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Background: It is well-known that there's more risk of neonatal respiratory distress with babies born by cesarean delivery than vaginal delivery, regardless of fetal gestational age. Objectives: The aim of this work was to evaluate if different modes of anesthesia affect fetal acid-base for cesarean sections. Patients and Methods: This cross-sectional study was conducted on newborns of 150 pregnant women of full-term babies aged 20 to 35 years with no previous maternal medical condition, undergoing elective caesarean section. Patients were allocated into two equal groups; SA group where cesarean sections were done under spinal anesthesia and GA group where cesarean sections were done under general anesthesia. All neonates underwent history taking, and postnatal history including general neonatal examination, Apgar score, neurological examination [Mental status, sensory perception, and reflexes] and systemic examination. Cord blood samples were taken from participant newborns, and immediately after birth and the taken samples were sent for blood gas analysis. Results: There was a significant strong positive correlation between the outcomes and PH, PO2, and PCO2. Regarding univariate correlations and multivariate correlations, there was a significant strong positive correlation between the outcomes and PH, PO2 and PCO2 (P value= <0.0001). Conclusions: It could be concluded that umbilical cord arterial blood gas values, Apgar score (at 1, 5 and 10 min after birth) and neonatal asphyxia are comparable between the two different modes of anesthesia (spinal and general). Moreover, there are significant strong positive correlations between the outcomes and PH, PO2, and PCO2, and they also are strong predictors of the neonatal outcome. [ABSTRACT FROM AUTHOR]

• Vaginal misoprostol administration increases cesarean rate and decreases the rate of vaginal delivery and Tachysystole. • Oral misoprostol decreases the rate of cesarean and increases the risk of hypertonicity compared with oxytocin. • Oral misoprostol had no significant effect on vaginal delivery compared with oxytocin. A large number of randomized controlled trials (RCTs) have been published on the effects of oral/vaginal misoprostol and oxytocin on delivery outcomes; however, data from these RCTs are conflicting. Although some meta-analyses summarized available findings in this regard, several eligible RCTs have been published since the release of those meta-analyses. Therefore, the current updated systematic review and meta-analysis of RCTs was conducted to compare the effects of oral/vaginal misoprostol and oxytocin on delivery and neonatal outcomes. A systematic search, using relevant keywords, was done in the online databases of PubMed/Medline, Scopus, and ISI Web of Science, up to April 2023, to identify eligible articles investigating the effect of oral/vaginal misoprostol and oxytocin on delivery outcomes including maternal [cesarean/vaginal delivery within 24 h after labour induction, Tachysystole, hypertonicity, hyper-stimulation, postpartum hemorrhage (PPH)] and neonatal outcomes [mean Apgar score, admission to neonatal intensive care unit (NICU), and death]. In total, 45 RCTs with a total sample size of 8406 participants were included. Meta-analysis revealed that vaginal misoprostol administration, compared with oxytocin, resulted in a significant reduction in the rate of cesarean and a significant increase in the rate of vaginal delivery and Tachysystole risk. Also, oral misoprostol was associated with a significant reduction in the rate of cesarean and a significant increase in the risk of hypertonicity compared with oxytocin. However, oral misoprostol had no significant effect on vaginal delivery compared with oxytocin. For other outcomes including hyper-stimulation, perinatal death, NICU admission, and mean Apgar score among newborns, we found no significant difference between oral/vaginal misoprostol and oxytocin. In total, vaginal/oral misoprostol might be a better method for labour induction compared with oxytocin. PROSPERO registration: CRD42023412325. [ABSTRACT FROM AUTHOR]

C 22 H 38 O 5 is a chemical that travels. Better known as misoprostol, it was designed as a stomach ulcer drug but is now used around the world as an abortion pill due to the self-experimentation of those in Latin American communities who were seeking ways to end unwanted pregnancies. We develop a chemical geography approach to misoprostol that allows us to scale inward to understand the chemical properties of this medication and also to scale out to understand how medicinal effects are interwoven with and determined by global politics. Misoprostol as a chemical alone does not guarantee a successful abortion and instead "scaffolding" in the form of mobility and information is required to transform misoprostol from a chemical to a safe and effective technology of abortion. First, we examine how misoprostol is moved by feminist networks in Mexico and Peru. Second, we argue that to be useful it is not enough just to access the pills, as information on how to use them is required. These themes culminate in our contribution of pharmacokinetical geographies, the microgeography of the placement of pharmaceuticals in and on a body and its ramifications. The chemical geographies of misoprostol tell a story of power, bodily autonomy, and resistance. [ABSTRACT FROM AUTHOR]

