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1.
BMC Complement Med Ther ; 20(1): 145, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32397980

RESUMO

BACKGROUND: Myrrh (Commiphora myrrha (Nees) Engl.) has a long history of traditional use as a herbal medicine for different purposes. In ancient traditional Persian manuscripts, it has been noted that myrrh may act as uterine stimulant and probably cause complete abortion. However, there is no evidence to verify this comment. Therefore, the current study was carried out to evaluate the efficacy and safety of Myrrh in the treatment of incomplete abortion. MATERIALS AND METHODS: In a randomized double-blinded placebo controlled clinical trial, 80 patients with ultrasound-documented retained products of conception (RPOC) were assigned to receive capsules containing 500 mg of Myrrh oleo-gum-resin or a placebo three times a day for 2 weeks. The existence of the retained tissue and its size were evaluated by ultrasound examination at the beginning and end of the study. RESULTS: After 2 weeks, the mean diameter of the RPOC in the Myrrh group was significantly reduced compared with the placebo group (P < 0.001). Meanwhile, the rate of successful complete abortion was 82.9% in the intervention group and 54.3% in the placebo group (P = 0.01). The patients in both groups reported no serious drug-related adverse effects. CONCLUSION: This study shows that Myrrh is effective and safe in the resolution of the RPOC and may be considered as an alternative option for treatment of patients with incomplete abortion. However, further studies on active compounds isolated from myrrh and their uterine stimulant effects are needed. TRIAL REGISTRATION: This study was retrospectively registered at Iranian Registry of Clinical Trials (www.irct.ir) IRCT code: IRCT20140317017034N7.


Assuntos
Aborto Incompleto/tratamento farmacológico , Resinas Vegetais/administração & dosagem , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Adulto Jovem
2.
Niger J Clin Pract ; 23(5): 638-646, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367870

RESUMO

Background: Manual vacuum aspiration is a safe and effective technology for the treatment of incomplete miscarriage but it is not widely available and affordable in rural areas particularly in low-resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of incomplete miscarriage. Aim: To compare the effectiveness, client acceptability and satisfaction, and cost-effectiveness of misoprostol with manual vacuum aspiration for the treatment of the first-trimester incomplete miscarriage. Subjects and Methods: This study was conducted between February 1, 2018 and August 31, 2018 at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. 100 participants were randomized to treatment with either manual vacuum aspiration or 600 µg oral misoprostol. The main outcome measures assessed at 1-week follow-up were complete uterine evacuation, client acceptability and satisfaction, and cost-effectiveness. Data were analyzed using SPSS version 25. Sociodemographic characteristics, treatment outcomes and other variables were summarized by descriptive statistics. Chi-square test was used for comparison between groups as regard categorical data while Student's't' test was used for comparison between groups for continuous data. P value of <0.05 was regarded as statistically significant. Results: There was a higher failure rate in the misoprostol arm when compared with MVA. Although this difference in complete uterine evacuation rate did not reach statistical significance (81.3% versus 95.7%, RR = 4.3, 95% CI 0.98-18.9, P value = 0.05), more participants in the misoprostol arm would choose the method again when compared with women in the MVA group (47 versus 30, X[2] = 16.95, P < 0.001). The mean client satisfaction score was significantly higher among women in the misoprostol arm compared to MVA group (13.2 (2.1) versus 7.3 (4.6), P < 0.001). The mean cost of primary treatment was higher in the MVA group compared with misoprostol arm ($67.8 (8.9) versus 14.4 (4.0), P < 0.001). There was no significant difference in the mean cost of repeat uterine evacuation in both study arms (MVA, $64.9 (6.3) versus misoprostol, $65.76 (6.6), P = 0.86). Conclusion: Although medical treatment was associated with a higher failure rate, there was no statistically significant difference in the effectiveness of both treatment methods. However, medical treatment was associated with higher client acceptance and satisfaction and was more cost-effective than surgical treatment.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Aborto Incompleto/cirurgia , Misoprostol/uso terapêutico , Curetagem a Vácuo/métodos , Abortivos não Esteroides/administração & dosagem , Administração Oral , Adulto , Feminino , Humanos , Misoprostol/administração & dosagem , Nigéria , Satisfação do Paciente , Gravidez , Primeiro Trimestre da Gravidez , Resultado do Tratamento
3.
BMC Pregnancy Childbirth ; 19(1): 443, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775677

