Comparing the outcomes of termination of second trimester pregnancy with a live fetus using intravaginal misoprostol between women with and without previous cesarean section.

OBJECTIVE: To compare the outcomes of termination of pregnancy with live fetuses in the second trimester (14-28 weeks), using misoprostol 400 mcg intravaginal every 6 h, between women with previous cesarean section (PCS) and no previous cesarean section (no PCS). METHODS: A comparative study was conducted on a prospective database of pregnancy termination in the second trimester, Chiang Mai university hospital. Inclusion criteria included: (1) singleton pregnancy; (2) gestational age between 14 and 28 weeks; and (3) pregnancy with a live fetus and medically indicated for termination. The participants were categorized into two groups; PCS and no PCS group. All were terminated using misoprostol 400 mcg intravaginal every 6 h. The main outcomes were induction to fetal delivery interval and success rate, defined as fetal delivery within 48 h. RESULTS: A total of 238 women, including 80 PCS and 158 no PCS, were recruited. The success rate of fetal delivery within 48 h between both groups was not significantly different (91.3% vs. 93.0%; p-value 0.622). The induction to fetal delivery interval were not significantly different (1531 vs. 1279 min; p-value > 0.05). Gestational age was an independent factor for the success rate and required dosage of misoprostol. The rates of most adverse effects of misoprostol were similar. One case (1.3%) in the PCS group developed uterine rupture during termination, ending up with safe and successful surgical removal and uterine repair. CONCLUSION: Intravaginal misoprostol is highly effective for second trimester termination of pregnancy with PCS and those with no PCS, with similar success rate and induction to fetal delivery interval. Gestational age was an independent factor for the success rate and required dosage of misoprostol. Uterine rupture could occur in 1.3% of PCS, implying that high precaution must be taken for early detection and proper management. SYNOPSIS: Intravaginal misoprostol is highly effective for termination of second trimester pregnancy with a live fetus, with a comparable success rate between women with and without previous cesarean section, with a 1.3% risk of uterine rupture among women with previous cesarean section.

Effectiveness and adverse effects of vaginal misoprostol as a single agent for second trimester pregnancy termination: the impact of fetal viability.

PURPOSE: To compare the effectiveness of vaginal misoprostol for second-trimester termination between pregnancies with a dead fetus in utero and those with a live fetus and to identify factors associated with the success rate. METHODS: Singleton pregnancies with live fetuses and dead fetuses, between 14 and 28 weeks of gestation, with an unfavorable cervix, were recruited to have pregnancy termination with intravaginal misoprostol 400 mcg every 6 h. RESULTS: Misoprostol was highly effective for termination, with a low failure rate of 6.3%. The effectiveness was significantly higher in pregnancies with a dead fetus (log-rank test; p: 0.008), with a median delivery time of 11.2 vs. 16.7 h. Fetal viability, fetal weight or gestational age, and an initial Bishop score were significantly associated with the total amount of misoprostol dosage used for induction. Fetal viability and gestational age/fetal weight were still independent factors after adjustment for other co-factors on multivariate analysis. CONCLUSION: Vaginal misoprostol is highly effective for second-trimester termination, with significantly higher effectiveness in pregnancies with a dead fetus. Also, the effectiveness is significantly associated with birth weight/gestational age, and initial Bishop score.

Prenatal Detection of Rapid Progressive Changes in Massive Lymphangioma from Flank to the Lower Extremity.

Lymphangioma is a congenital anomaly in which abnormal lymphatic drainages localize to form a benign mass, but it has the tendency to grow in size and the potential to infiltrate surrounding structures, causing devastating effects and leading to severe morbidity. The most common site of lymphangioma is the neck region (cystic hygroma colli), whereas lymphangioma in the lower limbs is very rare, accounting for only 2% of cases. Accordingly, the prenatal diagnosis of lymphangioma of the lower limbs has been scarcely reported. This study describes two cases of lymphangioma of the lower limbs, focusing on unique sonographic features and the natural course of rapidly progressive changes, which is different from nuchal lymphangioma. Based on previous isolated case reports together with our two cases, lymphangioma of the lower limbs usually develops in the second trimester, tends to have rapidly progressive changes, and is unlikely to be associated with aneuploidy and structural anomalies. Diagnoses can be made by using sonographic findings pertaining to the subcutaneous complex and multi-septate anechoic cystic lesions in the lower limbs, the latter of which can infiltrate visceral structures. Prenatal detection can be helpful in laying the groundwork for providing counseling to the parents and the planning of management strategies, i.e., opting to terminate the pregnancy, revising delivery plans, and looking towards the postnatal management of the infant.

