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Objetivo: Comparar la efectividad del misoprostol oral vs. oxitocina intramuscular en el manejo de la tercera fase del parto. Metodología: Se realizó un estudio de casos y controles en pacientes embarazadas tratadas con misoprostol oral (grupo A) u oxitocina intramuscular (grupo B) para el manejo de la tercera fase del parto. Se analizaron las características generales, valores de hemoglobina y hematocrito, perdida hemática post-parto y efectos adversos. Resultados: Los datos se obtuvieron en 191 en el grupo A y 197 en el grupo B. No se encontraron diferencias significativas entre los grupos en las características generales. Tampoco se encontraron diferencias significativas en los valores promedio de hemoglobina - hematocrito post-parto, duración de la tercera fase del parto y perdidas sanguíneas entre los grupos, así como en el uso de uterotónicos adicionales y necesidad de hemoderivados. Las pacientes del grupo A presentaron mayor frecuencia de escalofríos, diarrea, náuseas y fiebre comparado con el grupo B (p < 0,05). Conclusión: El misoprostol oral es igual de efectivo que la oxitocina intramuscular cuando se usa como agente farmacológico para el manejo de la tercera fase del parto. (provisto por Infomedic International)
Objective: To compare the effectiveness of oral misoprostol vs. intramuscular oxytocin in the management of the third stage of labor. Methodology: A case-control study was carried out in pregnant patients treated with oral misoprostol (group A) or intramuscular oxytocin (group B) for the management of the third stage of labor. General characteristics, hemoglobin and hematocrit values, postpartum blood loss and adverse effects were analyzed. Results: The data were obtained in 191 in group A and 197 in group B. No significant differences were found between groups in general characteristics. There were also no significant differences in mean postpartum hemoglobin-hematocrit values, duration of the third stage of labor and blood loss between the groups, as well as in the use of additional uterotonics and the need for blood products. Patients in group A had a higher frequency of chills, diarrhea, nausea and fever compared to group B (p < 0.05). Conclusion: Oral misoprostol is as effective as intramuscular oxytocin when used as a pharmacological agent for the management of the third stage of labor. (provided by Infomedic International)
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Background: Induction of labor is now a common practice and every institute faces the task of developing a safe and cost-effective protocol. We aimed to study the effects of sequential use of oral and vaginal misoprostol when compared to oral or vaginal misoprostol alone. Our primary objective was to determine the caesarean delivery rates and secondarily the maternal and neonatal complications between the different induction regimes.Methods: A single-center retrospective observational study was conducted, with patient records divided into three groups based on their methods of induction: those who were administered vaginal misoprostol only, those who had oral misoprostol only, and those who had oral misoprostol followed by vaginal misoprostol. We extracted all the necessary data from the records and analyzed it using SPSS.Results: 768 records with comparable demographic characteristics were reviewed. The majority of women were induced at 39 completed weeks. There was no significant difference in the proportion of caesarean deliveries when comparing the three groups but the number of caesarean sections was lower among women who had been administered vaginal misoprostol alone. Among the patients included in the study, the women who developed postpartum hemorrhage received a higher mean dose of misoprostol (130±70 mcg) compared to those who did not (104±57 mcg).Conclusions: Sequentially administering misoprostol may not decrease the caesarean section rate compared to using only one route of administration. However, it is important to monitor the amount of misoprostol given to each patient to prevent the incidence of PPH.
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RESUMO A criminalização do aborto no Brasil e o acesso restrito ao misoprostol obrigam mulheres a buscarem métodos inseguros para sua indução. Atenção hospitalar ao aborto induzido ou espontâneo é padrão. Na contracorrente, no cenário internacional, a telessaúde no aborto medicamentoso é padrão ouro da atenção às perdas gestacionais, espontâneas ou induzidas. Este artigo apresenta o Programa Atenas iniciativa inédita de atenção ao aborto no primeiro trimestre gestacional - com foco no atendimento extra-hospitalar, através de monitoramento telefônico por enfermeiras, facultando às mulheres escolher o método de esvaziamento uterino (expectante, medicamentoso ou cirúrgico), com vistas à humanização da atenção. Foi realizada pesquisa etnográfica, em maternidade pública nordestina, entre 2014 e 2021. No contexto de dificuldades estruturais e conjunturais, 723 participantes foram atendidas; 73,6% prescindiram de hospitalização para resolução do aborto: 58,4% ocorreram de forma espontânea e 15,2% através do misoprostol hospitalar. Não houve registro de complicações. O monitoramento telefônico promoveu vínculo e cuidado individualizado a este público invisibilizado. Esta iniciativa orgânica do SUS, sem apoio financeiro de órgãos externos, representa um avanço na atenção humanizada às mulheres com aborto. Recomenda-se estender a toda rede pública de saúde, visando ampliação do acesso a um cuidado integral e humanizado no aborto.