RESUMO

BACKGROUND: Early pregnancy failure (EPF) is a common complication of pregnancy. If women do not abort spontaneously, they will undergo medical or surgical treatment in order to remove the products of conception from the uterus. Curettage, although highly effective, is associated with a risk of complications; medical treatment with misoprostol is a safe and less expensive alternative. Unfortunately, after 1 week of expectant management in case of EPF, medical treatment with misoprostol has a complete evacuation rate of approximately 50%. Misoprostol treatment results may be improved by pre-treatment with mifepristone; its effectiveness has already been proven for other indications of pregnancy termination. This study will test the hypothesis that, in EPF, the sequential combination of mifepristone with misoprostol is superior to the use of misoprostol alone in terms of complete evacuation (primary outcome), patient satisfaction, complications, side effects and costs (secondary outcomes). METHODS: The trial will be performed multi-centred, prospectively, two-armed, randomised, double-blinded and placebo-controlled. Women with confirmed EPF by ultrasonography (6-14 weeks), managed expectantly for at least 1 week, can be included and randomised to pre-treatment with oral mifepristone (600 mg) or oral placebo (identical in appearance). Randomisation will take place after receiving written consent to participate. In both arms pre-treatment will be followed by oral misoprostol, which will start 36-48 h later consisting of two doses 400 µg (4 hrs apart), repeated after 24 h if no tissue is lost. Four hundred sixty-four women will be randomised in a 1:1 ratio, stratified by centre. Ultrasonography 2 weeks after treatment will determine short term treatment effect. When the gestational sac is expulsed, expectant management is advised until 6 weeks after treatment when the definitive primary endpoint, complete or incomplete evacuation, will be determined. A sonographic endometrial thickness < 15 mm using only the allocated therapy by randomisation is considered as successful treatment. Secondary outcome measures (patient satisfaction, complications, side effects and costs) will be registered using a case report form, patient diary and validated questionnaires (Short Form 36, EuroQol-VAS, Client Satisfaction Questionnaire, iMTA Productivity Cost Questionnaire). DISCUSSION: This trial will answer the question if, in case of EPF, after at least 1 week of expectant management, sequential treatment with mifepristone and misoprostol is more effective than misoprostol alone to achieve complete evacuation of the products of conception. TRIAL REGISTRATION: Clinicaltrials.gov (d.d. 02-07-2017): NCT03212352. Trialregister.nl (d.d. 03-07-2017): NTR6550. EudraCT number (d.d. 07-08-2017): 2017-002694-19. File number Commisie Mensgebonden Onderzoek (d.d. 07-08-2017): NL 62449.091.17.


Assuntos
Abortivos não Esteroides/uso terapêutico , Abortivos Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Aborto Incompleto/diagnóstico por imagem , Adolescente , Adulto , Análise Custo-Benefício , Método Duplo-Cego , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Mifepristona/administração & dosagem , Misoprostol/efeitos adversos , Estudos Multicêntricos como Assunto , Satisfação do Paciente , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia , Conduta Expectante , Adulto Jovem
4.
Glob Health Sci Pract ; 7(Suppl 2): S247-S257, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31455622