A preliminary study on the effectiveness of maternal to neonatal transfer of antibodies against SARS-CoV-2 in the women vaccinated with heterologous CoronaVac-ChAdOx1.

The objective is to evaluate the effectiveness of placental transfer of maternally derived SARS-CoV-2 IgG antibodies after the vaccination of pregnant women with heterologous CoronaVac-ChAdOx1. Thirty pregnant women were vaccinated with CoronaVac as the first dose, followed by ChAdOx1 3 weeks later. The antibody levels in the maternal blood and in the umbilical cord blood at the time of delivery were determined. The results showed that the vaccination effectively increased antibody levels in both mothers and newborns. The antibody levels in the mothers were strongly correlated with those in the newborns (P < .001). The high levels of passive immunity in the newborns were achieved when the first and second doses of vaccination were given more than 40 and 20 d before delivery, respectively. After 1 month of the second dose, the immune levels seemed to decline in the mothers but increase in the newborns. The antibody levels in the newborns appear to be higher than those in the mothers in cases of delivery after 20 d of the second dose (1419 ± 699 vs 1222 ± 593 BAU/L; p < .05). In conclusion, heterologous CoronaVac-ChAdOx1-S schedule can increase antibody levels in a short time during pregnancy. Also, the regimen effectively increases immunity in the newborns. The antibody levels in the newborns appear to be higher than that in the mothers in most cases, if receiving the second dose more than 3 weeks before delivery. Therefore, the regimen should be considered as an effective regimen for pregnant women, especially in settings where mRNA vaccine is not available.

Placental Transfer Immunity to the Newborns in a Twin Pregnant Women Vaccinated with Heterologous CoronaVac-ChAdOx1.

Pregnant women who receive the COVID-19 vaccine develop anti-SARS-CoV-2 antibodies, which can be transferred to the fetus. However, the effectiveness of placental transfer has not been evaluated in twin pregnancy, especially in cases vaccinated with heterologous CoronaVac (Sinovac)-ChAdOx1 (Oxford-AstraZeneca) regimen, which was commonly used in many countries. Case: A 34-year-old Thai woman with a twin pregnancy attended our antenatal care clinic at 21 + 2 weeks of gestation and requested COVID-19 vaccination. Her medical history and physical examination were unremarkable. She had not received COVID-19 vaccination before. Ultrasound screening for fetal anomaly revealed a dichorion diamnion twin pregnancy. Both twins showed no structural anomaly. She received the CoronaVac vaccine at 21 + 2 weeks of gestation without serious side effects and the ChAdOx1 vaccine at 24 + 2 weeks of gestation. Cesarean delivery was performed at 36 + 5 weeks of gestation, giving birth to the two healthy babies. The levels of anti-spike protein IgG levels (BAU/mL) in maternal blood just before delivery and umbilical cord blood of the two newborns were 313.349, 678.219, and 874.853, respectively. The levels of % inhibition (wild-type and delta) in the two newborns were also higher than those in the mother. In conclusion, heterologous CoronaVac-ChAdOx1-S vaccination in a twin pregnancy could effectively provide protective immunity to both twin newborns. The antibody levels in both were approximately two times higher than those in the mothers. This case report may serve as a reference in counseling couples with a twin pregnancy, while the studies on placental transfer of vaccine-derived antibodies in twin pregnancy are currently not available, especially in countries experiencing a vaccine shortage or unavailability of mRNA vaccines.

Outcomes of Pregnancy Termination of Dead Fetus in Utero in Second Trimester by Misoprostol with Various Regimens.

