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1.
In Vivo ; 36(3): 1285-1289, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478103

RESUMO

BACKGROUND/AIM: Labor is induced in 1 out of 5 pregnancies. This is why we aimed to compare two different protocols of orally administered misoprostol for the induction of labor (IOL), with special regard to maternal and fetal outcome, delivery mode and duration. PATIENTS AND METHODS: One hundred and twenty four patients with a medical indication for IOL were divided into two groups: Group A (n=63), which initially received 50 µg misoprostol escalated to 100 and, subsequently, to 200 µg every 4 h with a daily maximum of 600µg, between 11/2007 and 01/2008; and Group B (n=61), which initially received 25 µg misoprostol followed by 100 µg every 4 h with a daily maximum of 300 µg, between 12/2009 and 04/2010. RESULTS: The mean administration-delivery interval was significantly lower in Group A (19.0 h) compared to Group B (27.1 h, p<0.05). Overall caesarean section rate, average birth weight, APGAR score, umbilical cord pH and meconium-stained fluid rates were similar between both groups. CONCLUSION: A higher dosage protocol of orally administered misoprostol significantly reduces the mean induction-delivery interval without increasing the risk for an adverse maternal or fetal outcome.


Assuntos
Misoprostol , Ocitócicos , Índice de Apgar , Cesárea , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Misoprostol/efeitos adversos , Ocitócicos/efeitos adversos , Gravidez
2.
Pan Afr Med J ; 41: 90, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35432695

RESUMO

Introduction: single-dose of sublingual misoprostol 400mcg with the participant followed-up at the gynecology clinic one week after with an ultrasound scan for the completeness of the uterine evacuation. Objective: to compare the effectiveness of single-dose sublingual misoprostol to manual vacuum aspiration in the treatment of incomplete spontaneous abortion in Enugu, Nigeria. Methods: the primary outcome measure was the incidence of complete uterine evacuation (complete abortion) after one week of treatment while the secondary outcome measures included incidence, types, and tolerability of treatment side effects as well as participants' satisfaction with the treatment received. Results: two hundred and three participants who met the study criteria and completed the study were randomised into the intervention group (n=102) received single-dose sublingual misoprostol 400mcg and the control group (n= 101) received manual vacuum aspiration. Incidence of complete abortion was 86.3% for the misoprostol group and 100.0% for the control group, RR = 0.86, (CI 95%: 0.80 - 0.93), p <0.001. The most common side effect was abdominal pain with an incidence of 27.5% versus 48.55 for the misoprostol and control groups respectively (p = 0.002). Most participants in each group (81.1% versus 77.6% for the misoprostol and control groups respectively) considered the side effects as tolerable. The mean visual analogue scale score for maternal satisfaction was higher in the misoprostol group (86.7 ± 14.11) than the control group (81.36 ± 11.10), p < 0.001. Conclusion: the treatment of incomplete spontaneous abortion with single-dose sublingual misoprostol 400mcg produced a high rate of complete abortion among women in Enugu, Nigeria. Despite having a lower complete abortion rate, maternal satisfaction was higher when compared with women that had manual vacuum aspiration of the uterus. Trial registration: trial registration number - PACTR202009857889210, date of registration - September 23rd, 2020. Retrospectively registered.


Assuntos
Abortivos não Esteroides , Aborto Incompleto , Aborto Induzido , Aborto Espontâneo , Misoprostol , Curetagem a Vácuo , Abortivos não Esteroides/efeitos adversos , Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/terapia , Aborto Espontâneo/epidemiologia , Feminino , Humanos , Misoprostol/efeitos adversos , Misoprostol/uso terapêutico , Nigéria , Gravidez , Curetagem a Vácuo/efeitos adversos
3.
J Healthc Eng ; 2022: 3254586, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35449871

