de caso realizado com duas mulheres jovens que praticaram o aborto medicamentoso, com sucesso e sem sucesso respectivamente, e com duas mulheres adultas que têm aproximação com mulheres que fizeram uso do misoprostol. O estudo confirma a hipótese de que a difusão e a expansão do uso não-hospitalar do misoprostol estão associadas à decisão das mulheres, as quais buscam menores custos, menores riscos à sua saúde e privacidade. Também permite explorar a interpretação de que esse incremento de consumo vincula-se também à incorporação do medicamento a um conjunto de mercadorias que são comercializadas ilegalmente no Brasil. Como resultado, as mulheres são expostas a diferentes graus de vulnerabilidade, dependendo diretamente dos itinerários desenvolvidos, das mediações utilizadas e das redes sociais a que pertencem, recursos esses por meio dos quais mulheres e homens constroem a possibilidade de acesso ao uso abortivo do misoprostol, cujo êxito não é garantido.The scope of this article is to discuss the commercialization and use of misoprostol for abortion purposes in the illegal contexts that still persist in Brazil. The information presented was collected through case studies conducted with two young women who aborted using medication - one successfully and one unsuccessfully - and two adult women who have close ties with women who used misoprostol. The study confirms the hypothesis that the diffusion and expansion of the use of misoprostol outside the hospital context is associated with the decision of women who seek lower costs, lower risks to their health and privacy. It also permits examination of the interpretation that this increase in consumption is linked to the inclusion of the medication in a set of goods that

  11. Evaluation of pregnancy rates of Bos indicus cows subjected to different synchronization ovulation protocols using injectable progesterone or an intravaginal device

    Directory of Open Access Journals (Sweden)

    Jefferson Tadeu Campos

    2016-12-01

    Full Text Available This study evaluated the pregnancy rate in Nelore cows (Bos indicus that were subjected to fixed-time artificial insemination (FTAI using different protocols consisting of injectable progesterone (P4 or an intravaginal device (impregnated with P4. Multiparous cows 72-84 months in age, 30-45 days postpartum, were selected on the basis of the absence of a corpus luteum (CL and follicles < 8 mm after transrectal palpation and ultrasound examinations. On a random day of the estrus cycle (D0, the selected animals (n = 135 were randomly assigned to one of three experimental groups (n = 45 each. Group I (injectable P4/FTAI 36 hours received 250 mg of injectable P4 and 2 mg EB on D0; on D7, they received 500 µg of cloprostenol; on D8, 300 IU of eCG and 1 mg of EB were administered; and finally, FTAI was performed 36 hours after the application of EB. Group II (injectable P4/FTAI 48 hours received the same protocol as Group I, except that the FTAI was performed 48 hours after ovulation induction. The animals of Group III (Control/CIDR received a conventional protocol for FTAI using an intravaginal device (D0: P4 and 2 mg EB; D8: device removal, 500 µg cloprostenol, 300 IU eCG, 1 mg EB; and FTAI performed 48 hours after removal of the device. The results showed that cows synchronized with the conventional protocol for FTAI (Control/CIDR had a higher pregnancy rate (60 %, 27/45 than those synchronized with an injectable P4/FTAI 36 hours (33.33 %; 15/45, P = 0.010. However, the group receiving injectable P4 group/FTAI 48 hours had a similar pregnancy rate (48.9 %; 22/45; P = 0.290 when compared to both the group receiving the conventional protocol and that receiving injectable P4/FTAI 36 hours (P = 0.134. Although the injectable P4 may affect pregnancy rate with the FTAI performed in 36 hours, we found similar pregnancy rates from cows inseminated 48 hours after induction ovulation, considering injectable or intravaginal P4. Therefore, we suggest that

  12. Solução oral escalonada de misoprostol para indução do parto: estudo piloto Titrated oral solution of misoprostol for labour induction: a pilot study

    Directory of Open Access Journals (Sweden)

