Laminaria tent versus Misoprostol for cervical ripening before surgical process in missed abortion.

OBJECTIVE: To compare the efficacy of Laminaria tents with Misoprostol for cervical ripening before surgical process in missed abortion. METHOD: In a prospective study, 70 women with missed abortion were assigned to have either insertion of a 3 mm intracervical Laminaria tent (n = 35) or vaginal Misoprostol 400 µg (n = 35) on the day prior to suction dilation and curettage (D/C). The women were interviewed just prior to the D/C with regard to pain, vaginal bleeding, and cervical dilator preference. RESULT: Cervical dilation was greater in the Laminaria group but not significantly different from that in the Misoprostol group. However, additional cervical dilation before D/C was required in more patients in the Misoprostol group (45.7 vs 14.3%, P = 0.001). Women who received Laminaria reported significantly more pain at the time of insertion (62.8% in Laminaria group vs 22.8% in Misoprostol group) compared with women who received Misoprostol. Conversely, Misoprostol was associated with more nausea, vomiting, diarrhea and vaginal bleeding. CONCLUSIONS: Laminaria tents are more effective cervical dilators than vaginal Misoprostol when inserted the day prior to suction D and C. Vaginal Misoprostol insertion is more comfortable, although it is associated with an increased risk of vaginal bleeding.

Efficacy of tranexamic acid in reducing blood loss after cesarean section.

AIM: To assess the efficacy and safety of tranexamic acid in reducing blood loss at caesarian section (CS). METHOD: A prospective randomised study conducted on 90 primiparas divided into two groups who underwent CS. The study group, 45 women, received tranexamic acid immediately before CS, whereas the control group, 45 women received placebo. Blood loss volume was measured from the end of CS to 2 h postpartum and compared between the two groups. Hemoglobin (Hb) and hematocrit (Hct) were tested 24 h after CS and compared between the two groups. RESULTS: Tranexamic acid significantly reduced the blood loss from the end of CS to 2 h postpartum; 28.02 +/- 5.53 mL in the tranexamic group versus 37.12 +/- 8.97 mL in the control group (p = 0.000). Hb 24 h after CS was significantly greater in tranexamic group than control group (12.57 +/- 1.33 in the tranexamic group and 11.74 +/- 1.14 in the control group, p = 0.002). No complications or side effects were reported in either group. CONCLUSIONS: Tranexamic acid statistically reduces blood loss from end to 2 h after CS and its use was not associated with any side effects or complications. Consequently, tranexamic acid can be used safely and effectively to reduce bleeding resulting from CS.