RESUMO

In order to systematically evaluate the clinical efficacy and safety of misoprostol versus oxytocin in the prevention of postpartum hemorrhage, this paper provides evidence-based reference for clinical medication, computerized retrieval of Chinese biomedical literature database (CBM), PubMed, Embase, Cochrane Library, and clinical trials. The retrieval period is from the establishment of each database to October 1, 2021. Published randomized controlled trials (RCTS) are included in this study. The literature is screened and evaluated according to inclusion and exclusion criteria, and meta-analysis is performed using RevMan 5.3 software. A total of 13 RCTS are included, with a total of 24754 parturients. The meta-analysis shows the average blood loss (SMD = 0.10, 95% CI (-0.11, 0.32), P=0.35), the time of the third stage of labor (SMD = 0, 95% CI (-0.07, 0.08), P=0.95), and blood transfusion rate (RR = 0.80, 95% CI (0.63, 1.02), P=0.07). However, the incidences of shivering (RR = 2.61, 95% CI (1.79, 0.81), P < 0.00001) and vomiting (RR = 2.78, 95% CI (1.85, 4.18), P < 0.00001) are significantly higher than those in oxytocin group. The effect of misoprostol on preventing postpartum hemorrhage is similar to that of oxytocin, but the incidence of adverse reactions is high, and the occurrence of adverse reactions should be closely watched in the use process. Due to the limitations of the included studies, multicenter, large-sample, and high-quality RCTS are still needed in the future to further verify this conclusion.


Assuntos
Misoprostol , Ocitocina , Hemorragia Pós-Parto , Feminino , Humanos , Misoprostol/efeitos adversos , Misoprostol/uso terapêutico , Estudos Multicêntricos como Assunto , Ocitocina/efeitos adversos , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
J Med Econ ; 25(1): 428-436, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35297743

RESUMO

BACKGROUND: Various methods exist for the induction of labor (IOL), and there is limited consensus as to optimal methods. Off-label misoprostol is recommended by the World Health Organization (WHO) for IOL but preparing it into doses suitable for IOL lacks precision, with potential adverse outcomes if dosing is inaccurate. This study explores potential outcomes and costs associated with increased uptake of a low-dose (25 µg) oral misoprostol formulation (Angusta; Norgine BV, Amsterdam) approved for IOL, in France, Belgium, and the Netherlands. METHODS: A literature review was undertaken to derive probabilities of delivery outcomes (vaginal, instrumental, and cesarean sections) for IOL methods, from published meta-analyses. Outcomes for oral misoprostol tablets (25 µg) were unavailable in the meta-analyses, so were estimated using data from two published retrospective cohort studies. A model was developed to predict the frequency of IOL outcomes and associated costs at the national level, across multiple scenarios. Scenarios were tested using a moderate, medium, and high increase in oral misoprostol tablet (25 µg) uptake. Market shares, costs, and induction rates were defined for each country using multiple data sources. RESULTS: Increased uptake of oral misoprostol tablets (25 µg) was estimated to be associated with a slightly increased rate of routine vaginal deliveries, and concurrent decreases in instrumental vaginal deliveries and cesarean sections. Since routine vaginal deliveries are less costly than other delivery outcomes, increased uptake of oral misoprostol tablets (25 µg) within the IOL market has the potential to be cost-saving. These trends were predicted using 25 µg oral misoprostol tablet outcomes informed by both retrospective studies. CONCLUSION: Preliminary outcomes suggest that oral misoprostol tablets at 25 µg per dose may improve outcomes in IOL and be cost-saving. Further study is required to validate these findings and assess the comparative efficacy of IOL methods, including oral misoprostol tablets (25 µg).


Assuntos
Misoprostol , Ocitócicos , Administração Oral , Custos e Análise de Custo , Feminino , Humanos , Trabalho de Parto Induzido , Misoprostol/efeitos adversos , Gravidez , Estudos Retrospectivos , Comprimidos
5.
Ethiop J Health Sci ; 32(1): 213-216, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35250233

RESUMO

Abortion is defined as the termination of pregnancy before the fetus is viable. It is one of the most commonly performed procedures in gynecological departments worldwide. Termination of pregnancy in second trimester is one of the greatest challenges because of multiple modes of termination options with their risks of complication and making it riskier than the first trimester termination. We report this case because of a rare occurrence of posterior wall rupture which would have led to grave complication if not anticipated and detected early.