Objective: To determine the efficacy and adverse outcomes of misoprostol with various regimens for the second-trimester-pregnancy termination of a dead fetus in utero (DFIU). Patients and Methods: A retrospective descriptive study, based on the prospective database, was conducted on pregnancies with dead fetuses in utero in the second trimester. All patients underwent pregnancy termination with various regimens of misoprostol. Results: A total of 199 pregnancies meeting the inclusion criteria were included. The mean age of the participants and the mean gestational age were 30.2 years and 21.1 weeks, respectively. The two most common regimens were 400 mcg injected intravaginally every six hours and 400 mcg taken orally every four hours. In the analysis of the overall efficacy, including all regimens, the mean fetal delivery time was 18.9 h. When considering only the cases involving a delivery within 48 h (success cases), the mean fetal delivery time was 13.6 h. The rates of fetal delivery for all cases at 12, 24, 36, and 48 h were 50.3%, 83.8%, 89.3%, and 93.9%. In the comparison between the various regimens, there were no significant differences in the rate of fetal delivery at 12, 24, 36, and 48 h and adverse effects such as chill, diarrhea, nausea, vomiting, and other parameters such as the requirement for intravenous analgesia, the requirement for curettage for incomplete abortions, the mean total dose of misoprostol, and the rate of postpartum hemorrhage (PPH). Nevertheless, the rate of fever was significantly higher in the regimen of intravaginal insertion of 400 mcg every six hours and that of the requirement for oxytocin was significantly higher in the regimen of oral supplementation of 400 mcg every four hours. Conclusions: The overall success rate within 48 h was 93.6%, which was not different among the various misoprostol regimens. In addition, there were no significant differences in the mean fetal delivery times and the rates of fetal delivery at 12, 24, 36, and 48 h. However, some parameters such as fever, oxytocin requirement, and mean total dose of misoprostol were statistically significant between regimens. In the aspect of global health, misoprostol can be a good option in clinical practice, especially in geographical areas with low-resource levels.

Change of contraceptive preference after the free-LARC program for Thai teenagers.

BACKGROUND: In 2014, the Thai government launched a free-of-charge long-acting reversible contraception (LARC) program for Thai female adolescents. However, its acceptance had not been reported. Therefore, this study aimed to describe contraceptive use among women of reproductive age before and after the program was implemented. METHODS: This retrospective cross-sectional study was carried out from the medical records of 9000 women of reproductive age, who attended the Family Planning Clinic at Maharaj Nakorn Chiang Mai Hospital between 2009 and 2018. The Chi-square test was used to compare the contraceptive methods administered before and after the program was implemented, and binary logistic regression was used to find the factors associated with implant use after completion of the program. RESULTS: Depot medroxy progesterone acetate (DMPA) injection was the most popular contraceptive method used among 40.9% of the women. The rates of subdermal implant use were increased significantly after the program was implemented (2.3-9.3%, p < 0.001). Implant use for adolescents aged less than 20 years increased from 2.6% to 56.4%, while DMPA was the most popular method used among adult women at 36.4%. Factors associated significantly with implant use after implement of the program included age of less than 20 years (aOR = 4.17 (CI: 1.84-9.44); p = 0.001) and nulliparity (aOR = 8.55 (CI: 3.77-19.39); p < 0.001). CONCLUSION: This study showed a significant increase in contraceptive implant use after the free-LARC program for adolescents had been applied. STATEMENT OF IMPLICATIONS: Contraceptive implant is the most effective hormonal reversible contraception. Its use rate is low among all age groups, but increased clearly after the free-of-charge program was applied for adolescents.

Strong Positive Dichlorophenolindophenol Precipitation Suggests Hb Dhonburi (or Hb Neapolis) (HBB: c.380T>G) Inheritance in a Couple at Risk for Severe ß-Thalassemia.