ABSTRACT The criminalization of abortion and restricted access to misoprostol in Brazil force women to seek unsafe methods to terminate a pregnancy. Hospital care for miscarriage or abortion is standard. In contrast, telemedicine for the medical management of miscarriage and abortion is the gold standard of care internationally. This article presents the Atenas Program - an unprecedented initiative for first trimester abortion/miscarriage care, aiming at a humanized out-of-hospital service based on telephone monitoring by nurses, allowing women to choose the method of uterine evacuation (expectant, medical or surgical). For this purpose, ethnographic research was carried out in a northeastern public maternity hospital, between 2014 and 2021. In the context of structural and conjunctural difficulties, among the 723 Atenas participants, 73,6% dispensed with hospital admission for miscarriage and abortion resolution: 58,4% occurred spontaneously and 15,2% through hospital misoprostol. No complications were registered. Telephone monitoring by nurses provided the basis for continuity of individualized care for this invisibilized public. Atenas Program, initiative of a SUS institution run without external financial support, represents an advance in humanized care for women with miscarriage and abortion. It should be extended to the entire public health network, to expand access to rounded and humanized care for abortion and miscarriage.
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Background: Therapeutic abortion in the second trimester pregnancy is the choice treatment in cases with severe anomalies or intrauterine fetal death. It can be done by a number of medical (e.g. misoprostol and letrozole) or mechanical methods (e.g. laminaria). The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria for preoperative cervical ripening among women with under second trimester abortion. Methods: In this interventional study, 80 pregnant women in the second trimester pregnancy (Gestational age under 20 weeks) were randomly divided in two groups (n=40). One group received vaginal misoprostol in combination with laminaria and oral placebo and other group received vaginal misoprostol in combination with letrozole. Patients regularly examined every 4 hours and in the absence of abortion, vaginal misoprostol repeated after 4 hours. No report of products of conception abortion considered as complete abortion and the patient discharged. Data collected in a cheklist and then analyzed by statistical methods in SPSS version 21. Results: Complete abortion was reported in 70 (87.5%) of all patients which in group letrozole+misoprostol in 34 (85%) and in laminaria+misoprostol was reported in 36 (90%). 6 (15%) Curettage was reported in group letrozole+misoprostl and 4 (10%) in laminaria+misoprostol and the difference were not statistically significant. Conclusions: Results showed that both of combination are effective in the abortion but misoprostol in combination with laminaria is recommended for the induction of second trimester therapeutic abortion.
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Background: This study aimed to compare the efficacy of two labor induction methods, mifepristone alone and mifepristone followed by misoprostol, in cases of intrauterine fetal demise (IUFD) beyond 28 weeks of gestation.Methods: A prospective study was carried out at, BRD Medical College in Gorakhpur and aimed to investigate the efficacy of two different methods for labor induction in pregnancies with intrauterine fetal demise (IUFD) beyond 28 weeks of gestation during September 2019 to August 2020. Sixty participants were divided into two groups of 30 each, with mifepristone administered orally in both groups. Group 2 received additional vaginal misoprostol. Patient demographics, Bishop scores, induction to active labor intervals, and induction to delivery intervals were examined. Augmentation methods, side effects, complications, and time to full dilatation were analyzed.Results: The groups exhibited similar patient characteristics, including age, parity, socioeconomic status, and literacy rates. Gestational age at induction and Bishop scores were comparable. Both groups showed substantial improvements in Bishop scores. The induction to active labor interval was shorter in the mifepristone group, and the induction to delivery interval was similar. The mifepristone group required fewer mifepristone tablets, while the combination group used less misoprostol, reducing side effects. Complications were minimal, with a decreased need for augmentation methods in both groups.Conclusions: Mifepristone, whether used alone or followed by misoprostol, proved effective in labor induction for IUFD beyond 28 weeks. Mifepristone's ability to enhance cervical ripening and prostaglandin sensitivity makes it a promising option for reducing the risks associated with delayed birth in cases of IUFD. These findings suggest that mifepristone can be a valuable addition to obstetric practices, particularly in cases where traditional induction methods may pose greater risks.
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Cervical ripening is a prerequisite for induction of labour in women adjudged to have an unfavourable cervix. Misoprostol administered intravaginally has previously been shown to be effective for cervical ripening and labour induction. It is often used in dosages of 25 µg or 50 µg in single or repeated dose regimen as per guidelines. Higher doses or shorter dosing intervals were reportedly associated with a higher incidence of side effects, especially uterine hyperstimulation syndrome. Studies and clinical experience have shown that 50 µg dose was not as effective in nulliparous women as it was in multiparous women, which implies that this dose might not be optimal for nulliparous women. We report a series of seven carefully selected patients in whom we used 100 µg of misoprostol intravaginally for cervical ripening and induction of labour at term. We achieved a short induction delivery interval, had good improvement in Bishop’s score, with less need for oxytocin augmentation and good safety parameters.