Assuntos
Abortivos não Esteroides , Aborto Induzido , Misoprostol , Ruptura Uterina , Abortivos não Esteroides/efeitos adversos , Aborto Induzido/efeitos adversos , Cesárea/efeitos adversos , Feminino , Humanos , Misoprostol/efeitos adversos , Gravidez , Segundo Trimestre da Gravidez , Ruptura Uterina/etiologia
6.
J Obstet Gynaecol Res ; 48(4): 966-972, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35261120

RESUMO

AIM: To compare the success rate of vaginal misoprostol versus intravenous (IV) oxytocin in termination of pregnancy in the second trimester intrauterine fetal death (IUFD). METHODS: This was an open-label randomized controlled study for 106 women with second trimester IUFD. Patients were randomly divided into two groups: women given vaginal misoprostol (400 mcg every 6 h up to 48 h) versus those given IV oxytocin (starting with 50 units up to a maximum of 300 units). When the first-line treatment (as mentioned above) failed, treatment methods were replaced with each other. When the second-line treatment failed, the patients underwent dilation and evacuation. RESULTS: The first-line treatment yielded the successful rate of 88.7% versus 73.7% for misoprostol versus oxytocin, respectively (p = 0.047). Among those with first-line treatment failure, the second-line treatment yielded success rate of 85.7% versus 83.3% for misoprostol versus oxytocin (p = 0.891). The mean duration of induction to delivery in women with successful response to first-line treatment was 28.72 and 20.55 h after initially receiving misoprostol versus oxytocin, respectively (p < 0.001). While during second-line treatment, this mean interval was not significantly different among those with misoprostol versus oxytocin (p = 0.128). No severe adverse events were observed. CONCLUSION: Vaginal misoprostol was associated with higher termination rate than oxytocin without adverse events when used as the first-line treatment. Both methods yielded the same success rate when used as the second-line treatment.


Assuntos
Abortivos não Esteroides , Aborto Induzido , Misoprostol , Ocitócicos , Aborto Induzido/métodos , Administração Intravaginal , Feminino , Morte Fetal/etiologia , Humanos , Misoprostol/efeitos adversos , Ocitócicos/efeitos adversos , Ocitocina/efeitos adversos , Gravidez , Segundo Trimestre da Gravidez
7.
BMJ Open ; 12(1): e052192, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35105623

RESUMO

INTRODUCTION: Medical treatment is a less invasive alternative to surgical management of missed miscarriage. Studies have shown that pretreatment with mifepristone can increase the complete abortion rate in management of first-trimester missed miscarriage compared with misoprostol alone. Two studies have also shown that pretreatment with letrozole could increase the efficacy compared with misoprostol alone. So far, there is no trial comparing letrozole and mifepristone pretreatment for missed miscarriage. We designed this randomised controlled trial to test the hypothesis that for first-trimester missed miscarriage, letrozole pretreatment is non-inferior to mifepristone pretreatment followed by misoprostol in terms of complete abortion rate. METHODS AND ANALYSIS: This is a prospective open-label non-inferiority randomised controlled trial conducted in a single centre. In total, 294 women diagnosed with first-trimester missed miscarriage opting for medical treatment is recruited with informed consent. They are randomly assigned to receive mifepristone or letrozole pretreatment. In the mifepristone group, each woman takes 200 mg mifepristone orally followed 24-48 hours later by 800 µg misoprostol vaginally. In the letrozole group, each woman takes 10 mg letrozole orally per day for 3 days, followed by 800 µg misoprostol vaginally on the third day of letrozole administration. Follow-up is conducted on days 15 and 42 after misoprostol administration. The primary outcome is the overall complete abortion rate. Secondary outcomes include side effects and complications during the study period. Data will be analysed with both intention-to-treat and per protocol approaches. A p<0.05 will be considered as indicating statistical significance. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Institutional Review Board of the University of Hong Kong-Shenzhen Hospital with approval number: (2020)166. Findings will be disseminated in a peer-reviewed journal and in national and/or international meetings to guide future practice. TRIAL REGISTRATION NUMBER: ChiCTR2000041480.