RESUMO

INTRODUCTION: Unsafe abortion remains a problem in Rwanda, where abortion is highly restricted by law. To reduce mortality and morbidity from unsafe abortion, Rwanda implemented a national postabortion care (PAC) program in 2012, which included using misoprostol to treat incomplete abortion. Key components of PAC are offering and providing voluntary contraceptive methods and counseling on their use, but little is known about contraceptive uptake among PAC clients treated with misoprostol. The objectives of the current study were (1) to assess the contraceptive uptake of PAC clients treated with misoprostol, including whether extended bleeding hinders uptake; and (2) to assess providers' knowledge of contraception and their willingness to counsel PAC clients on contraception, provide methods, or refer for contraceptive services. METHODS: We surveyed 68 PAC clients treated with misoprostol and 43 providers (84% nurses) in 17 health facilities across 3 districts in Rwanda where misoprostol for PAC had been introduced recently. PAC clients were recruited into the study prior to facility discharge and surveyed between 10 days and 1 month after discharge. We asked PAC clients and providers about demographic characteristics and attitudes toward contraception. We also asked PAC clients about contraceptive counseling received and postabortion contraceptive uptake or reasons for nonuse, and providers about their knowledge about return to fertility, pregnancy and contraceptive counseling, practices related to contraceptive method provision, and their knowledge and potential biases about PAC clients using contraception. We used descriptive statistics for analysis. RESULTS: PAC clients were 19-46 years old, and most (69%) had at least 1 child. Almost all PAC clients (94%) reported being counseled on contraception, but only 47% reported choosing and receiving a method before being discharged from the facility. Nevertheless, by the time of the survey, 71% reported using a method. PAC clients' main reason for not using contraception was wanting to become pregnant. Only 1 woman reported nonuse because of bleeding. Among providers, more than half (56%) reported there are contraceptive methods PAC clients should never use and about a quarter (26%) reported incorrect information on when PAC clients' fertility could return. CONCLUSION: We found no evidence that bleeding associated with misoprostol for PAC influenced women's contraceptive uptake. However, as PAC programs expand to include misoprostol as a treatment option, accurate and high-quality postabortion contraception counseling and method provision at both treatment and follow-up visits must be strengthened.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Aborto Induzido , Aborto Espontâneo/tratamento farmacológico , Assistência ao Convalescente , Anticoncepção/estatística & dados numéricos , Misoprostol/uso terapêutico , Adulto , Anticoncepcionais/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Gravidez , Ruanda , Adulto Jovem
5.
Trials ; 20(1): 376, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31227019

RESUMO

BACKGROUND: A large proportion of abortion-related mortality and morbidity occurs in the second trimester of pregnancy. The Uganda Ministry of Health policy restricts management of second-trimester incomplete abortion to physicians who are few and unequally distributed, with most practicing in urban regions. Unsafe and outdated methods like sharp curettage are frequently used. Medical management of second-trimester post-abortion care by midwives offers an advantage given the difficulty in providing surgical management in low-income settings and current health worker shortages. The study aims to assess the safety, effectiveness and acceptability of treatment of incomplete second-trimester abortion using misoprostol provided by midwives compared with physicians. METHODS: A randomized controlled equivalence trial implemented at eight hospitals and health centers in Central Uganda will include 1192 eligible women with incomplete abortion of uterine size > 12 weeks up to 18 weeks. Each participant will be randomly assigned to undergo a clinical assessment and treatment by either a midwife (intervention arm) or a physician (control arm). Enrolled participants will receive 400 µg misoprostol administered sublingually every 3 h up to five doses within 24 h at the health facility until a complete abortion is confirmed. Women who do not achieve complete abortion within 24 h will undergo surgical uterine evacuation. Pre discharge, participants will receive contraceptive counseling and information on what to expect in terms of side effects and signs of complications, with follow-up 14 days later to assess secondary outcomes. Analyses will be by intention to treat. Background characteristics and outcomes will be presented using descriptive statistics. Differences between groups will be analyzed using risk difference (95% confidence interval) and equivalence established if this lies between the predefined range of - 5% and + 5%. Chi-square tests will be used for comparison of outcome and t tests used to compare mean values. P ≤ 0.05 will be considered statistically significant. DISCUSSION: Our study will provide evidence to inform national and international policies, standard care guidelines and training program curricula on treatment of second-trimester incomplete abortion for improved access. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03622073 . Registered on 9 August 2018.


Assuntos
Aborto Incompleto/tratamento farmacológico , Tocologia , Misoprostol/uso terapêutico , Médicos , Feminino , Humanos , Misoprostol/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Segundo Trimestre da Gravidez , Projetos de Pesquisa
6.
Chem Pharm Bull (Tokyo) ; 66(7): 708-713, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29657247

RESUMO

Abnormal uterine bleeding (AUB) induced by incomplete abortion is a common gynecological disease. Taohong Siwu decoction (TSD) is a traditional Chinese medicine (TCM) formula, which has been developed to treat AUB for hundreds of years. In this study, rats had incomplete abortion induced in early pregnancy using mifepristone and misoprostol. The duration and quantity of uterine bleeding were recorded and measured. The pathologic histologic grade was evaluated by hematoxylin-eosin staining (HE). Estradiol (E2) and progesterone (P) levels were measured by enzyme linked immunosorbent assays (ELISA). The expression levels of estrogen receptor alpha (ERα) and progesterone receptor (PR) were detected by immunohistochemistry and Western blotting analysis. We demonstrated that TSD significantly reduced the duration and quantity of uterine bleeding. Meanwhile, TSD promoted endometrial repair and significantly up-regulated the E2 levels and the ERα expression. These results suggest that TSD have a protective effect on the uteri; the mechanism may be concerned with up-regulation of the levels of E2 and the ERα expression.