Background: Medical abortion is safer than surgical abortion. Several studies have shown that combination of antiprogesterone drug mifepristone and prostaglandin misoprostol can increase complete abortion rate in medical management of first-trimester miscarriage compared to misoprostol alone. Letrozole, an aromatase inhibitor, has emerged as an alternative to mifepristone for induction of medical abortion as mifepristone is expensive and not registered in many countries. Aims and Objectives: The aim of the present study was to evaluate the safety and efficacy of combined regimen of letrozole and misoprostol in first-trimester medical abortion compared to misoprostol alone. Materials and Methods: It was a comparative observational study conducted at R. G. Kar Medical College, a tertiary care hospital in West Bengal, India. The study population was the antenatal mothers booked at antenatal clinic willing for termination of pregnancy at <12 weeks of gestational age. Participants were allocated, 39 in each group in a nonrandomized manner. Patients in one group (Group A) were posted for medical abortion with combination regimen of tablet letrozole (10 mg) once daily for 3 days followed by application of tablet misoprostol 800 mcg sublingually on day 4. In other group (Group B), patients were on misoprostol-only regimen with the application of tablet misoprostol 800 mcg sublingually. Results: Induction-abortion time was significantly less in the letrozole group (11±0.79 h) than the misoprostol group (13.23±0.81 h), P=0.0001. Complete abortion rate was significantly higher in the letrozole group compared to misoprostol group (84.62% and 64.10%, respectively, P=0.03). 15.38% patients in the letrozole group and 35.90% patients in the misoprostol group had excessive vaginal bleeding and the difference was statistically significant, P=0.03. The duration of vaginal bleeding was also significantly less in the letrozole group (2.45±0.29 days) than the misoprostol group (2.82±0.37 days), P<0.0001. Incidence of side-effects was comparable and the severity of side-effects was not significantly different between the groups. Conclusion: Letrozole and misoprostol combination regimen leads to significant increase in complete abortion rate and also significant reduction of the duration of vaginal bleeding, induction-abortion time, and need for surgical intervention when compared to misoprostol regimen. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of sublingual misoprostol in first trimester missed miscarriage among women seeking medical management as outpatient. Methodology: A descriptive cross sectional study was conducted at Hayatabad Medical Complex, Gynecology department, involving 179 women recruited through consecutive sampling. Eligible participants were women of reproductive age(20-40years) with singleton first-trimester miscarriage (<13 weeks gestation), residing near the hospital(at 15-30min distance) having >10Hb, hemodynamically stable and no active ongoing blood loss. The selected women received a single dose of 600 µg sublingual misoprostol in crushed form and were followed up for clinical and sonographic assessment of complete expulsion of conceptus. Data entry and analysis were performed using SPSS version 22. Results: Out of 179 women, 119 expelled the conceptus completely. Remaining patients switched over to other options due to retained products of conception or heavy bleeding. Success rate of sublingual misoprostol was found to be 66.5%. Satisfaction and acceptability is high for medical management of miscarriage 76.67% and 68.33% respectively, with statistically significant difference for satisfaction (p-0.004). Conclusion: Sublingual misoprostol is found to be effective in first trimester missed miscarriage among women seeking medical management as out patient. [ABSTRACT FROM AUTHOR]

Background & Objective: Inducing labor is a common practice in obstetrics to prevent maternal and fetal complications. There are several methods of labor induction, including pharmacological and mechanical approaches. The objective of this study was to determine the most effective approach for labor induction. Materials & Methods: A cross-sectional study at Al-Kadhimiya Teaching Hospital compared labor induction in pregnant females at their third trimester using Misoprostol & Foley Catheter (group A) and Misoprostol alone (group B). The study collected data on maternal age, gestational age, BMI, time frames, mode of delivery, and neonatal outcomes such as Apgar scores and ICU admissions. Results: In a cross-sectional study comparing labor induction with Misoprostol & Foley Catheter (group A) vs. Misoprostol alone (group B), most females in both groups had no cesarean section inductions, normal vaginal deliveries, and no complications. The study found significant differences in BMI, time frame, and time for ripening between the two groups, with group A having lower values for these variables. Conclusion: Foley's with vaginal misoprostol results in a shortened time between induction and delivery than misoprostol alone. [ABSTRACT FROM AUTHOR]

Objective: To analyze the evidence available in literature regarding unsuccessful labor induction with misoprostol in full-term pregnancies. Methods: This is an integrative review, carried out between January and November 2022, whose research question and descriptors were outlined using the PECO strategy. The searches were carried out in the MEDLINE, Web of Science, CINAHL, EMBASE and Scopus databases by two researchers independently as well as assessment. For the study selection and identification phase, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. The risk of bias assessment of included articles was carried out using the Newcastle-Ottawa Scale. Results: A total of 3,674 articles were identified, and 84 were read in full, of which 11 comprised the review (n=9,010 pregnant women), published between 2005 and 2021, with the majority in the United States. Regarding the level of evidence, all articles were classified as 2b, assessed according to the design of each study. The study showed evidence regarding the following factors: High BMI (greater than 30 kg/m2), nulliparity, immature bishop, cervical length (greater than 30 mm), height, ethnicity (non-Caucasians from southern Europe) and fetal weight (greater equal to 4 kg). Conclusion: The objective study was achieved, having demonstrated six maternal factors and one fetal factor that can lead to unsuccessful induction. It is worth highlighting the need for evidence that incorporates the individuality of each characteristic and the contribution of this study to support the choice of the best conduct for each pregnancy on an individual basis stands out. [ABSTRACT FROM AUTHOR]

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Copyright of Direito e Práxis is the property of Editora da Universidade do Estado do Rio de Janeiro (EdUERJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: We aimed to evaluate the effectiveness and usability of the uterocervical angle, which we examined ultrasonographically before misoprostol treatment, which we used in first-trimester pregnancy terminations, and its relationship with the abortion time. Material and Method: This prospective study includes 207 pregnant women diagnosed with an ex-fetus in utero hospitalized for medical termination in a single center. These patients were divided into two groups patients whose treatment was completed in the first cycle and who needed additional cycles. The characteristics of all pregnant women, abortion times, and misoprostol doses used were compared with uterocervical angle and cervical length and analyzed between groups. Results: The mean age of the patients in the entire study group was 30.1±6.3, the median uterocervical angle was 112 degrees, and the cervical length was 36 mm. Increasing cesarean number and increasing uterocervical angle degree were positively correlated with increasing abortion time. The number of cesarean sections and the degree of uterocervical angle differ significantly between the group whose treatment was completed in the first cycle and the groups that needed additional cycles. In the treatment groups with elevated uterocervical angle degrees, the first cycle was higher than the successful group. Additional dose and cycle requirements arise if the uterocervical angle is >110 degrees. Conclusion: Evaluation of the uterocervical angle in first-trimester medical terminations may guide the clinician in the early completion of treatment. With this evaluation before medical treatment, the duration of hospitalization can be shortened, and the need for surgical intervention for patients can be reduced. [ABSTRACT FROM AUTHOR]

The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.