Hb Dhonburi (also known as Hb Neapolis) (HBB: c.380T>G) is an unstable hemoglobin (Hb) variant that cannot be detected by high performance liquid chromatography (HPLC) or capillary electrophoresis (CE) in routine laboratory diagnosis. This could lead to prenatal misdiagnosis unless a molecular analysis is applied. Here, we report a Thai couple with a positive result for the dichlorophenolindophenol precipitation (DCIP) screening test. After routine laboratory investigation, the female was diagnosed with heterozygous Hb E (HBB: c.79G>A) during pregnancy; however, the male, whose case we present herein, was suspected to carry a rare heterozygous ß-thalassemia (ß-thal). Therefore, they were designated as a couple at-risk for having a fetus with a serious thalassemia genotype: compound heterozygosity for Hb E with ß-thal (Hb E/ß-thal). Based on the result of the DCIP test, his DNA was sequenced for a causative mutation and revealed heterozygosity for a rare Hb variant, Hb Dhonburi. Theoretically, this couple was not at risk for Hb E/ß-thal. Furthermore, this case demonstrates for the first time that in addition to a common Hb variant, i.e. Hb E, Hb Dhonburi (Hb Neapolis) also gives positive DCIP results, even in the heterozygous state.

A Randomized Controlled Double-Masked Study of Transdermal Androgen in Dry Eye Patients Associated With Androgen Deficiency.

PURPOSE: To evaluate the efficacy, safety, and quality of life (QOL) of transdermal androgen in treatment of dry eye patients associated with androgen deficiency. DESIGN: Randomized controlled trial. METHODS: Fifty patients with dry eye from a tertiary eye center in northern Thailand were randomized to receive transdermal androgen (AndroGel; Besins Healthcare, Brussels, Belgium) or placebo for 4 weeks. Main outcome measures were symptoms and signs of dry eye. Serum level of sex hormone and QOL questionnaires were also evaluated at the baseline and after treatment. RESULTS: After 4 weeks, the Ocular Surface Disease Index decreased significantly in the AndroGel group compared to the placebo (-14.36 ± 7.76 vs 0.14 ± 14.60, P < .001). Significant improvements of tear break-up time (7.40 ± 3.37 vs -1.14 ± 1.68 seconds, P < .001), corneal fluorescein staining (-0.62 ± 0.30 vs 0.19 ± 0.37, P < .001), and Schirmer test (6.84 ± 5.10 vs -0.48 ± 2.14 mm, P < .001) were observed in the AndroGel group compared to the placebo. Serum testosterone in female patients significantly increased in the AndroGel group compared to the placebo (P < .001), while no different change was observed in serum testosterone in male subjects and the sex hormone-binding globulin in both groups. In the AndroGel group, 20% of patients had oily skin and 4% had acne. No serious adverse effects were reported. The menopause rating score improved significantly in the AndroGel group compared to the placebo (P < .001), while the aging male symptoms were not different in both groups (P = .589). CONCLUSIONS: Transdermal androgen was effective in relieving symptoms and signs of dry eye as well as improving QOL in aging patients. There were no serious side effects during a short-term treatment.

Randomized controlled trial comparing efficacy between a vaginal misoprostol loading and non-loading dose regimen for second-trimester pregnancy termination.

AIM: The aim of this study was to compare the efficacy of vaginal misoprostol loading dose regimen with non-loading dose regimen for termination of second-trimester pregnancy with live fetuses. MATERIAL AND METHODS: A randomized controlled trial was conducted on pregnant women with a live fetus at 14-28 weeks. The patients were randomly allocated to receive either the vaginal misoprostol loading dose regimen (600 mcg, then 400 mcg every 6 h) or the non-loading dose regimen (400 mcg every 6 h). Failure to abort within 48 h was considered to be a failure. RESULTS: Of 157 recruited women, 77 were assigned to be in group 1 (loading group) and 80 were in group 2 (non-loading group). The median abortion time was not statistically different between the groups (14.08; 95% confidence interval: 12.45-17.77 h and 14.58; 95% confidence interval: 12.8-17.27 h, P > 0.05). The rates of abortion within 24 h and 48 h were also comparable between the groups. Fever and chills were more common in the loading group. No other serious complications, such as postpartum hemorrhage and uterine rupture, were found. CONCLUSION: Vaginal misoprostol in the loading dose regimen had a similar efficacy to the non-loading dose regimen but was associated with more adverse maternal effects.