Assuntos
Aborto Induzido , Aborto Espontâneo , Misoprostol , Aborto Induzido/efeitos adversos , Feminino , Humanos , Letrozol , Mifepristona/uso terapêutico , Misoprostol/efeitos adversos , Misoprostol/uso terapêutico , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Gynecol Obstet Fertil Senol ; 50(3): 229-235, 2022 Mar.
Artigo em Francês | MEDLINE | ID: mdl-34871786

RESUMO

OBJECTIVE: To compare the efficacy and safety of oral misoprostol 25µg compared to vaginal dinoprostone in the induction of labor at term. METHODS: Analytic, retrospective study of patients induced at term by prostaglandins with an unfavorable cervix, over two consecutive periods from 01/01/2019 to 19/02/2020 and from 20/02/2020 to 07/04/2021, within a regional level III university hospital center. We compared the safety and the efficacy between the oral misoprostol Angusta® used since 20/02/2020 and the vaginal dinoprostone previously used in gel or diffuser. The primary endpoint was the rate of vaginal deliveries within 24h. Secondary endpoints were cesarean section rate, indications for cesarean section, uterine contractility abnormalities and neonatal outcomes. RESULTS: Our study found no difference in terms of efficacy with similar rates of vaginal deliveries within 24h (51.88% vs. 51.25%; P=0.87) and caesarean sections (misoprostol group: 19.42% vs. dinoprostone group: 16.62%; P=0.33). However, the tolerance criteria revealed in the dinoprostone group an increase in tachysystole (misoprostol group: 9.28% vs. dinoprostone group: 16.90%; P=0.003) and acidosis (arterial pH<7.10, misoprostol group: 3.83% vs. dinoprostone group: 9.29%; P=0.006). CONCLUSION: No difference in efficacy was found between the two induction techniques. Oral misoprostol 25µg seems to be better tolerated from a maternal and fetal point of view.


Assuntos
Misoprostol , Ocitócicos , Administração Intravaginal , Cesárea , Dinoprostona , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido/métodos , Misoprostol/efeitos adversos , Gravidez , Estudos Retrospectivos
10.
Eur J Obstet Gynecol Reprod Biol ; 269: 16-23, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34952401

RESUMO

The purpose of this integrative literature review was to appraise studies conducted worldwide using misoprostol and estradiol in converting Type 3 transformation zone (TZ) of the cervix into Types 1 or 2 and to assess which regimen could be more feasible in low-and-middle-income countries (LMICs). We reviewed the English language literature for peer-reviewed studies that evaluated strategies to convert Type 3 TZs to Types 1 or 2 for cervical cancer screening. Web of Science and PubMed searches were performed up to July 2020. Search terms included: "cervical colposcopy," "inadequate colposcopy", "cervical cancer screening", "transformation zone," "estrogen", "estradiol", and "misoprostol." Inclusion criteria were articles published in the English language, original research, and peer reviewed articles. A total of 127 articles were abstracted, 24 articles were reviewed, and 9 articles met all inclusion criteria. We found that intravaginal misoprostol, intravaginal estradiol, and oral estradiol can successfully convert Type 3 TZ to Types 1 or 2. A single dose of vaginal misoprostol had a similar maximum response rate (20-80%) to a multi-dose regimen over several days or weeks of both intravaginal estradiol (64-83%) and oral estradiol (50-70%). Misoprostol administration was associated with more side effects such as abdominal cramping and vaginal bleeding compared to estradiol, although these were generally mild. In conclusion, Oral estradiol, intravaginal estradiol, and intravaginal misoprostol can be used to convert Type 3 TZ to Types 1 or 2. Intravaginal misoprostol is well tolerated and more feasible in LMICs due to availability and shorter treatment schedule compared to oral or intravaginal estradiol.


Assuntos
Misoprostol , Ocitócicos , Neoplasias do Colo do Útero , Administração Intravaginal , Maturidade Cervical , Detecção Precoce de Câncer , Estradiol , Feminino , Humanos , Misoprostol/efeitos adversos , Gravidez , Neoplasias do Colo do Útero/diagnóstico
11.
Sultan Qaboos Univ Med J ; 21(4): 657-659, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34888091

RESUMO

The use of misoprostol in the second trimester by a woman with a uterine scar may lead to severe contractions and uterine rupture. We report a 24-year-old pregnant female patient who presented at the Emergency Department at a tertiary care hospital in Puducherry, India, in 2020 with haemorrhagic shock. She was at 16 weeks of gestation and had taken over the counter misoprostol for inducing an abortion. A quick initial resuscitation and urgent laparotomy were performed. An irreparable circumferentially avulsed uterus suspended only by round ligaments was noted. Haemostasis required internal artery ligation and immediate total hysterectomy. The patient was doing well upon follow-up six months after the surgery. Proper and supervised use of misoprostol in the appropriate dosage can avoid life-threatening consequences of uterine rupture.