    Alex Sandro Rolland Souza

    2010-05-01

    Full Text Available OBJETIVO: avaliar a efetividade e a segurança da administração de uma nova formulação de misoprostol em solução por via oral, com doses escalonadas, para indução do parto de feto vivo a termo. MÉTODOS: realizou-se um estudo multicêntrico, do tipo ensaio clínico, aberto, não-randomizado, no período de Julho a Dezembro de 2008. Foram incluídas 30 pacientes com indicação de indução do trabalho de parto, a termo, com feto vivo, índice de Bishop 5. Foram excluídas mulheres com cicatriz uterina, cardiotocografia alterada, gestação múltipla, restrição de crescimento fetal, hemorragia genital e presença de tumores, ulcerações ou malformações genitais. A dose inicial da solução oral foi de 20µg/h de misoprostol, nas primeiras 6 horas, aumentando em 20µg/h de misoprostol a cada 6 horas, se o trabalho de parto não fosse deflagrado, até uma dose máxima de 80µg/h, nas primeiras 24 horas, mantendo a dose máxima (80µg/h por mais 24 horas, se necessário. RESULTADOS: o trabalho de parto foi induzido satisfatoriamente em 96,7% das gestantes. O intervalo entre a primeira dose e o início das contrações uterinas foi de 3,8±1,8 horas, enquanto o intervalo entre a dose inicial e o parto variou entre 6 e 24 horas. A frequência de parto vaginal foi de 80% (n=24. A maioria das gestantes iniciou o trabalho de parto com a dose de 20µg/h (60%; n=18. A taquissistolia ocorreu em 13,3% das gestações e líquido meconial foi detectado em 20% dos casos. Houve dois casos de escore de Apgar PURPOSE: to test effectiveness and safety of the oral administration of a new misoprostol formulation in titrated doses for the induction of delivery of a live fetus at term. METHODS: an open pilot multicenter, non-randomized clinical trial was conducted from July to December 2008. A total of 30 patients with indications for induction of labor were included. The patients had a live fetus, Bishop score 5. Exclusion criteria were previous uterine

  13. Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto State, Nigeria: Early results and lessons learned.

    Science.gov (United States)

    Orobaton, Nosakhare; Abdulazeez, Jumare; Abegunde, Dele; Shoretire, Kamil; Maishanu, Abubakar; Ikoro, Nnenna; Fapohunda, Bolaji; Balami, Wapada; Beal, Katherine; Ganiyu, Akeem; Gwamzhi, Ringpon; Austin, Anne

    2017-01-01

    Postpartum haemorrhage (PPH) is a leading cause of maternal death in Sokoto State, Nigeria, where 95% of women give birth outside of a health facility. Although pilot schemes have demonstrated the value of community-based distribution of misoprostol for the prevention of PPH, none have provided practical insight on taking such programs to scale. A community-based system for the distribution of misoprostol tablets (in 600ug) and chlorhexidine digluconate gel 7.1% to mother-newborn dyads was introduced by state government officials and community leaders throughout Sokoto State in April 2013, with the potential to reach an estimated 190,467 annual births. A simple outcome form that collected distribution and consumption data was used to assess the percentage of mothers that received misoprostol at labor through December 2014. Mothers' conditions were tracked through 6 weeks postpartum. Verbal autopsies were conducted on associated maternal deaths. Misoprostol distribution was successfully introduced and reached mothers in labor in all 244 wards in Sokoto State. Community data collection systems were successfully operational in all 244 wards with reliable capacity to record maternal deaths. 70,982 women or 22% of expected births received misoprostol from April 2013 to December 2014. Between April and December 2013, 33 women (misoprostol use and were promptly referred. There were a total of 11 deaths in the 2013 cohort which were confirmed as maternal deaths by verbal autopsies. Between January and December of 2014, a total 434 women (1.25%) that ingested misoprostol reported associated side effects. It is feasible and safe to utilize government guidelines on results-based primary health care to successfully introduce community distribution of life saving misoprostol at scale to reduce PPH and improve maternal outcomes. Lessons from Sokoto State's at-scale program implementation, to assure every mother's right to uterotonics, can inform scale-up elsewhere in Nigeria.

  14. Circulating progesterone concentrations in nonlactating Holstein cows during reuse of intravaginal progesterone implants sanitized by autoclave or chemical disinfection.

