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Abstract Background Misoprostol is the choice drug for inducing an abortion with intrauterine fetal death, but it has several side effects that increase with accumulating the dose received. Induction abortion with cheap and non-invasive methods with minimal complications is essential. This study aimed to compare the effect vaginal misoprostol plus vaginal evening primrose oil capsule with vaginal misoprostol alone on the consequences of abortion in pregnant women with intrauterine fetal death at 12–20 weeks of pregnancy. Methods This study is a randomized, triple-blind clinical trial with two parallel groups at a ratio of 1:1. We randomized 82 women with indications of termination of pregnancy due to intrauterine fetal death into two groups. The experimental group (n = 42) received 200 mcg of misoprostol tablet with 1000 mg evening primrose oil capsule intravaginal. The control group (n = 40) received 200 mcg of misoprostol tablet with 1000 mg evening primrose oil placebo capsule intravaginal. Both groups received the drugs every 4 h for up to five doses. The primary outcome was the mean induction-to-fetal expulsion interval. Secondary outcomes were the mean dose of misoprostol, the highest pain intensity in the induction-to-fetal expulsion interval, the frequency of participants requiring blood transfusion, curettage, and the frequency of side effects of misoprostol or evening primrose oil. Pain intensity was measured through the Visual Analog Scale. Results The mean age of the experimental group was 32.30 ± 6.19 years, and the control group was 30.27 ± 7.68 years. The mean gestational age of the experimental group was 15.29 ± 2.26 weeks, and the control group was 15.10 ± 1.89 weeks. The mean induction-to-fetal expulsion interval in the experimental group (3.12 ± 2.17 h) was significantly lower than that in the control group (8.40 ± 4.1 h) (p

Background: The labour induction involves the initiation of nonspontaneous contractions of the uterus prior to spontaneous onset leading to progressive effacement and dilation of the cervix and delivery of the baby. Labour is commonly induced in case of post-term pregnancy, pre-eclampsia, premature rupture of membranes etc. Induction is indicated in situations where pregnancy continuation is dangerous to the life of the pregnant women or well-being of the mother or the fetus. The aim of labour induction is to complete the process of labour within defined time frame in good condition and minimum discomfort and complications to the pregnant women. Objective: 1. To compare the efficacy of intravaginal misoprostol, intracervical dinoprostone and Foley's catheter for induction of labour in terms of induction-delivery interval, oxytocin augmentation and mode of delivery. 2. To compare the neonatal outcome in terms of APGAR score. METHODS: Prospective study was conducted on 180 pregnant women at Vani Vilas Hospital and Bowring & Lady Curzon Hospital, BMCRI, Bangalore after taking full informed consent. They were randomly assigned into 3 groups: Group 1: Intravaginal misoprostol. Group 2: Intracervical dinoprostone. Group 3: Transcervical Foley's catheter. Each group containing 60 pregnant women. Results: The mean (± SD) induction delivery interval was 11.50±2.19 hours in misoprostol group and 13.92±1.80 hours in dinoprostone group and 12.18±1.53 in foley's group. About 76.7% of misoprostol group, 68.3% of dinoprostone group and 83.3% of foley's group delivered vaginally. About 16.7% of misoprostol group, 10% of dinoprostone group and 6.7% of foley's group had NICU admission. Conclusion: This study shows that induction delivery interval was less, rate of caesarean section was less and number of NICU admission was less with foley's group. Hence transcervical Foley's catheter can be used to achieve effective and safe induction of labour. The sample size is small and hence the results cannot be generalized. [ABSTRACT FROM AUTHOR]