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Background: Induction of labor (IOL) is a procedure used to achieve vaginal birth when the hazards of extending the pregnancy for either the mother or the infant outweigh the dangers of delivery. It is often used in high-risk pregnancies, although it can also be useful in low-risk groups, as demonstrated by A Randomized Trial of Induction Versus Expectant Management (ARRIVE) study.Methods: The cross-sectional study was conducted among 414 patients at Department of Obstetrics and Gynaecology tertiary care hospital. The study was conducted for one-year duration in pregnant women with maternal age >18 years, gestational week >37 weeks, and Bishop score <7 was included in the study with no signs of labor. Demographic details such as age, pregnancy history, and mode of delivery were recorded for comparison. Patients with no induction of labor were administered misoprostol and/or dinoprostone based on clinical conditions with further evaluation of maternal complications, delivery time, birthweight of the fetus, and fetal heart rate. Data were analyzed based on percentages and a chi-square test was used (p-value <0.05).Results: The mode of delivery did not significantly affect delivery outcomes (p=0.354), with assisted delivery being the most common (35.41%). Indication for induction was found to be significant (p=0.034), with non-progress of labor being the most common indication (55.2%). Maternal complications were not significantly associated with delivery outcomes (p=0.390), with 60 (14.49%) patients experiencing complications. The use of misoprostol reported a significant difference between modes of delivery with 74.93% of vaginal delivery, 19.47% with lower segment cesarean section (LSCS), and 5.60% with assisted delivery (p value <0.03).Conclusions: In low-risk pregnant women, the dinoprostone or misoprostol vaginal inserts are both safe and effective for inducing labor. Nulliparous individuals and those who did not get epidural analgesia during labor had a higher chance of caesarean section.
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Objective:To investigate the effectiveness and safety of low-dose oral misoprostol solution for cervical ripening in late gestation.Methods:This was a prospective cohort study including 396 primiparas with singleton pregnancy who received low-dose oral misoprostol solution for cervical ripening (oral group) in Peking University Third Hospital from March to October 2022. They were further allocated to receive oral misoprostol alone (OA group, n=167) or oral misoprostol in combination with oxytocin/amniotomy (OC group, n=229). Moreover, 218 cases who received vaginal misoprostol for cervical ripening (vaginal group) during the same period in 2021 were reviewed (a retrospective cohort). Among them, 77 were given vaginal misoprostol alone (VA group) and 141 received vaginal misoprostol in combination with oxytocin/amniotomy (VC group). The OA group and VA group (72 and 73 cases) as well as the OC group and VC group (108 and 103 cases) were matched using propensity scores. Basic clinical information, hospital stay, duration of labor induction, uterine hyperstimulation, rate of labor initiation, vaginal delivery rate, rate of delivery within 24 h, duration of labor, neonatal condition, adverse pregnancy outcomes, and other information were compared between different groups. All data were statistically analyzed using independent sample t test, analysis of variance, nonparametric test, Chi-square test, or Fisher's exact probability test. Logistic regression model was used to analyze the factors affecting the labor initiation and the failure of labor induction. Results:The average hospital stay, the duration from medication to labor initiation and the duration from medication to vaginal delivery were significantly shorter in the oral group than those in the vaginal group [(5.4±2.4) vs. (6.5±2.6) d, (34.2±24.1) vs. (38.9±25.7) h, (45.8±25.8) vs. (53.4±27.8) h; t=5.24, 2.10 and 3.39; all P<0.05]. The total labor initiation rate and vaginal delivery rate in the oral group were significantly higher than those in the vaginal group [92.9% (368/396) vs. 83.5% (182/218), 72.2% (286/396) vs. 60.1% (131/218); χ 2=13.43 and 9.50; both P<0.05]. The incidence of failed induction of labor, uterine hyperstimulation, fetal distress, and intrauterine infection in the oral group were lower than those in the vaginal group [2.0% (8/396) vs. 6.9% (15/218), 4.3% (17/396) vs. 17.9% (39/218), 8.8% (35/396) vs. 14.7% (32/218), 1.3% (5/396) vs. 3.7% (8/218); χ 2=9.21, 31.36, 4.93 and 3.93; all P<0.05]. The duration from medication to labor initiation and to vaginal delivery in the OA group were higher than those in the VA group [(25.8±17.0) vs. (17.4±10.8) h, (37.2±18.8) vs. (29.7±13.5) h; t=3.49 and 2.74; both P<0.05]. There were no significant differences in the labor initiation rate, vaginal delivery rate, rate of delivery within 24 h or the incidence of failed induction of labor between the OA and VA groups (all P>0.05). Women in the VA group were more likely to develop uterine hyperstimulation than those in the OA group [19.2% (14/73) vs. 4.2% (3/72), χ2=7.89, P=0.005]. There