Assuntos
Abortivos não Esteroides , Aborto Induzido , Misoprostol , Ruptura Uterina , Abortivos não Esteroides/efeitos adversos , Aborto Induzido/efeitos adversos , Adulto , Feminino , Humanos , Misoprostol/efeitos adversos , Gravidez , Segundo Trimestre da Gravidez , Ruptura Uterina/induzido quimicamente , Ruptura Uterina/cirurgia , Adulto Jovem
12.
Ugeskr Laeger ; 183(38)2021 09 20.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34596518

RESUMO

Medical abortion with combined mifepristone and misoprostol is a highly effective, safe, and widely used method for medical termination of pregnancy. In this review, it is shown that self-testing with a urine human chorionic gonadotropin stix (detection limit greater than 25 IU/l) four weeks after administration of medication is a safe, practical, and cheap method to determine successful termination.


Assuntos
Aborto Induzido , Aborto Espontâneo , Misoprostol , Gonadotropina Coriônica , Feminino , Humanos , Mifepristona/efeitos adversos , Misoprostol/efeitos adversos , Gravidez
13.
Artigo em Inglês | MEDLINE | ID: mdl-34607746

RESUMO

Oral and vaginal misoprostol are effective induction methods, but there is a delicate balance between a quicker labour and avoiding side effects. In randomised comparisons with balloon catheters, oral misoprostol resulted in more vaginal births in the first 24 h as well as fewer caesarean sections without an increase in hyperstimulation events. Vaginal misoprostol was most effective when used concurrently with a balloon catheter. In comparison with dinoprostone, oral misoprostol had lower rates of caesarean section and uterine hyperstimulation with foetal heart rate changes, but fewer babies were born vaginally within 24 h. In contrast, vaginal misoprostol resulted in more vaginal births within 24 h, with no significant differences in caesarean section rates. There were no differences in perinatal adverse events with either route. When oral and vaginal misoprostol were compared, vaginal misoprostol resulted in more vaginal births in the first 24 h, but with more maternal and neonatal complications.


Assuntos
Misoprostol , Ocitócicos , Cesárea , Dinoprostona , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Misoprostol/efeitos adversos , Ocitócicos/efeitos adversos , Gravidez
14.
JNMA J Nepal Med Assoc ; 59(236): 396-398, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508522

RESUMO

Anencephaly is a condition in which there is an absence of skull and brain tissues. Absence of cranial vault mainly results because of defective neurulation. Absence of cerebral tissues may cause diminished heart size, due to decreased heart load causing various cardiac abnormalities. Here, we report a case of a primigravida lady at 17 weeks of gestation with misoprostol induced expulsion of fetus after ultrasonography revealed absence of brain tissue and calvarium above the orbits suggesting anencephaly. A 300g fetus was delivered which confirmed the ultrasound findings. The patient was discharged with advice for intake of folic acid beginning from 3 months before conception in future pregnancies. Neural tube defects can manifest within approximately 28 days of gestation which highlights the importance of oral folic acid intake before pregnancy.


Assuntos
Anencefalia , Misoprostol , Defeitos do Tubo Neural , Anencefalia/diagnóstico por imagem , Feminino , Feto , Humanos , Misoprostol/efeitos adversos , Gravidez , Ultrassonografia
15.
Am Fam Physician ; 103(8): 473-480, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33856168