Background: Vaginal misoprostol is a highly effective method of cervical ripening and induction of labor; however, it is associated with some complications. Therefore, there is need to explore other routes of administration that may be safer, acceptable, and also effective. Objective: The aim of this study was to compare the effectiveness and safety of vaginal versus sublingual misoprostol for cervical ripening and induction of labor. Materials and Methods: This was a randomized controlled trial conducted among booked antenatal women in Owerri, South-East Nigeria. The eligible participants were randomized to receive either 25 μg of misoprostol vaginally (n = 90) or 25 μg sublingually (n = 90). Outcome measures included delivery within 24 h, induction to delivery interval, cesarean section rate, side effects of misoprostol, Apgar Score at birth, and admission into the Neonatal Intensive Care Unit. Results: There was no significant difference in the effectiveness and side effects of both routes of administration (p > 0.05). The results were comparable in both groups, except for the time to reach the active phase of labor (vaginal route 16.64 ± 9.12 vs. sublingual route 13.78 ± 7.47, P = 0.023) and the number of doses of misoprostol used (vaginal route 2.81 ± 1.53 vs. sublingual route 2.34 ± 1.49, P = 0.040). Conclusion: The effectiveness of cervical ripening and induction of labor is comparable in both groups and the side effect profile is also similar. Hence, the sublingual route is as effective and as safe as the vaginal route but with added advantage of shortening the duration of active phase of labor and requiring less doses for induction of labor.

Abstract Objectives This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. Methods Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5). Results Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group. Conclusions Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

Background: Misoprostol is the choice drug for inducing an abortion with intrauterine fetal death, but it has several side effects that increase with accumulating the dose received. Induction abortion with cheap and non-invasive methods with minimal complications is essential. This study aimed to compare the effect vaginal misoprostol plus vaginal evening primrose oil capsule with vaginal misoprostol alone on the consequences of abortion in pregnant women with intrauterine fetal death at 12–20 weeks of pregnancy. Methods: This study is a randomized, triple-blind clinical trial with two parallel groups at a ratio of 1:1. We randomized 82 women with indications of termination of pregnancy due to intrauterine fetal death into two groups. The experimental group (n = 42) received 200 mcg of misoprostol tablet with 1000 mg evening primrose oil capsule intravaginal. The control group (n = 40) received 200 mcg of misoprostol tablet with 1000 mg evening primrose oil placebo capsule intravaginal. Both groups received the drugs every 4 h for up to five doses. The primary outcome was the mean induction-to-fetal expulsion interval. Secondary outcomes were the mean dose of misoprostol, the highest pain intensity in the induction-to-fetal expulsion interval, the frequency of participants requiring blood transfusion, curettage, and the frequency of side effects of misoprostol or evening primrose oil. Pain intensity was measured through the Visual Analog Scale. Results: The mean age of the experimental group was 32.30 ± 6.19 years, and the control group was 30.27 ± 7.68 years. The mean gestational age of the experimental group was 15.29 ± 2.26 weeks, and the control group was 15.10 ± 1.89 weeks. The mean induction-to-fetal expulsion interval in the experimental group (3.12 ± 2.17 h) was significantly lower than that in the control group (8.40 ± 4.1 h) (p < 0.001). The mean dose of misoprostol received in the experimental group (271.42 ± 115.39 mcg) was significantly lower than that in the control group (520 ± 201.53 mcg) (p < 0.001). Also, the mean pain intensity in the experimental group (5.02 ± 0.60) was significantly lower than that in the control group (8.65 ± 1.001) (p < 0.001). The two groups were not significantly different in the frequency of blood transfusion requirements, analgesia and drug side effects. The need for curettage in the experimental group (4.8%) was significantly lower than that in the control group (47.5%) (p < 0.001). Conclusions: Vaginal administration of evening primrose oil with misoprostol reduced duration of time of fetal expulsion, pain intensity, mean dose of misoprostol received, and the need for curettage in participants. Therefore, we suggest this method for induced abortion in women with intrauterine fetal death. Trial registration: IRCT20181207041873N3. Dated 16/2/2021 prospectively registered https://en.irct.ir/user/trial/53681/view. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate outcomes with mifepristone 200 mg orally followed 24-48 h later by misoprostol 800 mcg vaginally for medical abortion at 64-70 days of gestation.Study designWe reviewed electronic databases and medical records for medical abortion cases at 64-70 days' gestation at British Pregnancy Advisory Service clinics in England and Wales from May 2015 through October 2016. Women selected in-office follow-up or self-evaluation of abortion outcome using a checklist along with low-sensitivity urine pregnancy testing. We excluded cases in which we could not locate records and when women did not proceed with medical abortion, did not use misoprostol following mifepristone if abortion had not occurred and did not attend a scheduled follow-up assessment. We analyzed demographic characteristics, treatment outcomes and significant adverse events. We defined treatment success as complete abortion without surgical evacuation and without continuing pregnancy.ResultsOf 2743 cases identified, we could not locate 40 charts and excluded 30 cases, leaving a final sample of 2673. Overall, 2538 (94.9%, 95% CI 94.1-95.8) women had a successful medical abortion. Reasons for failure included continuing pregnancy (n=90, 3.4%, 95% CI 2.7-4.1), retained nonviable pregnancy (n=2, 0.1%, 95% CI 0-0.2) and incomplete abortion (n=43, 1.6%, 95% CI 1.1-2.1). Of those with continuing pregnancies, 81 underwent a uterine aspiration and 9 opted to continue the pregnancy. Thirty-five (1.3%, 95% CI 0.9-1.7) women had significant adverse events; 16 (0.6%, 95% CI 0.3-0.9) underwent an in-hospital aspiration. Pelvic infection (n=4, 0.2%) and transfusion (n=1, 0.03%) occurred rarely.ConclusionMedical abortion from 64 to 70 days with mifepristone and vaginal misoprostol is effective with a low rate of serious adverse events.ImplicationsMedical abortion between 64 and 70 days of gestation may be offered on an outpatient basis using mifepristone and vaginal misoprostol. Service provision without an in-person follow-up is feasible. Not all women with a continuing pregnancy after medical abortion treatment opt to have an aspiration procedure.