were no significant differences in the duration from medication to labor initiation or to vaginal delivery between the VC and OC groups (both P>0.05), but the duration were significantly longer than those in the corresponding medication alone group (VC vs. VA groups: (49.7±24.6) vs. (17.4±10.8) h and (61.6±25.7) vs. (29.7±13.5) h, t=5.31 and 5.13, both P<0.05; OC vs. OA groups: (45.3±26.6) vs. (25.8±17.0) h and (56.1±27.2) vs. (37.2±18.8) h, t=10.35 and 9.78, both P<0.05]. The labor initiation rate, vaginal delivery rate and rate of delivery within 24 h in the OC group were higher than those in the VC group [88.9% (96/108) vs. 77% (87/113), 63.0% (68/108) vs. 47.8% (54/113), 10.3% (7/108) vs. 0.0% (0/113); χ 2=5.49, 5.14 and 7.56; all P<0.05]. The incidence of uterine hyperstimulation in the OC group was 4.6% (5/108), which was lower than that in the VC group [18.6% (21/113), χ 2=10.37, P=0.001]. Logistic regression analysis showed that oral misoprostol and gestational age were positively correlated with labor initiation [ OR (95% CI): 2.18 (1.24-3.90) and 1.43 (1.14-1.79)], while maternal age was negatively correlated with labor initiation [ OR (95% CI): 0.90 (0.82-0.98)]. Moreover, failed induction of labor was negatively correlated with oral misoprostol [ OR (95% CI): 0.37 (0.14-0.91)], but positively correlated with maternal age [ OR (95% CI): 1.21 (1.05-1.40)]. Conclusions:Oral administration of low-dose misoprostol solution is as effective as vaginal misoprostol in promoting cervical ripening. Besides, it can shorten the average hospital stay and reduce the incidence of uterine hyperstimulation, suggesting that low-dose oral misoprostol solution is relatively safer and can be used to promote cervical ripening in late gestation.
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Resumo Objetivo Analisar as evidências disponíveis na literatura acerca do insucesso da indução do trabalho de parto com misoprostol em gestações a termo. Métodos Revisão integrativa, realizada entre janeiro e novembro de 2022, cuja pergunta de pesquisa e descritores foram delineados por meio da estratégia PECO. As buscas foram realizadas nas bases de dados MEDLINE; Web of Science; CINAHL; EMBASE e Scopus por duas pesquisadoras de forma independente, assim como a avaliação. Para a fase de seleção e identificação dos estudos foi utilizado o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A avaliação do risco de viés dos artigos incluídos foi realizada através do questionário Newcastle Ottawa Scale. Resultados Foram identificados 3.674 artigos, 84 foram lidos na íntegra, dos quais 11 compuseram a revisão (n=9.010 gestantes), com publicação entre os anos de 2005 a 2021, sendo a maioria nos Estados Unidos. Quanto ao nível de evidência, todos os artigos foram classificados como 2b, avaliada coforme o delineamento de cada investigação. O estudo apontou evidências quanto aos seguintes fatores: IMC elevado (maior igual a 30kg/m2), nuliparidade, bishop imaturo, comprimento cervical (maior igual a 30mm), estatura, etnia (não caucasianas do sul da Europa) e peso fetal (maior igual a 4kg). Conclusão Alcançou-se o objetivo do estudo tendo sido demonstrado seis fatores maternos e um fetal que podem levar ao insucesso da indução. Vale ressaltar a necessidade de evidências que incorporem a individualidade de cada característica e destaca-se a contribuição desse estudo para embasar a escolha da melhor conduta para cada gestação de forma individualizada.
Resumen Objetivo Analizar las evidencias disponibles en la literatura acerca del fracaso de la inducción del trabajo de parto con misoprostol en gestaciones a término. Métodos Revisión integradora, realizada entre enero y noviembre de 2022, cuya pregunta de investigación y descriptores fueron definidos mediante la estrategia PECO. Las búsquedas fueron realizadas en las bases de datos MEDLINE, Web of Science, CINAHL, EMBASE y Scopus por dos investigadoras de forma independiente, al igual que la evaluación. Para la fase de selección e identificación de los estudios se utilizó el Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La evaluación del riesgo de sesgo de los artículos incluidos se realizó a través del cuestionario Newcastle Ottawa Scale. Resultados Se identificaron 3.674 artículos, 84 se leyeron en su totalidad, de los cuales 11 conformaron la revisión (n=9.010 mujeres embarazadas), publicados entre los años 2005 y 2021, la mayoría en Estados Unidos. Respecto al nivel de evidencia, todos los artículos fueron clasificados como 2b, evaluada de acuerdo con el diseño de cada investigación. El estudio indicó evidencias respecto a los siguientes factores: IMC elevado (mayor igual a 30 kg/m2), nuliparidad, bishop bajo, longitud cervical (mayor o igual a 30 mm), estatura, etnia (no caucasoide del sur de Europa) y peso fetal (mayor igual a 4 kg). Conclusión Se alcanzó el objetivo del estudio y se demostraron seis factores maternos y uno fetal que pueden llevar al fracaso de la inducción. Cabe resaltar la necesidad de evidencias que incorporen la individualidad de cada característica y se destaca la contribución de este estudio para fundamentar la elección de la mejor conducta en cada gestación de forma individualizada.