RESUMO

Medication regimens using mifepristone and misoprostol are safe and effective for outpatient treatment of early pregnancy loss for up to 84 days' gestation and for medication abortion up to 77 days' gestation. Gestational age is determined using ultrasonography or menstrual history. Ultrasonography is needed when gestational dating cannot be confirmed using clinical data alone or when there are risk factors for ectopic pregnancy. The most effective regimens for medication management of early pregnancy loss and medication abortion include 200 mg of oral mifepristone (a progesterone receptor antagonist) followed by 800 mcg of misoprostol (a prostaglandin E1 analogue) administered buccally or vaginally. Cramping and bleeding are expected effects of the medications, with bleeding lasting an average of nine to 16 days. The adverse effects of misoprostol (e.g., low-grade fever, gastrointestinal symptoms) can be managed with nonsteroidal anti-inflammatory drugs or antiemetics. Ongoing pregnancy, infection, hemorrhage, undiagnosed ectopic pregnancy, and the need for unplanned uterine aspiration are rare complications. Clinical history, combined with serial quantitative beta human chorionic gonadotropin levels, urine pregnancy testing, or ultrasonography, is used to establish complete passage of the pregnancy tissue.


Assuntos
Abortivos não Esteroides/administração & dosagem , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Aborto Induzido , Aborto Espontâneo , Feminino , Humanos , Mifepristona/efeitos adversos , Misoprostol/efeitos adversos , Gravidez , Cuidado Pré-Natal
16.
Aust N Z J Obstet Gynaecol ; 61(4): 554-562, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33734433

RESUMO

BACKGROUND: Oral misoprostol is widely used for induction of labour (IOL) in developing countries because of its many advantages. However, limited data exist concerning its safety and efficacy when lower doses are used. AIM: To determine the safety and efficacy of a low-dose oral misoprostol regimen (commencing at 12 µg) compared to a standard-dose regimen (commencing at 25 µg) in Papua New Guinea (PNG) women undergoing IOL. MATERIALS AND METHODS: This was an open-label non-inferiority randomised controlled trial conducted at a provincial hospital in PNG. Women with singleton pregnancies ≥36 weeks with cephalic presentation and a Bishops score of <6, requiring IOL were enrolled. Both regimens were incremented second-hourly to a maximum required dose within 24 h or until commencement of labour. The primary outcome was the proportion of women who delivered within 24 h of drug administration without any severe adverse events. RESULTS: Of the 262 women induced (130 standard-dose vs 132 low-dose), rates of successful induction were high for both regimens (120/130 (92%) vs 118/132 (89%); P = 0.52). Fourteen women (11%) in the standard-dose regimen and 20 (15%) in the low-dose regimen had severe adverse events. There was no significant difference in the safety profile of the two regimens (106/130 (82%) vs 98/132 (74%); P = 0.18). The induction-to-delivery time was significantly shorter in the standard-dose arm (15.2 ± 8.7 h vs 18.0 ± 9.1 h; P = 0.01). CONCLUSION: The standard-dose regimen for IOL has greater efficacy in reducing induction-to-delivery time compared to the low-dose regimen. There was no significant difference in the number of adverse events between the two regimens.


Assuntos
Misoprostol , Ocitócicos , Administração Intravaginal , Administração Oral , Feminino , Humanos , Trabalho de Parto Induzido , Misoprostol/efeitos adversos , Ocitócicos/efeitos adversos , Papua Nova Guiné , Gravidez
17.
Int J Gynaecol Obstet ; 154(3): 558-564, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33615468

RESUMO

OBJECTIVE: To compare the effectiveness and safety of repeat misoprostol versus expectant management in women with first-trimester incomplete miscarriage who have been initially treated with misoprostol. METHODS: The study was an open-labeled randomized controlled trial including women with an incomplete first-trimester miscarriage after administration of misoprostol. The participants were randomly assigned to vaginal misoprostol or expectant management using a computer-generated table of random numbers. The primary outcome was the number of women with a complete miscarriage at 1 week. RESULTS: Eighty-eight women (44 women in each group) were analyzed. The rate of complete miscarriage at 1 week was significantly higher in the misoprostol group than the expectant management group-29 (69.0%) versus 7 (16.7%) (P < 0.001), respectively. Women in the misoprostol group were more satisfied (7.00 ± 0.77 vs 4.57 ± 1.61, P < 0.001) but reported more pain (7.95 ± 1.85 vs 5.26 ± 1.08, P < 0.001) than women in the expectant group. The misoprostol group reported more adverse effects than the expectant management group (P < 0.001). CONCLUSION: In women with an incomplete first-trimester miscarriage who were initially treated with misoprostol, repeat administration of misoprostol was more effective than expectant management for achieving complete miscarriage at 1 week. However, misoprostol was associated with more adverse effects. REGISTRATION SITE AND NUMBER: Clinicaltrials.gov: NCT03148561.