Objective: To determine the proportion of complete abortion without surgical intervention for patients who chose medication abortion with vaginal compared to buccal misoprostol following oral mifepristone through 70 days of gestation.Methods: We performed a retrospective cohort study. We reviewed charts via electronic medical record data abstraction of patients receiving medication abortion with mifepristone and buccal or vaginal misoprostol between September 1, 2017 and August 1, 2019. Primary outcome was complete abortion without surgical intervention for any indication. Secondary outcomes were ongoing pregnancy and uterine aspiration for indications other than ongoing pregnancy.Results: There were 14,504 encounters included in the data set. Of the 4814 patients who took vaginal misoprostol and the 4011 patients who took buccal misoprostol for whom follow up data is available, 4640 (96.4%) and 3917 (97.7%) had a complete abortion without surgical intervention, respectively (p = 0.002). At <64 days of gestation, complete abortion was 96.6% for vaginal administration compared to 98.0% for buccal (p = 0.001). At 64 to 70 days of gestation, complete abortion was 92.7% for vaginal administration compared to 93.2% for buccal (p = 0.08). Of the 1128 patients who took vaginal misoprostol at less than 6 hours after mifepristone, 95.3% experienced a complete abortion.Conclusion: Buccal administration of misoprostol is associated with a higher proportion of complete abortion before 64 days of gestation compared to vaginal misoprostol. Clinically, vaginal misoprostol is an effective route of administration through 70 days of gestation.Implications: Medication abortion with vaginal misoprostol is effective when administered through 70 days of gestation and with shorter intervals between mifepristone and misoprostol. Prospective research to better estimate effectiveness is warranted. Expanding medication abortion options promotes patient autonomy amid increasing restrictions and bans on abortion. [ABSTRACT FROM AUTHOR]

