Small cell carcinoma of the ovary hypercalcemic type (SCCOHT): A rare case after in vitro fertilization (IVF).

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a very rare and lethal tumor, mostly affecting young women, with aggressive clinical course. It has a worse prognosis in younger women and most of them died within two years of diagnosis. We are reporting a unique case of SCCOHT in a 35 years old, nulliparous lady with primary infertility in which symptomatic hypercalcemia was a presenting feature of her cancer. She was completely healthy before third cycle of IVF. Within two months of her third IVF cycle, she developed SCCOHT with a very rapid and aggressive course of disease and fatal outcome. Patient died within one month of her first symptom presentation (3 months after IVF cycle).

Clinical profile of haemodialysis patients with diabetic nephropathy leading to end stage renal disease.

BACKGROUND: The incidence of patients with end-stage renal failure and type 2 diabetes mellitus as a comorbid condition has increased progressively in the past decades. Causes of renal disease might vary from one population to another. The aim of this study was to know the characteristics of the diabetic patients on regular dialysis at Al-noor Specialist Hospital, Makkah, Saudi Arabia. METHODOLOGY: The data had been collected retrospectively in the month of Shawal 1425 corresponding to 13-11-2004----12-12-2004 from the diabetic patients directly that were on dialysis due to end stage renal disease (ESRD) and from their files. RESULTS: The mean age of Diabetics was (55.2 years) showing male predominance 31 (60.8%). All were Saudies. The mean duration of Diabetes mellitus & dialysis were (16.8 years) and (22 months), respectively. The mean age of start of Diabetes mellitus & dialysis was (37.4 years) & (53.5 years). The mean duration of onset of diabetes to dialysis was (16.1 years). Out of the total, 29 (56.9%) were non-smoker. Patients with family H/O diabetes with other associated illnesses were 23 (45%) followed by 15 (29.4%) had family H/O only diabetes. Type II diabetics were 40 (78.4%). Regarding metabolic profile, patients with high blood glucose level were 10 (19.6%) while 3 (5.9%), 50 (98%) & 18 (35.3%) patients had high cholesterol, low density lipoprotein & triglyceride levels, respectively. CONCLUSION: Maximum patients were in sixth decade of life. Up to three fourth patients had family H/O diabetes. Most of the subjects had only diabetic nephropathy Maximum patients had high low density lipoprotein level. Dialysis was main treatment to control diabetes.

Labour induction with randomized comparison of oral and intravaginal misoprostol in post date multigravida women.

The efficacy and safety of oral versus vaginal misoprostol for elective induction of labor in post date multigravida with an unfavourable cervix was compared over a period of one year in the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Eightyeight multigravida post date women were divided into two groups and given 50 mg misoprostol orally and 50 mg intravaginally, respectively. The induction to onset of significant uterine contractions and delivery intervals were lower in the first group (7.8 h vs. 8.9 h) when compared to (10.4 h vs. 12 h). The first group had a higher rate of Caesarean section (7% vs. 4%; p>0.05), uterine hyperstimulation (9% vs. 5%; p>0.05), uterine tachysystole (23% vs. 14%; p>0.05) and neonatal admissions to intensive care unit (12% vs. 4%; p>0.05) when compared to second group. Fifty mg oral misoprostol has the potential to induce labor as safely and effectively as the intravaginal route.

Reasons for delay in inpatient admission at an emergency department.