Abstract Background and Aim Due to the concern about the side effects of chemical drugs and their ineffectiveness, the use of natural compounds as alternatives or complementary therapies has received increasing attention. The purpose of this study was to investigate the effect of Nigella sativa oil on the outcome of missed abortion. Methods In this double‐blind clinical trial, 70 nulliparous pregnant women referred to Hajar Hospital and Imam Ali clinics of Shahrekord and had missed abortion before the 12‐week gestational age were selected and randomly divided into two interventions and control groups. The intervention group received 5 g of Nigella sativa oil alone daily for up to 3 days and the control group received a placebo. In case of nonresponse, 3 days after the last dose of medication or placebo, 800 μg of misoprostol (vaginal) were used. Data were analyzed by SPSS software. The chi‐square test, Fisher's exact test, independent t‐test and paired t‐test were used for analytical statistics. Results According to the results, 18 cases (51.4%) in the intervention group and seven cases (20%) in the control group showed complete evacuation of uterine contents which had a significant difference (p

IntroductionMifepristone-misoprostol treatment for medical abortion and miscarriage are safe and effective. This study aimed to assess clinical factors associated with subsequent surgical intervention after medical termination of early viable or non-viable pregnancy.MethodsThis retrospective, single-center study included women who underwent medical abortion at Taipei Medical University between January 2010 and December 2019. A total of 1,561 subjects, with 1,080 viable and 481 non-viable pregnancies, who were treated with oral mifepristone 600 mg followed by misoprostol 600 mg 48 h later were included. Data of all pregnancies and medical termination of pregnancy were evaluated using regression analysis. The main outcome was successful termination of pregnancy.ResultsThe success rate of medical abortion was comparable in women with viable and non-viable (92.13% vs. 92.93%) pregnancies. Besides retained tissue, more existing pregnancies with ultrasonographic findings were found in the non-viable pregnancy group than in the viable pregnancy group (29.4% vs. 14.1%, p = 0.011). Multivariate analysis showed that previous delivery was an independent risk factor for failed medical abortion among all included cases. In women with viable pregnancy, longer gestational age [adjusted odds ratio (aOR): 1.483, 95% confidence interval (CI): 1.224–1.797, p < 0.001] and previous Cesarean delivery (aOR: 2.177, 95% CI: 1.167–40.62, p = 0.014) were independent risk factors for failed medical abortion. Number of Cesarean deliveries (aOR: 1.448, 95% CI: 1.029–2.039, p = 0.034) was an independent risk factor for failed medication abortion in women with non-viable pregnancies.ConclusionThis is the first cohort study to identify risk factors for subsequent surgical intervention in women with viable or non-viable pregnancies who had undergone early medically induced abortions. The success rate of medical abortion is comparable in women with viable and non-viable pregnancies. Previous delivery is an independent risk factor for failed medical abortion. Clinical follow-up may be necessary for women who are at risk of subsequent surgical intervention.

ObjectiveTo develop a drug facts label prototype for a combination mifepristone and misoprostol product and to conduct a label-comprehension study to assess understanding of key label concepts.MethodsWe followed U.S. Food and Drug Administration guidance, engaged a multidisciplinary group of experts, and conducted cognitive interviews to develop a drug facts label prototype for medication abortion. To assess label comprehension, we developed 11 primary and 13 secondary communication objectives related to indications for use, eligibility, dosing regimen, contraindications, warning signs, side effects, and recognizing the risk of treatment failure, with corresponding target performance thresholds (80-90% accuracy). We conducted individual structured video interviews with people with a uterus aged 12-49 years, recruited through social media. Participants reviewed the drug facts label and responded to questions to assess their understanding of each communication objective. After transcribing and coding interviews, we estimated the proportion of correct responses and exact binomial 95% CIs by age and literacy group.ResultsWe interviewed 851 people (of 1,507 people scheduled); responses from 844 were eligible for analysis, and 35.7% (n=301) of participants were aged 12-17 years. The overall sample met performance criteria for 10 of the 11 primary communication objectives (93-99% correct) related to indications for use, eligibility for use, the dosing regimen, and contraindications; young people met nine and people with limited literacy met eight of the 11 performance criteria. Only 79% (95% CI 0.76-0.82) of the overall sample understood to contact a health care professional if little or no bleeding occurred soon after taking misoprostol, not meeting the prespecified threshold of 85.0%.ConclusionOverall, high levels of comprehension suggest that people can understand most key drug facts label concepts for a medication abortion product without clinical supervision and recommend minor modifications.

Early pregnancy loss can be treated medically with mifepristone followed by misoprostol, with ultrasonographic confirmation of pregnancy expulsion. Alternative strategies that ascertain treatment success remotely are needed. We compared percent decline in human chorionic gonadotropin (hCG) level with treatment success or failure between patients who received mifepristone pretreatment followed by misoprostol or misoprostol alone for early pregnancy loss between 5 and 12 weeks of gestation to determine a threshold decline that might predict success. Early pregnancy loss treatment success was associated with a greater percent hCG level decline compared with treatment failure, but no threshold was able to predict success. Additional research is needed to understand hCG trends after medical management of early pregnancy loss to develop reliable protocols for remote follow-up.