How to manage unresponsiveness to misoprostol in failed second trimester pregnancy termination.

AIM: To present the experience of management of second trimester pregnancy termination by misoprostol after failure to abort within 48 h of its use. MATERIAL AND METHODS: A retrospective, cohort descriptive study was carried out in the Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University Thailand between 1998 and 2010. All women at 14-28 weeks of gestation who failed to abort using misoprostol within 48 h were included. Management of failed pregnancy termination among these women is described here. RESULTS: Of a total of 680 women undergoing termination of pregnancy, 68 (10%) failed to abort. Mean maternal age was 28.71 years and mean gestational age was 19.91 weeks. Further management after failure included additional administration of misoprostol only (19.1%), modified condom balloon technique only (17.7%), modified condom balloon technique plus other methods (16.1%), while 47.1% needed only oxytocin as necessary. The mean interval between initiation of termination and delivery was 96.97 h. CONCLUSION: Failure of pregnancy termination using misoprostol can be successfully managed by introducing additional misoprostol, modified condom balloon technique and oxytocin infusion. These methods should be considered before proceeding to hysterotomy.

Sexual in menopausal women comparing perimenopausal and postmenopausal women.

OBJECTIVE: To compare aspects of sexual function between perimenopausal and postmenopausal women. MATERIAL AND METHOD: One hundred forty women, 70 perimenopausal women and 70 postmenopausal patients in the menopause clinic were interviewed at a first visit regarding aspects of sexual function compared between now and during the previous one-year period. All data were compared between perimenopausal and postmenopausal women. MAIN OUTCOME MEASURE: The following sexual function including sexual thoughts/fantasies, sexual desire, frequency of sexual intercourse, sexual excitement during sex, moisture in vagina during sex, amount of vaginal lubrication during sex, pain or discomfort during sex, vaginal stretching/flexibility during sex, intensity of orgasm during sex, sexual appeal in client's opinion, overall sexual satisfaction and sexually related anxiety were compared between groups. RESULTS: The mean age (+/- SD) of perimenopausal and postmenopausal women were 49.4 (+/- 3.0) years and 52.2 (+/- 2.8) years respectively in which there was no significant difference. Most women in both groups had sexual intercourse one to four times per month. There was statistically significant difference between groups in the following aspects, sexual thoughts/fantasies, sexual desire, frequency of sexual intercourse, sexual excitement during sex, moisture in vagina during sex, amount of vaginal lubrication during sex. All items had a negative impact on sexual function but a higher impact was found in postmenopausal women. However sexually related anxiety was unchanged in both and no significant difference was detected. CONCLUSION: Some sexual functions were significantly impaired in postmenopausal compared to perimenopausal women. However, the overall sexual satisfaction and sexually related anxiety were unchanged in postmenopausal women. So sexual problems are present but are not considered the most important problem among Thai women.

Outcomes of pregnancy termination by misoprostol at 14-32 weeks of gestation: a 10-year-experience.

OBJECTIVE: To review outcomes of pregnancy termination between 14-32 weeks of gestation based on a 10-year-experience of misoprostol use at Maharaj Nakorn Chiang Mai Hospital. STUDY DESIGN: A retrospective, descriptive study MATERIAL AND METHOD: Based on the authors' prospective database, all pregnancy terminations by misoprostol between 14-32 weeks of gestation between 1998 and 2008 were reviewed. The main outcomes included success rate of termination, mean induction-to-abortion time, and complication rate. In addition, regimens and routes of drug administration as well as indications for termination of pregnancy were also analyzed. RESULTS: Seven hundred forty one pregnancy terminations were performed using misoprostol with dosage varied from 50 mcg to 800 mcg, mostly 400 mcg intravagina every three hours. The most common indication for pregnancy termination was severe fetal thalassemia (35.8%). The majority of cases were pregnancies with live fetuses and only 18.2% were associated with a dead fetus in utero. Success rate of termination within 48 hours was 85.9%. Pregnancies with previous cesarean section accounted for 8.6% of cases. The mean gestational age was 20.94 weeks. The mean abortion time was 25.35 hours, ranging from 1.25 to 247.88 hours. The two most common adverse effects were chill and fever (43.7% and 34.3%). The rate of analgesia needed was 39.3%. No serious adverse complications such as uterine rupture were found CONCLUSION: This experience suggests that misoprostol has a high efficacy for pregnancy termination with acceptable minor side effects and it is relatively safe when used with precaution.