    Science.gov (United States)

    Melo, L F; Monteiro, P L J; Oliveira, L H; Guardieiro, M M; Drum, J N; Wiltbank, M C; Sartori, R

    2018-04-01

    The aim of this study was to compare plasma progesterone (P4) concentrations in nonlactating, multiparous Holstein cows (n = 24) treated with 2 types of intravaginal implants containing either 1.0 or 1.9 g of P4 either at the first use or during reuse of the implants after sanitizing the implant by autoclave or chemical disinfection. In a completely randomized design with a 2 × 3 factorial arrangement and 2 replicates, every cow underwent 2 of 6 treatments. Two sources of P4 [controlled internal drug release (1.9 g of P4) from Zoetis (São Paulo, Brazil), and Sincrogest (1.0 g of P4) from Ourofino (Cravinhos, Brazil)] and 3 types of processing, new (N), reused after autoclave (RA), and reused after chemical disinfection (RC), were used. After inducing luteolysis to avoid endogenous circulating P4, the cows were randomized in 1 of 6 treatments (1.9 g of N, 1.9 g of RA, 1.9 g of RC, 1.0 g of N, 1.0 g of RA, and 1.0 g RC). Cows were treated with the implants for 8 d and during this period blood samples were collected at 0, 2, 12, 24, 48, 72, 96, 120, 144, 168, and 192 h. Statistical analyses were performed using Proc-Mixed and the mean ± standard error of the mean P4 concentrations were calculated using the Proc-Means procedures of SAS 9.4 (SAS Institute Inc., Cary, NC). No interaction between treatments was observed. Comparing types of implant, average P4 concentrations during treatments were greater for 1.9 g than 1.0 g (1.46 vs. 1.14 ± 0.04 ng/mL). When types of processing were compared, average P4 concentrations did not differ between autoclaved and new inserts (1.46 vs. 1.37 ± 0.05 ng/mL; respectively), but both were greater than chemically disinfected implants (1.09 ± 0.04 ng/mL). Within 1.9-g P4 inserts, P4 concentrations from autoclaved implants were greater than new, which were greater than chemically disinfected (1.67 ± 0.06 vs. 1.49 ± 0.07 vs. 1.21 ± 0.05 ng/mL; respectively). For 1.0-g P4 implants, P4 concentrations from autoclaved did not differ

  15. Oxytocin via Uniject (a prefilled single-use injection) versus oral misoprostol for prevention of postpartum haemorrhage at the community level: a cluster-randomised controlled trial.

    Science.gov (United States)

    Diop, Ayisha; Daff, Bocar; Sow, Maimouna; Blum, Jennifer; Diagne, Mamadou; Sloan, Nancy L; Winikoff, Beverly

    2016-01-01

    Access to injectable uterotonics for management of postpartum haemorrhage remains limited in Senegal outside health facilities, and misoprostol and oxytocin delivered via Uniject have been deemed viable alternatives in community settings. We aimed to compare the efficacy of these drugs when delivered by auxiliary midwives at maternity huts. We did an unmasked cluster-randomised controlled trial at maternity huts in three districts in Senegal. Maternity huts with auxiliary midwives located 3-21 km from the closest referral centre were randomly assigned (1:1; via a computer-generated random allocation overseen by Gynuity Health Projects) to either 600 μg oral misoprostol or 10 IU oxytocin in Uniject (intramuscular), stratified by reported previous year clinic volume (deliveries) and geographical location (inland or coastal). Maternity huts that had been included in a previous study of misoprostol for prevention of postpartum haemorrhage were excluded to prevent contamination. Pregnant women in their third trimester were screened for eligibility either during community outreach or at home-based prenatal visits. Only women delivered by the auxiliary midwives in the maternity huts were eligible for the study. Women with known allergies to prostaglandins or pregnancy complications were excluded. The primary outcome was mean change in haemoglobin concentration measured during the third trimester and after delivery. This study was registered with ClinicalTrials.gov, number NCT01713153. 28 maternity hut clusters were randomly assigned-14 to the misoprostol group and 14 to the oxytocin group. Between June 6, 2012, and Sept 21, 2013, 1820 women were recruited. 647 women in the misoprostol group and 402 in the oxytocin group received study drug and had recorded pre-delivery and post-delivery haemoglobin concentrations, and overall 1412 women delivered in the study maternity huts. The mean change in haemoglobin concentrations was 3·5 g/L (SD 16·1) in the misoprostol group