Introduction: In the first trimester, almost one in five identified pregnancies end in spontaneous miscarriage, and another 22% result in induced abortion. After a spontaneous and/or induced abortion, there may be retained products of conception (POC). Because of its relatively poor efficacy and the unpredictability of the time interval until spontaneous evacuation, expectant treatment is not often chosen by healthcare professionals. In view of these facts, the current study's objective was to weigh the effectiveness of MVA and oral misoprostol 600 mg in managing incomplete abortion. Materials and Procedures: The investigation was conducted at the tertiary care center in India. The survey was conducted for one year. Subjects were selected from those attending the department for either spontaneous or induced abortions. A total of 230 women were randomly assigned to receive the interventions of a single dose of oral misoprostol 600 mcg or MVA. They were equally distributed to two groups and observed for the various parameters of success, signs and symptoms, satisfaction, and complications. The obtained values were compared statistically for the significance at

Background & aim: Considering the lack of scientific documents published on humans regarding the effect of Stachys lavandulifolia hydroalcoholic extract on abortion in traditional Iranian medicine, the aim of the present study was to determine and investigate the effect of hydroalcoholic extract of mountain tea in combination with misoprostol compared to misoprostol alone in terminating pregnancies less than 12 weeks. Methods: The present randomized clinical trial study was conducted at Imam Sajjad Hospital of Yasuj in 2019-2020 on 40 referring patients divided into two groups. Participants were assigned to two groups of mountain tea extract in combination with misoprostol (group A) or misoprostol alone (group B). In group A, mountain tea in the form of capsules (400 mg every three hours, up to three times, daily) along with 400 micrograms of misoprostol (every three hours, up to three doses, daily) were prescribed. In group B, misoprostol 800 micrograms were taken orally every three hours, up to three doses daily. In case of no abortion, the above dose was repeated on the second day. The intended outcomes included pain intensity, bleeding intensity, patient satisfaction, type of abortion, assessment of side effects (such as vital signs, clinical symptoms, blood parameters, analysis of kidney and liver function indicators). The collected data are analyzed using chi-square and t-test. Results: There was no statistically significant difference between the two groups in terms of complete abortion (p=0.52) and incomplete abortion (p=52). The duration of intervention in group A (6.10±1.11) was significantly shorter than group B (8.40±0.59) (p>0.001). There was no statistically significant difference between the two groups in terms of pain intensity (p=0.52) and bleeding intensity (p=0.14) at 4-8 hours and 8-12 hours after the intervention. Also, there was no significant difference between the two groups in terms of blood parameters, kidney and liver analysis (p0.001) was observed in group B compared to group A. Also, the results of the present study showed that patient satisfaction in group A (6±0) was significantly better than group B (4.60±1.14) (p

Abstract Background A missed abortion is a spontaneous abortion in which the embryo or fetus has already died but has remained in the uterus for days or weeks with a closed cervical ostium. Termination of pregnancy could be achieved either by surgical evacuation or medical or expectant management. Letrozole is a third-generation aromatase inhibitor. According to many recent studies, letrozole given for three days before the administration of misoprostol was more effective than misoprostol alone at inducing abortion. Our study compared the efficacy of various letrozole regimens (10 mg/d for three days and a single dose of 20 mg) combined with misoprostol vs. misoprostol alone in inducing abortion. To find the most efficient regimen of letrozole administered before misoprostol to induce an abortion. Methodology This prospective, parallel, three-arm, single-blinded, allocation-concealed randomized controlled trial was conducted in Sohag Teaching Hospital in Upper Egypt. We randomly divided 105 patients with anembryonic missed abortion (up to 63 days gestation) with no history of medical disorders or a history of allergies to misoprostol or letrozole into three equal groups (a single-dose letrozole group, a multiple-dose letrozole group, and a misoprostol-only group). The complete abortion rate, incomplete abortion rate, failure to abort rate, and induction-to-abortion interval were all collected. All statistical calculations were performed using the computer program SPSS (Statistical Package for the Social Science, SPSS Inc., Chicago, IL, USA). Results The complete abortion rate was significantly higher in the single-dose letrozole and multiple-dose letrozole groups than in the misoprostol group (p values = 0.0455 and 0.001, respectively). On the other hand, there was no significant difference in the complete abortion rate between the single-dose group and the multiple-dose letrozole group (p-value = 0.1713). The time to complete abortion was significantly shorter in the single-dose and multiple-dose letrozole groups than in the misoprostol group (p values = 0.0036 and 0.0049, respectively). On the other hand, there was no significant difference in the time to complete abortion between the single-dose letrozole group and the multiple-dose letrozole group (P = 0.532). Conclusion Single- and multiple-dose letrozole regimens followed by misoprostol had a higher rate and a shorter time to complete abortion than misoprostol alone. Trial registration The trial is registered at gov with the name “letrozole and abortion” and the identifier “NCT05198050”. The date of registration was April 1, 2022, registered prospectively. URL: https://register.clinicaltrials.gov/prs/app/action/ViewOrUnrelease?uid=U0004GED&ts=25&sid=S000BPDQ&cx=43mobl .

Sıçanlarda paklitaksel (PTX) kaynaklı akciğer hasarına karşı misoprostol’ün (MP) koruyucu etkilerinin incelendiği bu çalışmada, yirmi bir adet dişi Sprague-Dawley cinsi sıçan kullanıldı. Bu hayvanlardan rastgele bir seçimle Kontrol, PTX ve PTX + MP olmak üzere 3 grup (n=7) oluşturuldu. Kontrol grubuna 1 mL %0,9 NaCl intraperitoneal (i.p.) ve 1 mL %0,9 NaCl oral yolla 6 gün boyunca verildi. PTX ve PTX + MP gruplarına çalışmanın 0., 2., 4. ve 6. günlerinde her sıçana 2 mg/kg PTX i.p. olarak verildi. PTX + MP grubuna ayrıca 6 gün süreyle 0,2 mg/kg/gün MP oral olarak verildi. Doku numuneleri sıçanlardan anestezi altında alındıktan sonra bu numunelerde biyokimyasal ve histopatolojik analizler yapıldı. Yapılan analizlerde PTX grubu sıçanlarda akciğer dokusundaki süperoksit dismutaz (SOD) ve katalaz (CAT) aktiviteleri ile glutatyon (GSH) düzeyinin azaldığı, malondialdehit (MDA) düzeyinin ise yükseldiği belirlendi. Yapılan histopatolojik incelemelerde ise, PTX grubu sıçanlarda alveol yapısında düzensizlik ve kalınlaşma, perivasküler ödem ve perivasküler alanda inflamatuar hücre infiltrasyonu gibi histopatolojik değişikliklerin şekillendiği tespit edildi. PTX + MP grubunda ise, PTX grubunda tespit edilen patolojik değişikliklerin büyük oranda önlendiği görüldü. Elde edilen bu sonuçlar; PTX’in neden olduğu akciğer hasarının önlenmesinde MP’nin etkili olduğunu göstermekte olup, kanser tedavisinde bu iki ilacın birlikte kullanılmasının faydalı olacağını düşündürmektedir.