Background: In patients who have already undergone a cesarean section, there is increasing use of medications to terminate the pregnancy due to fetal death or fetal anomalies. Objectives: To study the safety and efficacy of pregnancy termination using vaginal misoprostol in women undergone a single lower segment cesarean section. Patients and methods: This clinical trial study included 100 women (attending the Department of Gynecology and Obstetrics, Benha University hospitals) with one previous lower segment cesarean section who were advised to terminate their pregnancy (after 13-26 weeks) due to intrauterine fetal death or fetal structural anomalies. They were divided into two equal groups Group I (cases) who had uterine scars, while Group II (control) without scars. History, clinical examination, and ultrasound imaging were performed on all patients. There were 72 hours in which the patient was given misoprostol every four hours via the vaginal route. Results: It was found that the induction-to-abortion period was much shorter in the control group than in the cases group despite no significant differences in age, parity, gestational age, or doses required to induce abortion between the two groups. There were non-significant differences between patient group I with uterine scar and control group II without uterine scar regarding doses needed, except for 1-4 doses and 9-12 doses which exhibited significant differences. Conclusion: In women who have had a previous cesarean section, the vaginal route of misoprostol in a dose of 50 µg /4 hours is safe and successful for inducing a second-trimester abortion. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of early versus late amniotomy after induction of labor (IOL) with vaginally administered misoprostol. Methods: This randomized clinical trial was conducted at the Department of Obstetrics and Gynecology, Menoufia University, from May 2019 to March 2020, and included 120 nulliparous women at term (≥ 37 weeks' gestation) undergoing IOL. Computer-generated randomization was used to randomize the participants into either the early amniotomy group (3 cm cervical dilatation; n = 60) or the late amniotomy group (7 cm cervical dilatation; n = 60). All participants received misoprostol (25 μg) vaginally to induce labor. The primary outcome was the induction-to-delivery interval, defined as the time from the initiation of IOL to the time of delivery. Results: Women in the early amniotomy group had a shorter duration of labor (12.60 ± 5.36 h) than those in the late amniotomy group (16.67 ± 7.26 h). The mean time from rupture of the fetal membrane to delivery was significantly shorter in the late (2.51 ± 0.36 h) than in the early amniotomy group (3.1 ± 0.89 h). There was no statistically significant difference between the groups in terms of maternal complications (fever, nausea, vomiting, and uterine hyperstimulation) or neonatal complications (meconium-stained liquor, APGAR score

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Background The objective of this study was to evaluate the safety and efficacy of membrane stripping and vaginal misoprostol in the induction of labor in low-risk patients at term pregnancy (38–40 gestational weeks). Aim This study was done to compare the efficacy and safety of the two techniques for cervical ripening/labor induction by stripping of membranes and low-dose vaginal misoprostol on the outcome of labor induction in singleton pregnancies between 38 and 40 weeks. Patients and methods This prospective study was conducted for 9 months. The study included 100 women divided randomly into two groups: group I (n = 50) in which stripping of membranes was performed and group II (n = 50) which received intravaginal misoprostol. In group I, stripping of membranes was performed to be repeated after 48 h then followed up within 72 h of the first visit. In group II, patients received 25 μg vaginal misoprostol tablets every 6 h with a maximum of four doses after admission for follow-up of fetal well-being and observations of the route of delivery and indication of cesarean section. Time interval from the start of induction to the delivery time and need for oxytocin augmentation and labor complications were observed. Outcome data as fetal weight, Apgar scores at 1 and 5 min, and need for admission to neonatal ICU were recorded. Results Stripping of membranes is as effective as vaginal misoprostol, but the induction-delivery interval was significantly lower in misoprostol. There were no statistically significant differences between the two groups in the results of neonatal outcome. Conclusion Both methods were effective and safe in the induction of labor; however, misoprostol needs hospital admission, with no increases in the risk of neonatal outcome and minimal adverse effects.