Assuntos
Aborto Incompleto/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Hemorragia Uterina/tratamento farmacológico , Hemorragia Uterina/etiologia , Aborto Induzido/efeitos adversos , Animais , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Gravidez , Ratos , Ratos Sprague-Dawley
7.
Gynecol Endocrinol ; 34(7): 609-611, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29345165

RESUMO

Many Patients with persistent retained products of conception prefers to avoid surgical interventions, such as a dilatation and curettage (D&C) that might pose an additional future risk to their already compromised fertility or obstetric performance. The aim of this study was to the possibility of induced withdrawal bleeding following oral contraceptive administration as a non-surgical treatment for patients with persistent retained products of conception (RPOC). A retrospective study of patients presenting with retained products of conception (RPOC) after failed expectant management or after treatment with PGE1 was performed. Twelve women presenting with RPOC at ≤8 weeks gestation with minimal to mild vaginal bleeding and no signs of infection were treated with oral contraceptive pill (OCP) containing 0.03 mg ethinylestradiol and 0.15 mg of desogestrel for 3 weeks. Out of the 12 patients treated, nine women (75%) successfully expelled the RPOC after completing the three-week course of OCPs. The three cases (25%) that did not resolve following OCP treatment had pregnancy products with positive blood flow on Doppler examination. We conclude that OCPs may be a useful medical treatment option for persisting RPOC in selected patients with absence blood flow on Doppler examination wishing to avoid surgical intervention.


Assuntos
Aborto Incompleto/tratamento farmacológico , Comportamento de Escolha , Anticoncepcionais Orais Combinados/uso terapêutico , Desogestrel/uso terapêutico , Etinilestradiol/uso terapêutico , Aborto Incompleto/epidemiologia , Aborto Incompleto/etiologia , Aborto Induzido/efeitos adversos , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/tratamento farmacológico , Aborto Espontâneo/cirurgia , Adulto , Dilatação e Curetagem , Feminino , Humanos , Misoprostol/uso terapêutico , Projetos Piloto , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos , Comprimidos , Falha de Tratamento , Hemorragia Uterina/tratamento farmacológico , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
8.
Ultrasound Obstet Gynecol ; 51(1): 24-32, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29072372

RESUMO

OBJECTIVE: To compare vaginal misoprostol treatment with expectant management in early non-viable pregnancy with vaginal bleeding with regard to complete evacuation of the uterine cavity within 10 days after randomization. METHODS: This was a parallel randomized controlled, open-label trial conducted in Skåne University Hospital, Sweden. Patients with anembryonic pregnancy or early fetal demise (crown-rump length ≤ 33 mm) and vaginal bleeding were randomly allocated to either expectant management or treatment with a single dose of 800 µg misoprostol administered vaginally. Patients were evaluated clinically and by ultrasound until complete evacuation of the uterus was achieved (no gestational sac in the uterine cavity and maximum anteroposterior diameter of the intracavitary contents < 15 mm as measured by transvaginal ultrasound on midsagittal view). Follow-up visits were planned at 10, 17, 24 and 31 days. Dilatation and evacuation (D&E) was recommended if miscarriage was not complete within 31 days, but was performed earlier at patient's request, or if there was excessive bleeding as judged clinically. Analysis was by intention to treat. The main outcome measure was number of patients with complete miscarriage without D&E ≤ 10 days. RESULTS: Ninety-four patients were randomized to misoprostol treatment and 95 to expectant management. After exclusion of three patients and withdrawal of consent by two patients in the expectant management group, 90 women were included in this group. Miscarriage was complete ≤ 10 days in 62/94 (66%) of the patients in the misoprostol group and in 39/90 (43%) of those in the group managed expectantly (risk difference (RD) = 23%; 95% CI, 8-37%). At 31 days, the corresponding figures were 81/94 (86%) and 55/90 (61%) (RD = 25%; 95% CI, 12-38%). Two patients from each group underwent emergency D&E because of excessive bleeding and one of these in each group received blood transfusion. The number of patients undergoing D&E at their own request was higher in the expectantly managed group, 15/90 (17%) vs 3/94 (3%) in the misoprostol group (RD = 14%; 95% CI, 4-23%), as was the number of patients making out-of-protocol visits, 50/90 (56%) vs 27/94 (29%) (RD = 27%; 95% CI, 12-40%). Compared with the expectant management group, more patients in the misoprostol group experienced pain (71/77 (92%) vs 91/91 (100%); RD = 8%; 95% CI, 1-17%) and used painkillers (59/77 (77%) vs 85/91 (93%); RD = 17%; 95% CI, 5-29%). No major side effect was reported in any group. CONCLUSIONS: In women with early non-viable pregnancy and vaginal bleeding, misoprostol treatment is more effective than is expectant management for complete evacuation of the uterus. Both methods are safe but misoprostol treatment is associated with more pain than is expectant management. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Abortivos não Esteroides , Aborto Incompleto/tratamento farmacológico , Aborto Espontâneo/tratamento farmacológico , Tratamento Conservador , Misoprostol , Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/cirurgia , Aborto Espontâneo/cirurgia , Adulto , Dilatação e Curetagem/métodos , Feminino , Seguimentos , Humanos , Misoprostol/uso terapêutico , Gravidez , Primeiro Trimestre da Gravidez , Suécia , Resultado do Tratamento , Hemorragia Uterina
9.
Curr Drug Saf ; 13(1): 65-68, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29173181