Background: Myomectomy is a common surgical intervention for the removal of uterine fibroids. Excessive blood loss during the procedure remains a concern. However, there is currently no agreement on the optimal method for minimizing blood loss during myomectomy procedures.Aim of the Work: This comparative study aimed to assess the efficacy of two approaches, namely preoperative misoprostol administration and intraoperative cervical hemostatic uterine artery ligation, in reducing intraoperative blood loss.Patients and Methods: A prospective randomized controlled trial was conducted, including a total of 80 patients undergoing myomectomy for symptomatic uterine fibroids. These patients were divided into two groups: Group A [40 patients] received preoperative misoprostol and Group B [40 patients] underwent intraoperative cervical hemostatic uterine artery ligation. The primary outcome measure was the difference in blood loss between the two groups. Secondary outcomes included operation time, postoperative hemoglobin levels and transfusion rates. Results: The findings revealed that the amount blood loss was significantly less in Uterine Artery Ligation group. The mean blood loss in Group A was 440.0±78.1 ml, while in Group B, it was 375.0±96.3 ml [p 0.006]. Furthermore, Group B demonstrated a lower transfusion rate and higher postoperative hemoglobin levels compared to Group A.Conclusion: Intraoperative cervical hemostatic uterine artery ligation was found to be more effective than preoperative misoprostol administration in reducing blood loss during myomectomy procedures. This technique shows promise in improving surgical outcomes, minimizing blood loss, and potentially reducing the need for blood transfusion, but further research and long-term follow-up studies are needed for validation and to determine its clinical significance.

Introduction: Misoprostol is widely used in the medical management of missed abortions. However, pretreatment with Mifepristone has shown to be effective but still not recommended to be used in missed abortions. Aims and Objectives: To compare the outcome of medically managed missed abortion or blighted ovum using combination regime (Mifepristone and Misoprostol) vs Misoprostol alone. Materials and Methods: It was a prospective single-centre study performed in the Department of Obstetrics and Gynaecology, HIMSR and HAHC hospital, New Delhi, over, for one year. All the patients with diagnosed missed abortions were randomized into two groups (Group A and Group B). Group A was given Mifepristone 200 mg orally followed by Misoprostol 800 microgram per vaginal. Group B was given Misoprostol 800 microgram per vaginal. All the patients were observed for 24 hours for the expulsion of products of conception following the given regime. Ethical approval was taken from the Institutional Ethical Committee. Results: Both groups were comparable in demographic characteristics. On applying Fisher’s exact test, it has been observed that the odds of nonexpulsion of the product of conception, time taken in expulsion, and surgical evacuation because of excessive bleeding were significantly higher in Group B (Misoprostol) compared with Group A (Mifepristone followed by Misoprostol). The cost-effective analysis showed that the cost is higher among Misoprostol Group B compared with combination drugs of Group A (Mifepristone + Misoprostol), but this result is not significant. Conclusion: Mifepristone can be considered before Misoprostol in missed abortions. This regime might decrease the need for surgical evacuation.

Objective(s)To estimate the effectiveness, acceptability, and feasibility of medication abortion with mifepristone dispensed by a mail-order pharmacy after in-person clinical assessment.Study designThis is an interim analysis of an ongoing prospective cohort study conducted at five sites. Clinicians assessed patients in clinic and, if they were eligible for medication abortion and ≤ 63 days' gestation, electronically sent prescriptions for mifepristone 200 mg orally and misoprostol 800 mcg buccally to a mail-order pharmacy, which shipped medications for next-day delivery. Participants completed surveys three and 14 days after enrollment, and we abstracted medical chart data.ResultsBetween January 2020 and April 2021 we enrolled 240 participants and obtained clinical outcome information for 227 (94.6%); 3 reported not taking either medication. Of those with abortion outcome information (N = 224), 216 (96.4%) completed day-3 and 212 (94.6%) day-14 surveys. Of the 224 that took medications, none reported taking past 70 days' gestation, and complete medication abortion occurred for 217 participants (96.9%, 95% CI 93.7%-98.7%). Most received medications within three days (82.1%, 95% CI 76.5%-86.9%). In the day-3 survey, 95.4% (95% CI 91.7%-97.8%) reported being very (88.4%) or somewhat (6.9%) satisfied with receiving medications by mail. In the day-14 survey, 89.6% (95% CI 84.7%-93.4%) said they would use the mail-order service again if needed. Eleven (4.9%, 95% CI 2.5%-8.6%) experienced adverse events; two were serious (one blood transfusion, one hospitalization), and none were related to mail-order pharmacy dispensing.ConclusionsMedication abortion with mail-order pharmacy dispensing of mifepristone appears effective, feasible, and acceptable to patients.ImplicationsThe in-person dispensing requirement for mifepristone, codified in the drug's Risk Evaluation and Mitigation Strategy, should be removed.