Background: Uterine leiomyomas are the commonest benign tumours in women, which are estrogen-dependent and grow during the reproductive life. Standard treatment for leiomyoma is hysterectomy or myomectomy according to women's age and fertility. Prostaglandins and particularly PGE1 as misoprostol have an impact on uterine contractions and decrease blood loss. Objective: To evaluate the effect of using a single dose of vaginal misoprostol (400 Microgram) one hour before abdominal myomectomy on intraoperative blood loss. Materials and methods: This prospective randomized study was carried out postmenstrual upon 50 women with symptomatic uterine myoma who attended to Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University during the period from October 2019 until October 2020. All subjects were divided into two equal groups: Misoprostol group included 25 women administered 400 mg misoprostol vaginally one hour before operation, and control group included 25 women underwent operation without misoprostol. Outcome variables included: intraoperative blood loss (ml), postoperative hemoglobin values, postoperative hematocrit values and operative time. Results: there was statistically significant difference between the two studied groups according to amount of intraoperative blood loss (ml) as Misoprostol group showed less blood loss than control group [(308.0 ± 32.66 vs. 404.4 ± 87), with p = 0.001]. In addition, there was statistically significant difference between the two studied groups regarding operative time as Misoprostol group showed shorter duration than control group [(56.8 ± 3.12 vs. 78.6 ± 10.6), with p=0.001]. Conclusion: A single dose of preoperative vaginal misoprostol is an effective method for reducing blood loss and operative time during abdominal myomectomy operations. [ABSTRACT FROM AUTHOR]

Objective: To determine if vaginal misoprostol is more effective than oral misoprostol for cervical ripening in obese women.Study design: A retrospective cohort study of obese women undergoing induction of labor from Jan 2013 to Dec 2016 with singleton, viable pregnancies beyond 37 completed weeks of gestational age. Women with an initial Bishop score of 7 or less, with a cervical dilatation of less than 2 cm, who received either vaginal or oral misoprostol as a cervical ripening agent, were included. Primary outcome was interval from the start of induction to the attainment of 3 cm cervical dilatation. Secondary outcomes included the interval from the start of induction to delivery and the rate of cesarean delivery (CD).Result: Of women who met the inclusion criteria, 966 (75.5%) women received oral misoprostol and 314 (24.5%) received vaginal misoprostol. The mean time-interval from the start of induction to attainment of 3-cm dilatation was shorter in the vaginal group (10.5 ± 10.4 h) compared to the oral group (17.2 ± 11.5 h), (p < .0001). Significantly shorter times to delivery were also noted in the vaginal group (17.4 h for vaginal vs. 24.8 h for oral, p < .0001). In the subgroup analysis of nulliparous women, shorter time intervals from the start of induction to attainment of 3-cm dilatation, as well as to delivery, were noted in the vaginal misoprostol group (p < .0001 for both). Multiple linear regression model confirmed route of misoprostol administration as an independent variable in predicting the outcomes (time from start of induction to 3 cm as well as to delivery). Significant findings amongst neonatal outcomes included lower umbilical artery pH and higher rates of neonatal jaundice in the oral misoprostol group.Conclusion: In a population of obese women undergoing induction of labor, vaginal administration of misoprostol was associated shorter time intervals from the start of induction to the attainment of 3 cm of dilatation, as well as to delivery, without increasing the rate of cesarean deliveries or the incidence of adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Abstract Purpose To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Methods Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease ormisoprostol allergy; nomore than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 μg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later - if the intrauterine gestational sac was still present, the application of 800 μg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol - if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Results Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; p = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac (p = 0.049). Conclusions We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences.

Objective: The objective of this study was to compare the efficacy of buccal and vaginal administration of misoprostol for induction of labour at term. Materials & Methods: The present randomized prospective study was carried out on 100 pregnant women, out of which 50 cases were induced by buccal misoprostol and the remaining 50 cases were induced by the vaginal misoprostol. Results: In the study, it was found that 36% of the patients in the buccal group (group 1) were induced after a single dose but it was only 32% in vaginal misoprostol group (group 2). However, the tachysystole developed in the buccal group was higher than that of in vaginal group. Conclusion: It was contemplated in our study that buccal misoprostol was more effective than vaginal misoprostol in inducing labour but was associated with more side effects. [ABSTRACT FROM AUTHOR]

