A pilot study of pre-operative misoprostol in reducing operative blood loss during hysterectomy.

OBJECTIVE: To investigate the effectiveness of a single pre-operative dose of sublingual misoprostol on reducing blood loss in abdominal hysterectomies performed for symptomatic uterine leiomyomas. STUDY DESIGN: A cohort of 64 women undergoing total abdominal hysterectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of sublingual 400 mcg misoprostol (n=32) or placebo containing 20mg vitamin B(6) (n=32) 30 min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were requirement for blood transfusion, change in haemoglobin level after operation, and the incidence of side effects. RESULTS: Women who had misoprostol were found to have similar operative blood loss to those who had placebo (570.9 ± 361.3 ml versus 521.4 ± 297.4 ml, for misoprostol and placebo group respectively; P=0.803). This study with a sample size of 64 was sufficient to have 80% power at the 5% level of significance to detect a reduction of blood loss greater than or equal to 30%. There were no observed differences in the need for post-operative blood transfusion (25% versus 15.6%, for misoprostol and placebo group respectively; P=0.536), the change in haemoglobin level after the operation, and the side effects profiles between the two groups. CONCLUSION: A single pre-operative dose of sublingual misoprostol is not effective in reducing intra-operative blood loss and need for post-operative blood transfusion after total abdominal hysterectomies for symptomatic uterine leiomyomas.

Potential use of the adenosine triphosphate cell viability assay in endometrial cancer.

OBJECTIVE: Adenosine triphosphate cell viability assay (ATP-CVA) was used previously to evaluate chemotherapy in uterine cancer cell lines. In this study, we have performed the ATP-CVA on endometrial cancer patients to study the feasibility of using ATP-CVA in endometrial cancer to determine the intrinsic chemosensitivity of the cytotoxic drugs. METHODS: Thirty-three patients with endometrial adenocarcinoma who presented for a staging operation were recruited. Endometrial cancer samples were obtained at the time of operation. In vitro ATP-CVA and chemosensitivity testing was performed using cisplatin, carboplatin, paclitaxel, etoposide, doxorubicin, 4-epidoxorubicin, and topotecan. RESULTS: Thirty-two of the 33 endometrial cancer samples were evaluable for SF50 (survival fraction at 50% of the peak plasma concentration [PPC]) using ATP-CVA. The median SF50 of carboplatin (0.33) was significantly less than the median SF50 of cisplatin (0.71), topotecan (0.93), paclitaxel (0.68), doxorubicin (1.0), etoposide (0.70), or 4-epidoxorubicin (0.88) (Wilcoxon signed rank test, P <.001). CONCLUSION: This study showed the feasibility of using the ATP-CVA in endometrial cancer to determine the intrinsic chemosensitivity of cytotoxic drugs.

A pilot study on the acceptability of levonorgestrel-releasing intrauterine device by young, single, nulliparous Chinese females following surgical abortion.

This study investigated the acceptability of the levonorgestrel-releasing intrauterine device (LNG-IUS) as contraception among young, single women after termination of pregnancy. Twenty subjects, with a median age of 21 years, had LNG-IUS inserted immediately after suction termination of first-trimester pregnancy. The subjects were followed-up at 6 weeks, 3 months, 6 months and 12 months. Fifteen subjects (75%) had other pregnancies terminated in the past. There were no serious complications or pregnancies. The acceptability of the LNG-IUS was generally above 86% during each follow-up visit. A total of seven (35%) subjects were lost to follow-up at different periods of the study. Overall, four subjects (22%) had the LNG-IUS removed. Nine subjects were seen at the end of the 1-year study period and all continued with the LNG-IUS for contraception. Side effects were commonly observed and irregular vaginal bleeding was the most common. We conclude that the LNG-IUS may be an acceptable method among selective young, single, nulliparous clients after termination of pregnancy and could be offered as an option of contraception to them. However, the small sample size and the high lost-to-follow-up rate are the major limitations of this study.

A study of the efficacy of cervical ripening with nitric oxide donor versus placebo for cervical priming before second-trimester termination of pregnancy.

This was a double-blind randomized control study to evaluate the efficacy of cervical priming by nitric oxide donor before second-trimester induced abortion. One-hundred healthy women with a singleton pregnancy between 14 and 20 weeks of gestation were randomized into either 40 mg isosorbide mononitrate or placebo, given intravaginally 12 h before induction. This was followed by intravaginal misoprostol induction. The induction-abortion interval, abortion rate, side effects and the woman's acceptability of the priming agent were recorded. All women completed the study and there was no severe complication recorded. There was no significant difference in the induction-abortion interval and abortion rate between the two groups. Isosorbide mononitrate group reported significantly more side effects of headache. More than 90% of the women in both groups found the priming agent acceptable. The application of intravaginal nitric oxide donors prior to the prostaglandins induction did not significantly improve the second-trimester induced-abortion process.

A study of co-treatment of nonsteroidal anti-inflammatory drugs (NSAIDs) with misoprostol for cervical priming before suction termination of first trimester pregnancy.

This double-blind randomized control study was conducted to evaluate whether a nonsteroidal anti-inflammatory drug (NSAID) could act as an effective pain control method during first trimester suction abortion, and whether co-treatment of NSAID with misoprostol will decrease the efficacy of the cervical ripening effect of misoprostol. Subjects were randomized to receive misoprostol alone or misoprostol together with diclofenac sodium. Both groups of subjects suffered from similar incidence of preoperative side effects. Co-treatment of NSAID with misoprostol did not attenuate the cervical ripening efficacy of misoprostol. There was no significant pain reduction in the group treated with NSAID, except that a marginal benefit was found in the subgroup of multiparous women. About two thirds of the subjects in both treatment groups found that this was a satisfactory pain relief method during the procedure.