ObjectivesTo evaluate mifepristone impact on osmotic dilator placement and procedural outcomes when given 18 to 24 hours before dilator placement for dilation and evacuation (D&E) at 18 weeks 0 days to 23 weeks 6 days gestation.Study designWe performed a randomized, double-blind, placebo-controlled trial from April 2019 through February 2021, enrolling participants undergoing osmotic dilator (Dilapan) placement for a planned, next-day D&E. Participants took mifepristone 200 mg or placebo orally 18 to 24 hours before dilator placement. We used a gestational age-based protocol for minimum number of dilators. Our primary outcome was the proportion of participants for whom 2 or more additional dilators could be placed compared to the minimum gestational age-based standard. We secondarily evaluated cervical dilation after dilator removal in the operating room, subjective procedure ease, and complication rates (cervical laceration, uterine perforation, blood transfusion, infection, hospitalization, or extramural delivery).ResultsOf the planned 66 participants, we enrolled 44 (stopped due to coronavirus disease 2019-related obstacles), and 41 (19 mifepristone; 22 placebo) completed the study. We placed 2 or more additional dilators compared to standard in 7 (36.8%) and 3 (13.6%) participants after mifepristone and placebo, respectively (p = 0.14). We measured greater median initial cervical dilation in the mifepristone (3.2 cm[2.6-3.6]) compared to placebo (2.6 cm[2.2-3.0]) group, p = 0.03. Surgeon's perception of procedure being "easy" (8/19[42.1] vs 9/22[40.9], respectively, p = 1.00) and complication rate (3/19[15.8%] vs 3/22[13.6], respectively, p = 1.00) did not differ.ConclusionOur underpowered study did not demonstrate a difference in cervical dilator placement, but mifepristone 18 to 24 hours prior to dilators increases cervical dilation without increasing complications.ImplicationsMifepristone 18 to 24 hours prior to cervical dilator placement may be a useful adjunct to cervical dilators based on increased cervical dilation at time of procedure; however, logistical barriers, such as an additional visit, may preclude routine adoption without definite clinical benefit.

Background: The use of medical abortion increases among unplanned pregnant women. The primary objective of this study is to assess the outcomes of using a combination of Mifepristone followed by sublingual Misoprostol for the termination of pregnancy up to 63 gestational days. The secondary objectives were identifying significant factors that contribute to an increased rate of incomplete abortions resulting in surgical intervention and evaluating the safety of this medical procedure. Methods: This retrospective cohort study was conducted at Siriraj Hospital, a tertiary care center in Thailand, from July 2021 to December 2023. Women were given 200 mg of oral Mifepristone at the clinic, followed by self-administration of 800 μg of sublingual Misoprostol at home 36–48 hours later. A follow-up visit was scheduled approximately 14 days later to confirm the outcome of the procedure. Demographic and medical data were collected from medical records and subsequently analyzed. The primary outcome was defined as the success of the procedure, indicated by complete abortion without the need for surgical intervention. Secondary outcomes included assessing side effects and complications following medication administration, as well as identifying factors associated with an increased rate of incomplete abortions. Results: The final analysis included follow-up data from 205 women. Medical abortion was successful in 70.7% (145 out of 205) of cases, with no ongoing pregancies recorded. No serious side effects or complications were detected. Diarrhea and chills were the most commonly observed side effects. The study found that women with a history of previous abortions and those experiencing significantly heavier bleeding after the procedure were at a higher risk of incomplete abortion, requiring surgical aspiration. Conclusions: The regimen of oral Mifepristone followed by sublingual Misoprostol for medical termination of pregnancy is effective and safe through 63 days of gestation. A history of previous abortion and experiencing heavier bleeding after the procedure were identified as risk factors for incomplete abortion.

Background: Hysteroscopy is a valuable surgical technique, but some complications are related to cervical dilatation. Sublingual trinitroglycerin (TNG) is a vasodilator that can facilitate cervical dilation. In our study, we compared its effectiveness to that of misoprostol. Methods: This randomized controlled trial study was conducted on 199 women of reproductive age who were referred to Rasoul Akram Hospital. Patients were randomly divided into two groups: TNG and misoprostol. Next, they were examined for clinical and practical indicators of cervical preparation. The data was analyzed using SPSS software. Results: Demographic characteristics exhibited no significant differences between the groups. The mean size of the largest dilator inserted without resistance showed not statistically significant difference between the TNG and misoprostol groups (6.26 ± 1.95 vs. 6.57 ± 2.05; p = 0.20). Side effects were reported in 66 (33.2%) of the women studied. The misoprostol group experienced a significantly higher rate of side effects (53.7%) compared to the TNG group (14.4%; p < 0.001). The most frequently observed side effect in the TNG group was headache, which occurred at a statistically significantly higher rate than in the misoprostol group (p = 0.04). On the other hand, uterine bleeding before hysteroscopy was significantly lower in the TNG group compared to the misoprostol group (p < 0.001). Conclusions: There was no statistically significant difference in the mean size of the largest dilator inserted without resistance between the TNG and misoprostol groups. Additionally, TNG experienced significantly fewer side effects than sublingual misoprostol group, with headache being the most prominent side effect. Sublingual TNG can be used to improve cervical preparation before hysteroscopy. Clinical Trial Registration: The study has been registered on https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20191123045476N4 (registration number: IRCT20191123045476N4).

The study aimed to perform a comprehensive in vitro and in vivo evaluation of a newly developed, patent-pending, powder-to-hydrogel, film-forming polymer complex base, which possesses tissue-protective and microbiome-supportive properties, and to compare its characteristics with poloxamer 407. The study used a combination of in vitro assays, including tissue viability and cell migration, and in vivo wound healing evaluations in male diabetic mice. Microbiome dynamics at wound sites were also analyzed. The in vitro assays demonstrated that the polymer complex base was non-cytotoxic and that it enhanced cell migration over poloxamer 407. In vivo, the polymer complex base demonstrated superior wound healing capabilities, particularly in combination with misoprostol and phenytoin, as evidenced by the reduced wound area and inflammation scores. Microbiome analysis revealed favorable shifts in bacterial populations associated with the polymer complex base-treated wounds. The polymer complex base demonstrates clinical significance in wound care, potentially offering improved healing, safety and microbiome support. Its transformative properties and efficacy in drug delivery make it a promising candidate for advanced wound care applications, particularly in chronic wound management.