OBJECTIVE: This study highlighted the reasons which contributed to longer stay of patients in Emergency Department (ED) who were advised admission. METHODOLOGY: This study was conducted from August 4 to 11, 2004G as a retrospective review of the ED cards of patients admitted to inpatients wards of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The demographic data, doctors & nurses notes with their timings were reviewed. The maximum consumed time by a reason was considered as the main reason of delay for that subject. The delayed patients were divided into Group A and B, delayed before and after admission was advised, respectively. Prolonged length of stay (Delay) in ED was defined as stay longer than 2 hours after patient's arrival in ED until they were received to wards. RESULTS: Out of total 4876 visits during study period, 355 (7.3%) patients were admitted, and 238 (67%) were delayed. Age group 13-30 years was common in delayed 78 (32.8%) and not delayed 56 (47.9%) subjects. The mean length of stay of delayed subjects was 256 minutes. Group A 146 (61.4%) had more subjects than group B 92 (38.6%) (p < 0.001). Fifty eight (39.7%) patients stayed between 2-3hours in Group A vs. B 23 (25%) (OR 2, 95% CI 1.1-3.5). Common reason of delay in Group A was multiple consultations with further investigations 70 (48%) (p < 0.001) while file making process was common 40 (43.5%) in group B (p < 0.001). CONCLUSIONS: Out of admitted patients 67% were delayed mainly due to late advised admission with major reason of delay were multiple consultations.

Physicians' perception about electronic medical record system in Makkah Region, Saudi Arabia.

OBJECTIVES: The study was done to determine the physicians' perception about electronic medical record system (EMRS) in the context of its productivity in order to improve its functionality and advantages. MATERIALS AND METHODS: This cross-sectional survey was performed from July to August 2009 with structured questionnaire of 15 closed-ended questions with five points Likert scaling starting from strongly disagree to strongly agree as 1-5, reflecting the perception of physicians about EMRS. The physicians of the Makkah region working in six different hospitals were selected. "Positive" response means if percent of responses were rated 4 or 5 (agree/strongly agree), "neutral" if rated 3, and negative if rated 1 or 2 (strongly disagree/disagree). Descriptive data analysis techniques were used. RESULTS: We selected 317 completed questionnaires. Majority of subjects were from King Fahd Hospital, Jeddah (83, 26.3%), residents (147, 46.4%), male (200,63.1%), expatriates (207, 65%), and age group 36-45 years (133, 42%) were dominant. The stem regarding importance of computers for practicing medicine and EMRS to improve quality of practice was appreciated by majority, that is, 77.7 and 71.2%, respectively. However, "It does not disrupt the workflow" (35.1%) and "EMRS is comfortable while entering the data instead of writing" (34.8%) were appreciated negatively. Consultants (53.9%), male (53.4%), expatriates (56.7%), physicians of King Abdul Aziz Hospital, Ta'if (56.9%), and age group of 46-55 years (53.8%) appreciated EMRS positively. Overall perception of EMRS was found positive by 52.8%. CONCLUSION: Majority appreciated the EMRS, but specific concerns about its usage easiness and workflow disturbance were opposed by them also.

Thyroid transcription factor-1 expression in advanced non- small cell lung cancer: impact on survival outcome.

BACKGROUND: The prognostic role of thyroid transcription factor-1 (TTF-1) expression in lung cancer has been assessed but with inconsistent results. The present study aimed to evaluate the prognostic value of TTF1 expression in advanced non-squamous non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: In this retrospective study, patients with stage IIIB-IV non-squamous NSCLC were enrolled. Progression free survival (PFS) and overall survival (OS) were assessed according to TTF1 expression status, age categories (≤60 vs >60 years), gender, performance status (PS) (0-2 vs 3-4), type of 1st line chemotherapy (pemetrexed containing vs others) and EGFR status. RESULTS: A total of 120 patients were included. In univariate analysis, PFS was improved in patients with PS 0-2 (7.0 vs 2.0 months, p=0.002) and those who received pemetrexed-containing chemotherapy (9.2 vs 5.8 months, p=0.004). OS was improved in female patients (23.0 vs 8.7 months, p<0.0001), PS 0-2 (14.4 vs 2.0 months, p<0.0001), those with pemetrexed-containing chemotherapy (17.0 vs 11.0 months, p=0.019), TTF1-positive (12.8 vs 5.8 months, p=0.011) and EGFR- mutant patients (23.0 vs 11.7 months, p=0.006). In multivariate analysis, male gender (HR=2.34, p=0.025) and non-pemetrexed containing therapy (HR=2.24, p=0.022) were independent predictors of worse PFS. Wild EGFR status (HR=2.49, p=0.015) and male gender (HR=2.78, p=0.008) were predictors of worse OS. CONCLUSIONS: Pemetrexed-containing therapy significantly improved PFS while OS was improved in EGFR mutant patients. Female patients had better PFS and OS. TTF1 expression was not a prognostic marker in advanced non-squamous NSCLC.