Abstract Objective To analyze the evidence available in literature regarding unsuccessful labor induction with misoprostol in full-term pregnancies. Methods This is an integrative review, carried out between January and November 2022, whose research question and descriptors were outlined using the PECO strategy. The searches were carried out in the MEDLINE, Web of Science, CINAHL, EMBASE and Scopus databases by two researchers independently as well as assessment. For the study selection and identification phase, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. The risk of bias assessment of included articles was carried out using the Newcastle-Ottawa Scale. Results A total of 3,674 articles were identified, and 84 were read in full, of which 11 comprised the review (n=9,010 pregnant women), published between 2005 and 2021, with the majority in the United States. Regarding the level of evidence, all articles were classified as 2b, assessed according to the design of each study. The study showed evidence regarding the following factors: High BMI (greater than 30 kg/m2), nulliparity, immature bishop, cervical length (greater than 30 mm), height, ethnicity (non-Caucasians from southern Europe) and fetal weight (greater equal to 4 kg). Conclusion The objective study was achieved, having demonstrated six maternal factors and one fetal factor that can lead to unsuccessful induction. It is worth highlighting the need for evidence that incorporates the individuality of each characteristic and the contribution of this study to support the choice of the best conduct for each pregnancy on an individual basis stands out.
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Humans , Female , Pregnancy , Misoprostol , Delivery, Obstetric , Pregnant Women , Term Birth , Labor, Induced , Review Literature as TopicABSTRACT
Abstract Objectives: to determine efficiency and safety of three misoprostol regimens for 2nd trimester pregnancy termination in individuals with two or more cesarean section scars. Methods: a cross-sectional study included 100 pregnant ladies at 13th-26th weeks gestation with previous two cesarean sections (CSs) who were scheduled for pregnancy termination using misoprostol. Patients were conveniently assigned to 100µg/3h, 200µg/3h or 400 µg/3h regimens. Primary outcome was time to abortion, secondary outcomes were side effect and complications. Results: a significant association was found between number previous CSs and longer time to abortion (p=0.01). A highly significant association was identified between earlier gestational age and longer time to abortion (p<0.001). Lower side effects and complications were associated with 200 µg misoprostol every 3 hours of (p<0.001). Incomplete abortion was the most frequent recorded complication for the successive doses of misoprostol. Conclusions: misoprostol is an effective drug at low doses for pregnancy termination in women with prior two or more caesarean sections. However, its safety needs monitoring of the patient in the hospital to decrease morbidity and mortality behind its use.
Resumo Objetivos: determinar a eficiência e segurança de três regimes de misoprostol para interrupção da gravidez no segundo trimestre em indivíduos com duas ou mais cicatrizes de cesariana. Métodos: um estudo transversal incluiu 100 gestantes entre 13ª e 26ª semanas de gestação com duas cesarianas (CEs) anteriores que foram agendadas para interrupção da gravidez com uso de misoprostol. Os pacientes foram convenientemente designados para regimes de 100 µg/3 horas, 200 µg/3 horas ou 400 µg/3 horas. O desfecho primário foi o tempo para o aborto, os desfechos secundários foram efeitos colaterais e complicações. Resultados: foi encontrada associação significativa entre o número de cesáreas anteriores e o maior tempo até o aborto (p=0,01). Foi identificada associação altamente significativa entre idade gestacional mais precoce e maior tempo para abortar (p<0,001). Menores efeitos colaterais e complicações foram associados com 200 µg de misoprostol a cada 3 horas (p<0,001). O aborto incompleto foi a complicação mais frequente registrada para as doses sucessivas de misoprostol. Conclusões: o misoprostol é um medicamento eficaz em doses baixas para interrupção da gravidez em mulheres com duas ou mais cesarianas anteriores. Porém, sua segurança necessita de monitoramento do paciente no hospital para diminuir a morbimortalidade por trás de seu uso.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Trimester, Second , Misoprostol/administration & dosage , Abortion, Induced , Cesarean Section, Repeat , Cross-Sectional StudiesABSTRACT