RESUMO

BACKGROUND: Misoprostol is a synthetic analog of prostaglandin-E1 and it is the most widely used drug for the medical management of incomplete abortion. Acute Coronary Syndrome (ACS) rarely occurs in perimenopausal women, in addition, its presentation is atypical, so the disease is not always recognized. CASE REPORT: We describe a case of 39-year-old woman with no major underlying cardiovascular risk factors, who developed an episode of ACS following the administration of two doses of misoprostol. After the discontinuation of misoprostol treatment, there was a complete resolution of patient's symptoms. The case draws attention to a rare side effect of a commonly used drug and alerts the clinicians to be cautious in those patients having baseline risk factors which make the patient more susceptible to such serious adverse drug effect.


Assuntos
Abortivos não Esteroides/efeitos adversos , Aborto Incompleto/tratamento farmacológico , Síndrome Coronariana Aguda/induzido quimicamente , Síndrome Coronariana Aguda/diagnóstico , Misoprostol/efeitos adversos , Pré-Menopausa/efeitos dos fármacos , Aborto Incompleto/diagnóstico , Adulto , Feminino , Humanos , Pré-Menopausa/fisiologia
10.
Hum Reprod ; 32(6): 1202-1207, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28402415

RESUMO

STUDY QUESTION: Does repeat administration of misoprostol for early pregnancy loss increase the treatment success rate? SUMMARY ANSWER: Repeat administration of misoprostol does not increase the treatment success rate, and is associated with more analgesics use. WHAT IS KNOWN ALREADY: Misoprostol reduces the need for surgical evacuation and shortens the time to complete expulsion in patients with early pregnancy loss. However, the impact of repeat doses of misoprostol is not clear. STUDY DESIGN, SIZE, DURATION: A randomized clinical trial was conducted in a single tertiary hospital, recruiting women with early pregnancy loss (<12 weeks), seeking medical treatment, between August 2015 and June 2016. A sample size of 160 patients was sufficient to detect a 30% decrease in treatment success. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants received 800 µg of misoprostol vaginally on Day 1, and were then randomly assigned into two groups: Patients in the single-dose group were evaluated on Day 8. Patients in the repeat-dose group were evaluated on Day 4, when they were given a repeat dose if required, and scheduled for re-evaluation on Day 8. If complete expulsion was not achieved on Day 8 (endometrial thickness >15 mm or the presence of gestational sac on transvaginal sonography), participants underwent surgical evacuation. The primary outcome was treatment success, defined as no need for surgical intervention up to Day 8. MAIN RESULTS AND THE ROLE OF CHANCE: Final analysis included 87 participants in the single-dose group and 84 participants in the repeat-dose group, out of whom 41 (48.8%) received a second dose. Treatment succeeded in 67 (77%) patients in the single-dose group and 64 (76%) patients in the repeat-dose group (RR 0.98; 95% CI 0.83-1.16; P = 0.89). Patients in the repeat-dose group reported more use of over the counter analgesics (82.1% versus 69.0%, P = 0.04). LIMITATIONS, REASONS FOR CAUTION: The study was not blinded and our definition of complete expulsion may be debated. Follow-up time was not equal in all participants, since some had a complete expulsion on Day 4 and some underwent emergent D&C before Day 8. This, however, should not affect the primary outcome. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest that a single-dose protocol is superior to a repeat-dose protocol due to a comparable success rate and more favorable outcomes regarding the need for analgesic drugs. STUDY FUNDING/COMPETING INTEREST(S): We did not receive funding for this study and we declare no conflict of interest. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT02515604). TRIAL REGISTRATION DATE: 2 August 2015. DATE OF FIRST PATIENT'S ENROLMENT: 19 August 2015.