Metformin-clomiphene citrate vs. clomiphene citrate alone: Polycystic ovarian syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy in women that is associated with reproductive and metabolic disorders. OBJECTIVES: We compared the ovulation and conception rates after the treatment with clomiphene citrate (CC) alone and in combination with metformin in infertile patients presented with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: This randomized controlled trial of independent cases and controls was conducted at the Department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia from February 01 to December 31, 2008. The 42 subjects diagnosed as PCOS were divided into group A and B (21 subjects in each) for management with CC + metformin and CC alone, respectively. Group A received 500 mg three times a day of metformin continuously from the first cycle for 6 months or till pregnancy was confirmed. In both groups CC was started at a dose of 50 mg from day-2 till day-6 of the menstrual cycle. The dose of CC was increased to 100 mg in second and 150 mg in third cycle, and then remained 150 mg for the remaining three cycles. With ovulation the dose of CC was unaltered in both groups. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 16. RESULTS: More than 50% females in both groups were had body mass index > 25. Group A achieved high rate of regular cycles, ovulation success, and conception than group B (71.4% vs. 38.1%; P = 0.03), (76.2% vs. 38.1%; P = 0.021), and (66.6% vs. 28.6%; P = 0.01), respectively. CONCLUSION: Management with metformin + CC increased the ovulation and conception rates.

Clinical course of ectopic pregnancy: A single-center experience.

OBJECTIVES: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP) in a general hospital. MATERIALS AND METHODS: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007). RESULTS: Out of total 7564 pregnancies, 44 (0.58%) patients were diagnosed as EP. Out of 44, 22 (50%) patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%), and 21 (48%) had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%), abdominal pain (39, 88.6%), and tenderness (38, 86%). Previous pelvic surgery (13, 29.5%), infertility treatment (11, 25%), and pelvic inflammatory disease (10, 22.7%) were the common predisposing factors. Twenty-five (57%) presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%). No mortality was observed. CONCLUSION: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

Computer literacy improvement needs: physicians' self assessment in the makkah region.

OBJECTIVE: A confidential inquiry by the Directorate General of health affairs, Makkah region, Saudi Arabia, found physicians were resistant to enter patient-related information in the electronic medical records system at different hospitals. This study aims to highlight their computer literacy needs. METHODS: This cross-sectional survey was conducted on physicians using a structured questionnaire bearing nine questions/stems with dichotomous answers, (i.e., yes/no) that was distributed among physicians at six different Ministry of Health hospitals in the Makkah Region, Saudi Arabia, between May and August 2009. The results for future needs in computer skills were categorized as "none" if the rate of answer "yes" to any stem was 0-25%, "little" if 26-50%, "some" if 51-75% and "substantial" if >75% rated "yes". RESULTS: The response rate of 82% of determined sample size (n = 451) was attained. Computer literacy improvement elements (CLIE), i.e., "word processing software skills (MS Word)", "presentation software skills (Power Point)", "internet search skills", "medical database search skills", "spreadsheet software skills (Excel)" and "advanced e-mail management skills" were in "substantial" need of improvement among the majority of settings and categories. All other computer literacy improvement elements were in "some" need of improvement. CONCLUSION: The overall outcome of this study indicates that physicians need further computer literacy improvements.

Palatal lifting prosthesis and velopharyngeal insufficiency: preliminary report.

