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Trial design: A randomised, parallel-group, double-blind, placebo-controlled multicentre study with health economic and nested qualitative studies to determine if mifepristone (Mifegyne®, Exelgyn, Paris, France) plus misoprostol is superior to misoprostol alone for the resolution of missed miscarriage. Methods: Women diagnosed with missed miscarriage in the first 14 weeks of pregnancy were randomly assigned (1 : 1 ratio) to receive 200 mg of oral mifepristone or matched placebo, followed by 800 μg of misoprostol 2 days later. A web-based randomisation system allocated the women to the two groups, with minimisation for age, body mass index, parity, gestational age, amount of bleeding and randomising centre. The primary outcome was failure to pass the gestational sac within 7 days after randomisation. The prespecified key secondary outcome was requirement for surgery to resolve the miscarriage. A within-trial cost-effectiveness study and a nested qualitative study were also conducted. Women who completed the trial protocol were purposively approached to take part in an interview to explore their satisfaction with and the acceptability of medical management of missed miscarriage. Results: A total of 711 women, from 28 hospitals in the UK, were randomised to receive either mifepristone plus misoprostol (357 women) or placebo plus misoprostol (354 women). The follow-up rate for the primary outcome was 98% (696 out of 711 women). The risk of failure to pass the gestational sac within 7 days was 17% (59 out of 348 women) in the mifepristone plus misoprostol group, compared with 24% (82 out of 348 women) in the placebo plus misoprostol group (risk ratio 0.73, 95% confidence interval 0.54 to 0.98; p = 0.04). Surgical intervention to resolve the miscarriage was needed in 17% (62 out of 355 women) in the mifepristone plus misoprostol group, compared with 25% (87 out of 353 women) in the placebo plus misoprostol group (risk ratio 0.70, 95% confidence interval 0.52 to 0.94; p = 0.02). There was no evidence of a difference in the incidence of adverse events between the two groups. A total of 42 women, 19 in the mifepristone plus misoprostol group and 23 in the placebo plus misoprostol group, took part in an interview. Women appeared to have a preference for active management of their miscarriage. Overall, when women experienced care that supported their psychological well-being throughout the care pathway, and information was delivered in a skilled and sensitive manner such that women felt informed and in control, they were more likely to express satisfaction with medical management. The use of mifepristone and misoprostol showed an absolute effect difference of 6.6% (95% confidence interval 0.7% to 12.5%). The average cost per woman was lower in the mifepristone plus misoprostol group, with a cost saving of £182 (95% confidence interval £26 to £338). Therefore, the use of mifepristone and misoprostol for the medical management of a missed miscarriage dominated the use of misoprostol alone. Limitations: The results from this trial are not generalisable to women diagnosed with incomplete miscarriage and the study does not allow for a comparison with expectant or surgical management of miscarriage. Future work: Future work should use existing data to assess and rank the relative clinical effectiveness and safety profiles for all methods of management of miscarriage. Conclusions: Our trial showed that pre-treatment with mifepristone followed by misoprostol resulted in a higher rate of resolution of missed miscarriage than misoprostol treatment alone. Women were largely satisfied with medical management of missed miscarriage and would choose it again. The mifepristone and misoprostol intervention was shown to be cost-effective in comparison to misoprostol alone. Trial registration: Current Controlled Trials ISRCTN17405024. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 68. See the NIHR Journals Library website for further project information.