Assuntos
Aborto Incompleto/tratamento farmacológico , Aborto Espontâneo/fisiopatologia , Perda do Embrião/fisiopatologia , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Aborto Incompleto/diagnóstico por imagem , Aborto Incompleto/etiologia , Aborto Incompleto/cirurgia , Centros Médicos Acadêmicos , Adulto , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Terapia Combinada/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Israel , Perda de Seguimento , Misoprostol/efeitos adversos , Misoprostol/uso terapêutico , Ocitócicos/efeitos adversos , Ocitócicos/uso terapêutico , Pacientes Desistentes do Tratamento , Gravidez , Centros de Atenção Terciária , Ultrassonografia , Curetagem a Vácuo/efeitos adversos
11.
Int J Gynaecol Obstet ; 136(2): 215-219, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28099728

RESUMO

OBJECTIVE: To evaluate the results of an intervention by the Societé de Gynécologues et Obstétriciens du Burkina (SOGOB) to improve postabortion care (PAC) in rural areas of Burkina Faso. METHODS: From June 1, 2012, to May 31, 2013, SOGOB increased capacity for PAC by providing training in health care and equipment to 45 rural health facilities. Performance in PAC in the year before intervention (June 1, 2011, to May 31, 2012) was compared with that in the year following intervention (June 1, 2013, to May 31, 2014). RESULTS: The number of cases of incomplete abortion managed within a year increased from 1812 before the intervention to 2738 afterwards. Before capacity building, none of the health facilities was using misoprostol for management of incomplete abortion. After capacity building, misoprostol was used in 805 (29.4%) cases. The use of inappropriate methods to empty the uterus decreased (27.5% [498/1812] vs 1.4% [38/2738]; P<0.001). The frequencies of uterine perforation and pelvic infection also decreased (P≤0.01 for both). In the year after implementation, 2035 (78.3%) of 2600 women had taken up a family planning method before leaving the facility. CONCLUSION: SOGOB's intervention has improved the quality of PAC in rural health facilities in Burkina Faso.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Incompleto/tratamento farmacológico , Assistência ao Convalescente/normas , Instalações de Saúde/provisão & distribução , Pessoal de Saúde/educação , Misoprostol/administração & dosagem , Aborto Incompleto/epidemiologia , Adulto , Burkina Faso , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Gravidez , População Rural , Sociedades Médicas
12.
Glob Health Sci Pract ; 4(3): 481-94, 2016 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-27571343

RESUMO

Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30-70 percentage points within 1-3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning counseling and services before leaving the facility, especially because fertility returns rapidly (within 2 to 3 weeks); postabortion family planning services can be quickly replicated to multiple sites with high acceptance rates. Voluntary family planning uptake by method should always be monitored to document program and provider performance. In addition, vacuum aspiration and misoprostol should replace sharp curettage to treat incomplete abortion for women who meet eligibility criteria.