Rectal misoprostol in management of retained placenta: a contradictory result.

BACKGROUND: Retained placenta is one of the common problems in obstetric practice. The most common procedure to manage cases with retained placenta is manual removal of placenta (MROP) under general anesthesia. Recent data indicates that misoprostol may be helpful in decreasing the rate of MROP. OBJECTIVE: To assess the efficacy of rectal misoprostol in women with delayed placental separation. MATERIAL AND METHOD: A descriptive, retrospective cohort was conducted. All pregnant women with retained placenta longer than 30 minutes after fetal delivery, either in second or third trimester that received 800 mcg rectal misoprostol were included in the present study. Successful treatment was defined as spontaneous placental expulsion within 30 minutes after rectal misoprostol administration. RESULTS: The rate of spontaneous placental expulsion within 30 minutes after misoprostol administration was very low, only three out of 20 cases (15%). CONCLUSION: High dose rectal misoprostol does not give a promising result in cases of retained placenta. It is ineffective to facilitate placental separation in cases of retained placenta and does not seem to decrease the rate of MROP.

Randomized controlled study comparing misoprostol moistened with normal saline and with acetic acid for second-trimester pregnancy termination. Is it different?

OBJECTIVE: To compare the efficacy and adverse effects of 400 µg intravaginal misoprostol for second-trimester pregnancy termination in live fetuses between two groups: one in which misoprostol was moistened with normal saline solution (NSS) and the other in which misoprostol was moistened with acetic acid. MATERIALS AND METHODS: A total of 179 pregnant women between 14 and 28 weeks of gestation with live fetuses indicated for pregnancy termination were recruited. They were randomly allocated to receive 400 µg intravaginal misoprostol either moistened with NSS (n = 96) or moistened with acetic acid (n = 83). The same dosage was then repeated every 3 h if adequate uterine contractions were not achieved until 48 h after the initiation of misoprostol. The main outcomes were mean abortion time, success rate, and adverse effects. RESULTS: The mean abortion time was not significantly different between the groups (24.98 ± 16.42 h vs 25.89 ± 10.34 h, P > 0.05). The rates of abortion within 24 h and 48 h and the adverse effects were also comparable between the groups. Chills and fever were the most common adverse effects in this study. CONCLUSION: Intravaginal misoprostol either moistened with NSS or acetic acid was comparable in terms of efficacy and adverse effects.

Bone mineral density in women using the subdermal contraceptive implant Implanon for at least 2 years.

OBJECTIVE: To compare the effect of the long-term use of a subdermal single-rod contraceptive implant on bone mineral density (BMD) between users and a control group. METHODS: In this cross-sectional study, BMD was measured at the lumbar spine, femur, and distal radius and ulna in 100 Thai women of reproductive age, 50 who had used the Implanon implant for contraception for at least 2 years and 50 controls. RESULTS: Ethnicity, age, age at menarche, parity, menstrual pattern, and body mass index were similar in the 2 groups. The mean duration of Implanon use was 32.8+/-6.3 months. Although the prevalence of osteoporosis was rare at all sites in both groups, the Implanon users had a significantly lower BMD at the distal radius and ulna than the controls. CONCLUSION: The long-term use of Implanon seemed to have a negative impact on the mineral density of the distal radius and ulna.

Bone mineral density in women using depot medroxyprogesterone acetate (DMPA) for at least 2 years compared to a control group: a cross sectional study.

OBJECTIVE: To compare the effect of long-term use of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) in Thai women compared to the control. MATERIAL AND METHOD: A cross sectional study was conducted on Thai women of reproductive age who used DMPA (50 subjects) for contraception for at least 2 years and non-hormonal users (50 subjects). BMD was measured at the lumbar spine, femur and distal radius, and ulna. RESULTS: There was significantly lower BMD at the lumbar spines in the DMPA group but there was no significant difference in BMD between groups at the femur distal radius, and ulna. CONCLUSION: Long-term use of DMPA has a negative impact on lumbar spine BMD.