SUMMARY OBJECTIVE: The aim of this study was to evaluate the success rate and predictors of labor induction using vaginal misoprostol in a low-risk pregnant women population. METHODS: A prospective cohort study was carried out with 196 pregnant women. Groups 2 and 4 of the Robson Classification admitted for induction of labor with vaginal misoprostol (25 μg tablets every 6 h, up to 4 tablets, for a maximum of 24 h). The success of labor induction was considered the achievement of vaginal delivery. Binary logistic regression was used to determine the best predictors of successful induction of labor with vaginal misoprostol. RESULTS: Of all the pregnant women analyzed, 140 (71.4%) were successful and 56 (28.6%) were unsuccessful. Pregnant women who achieved successful induction had a higher number of pregnancies (1.69 vs. 1.36, p=0.023), a higher number of deliveries (0.57 vs. 0.19, p<0.001), a higher Bishop score (2.0 vs. 1.38, p=0.002), and lower misoprostol 25 μg tablets (2.18 vs. 2.57, p=0.031). No previous deliveries [x2(1)=3.14, odds ratio (OR): 0.24, 95% confidence interval (CI): 0.10-0.57, R2 Nagelkerke: 0.91, p=0.001] and the presence of one previous delivery [x2(1)=6.0, OR: 3.40, 95% CI: 1.13-10.16, R2 Nagelkerke: 0.043, p=0.029] were significant predictors of successful induction of labor with vaginal misoprostol. CONCLUSION: A high rate of labor induction success using vaginal misoprostol in a low-risk population was observed, mainly in multiparous and with gestational age>41 weeks. No previous delivery decreased the success of labor induction, while one previous delivery increased the success of labor induction.
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Resumen El estudio tuvo como objetivo explorar la experiencia y significados de la Interrupción Legal del Embarazo (ILE) con medicamentos, en nueve mujeres jóvenes habitantes de la Ciudad de México y Zona Metropolitana. Desde una postura fenomenológica, se empleó una metodología interpretativa. Con la técnica de la entrevista en profundidad, se recuperaron las narraciones de las mujeres sobre el proceso del aborto. Los resultados indican que el método medicamentoso supone una alternativa aceptable y ventajosa para la resolución del aborto. Sin embargo, también puede generar situaciones imprácticas e incómodas, e incluso resultar en complicaciones cuando se realiza con misoprostol y sin mifepristona. El contexto de legalidad conlleva consecuencias prácticas y simbólicas en la experiencia de aborto, y el acompañamiento y apoyo de otras personas es muy relevante en cómo se vive y significa esta práctica.
Abstract The objective of the study was to explore the experience and meanings of the Legal Interruption of Pregnancy (LIP) with medication, in nine young women living in Mexico City and the Metropolitan Area. From a phenomenological position, an interpretive methodology was used. Using the in-depth interview technique, the women's narratives about the abortion process were recovered. The results indicate that the medical procedure is an acceptable and advantageous method for abortion. However, it can also lead to impractical and uncomfortable situations, and even result in complications when only misoprostol is used without mifepristone. The context of legality results in practical and symbolic consequences in the abortion experience. Accompaniment and support from other people are very relevant in both the experience and meaning of abortion.
Resumo O objetivo do estudo foi explorar a experiência e os significados da interrupção legal da gravidez (ILE) com medicação entre nove mulheres jovens que vivem na Cidade do México e em sua área metropolitana. A partir de uma perspectiva fenomenológica, foi utilizada uma metodologia interpretativa. Usando a técnica de entrevista em profundidade, foram coletadas as narrativas das mulheres sobre o processo de aborto. Os resultados indicam que o método médico é uma alternativa aceitável e vantajosa para a resolução do aborto. No entanto, ele também pode gerar situações impraticáveis e desconfortáveis, e até mesmo resultar em complicações quando realizado com misoprostol e sem mifepristona. O contexto da legalidade tem consequências práticas e simbólicas para a experiência do aborto, e o acompanhamento e o apoio de outras pessoas são muito relevantes para a forma como essa prática é vivenciada e significada.