Assuntos
Aborto Incompleto , Aborto Induzido/métodos , Assistência ao Convalescente , Anticoncepção , Tratamento de Emergência , Serviços de Planejamento Familiar , Aborto Incompleto/tratamento farmacológico , Aborto Induzido/efeitos adversos , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Feminino , Humanos , Gravidez , Gravidez não Planejada
13.
PLoS One ; 11(2): e0149172, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26872219

RESUMO

OBJECTIVE: This study aimed to assess women´s acceptability of diagnosis and treatment of incomplete abortion with misoprostol by midwives, compared with physicians. METHODS: This was an analysis of secondary outcomes from a multi-centre randomized controlled equivalence trial at district level in Uganda. Women with first trimester incomplete abortion were randomly allocated to clinical assessment and treatment with misoprostol by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and stratified for health care facility. Acceptability was measured in expectations and satisfaction at a follow up visit 14-28 days following treatment. Analysis of women's overall acceptability was done using a generalized linear mixed-effects model with an equivalence range of -4% to 4%. The study was not masked. The trial is registered at ClinicalTrials.org, NCT 01844024. RESULTS: From April 2013 to June 2014, 1108 women were assessed for eligibility of which 1010 were randomized (506 to midwife and 504 to physician). 953 women were successfully followed up and included in the acceptability analysis. 95% (904) of the participants found the treatment satisfactory and overall acceptability was found to be equivalent between the two study groups. Treatment failure, not feeling calm and safe following treatment, experiencing severe abdominal pain or heavy bleeding following treatment, were significantly associated with non-satisfaction. No serious adverse events were recorded. CONCLUSIONS: Treatment of incomplete abortion with misoprostol by midwives and physician was highly, and equally, acceptable to women. TRIAL REGISTRATION: ClinicalTrials.gov NCT01844024.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Misoprostol/uso terapêutico , Abortivos não Esteroides/efeitos adversos , Aborto Incompleto/epidemiologia , Adulto , Feminino , Humanos , Tocologia , Misoprostol/efeitos adversos , Uganda/epidemiologia
16.
Lancet ; 385(9985): 2392-8, 2015 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-25817472

RESUMO

BACKGROUND: Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol, compared with physicians. METHODS: We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda. Eligibility criteria were women with signs of incomplete abortion. We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and was stratified for study site. Primary outcome was complete abortion not needing surgical intervention within 14-28 days after initial treatment. The study was not masked. Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects model. The predefined equivalence range was -4% to 4%. The trial was registered at ClinicalTrials.gov, number NCT01844024. FINDINGS: From April 30, 2013, to July 21, 2014, 1108 women were assessed for eligibility. 1010 women were randomly assigned to each group (506 to midwife group and 504 to physician group). 955 women (472 in the midwife group and 483 in the physician group) were included in the per-protocol analysis. 452 (95·8%) of women in the midwife group had complete abortion and 467 (96·7%) in the physician group. The model-based risk difference for midwife versus physician group was -0·8% (95% CI -2·9 to 1·4), falling within the predefined equivalence range (-4% to 4%). The overall proportion of women with incomplete abortion was 3·8% (36/955), similarly distributed between the two groups (4·2% [20/472] in the midwife group, 3·3% [16/483] in the physician group). No serious adverse events were recorded. INTERPRETATION: Diagnosis and treatment of incomplete abortion with misoprostol by midwives is equally safe and effective as when provided by physicians, in a low-resource setting. Scaling up midwives' involvement in treatment of incomplete abortion with misoprostol at district level would increase access to safe post-abortion care. FUNDING: The Swedish Research Council, Karolinska Institutet, and Dalarna University.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Tocologia/estatística & dados numéricos , Misoprostol/uso terapêutico , Médicos/estatística & dados numéricos , Aborto Incompleto/diagnóstico , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , Uganda , Curetagem a Vácuo , Adulto Jovem
17.
Int J Gynaecol Obstet ; 129(2): 98-103, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25660084

RESUMO

BACKGROUND: Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester. OBJECTIVES: To establish evidence-based recommendations for PAC in the second trimester. SEARCH STRATEGY: Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched. SELECTION CRITERIA: Clinical trials and comparative studies of women presenting in the second trimester (12-28weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately. DATA COLLECTION AND ANALYSIS: Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed. MAIN RESULTS: Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200µg of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin. CONCLUSION: Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200µg vaginally, sublingually, or buccally every 6-12hours.


