Sublingual vs vaginal misoprostol for completion of first trimester missed abortion: a randomised controlled trial.

OBJECTIVE: The study aimed to compare the efficacy and safety of sublingual and vaginal misoprostol for termination of pregnancy in women with first trimester missed abortion. METHODS: A single-blind, parallel group, randomised clinical trial (ClinicalTrials.gov NCT02686840) was conducted in a university hospital between 1 February 2016 and 31 January 2017. All women who presented with first trimester missed abortion were invited to participate in the study and were randomised to one of two groups: one group received sublingual misoprostol in three doses of 800 µg every 4 h, while a second group received vaginal misoprostol in the same dosage regimen. The primary outcome of the study was the rate of complete abortion within 7 days after initiation of treatment. RESULTS: The study included 200 women (100 in each arm). By day 7, successful complete abortion was significantly more frequent in the sublingual misoprostol group (71.4%) than in the vaginal misoprostol group (51.5%) (p = .006). By day 30, the rate of complete abortion was higher in the sublingual misoprostol group (90.6%) than in the vaginal misoprostol group (83.9%), but with no statistically significant difference (p = .164). The mean length of the induction-expulsion interval in the sublingual misoprostol group was significantly shorter compared with the vaginal misoprostol group (12.3 ± 3.1 h vs 16.4 ± 4.2 h, respectively; p = .001) and the sublingual misoprostol group had a smaller drop in haemoglobin level (p = .001). The side effects of misoprostol were significantly more frequent in the sublingual group compared with the vaginal group. CONCLUSION: Sublingual misoprostol is more effective than vaginal misoprostol in completing first trimester missed abortion, with a shorter induction-expulsion time. Sublingual misoprostol is, however, associated with more side effects, such as unpleasant taste, gastrointestinal symptoms and fever, compared with vaginal misoprostol.

Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study.

BACKGROUND/OBJECTIVE: The purpose of this study is to evaluate the cases of lower urinary tract injuries during cesarean section with or without hysterectomy in cases with morbid placental adherence. METHODS: This record based retrospective study was conducted at Ain Shams University Maternity Hospital in Cairo, Egypt during the period between January 2014 and December 2016. It included all patients who had urinary tract injuries during cesarean section with or without hysterectomy in the cases with morbid placental adherence and they were collected from files of pregnant women who were admitted at hospital planned for termination of pregnancy. Patients were enrolled in four groups, Group 1: cases without urinary tract injuries. Group 2: cases with injuries to the bladder. Group 3: cases with injuries of the ureter. Group 4: cases with injuries to the bladder and ureter. RESULTS: This study gave us new information about the incidence of urinary tract injuries during cesarean section with morbid adherence placenta was 21.7% (Bladder 11.7%, Ureter 4.7%, and bladder with ureter 5.3%). There were various types of repair of urinary tract injury, as the following, bladder repair 10.8%, ureteric catheterization 0.9%, ureterovesical repair or reimplantation 1.5%, bladder repair and ureterovesical 1.2%, bladder repair and ureteric catheterization 2.3%, ureteric catheterization and ureterovesical 1.5 and 6.4% of cases needed urologic consultations. There is a real relation between urinary tract injury and obesity (55.3%). Bladder invasion was found in only 26.9% of all cases according to sonography findings. Most of the cases were delivered by cesarean section in 67.5%, and the remainders were delivered by cesarean hysterectomy 32.5%. About 96.5% of cases needed a blood transfusion. CONCLUSIONS: The morbid adherent placenta is still a challenge, which faces us as obstetricians, due to high morbidity and mortality. A multidisciplinary team is mandatory to avoid complications.

Five-dimensional long bones biometry for estimation of femur length and fetal weight at term compared to two-dimensional ultrasound: a pilot study.

BACKGROUND/OBJECTIVE: This study aimed to evaluate accuracy of five-dimensional long bones (5D LB) compared to two-dimensional ultrasound (2DUS) biometry to predict fetal weight among normal term women. METHODS: Fifty six normal term women were recruited at Ain Shams Maternity Hospital, Egypt from 14 May to 30 November 2015. Fetal weight was estimated by Hadlock's IV formula using 2DUS and 5D LB. Estimated fetal weights (EFW) by 2DUS and 5D LB were compared with actual birth weights (ABW). RESULTS: Mean femur length (FL) was 7.07 ± 0.73 cm and 6.74 ± 0.67 cm by 2DUS and 5D LB (p = .02). EFW was 3309.86 ± 463.06 g by 2DUS and 3205.46 ± 447.85 g by 5D LB (p = .25). No statistical difference was observed between ABW and EFW by 2DUS (p = .7) or 5D LB (p = .45). Positive correlation was found between EFW by 2DUS, 5D LB, and ABW (r = 0.67 and 0.7; p < .001). There was strong agreement between FL measured by 2DUS and 5D LB (ICC = 0.78), and perfect agreement between EFW by 2DUS and EFW by 5D LB (ICC = 0.918). 2DUS and 5D LB showed mean absolute percentage error for EFW of 10 ± 7% and 8 ± 7% compared to ABW (p = .15). CONCLUSIONS: 2DUS and 5D LB had same accuracy for fetal weight estimation at normal term pregnancy.