Assuntos
Abortivos não Esteroides , Aborto Incompleto , Aborto Espontâneo , Misoprostol , Abortivos não Esteroides/efeitos adversos , Aborto Incompleto/tratamento farmacológico , Feminino , Humanos , Misoprostol/efeitos adversos , Gravidez , Primeiro Trimestre da Gravidez , Resultado do Tratamento , Conduta Expectante
19.
Eur J Contracept Reprod Health Care ; 26(1): 42-47, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33044101

RESUMO

OBJECTIVE: The aim of the study was to compare the efficacy and safety of two combined misoprostol regimens for second trimester medical abortion. METHODS: This was a retrospective cohort study examining data on singleton pregnancies that underwent second trimester medical abortion between November 2011 and November 2019 in a tertiary care centre in northern Greece. In the first study period (November 2011 to August 2015), the management protocol (protocol 1) consisted of 800 µg vaginal misoprostol followed by 400 µg oral misoprostol, every 3 h, for up to five doses. In the second study period (September 2015 to November 2019), a new protocol (protocol 2) was introduced, where the oral route was changed to sublingual, using the same dosage. The two routes were compared in terms of efficacy and safety. RESULTS: The study comprised 85 women: 43 (50.6%) received the protocol 1 regimen (vaginal-oral), while 42 (49.4%) received the protocol 2 regimen (vaginal-sublingual). The groups did not differ in terms of maternal age, gestational age and parity. Sublingual misoprostol was more effective than oral misoprostol, both in terms of dose needed (median 1600 µg vs 2000 µg; p = 0.031) and induction-to-abortion interval (8 h vs 11 h; p = 0.001). Surgical evacuation due to incomplete abortion was necessary in 11.9% of women in the sublingual group vs 18.6% in the oral group (p = 0.394). Women in the sublingual group reported a higher rate of severe pain (odds ratio [OR] 6.061; 95% confidence interval [95% CI] 1.240, 29.619) and shivering (OR 4.632; 95% CI 1.788, 11.995). CONCLUSION: The administration of vaginal-sublingual misoprostol, when compared with the vaginal-oral regimen, was associated with a shorter induction-to-abortion interval but a higher incidence of severe pain and shivering.


Assuntos
Abortivos não Esteroides/efeitos adversos , Aborto Induzido/métodos , Misoprostol/efeitos adversos , Abortivos não Esteroides/administração & dosagem , Administração Intravaginal , Administração Oral , Adulto , Estudos de Coortes , Feminino , Humanos , Misoprostol/administração & dosagem , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos
20.
J Matern Fetal Neonatal Med ; 34(4): 493-499, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31006282

RESUMO

Background: Misoprostol has been shown to be effective in induction of labor (IOL) with different dosages and routes of administration.Objectives: This study compared the efficacy and safety of hourly titrated and 2-hourly static low dose oral misoprostol for IOL in Ekiti State University Teaching Hospital, Ado-Ekiti.Methods: One hundred fifty women with singleton pregnancy at term admitted for IOL were randomized into the two groups. Oxytocin augmentation was done as necessary. The primary outcome is rate of vaginal delivery within 24 hours. Data were analyzed using SPSS.Results: Vaginal delivery was achieved within 24 hours in 40 (67.8%) women who received hourly titrated-doses oral misoprostol and 42 (70.0%) women who received 2-hourly static-dose of oral misoprostol, p > .05. The rate of vaginal delivery, oxytocin augmentation, induction delivery time and cesarean section rate were similar in both groups, p > .05. Occurrence of uterine hyperactivity did not differ significantly among the women (p > .05) and no cases of uterine rupture were recorded. There were no adverse neonatal outcomes.Conclusions: The hourly titrated oral misoprostol is as effective and safe as the 2-hourly static oral misoprostol for IOL. Both can be utilized in IOL without the fear of adverse outcomes.


Assuntos
Misoprostol , Ocitócicos , Administração Intravaginal , Administração Oral , Cesárea , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Misoprostol/efeitos adversos , Gravidez
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