Background: Progesterone is essential for a healthy pregnancy. Several small trials have suggested that progesterone therapy may rescue a pregnancy in women with early pregnancy bleeding, which is a symptom that is strongly associated with miscarriage. Objectives: (1) To assess the effects of vaginal micronised progesterone in women with vaginal bleeding in the first 12 weeks of pregnancy. (2) To evaluate the cost-effectiveness of progesterone in women with early pregnancy bleeding. Design: A multicentre, double-blind, placebo-controlled, randomised trial of progesterone in women with early pregnancy vaginal bleeding. Setting: A total of 48 hospitals in the UK. Participants: Women aged 16–39 years with early pregnancy bleeding. Interventions: Women aged 16–39 years were randomly assigned to receive twice-daily vaginal suppositories containing either 400 mg of progesterone or a matched placebo from presentation to 16 weeks of gestation. Main outcome measures: The primary outcome was live birth at ≥ 34 weeks. In addition, a within-trial cost-effectiveness analysis was conducted from an NHS and NHS/Personal Social Services perspective. Results: A total of 4153 women from 48 hospitals in the UK received either progesterone (n = 2079) or placebo (n = 2074). The follow-up rate for the primary outcome was 97.2% (4038 out of 4153 participants). The live birth rate was 75% (1513 out of 2025 participants) in the progesterone group and 72% (1459 out of 2013 participants) in the placebo group (relative rate 1.03, 95% confidence interval 1.00 to 1.07; p = 0.08). A significant subgroup effect (interaction test p = 0.007) was identified for prespecified subgroups by the number of previous miscarriages: none (74% in the progesterone group vs. 75% in the placebo group; relative rate 0.99, 95% confidence interval 0.95 to 1.04; p = 0.72); one or two (76% in the progesterone group vs. 72% in the placebo group; relative rate 1.05, 95% confidence interval 1.00 to 1.12; p = 0.07); and three or more (72% in the progesterone group vs. 57% in the placebo group; relative rate 1.28, 95% confidence interval 1.08 to 1.51; p = 0.004). A significant post hoc subgroup effect (interaction test p = 0.01) was identified in the subgroup of participants with early pregnancy bleeding and any number of previous miscarriage(s) (75% in the progesterone group vs. 70% in the placebo group; relative rate 1.09, 95% confidence interval 1.03 to 1.15; p = 0.003). There were no significant differences in the rate of adverse events between the groups. The results of the health economics analysis show that progesterone was more costly than placebo (£7655 vs. £7572), with a mean cost difference of £83 (adjusted mean difference £76, 95% confidence interval –£559 to £711) between the two arms. Thus, the incremental cost-effectiveness ratio of progesterone compared with placebo was estimated as £3305 per additional live birth at ≥ 34 weeks of gestation. Conclusions: Progesterone therapy in the first trimester of pregnancy did not result in a significantly higher rate of live births among women with threatened miscarriage overall, but an important subgroup effect was identified. A conclusion on the cost-effectiveness of the PRISM trial would depend on the amount that society is willing to pay to increase the chances of an additional live birth at ≥ 34 weeks. For future work, we plan to conduct an individual participant data meta-analysis using all existing data sets. Trial registration: Current Controlled Trials ISRCTN14163439, EudraCT 2014-002348-42 and Integrated Research Application System (IRAS) 158326. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 33. See the NIHR Journals Library website for further project information.

A prospective study of 125 patients diagnosed with first trimester miscarriage was carried out in order to compare management outcomes and patient satisfaction. Miscarriage managed medically and surgically was compared. A comfort score between 1 and 5 (1 very uncomfortable, 5 no discomfort) was given by each patient during, where appropriate, and following the intervention; rates of success (determined by negative scan/absence of re-presentation) and whether the patient required subsequent admission to hospital/delayed stay (deemed as >24 h) were also recorded. Manual vacuum aspiration (MVA) compared favourably vs other procedures with a mean comfort score during procedure of 2.61 vs 3.9 in medical management and a mean comfort score post procedure of 3.95 vs 4.0 for MMM and 3.81 for surgical management. Similarly, MVA demonstrated a lower failure rate (2.5%) vs MMM (68%) and SMM (10%) and none required admission or a delayed stay vs MMM (4%) and SMM (10%).

Foeniculum vulgare Mill. (F. vulgare) belongs to the family Apiaceae with numerous medicinal and traditional applications. It has been widely used in South Asia as an important medicine for the treatment of many ailments. Different parts of F. vulgare, including seeds, leaves, aerial part and fruits, has been found to contain diverse phytochemicals such as anethole, fenchone, limonene, estragole, and p-coumaric acid. In particular, anethole and fenchone as the chief bioactives isolated from F. vulgare, have been proven to possess notable antioxidant, antitumor, carminative, diuretic, and galactagogue effects and is useful in amenorrhoea, dental decay and irritable bowel syndrome. This review summarizes the botanical activities, traditional uses, phytochemistry, and pharmacology of F. vulgare, along with the clinical studies to serve as the basis for further research and development on this medicinal plant.

ABSTRACT: Epilepsy is a chronic neurologic illness that is extremely common and has an impact on social functioning, behavior, health, and the economy. An estimated 5 million people worldwide receive an epilepsy diagnosis each year. Globally, it is estimated that more than 50 million people are affected. 49% of epilepsy sufferers reside in low-to middle-income nations; in rare circumstances, this proportion may rise to 139 per 100,000 individuals. The ''treatment gap'' ranges from 10% in rich nations to 75% in low-income nations. Epilepsy is frequently associated with stigma and prejudice across the world. The most crucial tools for assessing an epilepsy patient are electroencephalography (EEG) and functional imaging techniques in epilepsy are position emission tomography (PET), single photon emission computed tomography(SPECT), tissue ablation with high intensity focused ultrasound, noninvasive neuromodulation of deep and superficial targets, opening of the blood brain barrier with focused ultrasound, magnetoencephalography (MEG), and magnetic resonance imaging (MRI). An essential tool for identifying the kind of seizure and determining the brain's epileptogenic zone is video-EEG monitoring. A thorough neuroimaging assessment is required to determine the etiology of the epilepsies. The likelihood of discovering the etiology of various forms of epilepsy has improved thanks to genetic testing. Drugs that are inexpensive can be used to treat epilepsy. About one-third of people with epilepsy who have recently been diagnosed experience refractory seizures. National health policy is not prioritised, there aren't enough resources for educated staff, and there aren't enough basic antiepileptic drugs in civilizations that aren't well-organized. There are possibilities for surgical therapy, dietary changes, and neurostimulation for this group of individuals to enhance seizure control and quality of life.