Subject(s)
Humans , Female , Adult , Abortion, Induced , Social Support , Women's Health Services , Misoprostol , Abortion , Family SupportABSTRACT
SUMMARY OBJECTIVE: The aim of the study was to compare two labor induction regimens (4 and 6 h), to determine predictors of successful labor induction with intravaginal misoprostol 25 μg tablets, and to evaluate the association with adverse perinatal outcomes. METHODS: This was a retrospective cohort study that included singleton pregnancies undergoing induction of labor with an intravaginal misoprostol 25 μg tablet between 37 and 42 weeks of gestation. The pregnant women were divided into two groups: Group 1—intravaginal misoprostol 25 μg every 4 h and Group 2—intravaginal misoprostol 25 μg every 6 h. RESULTS: Pregnant women were divided into Group 1 (n=289) and Group 2 (n=278). Group 1 had a higher median number of intravaginal misoprostol 25 μg tablets (3.0 vs. 2.0 tablets, p<0.001), a lower prevalence of postpartum hemorrhage (7.6 vs. 32.7%, p<0.001), and a higher need for oxytocin (odds ratio [OR]: 2.1, 95%CI: 1.47-2.98, p<0.001) than Group 2. Models including intravaginal misoprostol 25 μg tablets every 4 and 6 h [x2(1)=23.7, OR: 4.35, p<0.0001], parity [x2(3)=39.4, OR: 0.59, p=0.031], and Bishop's score [x2(4)=10.8, OR: 0.77, p=0.019] were the best predictors of failure of labor induction. A statistically significant difference between groups was observed between the use of the first intravaginal misoprostol 25 μg tablet at the beginning (Breslow p<0.001) and the end of the active labor phase (Long Hank p=0.002). CONCLUSION: Pregnant women who used intravaginal misoprostol 25 μg every 4 h had a longer time from the labor induction to the beginning of the active phase of labor and higher rates of adverse perinatal outcomes than women who used intravaginal misoprostol 25 μg every 6 h.
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RESUMEN La disponibilidad de medicamentos para producir un aborto, sobre todo en contextos de acceso restringido, transformó las prácticas y permitió que las propias mujeres y/o sus organizaciones comunitarias ayuden a otras mujeres a abortar, interactuando o no con el sistema de salud. Este estudio recupera la experiencia de una organización feminista de la comunidad que, desde la provincia de Neuquén, se extiende a todo el país, generando una red de cuidados comunitarios. Se realizó un estudio exploratorio descriptivo, con enfoque cualitativo con el propósito de analizar las experiencias de las mujeres que facilitan el acceso al aborto permitido en Argentina. A través de entrevistas en profundidad a tres líderes de la colectiva feminista La Revuelta y de entrevistas semiestructuradas a 33 integrantes de las grupas socorristas, realizadas entre noviembre de 2019 y diciembre de 2020, describimos su historia y los procesos de trabajo y crecimiento; exploramos sus motivaciones y sentimientos y caracterizamos las interacciones de dichas organizaciones con los sistemas de salud público y privado. Los resultados de este trabajo coinciden con la conversación y la producción bibliográfica internacional acerca de estas organizaciones y sus particularidades y con la necesidad de incorporar estos cuidados a los sistemas de salud institucionales.
ABSTRACT The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.
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Background: Induction of labor at any time before the spontaneous onset of labor is indicated when the benefits of termination of pregnancy for the mother and fetus outweigh the benefits of continued pregnancy. The aim of this study was to compare the effect of vaginal misoprostol alone and in combination with evening primrose capsule on the course of labor in pregnant women candidates for termination of pregnancy. Methods: In this double-blind randomized clinical trial, 30 pregnant women were candidates for termination of pregnancy. At the time of referral, the examination was performed to calculate the bishop score (primary outcome) and the partograph was recorded and plotted once every hour until the end of labor. Length of active phase of labor (from dilatation 3-6 cm to birth), type of labor, Apgar score of the first and fifth minute of the baby and volume of postpartum hemorrhage and pain intensity every 30 minutes was recorded in two groups for up to 2 hours using a ruler. Results: The mean length of the latent labor phase in the misoprostol and evening primrose groups was 9.07±0.96 and in the misoprostol group was 10.13±0.83 hours and this difference was significant. There was no significant difference in bishop score between the two groups at the beginning of the study but after the intervention was significant. Conclusions: Our study showed that using evening primrose oil capsule instead of misoprostol is effective in induction of labor.
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Abstract Objective To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. Data sources The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Selection of studies Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data collection Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. Data synthesis When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. Conclusion Misoprostol has been determined as a safe option with good acceptance by patients.