OBJECTIVES: Our study aimed to highlight the effectiveness of palatal lift prosthesis in patients with velopharyngeal insufficiency with previous operated cleft palate. METHODS: This study was done undertaken January 2008 to December of 2009 in the Phoniatic unit of Alnoor Specialist Hospital, Makkah, Saudi Arabia. Ten patients of ≥ 8 years to ≤ 10 years of age, who had previously undergone surgery for cleft palate, with or without cleft lip, with no other systemic illness and normal intelligent quotient level, were selected and managed by palatal lift prosthesis. All the study subjects were subjected to auditory perceptual speech evaluation for assessment of the degree of hypernasality, compensatory articulator mechanisms, glottal and pharyngeal articulation, audible nasal emission, facial grimace and overall intelligibility of speech. Data were analyzed using SPSS version 16. RESULTS: The study included 10 subjects whose mean ± standard deviation of age was (8.9±0.9). On auditory speech perceptual evaluation after prosthesis application, significant improvement was found in glottal articulation 6 (85.7%), p=0.04, facial grimace 6 (85.7%) p=0.04, hyper nasality 10 (10%) p=0.008, and speech intelligibility 9 (90%) p=0.008. CONCLUSION: Young patients with repaired palatal cleft have significant improvement after application of palatal lift prosthesis.

Crypto-Giardia antigen rapid test versus conventional modified Ziehl-Neelsen acid fast staining method for diagnosis of cryptosporidiosis.

OBJECTIVE: To evaluate the validity of Crypto-Giardia antigen rapid test (CA-RT) in comparison with the conventional modified Ziehl-Neelsen acid fast (MZN-AF) staining method for the diagnosis of cryptosporidiosis. METHODS: Fifteen preserved stool samples from previously confirmed infections were used as positive controls and 40 stool samples from healthy people were used as negative control. A total of 85 stool samples were collected from suspected patients with cryptosporidiosis over 6 months during the period from January till June, 2011. The study was conducted in the department of parasitology, central laboratory, Alnoor Specialist Hospital, Makkah, Saudi Arabia. All samples were subjected to CA-RT and conventional MZN-AF staining method. Validation parameters including sensitivity (SN), specificity (SP), accuracy index (AI), positive predictive value (PPV), and negative predictive value (NPV) were evaluated for both tests. RESULTS: Out of 15 positive controls, CA-RT detected 13 (86.7%) while MZN-AF detected 11(73.3%) positive cases. However, CA-RT detected no positive case in 40 normal controls but MZN-AF detected 2(5%) as positive cases. Based on the results, the SN, SP, AI, PPV and NPV were high in CA-RT than MZN-AF staining method, ie., 86.7%vs. 73.3%, 100%vs. 95%, 96.4%vs. 89.1%, 100%vs. 84.6% and 95.2%vs. 90.5%, respectively. Out of a total of 85 suspected specimens, CA-RT detected 7(8.2%) but MZN-AF detected 6(7.1%) cases as positive. CONCLUSIONS: CA-RT immunoassay is more valid and reliable than MZN-AF staining method.

First case report of human myiasis with Sarcophaga species in Makkah city in the wound of a diabetic patient.

We have reported a case of a 40-year-old male diabetic patient, resident of a rural area, who visited the outpatient clinic of the diabetic center in Alnoor Specialist Hospital, Makkah, Saudi Arabia. He came to seek medical advice for a single wound in the back of the shoulder since 1 month. After examination, a larva was eliminated and sent to laboratory for confirmation. It was confirmed as the third-stage larva of Sarcophaga species after macroscopic and microscopic examination. This is the first case of a patient having diabetic wound myiasis with the larva of Sarcophaga species reported in the Makkah region of Saudi Arabia.

Risk of adverse maternal and peri-natal outcome in subjects with placenta previa with previous cesarean section.