Randomized comparison of dry tablet insertion versus gel form of vaginal misoprostol for second trimester pregnancy termination.

AIM: To compare the effectiveness of vaginal misoprostol between dry tablet insertion and gel form for second trimester pregnancy termination. METHODS: A non-blinded block randomized controlled trial was conducted on 148 pregnant women with live fetuses in the second trimester undergoing pregnancy termination. They were randomly allocated to receive vaginal misoprostol (400 microg) either dry tablet insertion (n=72) or gel form (n=76). The same dose was then repeated every 3 h if adequate uterine contraction was not achieved until 48 h after the initiation of misoprostol. If abortion did not occur within this period, the treatment was considered a failure and other technique of termination was then given based on the decision of the attending physicians and the cervical status. RESULTS: The mean induction-abortion interval in group 1 (20.9+/-12.3 h) was not significantly different from that in group 2 (17.7+/-10.2 h). The mean total dose of misoprostol was also not significantly different between the two groups (group 1, 1556.9 microg; group 2, 1350.9 microg), but the adverse effects of misoprostol (chill and diarrhoea) were more common in the gel group. CONCLUSION: Tablet insertion or gel form of vaginal misoprostol have similar effectiveness but the gel form was associated with more common adverse effects.

Second-trimester pregnancy interruption with vaginal misoprostol in women with previous cesarean section.

OBJECTIVE: To describe the experience of misoprostol use for pregnancy interruption in the second trimester of women with previous cesarean section. MATERIAL AND METHOD: Seventeen pregnant women with viable fetuses and with previous cesarean section indicated for second trimester pregnancy interruption attending Maharaj Nakorn Chiang Mai Hospital were recruited. All received the same regimen of 400 mcg intravaginal misoprostol every 6 hours. The data was analyzed for demographic characteristics, the adverse outcomes, success rate, and time interval to fetal expulsion. RESULTS: The incidences of adverse outcomes were as follows, fever (47.1%), chill (23.5%), and nausea (17.6%). No uterine rupture occurred in this series at all. The rate of oxytocin use and analgesia requirement was 29.4%. Success rate of pregnancy interruption was 100%, though two of them had an abortion time of more than 48 hours. Time interval from misoprostol administration to fetal expulsion was 25.9 +/- 34. 1 hours (range 4.0-142.7 hours). CONCLUSION: This case series reaffirms the efficacy of misoprostol and suggests that misoprostol may relatively be safe even in cases with previous cesarean section. Therefore, misoprostol may be an option of pregnancy interruption in the second trimester to avoid unnecessary surgical procedure including hysterotomy. However, the safety should be tested by further studies with a larger sample size.

Mammographic changes related to different types of hormonal therapies.

OBJECTIVES: To determine the effects of different types of hormone therapies (HT) on mammographic breast density changes. MATERIAL AND METHOD: Between 1999 and 2002, mammograms obtained before and 12-18 months after different types of HT in 170 women were evaluated Estrogen alone (n = 66), or estrogen in cyclic (n = 59) or continuous (n = 45) combination with progesterone were used. The baseline mammographic density was classified according to the Breast Imaging Reporting and Data Systems (BI-RADS). The serial changes observed mammographically were categorized as follows; no change, minimal change (10-25% increased density), moderate change (26-50% increased density), and marked change (> 50% increased density). RESULTS: Twelve (7%) of the women developed an increase in parenchymal density after HT: Mammographic changes were minimal change in five (2.9%) of the women, moderate change in four (2.3%), and marked change in three (1.8%). No mammographic change was observed in women receiving cyclic estrogen-progesterone. A greater percentage of women who had undergone continuous estrogen-progesterone therapy (22.2%, 10 of 45) demonstrated more change than those who had estrogen alone (3%, 2 of 66). The difference was statistically significant (p < 0.01). CONCLUSION: Changes of increased density after HT was seen in only 7% of mammograms and depended on the selected hormone regimen.