  16. Determination of Prognostic Factors for Vaginal Mucosal Toxicity Associated With Intravaginal High-Dose Rate Brachytherapy in Patients With Endometrial Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bahng, Agnes Y.; Dagan, Avner [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Bruner, Deborah W. [University of Pennsylvania School of Nursing, Philadelphia, PA (United States); Lin, Lilie L., E-mail: lin@xrt.upenn.edu [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)

    2012-02-01

    Purpose: The objective of this study was to determine the patient- and treatment-related prognostic factors associated with vaginal toxicity in patients who received intravaginal high dose rate (HDR) brachytherapy alone as adjuvant treatment for endometrial cancer. Secondary goals of this study included a quantitative assessment of optimal dilator use frequency and a crude assessment of clinical predictors for compliant dilator use. Methods and Materials: We retrospectively reviewed the charts of 100 patients with histologically confirmed endometrial cancer who underwent total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection and adjuvant intravaginal brachytherapy between 1995 and 2009 at the Hospital of University of Pennsylvania. The most common treatment regimen used was 21 Gy in three fractions (71 patients). Symptoms of vaginal mucosal toxicity were taken from the history and physical exams noted in the patients' charts and were graded according to the Common Toxicity Criteria for Adverse Events v. 4.02. Results: The incidence of Grade 1 or asymptomatic vaginal toxicity was 33% and Grade 2-3 or symptomatic vaginal toxicity was 14%. Multivariate analysis of age, active length, and dilator use two to three times a week revealed odds ratios of 0.93 (p = 0.013), 3.96 (p = 0.008), and 0.17 (p = 0.032) respectively. Conclusion: Increasing age, vaginal dilator use of at least two to three times a week, and shorter active length were found to be significantly associated with a decreased risk of vaginal stenosis. Future prospective studies are necessary to validate our findings.

  17. Different Routes of Misoprostol for Same-Day Cervical Priming Prior to Operative Hysteroscopy: A Randomized Blinded Trial.

    Science.gov (United States)

    Ganer Herman, Hadas; Kerner, Ram; Gluck, Ohad; Feit, Hagit; Keidar, Ran; Bar, Jacob; Sagiv, Ron

    To compare the effectiveness of and patient satisfaction with different routes of misoprostol administration for short-term cervical priming before operative hysteroscopy. Randomized blinded trial (Canadian Task Force classification I). University hospital. One hundred and twenty patients undergoing operative hysteroscopy. Patients were randomly assigned to receive 400 μg of misoprostol administered orally (n = 40), vaginally (n = 40), or sublingually (n = 40) for cervical priming at 1.5 to 4 hours before undergoing operative hysteroscopy. The primary outcome was preoperative cervical dilatation. Secondary outcomes included cervical consistency, ease of dilation and time of dilation, patient discomfort, and side effects. No differences were noted among the 3 groups in terms of patient age, parity, previous vaginal delivery, menopausal status, and time interval from preparation to procedure. Patients in the 3 groups reported similar discomfort and side effects. Initial mean cervical dilatation was 6.1 ± 2.0 mm in the oral group, 6.4 ± 2.1 in the vaginal group, and 6.4 ± 1.8 mm in the sublingual group (p = .75). Cervical consistency and ease of dilation were similar among the groups. The mean time of dilation was 37.2 ± 30.6 seconds in the oral group, 31.7 ± 29.0 seconds in the vaginal group, and 31.5 ± 21.7 seconds in the sublingual group (p = .59). Additional subanalyses according to menopausal status and parity did not demonstrate any differences among the groups. Same-day cervical priming for operative hysteroscopy is achieved equally with all routes of misoprostol administration, with similar patient satisfaction and side effects. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.