Resumo Objetivo Avaliar a eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto. Fontes de dados Os bancos de dados PubMed, Scopus, Embase, Web of Science, Cochrane Library e bancos de dados de Ensaios Clínicos (clinicaltrials.gov) foram pesquisados para os artigos relevantes, e estratégias de busca foram desenvolvidas usando uma combinação de termos temáticos de Medical Subject Headings e palavras de texto. A última pesquisa foi realizada em 4 de julho de 2022. Nenhuma restrição de idioma foi aplicada. Seleção dos estudos Foram incluídos ensaios clínicos randomizados com pacientes com idade gestacional até 6/7 semanas com diagnóstico de aborto incompleto e que foram manejadas com pelo menos um dos três tipos de tratamento estudados. Um total de 8.087 estudos foram selecionados. Coleta de dados Os dados foram sintetizados usando o pacote estatístico Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). Para resultados dicotômicos, o odds ratio (OR, na sigla em inglês) e o intervalo de confiança (IC) de 95% foram derivados para cada estudo. A heterogeneidade entre os resultados do ensaio foi avaliada usando o teste padrão, estatística I2. Síntese dos dados Ao comparar misoprostol com aspiração a vácuo médico (MVA, na sigla em inglês), a taxa de aborto completo foi maior no grupo MVA (OR = 0,16; IC95% = 0,07-0,36). Hemorragia ou sangramento intenso foi mais comum no grupo do misoprostol (OR = 3,00; 95%CI = 1,96-4,59), mas a dor após o tratamento foi mais comum em pacientes tratados com MVA (OR = 0,65; 95%CI = 0,52-0,80). Não foram observadas diferenças estatisticamente significativas na aceitabilidade geral dos tratamentos. Conclusão O misoprostol tem se mostrado uma opção segura e com boa aceitação pelos pacientes.
Subject(s)
Humans , Female , Pregnancy , Misoprostol/therapeutic use , Curettage , AbortionABSTRACT
Background: The MTP (Amendment) Act 2021 has allowed termination of pregnancy up to 24 weeks on only certain indications. Decision of two medical practitioners are required for termination beyond 20 weeks. Misoprostol is one drug used for medical termination of pregnancy. It can be used alone in single or multiple doses, or in combination with other drugs. The study was undertaken to determine the efficacy of a single dose of 800 ?g of misoprostol in the first trimester pregnancy termination.Methods: It was a cross-sectional study conducted among 124 women in the first trimester who were undergoing termination of pregnancy. After administering 800 ?g of misoprostol vaginally, participants were kept under observation for 48 hours. Data were collected and analysed.Results: Around half of the participants (56.4%) expelled the conceptus completely by 12 hours, 78.2% by 48 hours. Seven (5.6%) out of those 27 failed cases were given further doses of misoprostol, while in the remaining 20 (16.1%), surgical intervention was undertaken.Conclusions: The efficacy of a single dose of misoprostol for 1st trimester termination of pregnancy varies widely from study to study, but, the efficacy increases with adding further doses of the same drug or addition of mifepristone. Misoprostol is a safe, cost effective, and reasonable drug for the termination of pregnancy in first trimester.
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Background: This study was done to compare two dosing schedules of tablet misoprostol single dose 600 µg (M600) versus multiple doses 400 µg (M400), kept per vaginally for second termination of pregnancy and to analyze induction to abortion time, side effects, and failure to achieve termination of pregnancy.Methods: Women admitted for second-trimester pregnancy termination were considered. Inclusion and exclusion criteria were followed. The women were randomized into two groups, with one group receiving single dose of M600 per vaginal and the other one multiple doses of M400, and the two groups were compared in their outcomes.Results: In the present study no statistical significance was found between the two dosing regimens with regard to induction abortion interval, post-expulsion need for suction, and evacuation.Conclusions: The study revealed that the dose between M400 and M600 has not shown significance compared with two dosing regimens. Single dose M600 can be considered for second-trimester pregnancy termination due to better compliance.
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Background: This study was done to compare two dosing schedules of tablet misoprostol single dose 600 µg (M600) versus multiple doses 400 µg (M400), kept per vaginally for second termination of pregnancy and to analyze induction to abortion time, side effects, and failure to achieve termination of pregnancy.Methods: Women admitted for second-trimester pregnancy termination were considered. Inclusion and exclusion criteria were followed. The women were randomized into two groups, with one group receiving single dose of M600 per vaginal and the other one multiple doses of M400, and the two groups were compared in their outcomes.Results: In the present study no statistical significance was found between the two dosing regimens with regard to induction abortion interval, post-expulsion need for suction, and evacuation.Conclusions: The study revealed that the dose between M400 and M600 has not shown significance compared with two dosing regimens. Single dose M600 can be considered for second-trimester pregnancy termination due to better compliance.
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Background: Aim of study was to compare effectiveness, adverse effects and patient’s acceptability of buccal and vaginal routes of administration of misoprostol in 1st and 2nd trimester abortion, type of study-randomized control trialMethods: A total of 200 women with indications for abortion up to 20 weeks of pregnancy were enrolled over a period of 1 year and received misoprostol either through buccal (Group A) or vaginal (Group B) route. Each group containing 50 patients of first trimester and second trimester.Results: Incomplete abortion rate (25%) was significantly higher in vaginal group while drug related side-effects (47%), patients’ satisfaction and acceptability (82%) was higher in buccal group respectively.Conclusions: Buccal route may be preferred owing to a better complete abortion rate, better patient satisfaction and acceptability as compared to vaginal route.