Assuntos
Abortivos não Esteroides , Aborto Incompleto/tratamento farmacológico , Assistência ao Convalescente/métodos , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Segundo Trimestre da Gravidez , Estudos de Coortes , Feminino , Morte Fetal , Humanos , Mifepristona , Misoprostol , Ocitócicos , Ocitocina , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Arch Gynecol Obstet ; 291(1): 105-13, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25078052

RESUMO

BACKGROUND: Study objective To assess the efficacy of outpatient misoprostol administration versus inpatient misoprostol administration for the treatment of first trimester incomplete miscarriage. MATERIALS AND METHODS: A prospective randomised controlled trial was conducted at a tertiary hospital from May 2012 to April 2013. A total of 154 patients with first trimester incomplete miscarriage were randomised to receive misoprostol either as outpatient or inpatient. Intra-vaginal misoprostol 800 mcg was administered eight hourly to a maximum of three doses. Complete evacuation is achieved when the cervical os was closed on vaginal examination or ultrasound showed no more retained products of conception evidenced by endometrial thickness of less than 15 mm. Treatment failure was defined as failure in achieving complete evacuation on day seven hence surgical evacuation is offered. RESULTS: Outpatient administration of misoprostol was as effective as inpatient treatment with success rate of 89.2 and 85.7 % (p = 0.520). The side effects were not significantly different between the two groups. Side effects that occurred were minor and only required symptomatic treatment. Duration of bleeding was 6.0 days in both groups (p = 0.317). Mean reduction in haemoglobin was lesser in the outpatient group (0.4 g/dl) as compared to in the inpatient group (0.6 g/dl) which was statistically significant (p = 0.048). CONCLUSION: Medical evacuation using intra-vaginal misoprostol 800 mcg eight hourly for a maximum of three doses in an outpatient setting is as effective as in inpatient setting with tolerable side effects.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Misoprostol/uso terapêutico , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Aborto Induzido/métodos , Administração Intravaginal , Adulto , Assistência Ambulatorial/métodos , Colo do Útero , Feminino , Humanos , Pacientes Internados , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Pacientes Ambulatoriais , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos
19.
J Obstet Gynaecol ; 34(8): 726-9, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24988526

RESUMO

The purpose of this study was to examine the effectiveness, side-effects and acceptability of a single dose of oral misoprostol 600 µg for treatment of 1st trimester pregnancy failure. A prospective descriptive study was conducted on pregnant women of < 13 weeks' gestation, diagnosed as 1st trimester pregnancy failure. Patients were assigned to receive a single dose of misoprostol 600 µg orally and then evaluated 48 h after drug administration for complete abortion. A total of 55 women were recruited to the study. The complete abortion rate was 65.5%. Pain and diarrhoea were the most common side-effects. Acceptability and satisfactory rates were 70.9% and 70.9%, respectively. In conclusion, a single dose of oral misoprostol 600 µg is a fair method for the management of 1st trimester pregnancy failure. Side-effects are tolerable and satisfaction is high. Thus, this method may be used as an alternative treatment.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Incompleto/tratamento farmacológico , Misoprostol/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Adulto , Feminino , Humanos , Misoprostol/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos
20.
Int J Gynaecol Obstet ; 126(3): 223-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24893962

RESUMO

OBJECTIVE: To expand access to postabortion care (PAC) services in Senegal by introducing misoprostol as a first-line treatment at the community level. METHODS: The present prospective study enrolled 481 women seeking treatment for incomplete abortion at 11 community health posts in Senegal between September 2011 and August 2012. Participants were given 400 µg of sublingual misoprostol and asked to return to the clinic 1 week later to confirm clinical status. At study completion, all women were asked to respond to a series of questions regarding their experience with this method. All care was provided by nurse midwives. RESULTS: All but three of the study women (99.4%; 474/477) had successful complete abortion after taking misoprostol. Almost all women were satisfied or very satisfied with the treatment (99.6%; 469/471), would select the method again if needed (98.9%; 465/470), and would recommend the method to a friend (99.8%; 468/469). CONCLUSION: The results provide further evidence that 400 µg of misoprostol is highly effective for first-line treatment of incomplete abortion. Furthermore, this regimen can be fully provided by nurse midwives, and can be easily and successfully introduced in community health settings where other methods of PAC may not previously have been available. Clinicaltrials.gov: NCT01939457.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Incompleto/tratamento farmacológico , Acesso aos Serviços de Saúde , Bem-Estar Materno , Misoprostol/administração & dosagem , Satisfação do Paciente , Administração Sublingual , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Tocologia , Gravidez , Estudos Prospectivos , Senegal , Inquéritos e Questionários , Resultado do Tratamento
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