BackgroundA growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion. We aim to describe self-managed abortion (SMA) experiences of people recruited outside of clinics, including their motivations for SMA, pregnancy confirmation and decision-making processes, method choices, and clinical outcomes.MethodsIn 2017, we conducted 14 in-depth interviews with self-identified females of reproductive age who recently reported in an online survey administered to Ipsos' KnowledgePanel that, since 2000, they had attempted SMA while living in the United States. We asked participants about their reproductive histories, experiences seeking reproductive health care, and SMA experiences. We used an iterative process to develop codes and analyzed transcripts using thematic content analysis methods.ResultsMotivations and perceptions of effectiveness varied by whether participants had confirmed the pregnancy prior to SMA. Participants who confirmed their pregnancies chose SMA because it was convenient, accessible, and private. Those who did not test for pregnancy were motivated by a preference for autonomy and felt empowered by the ability to try something on their own before seeking facility-based care. Participants prioritized methods that were safe and available, though not always effective. Most used herbs or over-the-counter medications; none used self-sourced abortion medications, mifepristone and/or misoprostol. Five participants obtained facility-based abortions and one participant decided to continue the pregnancy after attempting SMA. The remaining eight reported being no longer pregnant after SMA. None of the participants sought care for  SMA complications; one participant saw a provider to confirm abortion completion.ConclusionsThere are many types of SMA experiences. In addition to those who pursue SMA as a last resort (after facing barriers to facility-based care) or as a first resort (because they prefer homeopathic remedies), our findings show that some individuals view SMA as a potential interim step worth trying after suspecting pregnancy and before accessing facility-based care. These people in particular would benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill.

ObjectivesTo compare participant-reported bleeding and pain with two medication regimens for early pregnancy loss (EPL).Study designWe performed a secondary analysis of a randomized trial in which participants took either mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally 24 hours later or misoprostol alone for medical management of EPL. Participants reported bleeding and pain (Numeric Pain Rating Scale, NPRS, 0-10) with daily paper diaries and at study visits on trial days 3, 8, and 30. We used, Fisher's exact, Pearson chi-square, Wilcoxon rank sum, and Student's t-tests to compare onset, duration, and severity of bleeding and pain symptoms between trial arms after misoprostol administration.ResultsAmong 291 participants who submitted diary data, 143 received mifepristone pretreatment. A larger proportion of this group reported moderate or heavy bleeding on trial day 2, the day of misoprostol administration, compared with those who did not receive pretreatment (73% vs 47%, p < 0.01). Between days 4 and 8, more mifepristone-pretreatment participants reported mild or no bleeding, compared with the misoprostol-only arm (78% vs 61%, p < 0.01). Average pain score for trial days 2-4 was higher for the pretreatment group compared with the misoprostol-only group (6.9 vs 6.0, p = 0.01), and there was a trend toward shorter total duration of pain (15 vs 19 hours, p = 0.08). These differences remained after controlling for treatment success across arms.ConclusionsMifepristone pretreatment increased the severity of pain but not bleeding and resulted in a shorter trajectory of symptoms during medical management of EPL.ImplicationsMifepristone pretreatment decreases the duration of heavy bleeding and there was a trend toward decreased duration of pain during medical management of miscarriage, indicating that this medication improves the efficiency, in addition to the efficacy, of this treatment.

Abstract Introduction Misoprostol is widely used for medication abortion and postpartum hemorrhage. However, it has been associated with the adverse effect of fever, which can pose challenges in management and potentially contribute to unnecessary antibiotic use. The incidence of misoprostol-induced fever in the context of medical abortion has not been extensively studied. Methods This retrospective cohort study aimed to determine the incidence of fever following misoprostol administration at a tertiary care hospital in Saudi Arabia. The study included female patients who received misoprostol for pregnancy termination or management of missed or incomplete abortion between January 2017 and December 2019. Data on demographics, misoprostol dosage and route, fever characteristics, outcome of abortion, and antibiotic use were collected. Statistical analysis was preformed using appropriate tests. Results A total of 213 patients were included in the study. The incidence of fever post-misoprostol administration was 8%. Patients who developed fever had a higher gestational age and received higher doses of misoprostol. However, no significant associations were found between other patient variables and fever incidence. Antibiotic therapy was administered to a almost half of the patients who developed fever post-misoprostol but was determined to be unnecessary in all cases. Conclusion This study contributes to the understanding of misoprostol-induced fever in the context of medical abortion. Further research is needed to explore strategies for reducing unnecessary antibiotic use in this population.

Introduction: Termination of pregnancy through curettage in the first trimester requires cervical ripening (CR) which can be induced by medicinal or mechanical methods. In the pharmaceutical method, vaginal administration of misoprostol, as well as vaginal trinitroglycerin (TNG), has been shown to induce effective CR. This study was conducted with the aim of comparing vaginal misoprostol and vaginal TNG in the CR of women candidates for the first-trimester curettage. Materials and Methods: This double-blind clinical trial study was conducted on 168 pregnant women with a gestational age of less than 14 weeks who were candidates for curettage. Participants were randomly divided into two groups receiving vaginally either TNG (400 µgr)(n=87) or misoprostol (400 µgr) (n=81). Then, the state of CR and the need for mechanical dilatation were compared between the two groups. Also, the presence of any side effects caused by drug use was determined. Results: The percentage of CR in the misoprostol group (67.9%) was significantly higher than in the TNG group (32.2%) (P0.001). Generally, the rate of complications in the TNG group (35.6%) was significantly higher compared with the misoprostol group (13.6%) (P>0.001). Conclusion: Vaginally Misoprostol is more effective than vaginally TNG on CR of first-trimester curettage as well as it significantly reduces the need for mechanical dilatation of the cervix.