The aim of this study was to compare maternal and perinatal adverse outcomes between groups of placenta previa (PP) with and without previous cesarean section (CS). A prospective study was carried out from March 2008 to August 2009 at the department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia. Diagnosed cases of PP with singleton pregnancy presenting with ante-partum hemorrhage (APH) in the 3rd trimester undergoing either emergency or elective CS were included. Subjects were divided into two groups, 30 with previous CS (group A) and 27 without previous CS (group B), and the risks of adverse maternal and perinatal outcomes were compared. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA).One mother in group A died due to disseminated intravascular coagulation. The risk of post partum hemorrhage (PPH), blood transfusion and coagulopathy was higher in group A, (OR 4.8, 95% CI 1.5-15; p=0.008; OR 4.8, 95% CI 1.5-15; p=0.008; OR 9.5, 95% CI 1.2-81.6; p=0.03, respectively). Mean length of hospital stay (days±SD) in group A was significantly longer than that in group B (5.3±3.2 vs. 3.2±1.5, 95% CI 0.8-3.2; p=0.002). A higher risk of perinatal adverse outcome was found in group A, but the difference was not significant.Risk of maternal morbidity was higher than that of perinatal morbidity in Group A.

Usability evaluation of paper-based "Hajji" Health Record format.

The study objective was the development and content evaluation of the paper-based Hajji Health Record (PHHR) instrument to make it appropriate for developmental phases of web based electronic Hajji (Pilgrim) Health Record (WEHHR) implementation. A qualitative and quantitative survey was done on 13 December 2008G in Alnoor Specialist Hospital, Makkah, Saudi Arabia. Twenty-two physicians of 19 countries were given a preliminary questionnaire containing basic sociodemographic information, followed by Hajjis' health information sheet (HHIS) with a sample scenario of a case history. A structured evaluation questionnaire about HHIS was given afterwards. Five point Likert scaling was used starting from strongly agree to strongly disagree as 1 to 5. Data was analyzed by using SPSS programme version 16. Two tailed p-value <0.05 was considered as significant. Mean age was 48.6 years with range (35-64). Specialists were 10(45.5%) and teaching hospitals' physicians were 11(50%). Twelve (54.5%) physicians had concept about EHR, while the same number had their Hajjis' health record but only 33.3% (4/12) had sufficient health information. Response rate was 91.9% with average rating of 2.2 ± 1. Agreement response (78.8%) was noted for "medical history" category followed by "medication history" (76.2%). Average rating of consultants was (2 ± 0.88), while specialists, residents and general practitioners had 2.3 ± 1.2, 2.7 ± 1, 2.1 ± 0.58, respectively. Physicians without EHR concept had average rating 2.1 ± 1.16 than other group (2.3 ± 0.92). Majority of physicians were specialists. Overall response rate was superb with agreement response. No significant difference in rating was found among all categories of physicians.

The role of doppler ultrasound in high risk pregnancy: A comparative study.

BACKGROUND: The objective was to determine the effectiveness of Doppler velocimetry results in the management of high-risk pregnancy. MATERIALS AND METHODS: This cohort study was conducted from January 2005 to December 2006 in Obstetrics and Gynecology Department of Alnoor Specialist Hospital, Makkah, Saudi Arabia. A total of 200 high-risk pregnant women with gestational age >28 weeks were selected for the study and divided into group A (100) subjected to Doppler velocimetry and group B (100) without Doppler velocimetry. Standard management protocols were followed in all cases. The primary outcome measures were mode of delivery and gestational age at the time of delivery. The secondary outcome measures were prenatal and neonatal complications. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). RESULTS: Preterm deliveries, preterm as well as full-term neonatal admissions were more frequent in group A than those in group B, i.e., (39% vs. 26%), (56% vs. 88%) (OR 0.2, 95% CI 0.04-0.7), and (30% vs. 57%) (OR 0.3, 95% CI 0.2-0.7), respectively. Similarly preterm and full-term neonatal deaths were rare in group A than those in group B, i.e., (9% vs. 78%) (OR 0.1, 95% CI 0.02-0.7), and (6% vs. 29%) (OR 0.2, 95% CI 0.03-1.8), respectively. Emergency caesarean section rate was rare in the subjects with normal Doppler than those with abnormal Doppler (48% vs. 100%) (OR 0.1, 95% CI 0.03-0.4) as well as in group B (48% vs. 82%) (OR 0.2, 95% CI 0.1-0.4). CONCLUSION: Doppler studies in high-risk pregnancies are more beneficial in the management of perinatal as well as neonatal management.

Audit of an urban paediatric emergency department visits.

BACKGROUND: This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED). MATERIALS AND METHODS: Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered. RESULTS: In one month period a total 21000 patients visited our ED, out of them 6120 (29%) were children. Males, Saudis and children of (1-6 years) were more frequent, i.e., 3540 (57.8%), 5760 (94.1%) and 3180 (52%), respectively. Majority of patients visited in shift "2", i.e., 15:30 hours to 23:30 hours. Among the patients "diseases of respiratory system" were found more frequent 4170 (68.1%) and main diagnosis was "acute upper respiratory tract infection" 3300 (53.9%). Non-urgent cases were 2020 (33%) while 244 (4%) were admitted. CONCLUSION: Young children as well as non-urgent cases were predominant. Evening shift was the busiest one.

Induction of labor: a comparative study of intravaginal misoprostol and dinoprostone.

OBJECTIVE: To compare the efficacy and safety of intravaginal misoprostol and dinoprostone for elective induction of labor in nulliparous women with an unfavorable cervix. MATERIALS AND METHODS: A quasi-experimental study was conducted in Bahawal Victoria Hospital, Bahawalpur, Pakistan, from July 1, 2005 to August 31, 2006. A total of 120 primigravid women with gestational ages of > 40 weeks to < 42 weeks were divided into two groups. Group A (n = 60) was given 50 microg of misoprostol and Group B (n = 60) was given 3 mg of dinoprostone every 6 hours, for a maximum of three doses. RESULTS: The induction to onset of significant uterine contractions and delivery intervals were lower in Group A than in Group B (6.1 vs. 7.2 hours; p = 0.16; and 8.2 vs. 11.0 hours; p = 0.007, respectively). Group A had a lower cesarean section rate than Group B (7% vs. 30%; p = 0.003), but a higher rate of uterine hyperstimulation (10% vs. 3%; p = 0.16), tachysystole (17% vs. 3%; p = 0.02), and neonatal admissions to the intensive care unit within 24 hours of delivery (4 vs. 3; p = 0.71) and after 24 hours (2 vs. 1; p = 0.56) than Group B. CONCLUSION: Vaginal misoprostol is more effective than dinoprostone for the elective induction of labor beyond 40 weeks of gestation, but is associated with more uterine hyperstimulation, tachysystole, and neonatal intensive care unit admissions.

Pre-labor rupture of membranes at term in patients with an unfavorable cervix: active versus conservative management.

OBJECTIVE: To compare the safety and efficacy of conservative management of pre-labor rupture of membranes (PROM) at term in patients with an unfavorable cervix, with active treatment using oral misoprostol. MATERIALS AND METHODS: This quasi-experimental study was conducted between June 1, 2004 and November 30, 2004 at Bahawal Victoria Hospital, Bahawalpur, Pakistan. Eighty-four multigravid women (parity, < 5) at > or = 37 weeks' gestation and with unfavorable cervices were divided equally between group S (study) and group C (conservative). Group S was given 50 micrograms of oral misoprostol every 4 hours for a maximum of four doses, while group C was managed conservatively. The intervals between PROM and significant uterine contractions and delivery, the mode of delivery, and maternal and fetal/neonatal complications were the main outcome measures. RESULTS: The intervals between PROM and the onset of uterine contractions and delivery were lower in group S than group C (9.6 vs. 14.8 hours; p < 0.001) and (11.6 vs. 17 hours; p < 0.001), respectively. Fewer women delivered abdominally within 24 hours of PROM in group S than in group C (5% vs. 24%; p < 0.05). Induction failure in group S was less than conservative management failure in group C (10% vs. 60%; p < 0.001). The maternal complication rate was less in group S than in group C (7% vs. 14%; p > 0.05), but the fetal/neonatal complication rate was similar in both groups (5%). CONCLUSION: Oral misoprostol (50 micrograms) is safe and effective for cervical ripening and labor induction in patients with PROM and an unfavorable cervix.