Sophie Goemans,1 Abhishek Singh,2,3 Ajit Kumar Yadav,4 Lotus McDougal,5 Anita Raj,5 Sarah H Averbach1,5 1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA; 2Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India; 3Centre of Demography of Gender, International Institute for Population Sciences, Mumbai, Maharashtra, India; 4GENDER Project, International Institute for Population Sciences, Mumbai, Maharashtra, India; 5Center on Gender Equity and Health, University of California San Diego, La Jolla, CA, USACorrespondence: Sarah H Averbach, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, 9300 Campus Point Drive, San Diego, CA, MC 7433, USA, Tel +1 858-249-1205, Fax +1 858-657-7212, Email saverbach@health.ucsd.eduPurpose: To examine the association between self-managed abortion and the self-reported experience of abortion complications in India, a country with a high incidence of self-managed abortion.Patients and Methods: The study used a cross-sectional multivariable logistic regression analysis of data from the National Family Health Survey (NFHS-4) of 2015– 2016 to compare the odds of self-reported complications experienced during abortion between self-managed and clinician-managed abortions in India.Results: On average, self-managed abortions occurred earlier in gestation than clinician-managed abortions, 7.8 weeks and 11.3 weeks, respectively (p < 0.001). Self-managed abortion was associated with fewer self-reported abortion-related complications than clinician-managed abortions when adjusted for covariates not including gestational age (Adjusted Odds Ratio (aOR) 0.82, 95% confidence interval (CI) 0.69, 0.97). However, once adjusted for gestational age, there was no longer a clinically meaningful or statistically significant difference in the odds of self-reported complications between self-managed and clinician-managed abortions (aOR = 0.98, 95% CI 0.81, 1.18).Conclusion: These findings suggest that people in India are using safe methods to self-manage abortions and support the hypothesis that self-managed abortion can improve access to abortion and reproductive choice without increasing risk.Keywords: reproductive autonomy, reproductive choice, self-use, medication abortion, misoprostol, mifepristone

Objective: To determine whether addition of evening primrose to a misoprostol-based abortion regimen can increase the success of abortion.Materials and Methods: In this randomized clinical trial., 148 women referring to Niknafas Hospital in Rafsanajn with diagnosis of missed abortion were randomly allocated into two 74-subject groups. The intervention group used 2000 mg vaginal evening primrose capsules the night before the hospitalization, while the control group did not receive any medication. Both groups received an initial dose of 800 μg of vaginal misoprostol after admission and the next dose was given three hours later if necessary.Results: The two groups had significant differences in terms of full abortion, consistency and dilatation of cervix, duration between the first dose of misoprostol until the ejection of fetus, the misoprostol dose administered, and the level of vaginal bleeding during the hospitalization. They had no significant differences regarding curettage, duration of hospitalization, or side effects. The mean pain score had no significant difference between the two groups, though the score was lower in the intervention group (p>0.05).Conclusion: Administration of vaginal evening primrose before vaginal misoprostol was found to be more effective compared to misoprostol alone in missed abortion.

Abstract Objective This study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to that of IV tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss in high-risk women for postpartum haemorrhage (PPH) following cesarean section (CS). Methods About 315 high-risk pregnant women undergoing CS participated in this trial. They were randomly assigned into three groups; tranexamic group, misoprostol group, and control group, according to the medication given in the operative theatre. All patients received oxytocin intraoperatively. They were assessed regarding intraoperative blood loss, the incidence of PPH, and the reduction in haemoglobin and hematocrit values. Results Both tranexamic and misoprostol groups had similar results in reducing intra and post-operative blood loss. However, the reduction in haemoglobin and hematocrit were significantly lower in tranexamic and misoprostol groups compared to the control group (-0.78 ± 0.57 vs. -0.83 ± 0.52 vs. -1.32 ± 0.57 gm/dl, P

Background: Suction evacuation is the most common surgical method of first-trimester pregnancy termination and cervical dilatation is the most critical step. Misoprostol is increasingly being used as a cervical priming agent before suction evacuation although the ideal dosage and route of administration is not yet agreed upon. Objective: The present study aimed to compare the efficacy, side effects and acceptability of the sublingual vs. vaginal route of administration of misoprostol. Methodology: 120 women seeking first-trimester termination of pregnancy between 6 to 12 weeks of gestation were randomized to receive 400mcg of misoprostol either sublingually or vaginally. Women in the two groups were comparatively evaluated for cervical dilatation before a surgical abortion, operative blood loss, time duration of surgery, adverse effects and overall satisfaction with the route of administration. Result: Successful dilatation of more than 8mm was achieved in 41(68.3%) women in the sublingual group and 23(38 %) in the vaginal group (p

Resumo Objetivo Analisar as evidências disponíveis na literatura acerca do insucesso da indução do trabalho de parto com misoprostol em gestações a termo. Métodos Revisão integrativa, realizada entre janeiro e novembro de 2022, cuja pergunta de pesquisa e descritores foram delineados por meio da estratégia PECO. As buscas foram realizadas nas bases de dados MEDLINE; Web of Science; CINAHL; EMBASE e Scopus por duas pesquisadoras de forma independente, assim como a avaliação. Para a fase de seleção e identificação dos estudos foi utilizado o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A avaliação do risco de viés dos artigos incluídos foi realizada através do questionário Newcastle Ottawa Scale. Resultados Foram identificados 3.674 artigos, 84 foram lidos na íntegra, dos quais 11 compuseram a revisão (n=9.010 gestantes), com publicação entre os anos de 2005 a 2021, sendo a maioria nos Estados Unidos. Quanto ao nível de evidência, todos os artigos foram classificados como 2b, avaliada coforme o delineamento de cada investigação. O estudo apontou evidências quanto aos seguintes fatores: IMC elevado (maior igual a 30kg/m2), nuliparidade, bishop imaturo, comprimento cervical (maior igual a 30mm), estatura, etnia (não caucasianas do sul da Europa) e peso fetal (maior igual a 4kg). Conclusão Alcançou-se o objetivo do estudo tendo sido demonstrado seis fatores maternos e um fetal que podem levar ao insucesso da indução. Vale ressaltar a necessidade de evidências que incorporem a individualidade de cada característica e destaca-se a contribuição desse estudo para embasar a escolha da melhor conduta para cada gestação de forma individualizada.