Introduction: Medical method of abortion has advantages over surgical methods as it is noninvasive. Hence, no complications of anesthesia and administration of drugs is easy in medical methods. There is a need for evolving a safe and effective method for safe and effective method for terminating pregnancy in the first trimester. Aim: We have taken up the present study to know the efficacy of combination of mifepristone and misoprostol versus single drug misoprostol alone for 1st trimester abortion. Materials and methods: It was a Cross-Sectional Study carried on pregnant women coming for MTP under family planning op at CKM hospital for 2 years. The study included two groups Group-A and Group-B. Group-A consisted of 50 randomly selected cases received Vaginal Misoprostol 600 micrograms stat dose followed every 4th hourly by 400 micrograms for 24 hours, for a maximum of 4 doses. Group-B has 50 cases received Oral Mifepristone 200 mg and simultaneously 600 micrograms of vaginal Misoprostol stat dose followed every 4th hourly with 400 micrograms vaginal Misoprostol for a period of 24 hours maximum 4 doses. Depending on response USG was done within 24-48 hours in both studies and rescan after 2 weeks. Results: Among Group B subjects 86% had expulsion within 5-10 hrs and remaining 14% had expulsion within 10-15 hours. Among Group A subjects 76% required >24 hrs for expulsion, 10% required 20-24 hrs, 6% required 15-20 hrs and 8% needed 10-15 hrs for expulsion. The difference between grouping and induction to abortion interval was found to be statistically significant. In Group A, 15 subjects (30%) had complete expulsion of products. 35 subjects (70%) required D&C. In Group B, 43 subjects (86%) had complete expulsion, 7 subjects (14%) required D&C. The difference between grouping and final outcome was found to be statistically significant. Majority of study subjects who require D&C were present in Group A compared to Group B. The difference between grouping and D&C was found to be statistically significant. Conclusion: Thus combination of Mifepristone and vaginal Misoprostol is more efficacious than vaginal Misoprostol alone. [ABSTRACT FROM AUTHOR]

Background: Uterine leimyomas are tumors of the smooth muscles and the connective tissues of the uterus. They are considered to be the most common benign pelvic tumor affecting about 20% of women above the age of 35. The diverse symptomatology of fibroids can be attributed to size, number and location of the tumors. The common symptoms include menorrhagia, infertility, abdominal mass and pressure effects. Aim of the Work: The aim of this study is to compare between the effect of medical (preoperative vaginal misoprostol) and non-medical (bilateral uterine artery ligation) regarding their efficacy to decrease blood loss in trans-abdominal myomectomy. Patients and Methods: Prospective randomized controlled interventional clinical trial. The study was conducted in Ain Shams University Maternity Hospital, Cairo, Egypt in the period between August 2015 till December 2016. It was approved by the Ethical Research Committee, Obstetrics and Gynecology Department, Ain Shams University, Cairo, Egypt. It included 60 women recruited from those attending the outpatient gynecology clinic, seeking treatment for symptomatic uterine myomas. Results: The current study revealed that there was no statistically significant difference between both groups regarding operative time, blood loss and postoperative hospital stay. Conclusion: A single pre-operative dose of 400 micrograms of vaginal misoprostol is as effective as uterine artery ligation in decreasing blood loss in transabdominal myomectomy. Misoprostol is a simple, cheap, fast, available and applicable tool that can be administered even an hour preoperatively. Recommendations: Preoperative vaginal misoprostol is an effective practical tool in decreasing blood loss in transabdominal myomectomy. Investigation of misoprostol use in larger population groups and with different dosages and administration routes, together with comparison of other methods used to reduce bleeding during myomectomy, is recommended [ABSTRACT FROM AUTHOR]

Background: Misoprostol is a new promising agent for cervical ripening and induction of labour .The ideal dose, route and frequency of administration of misoprostol are still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable mean of induction, there is a patient resistance to digital examination and there is a risk of ascending infection. For this reason, oral administration of misoprostol for cervical ripening and labour induction has been tried. Aims and Objectives: To compare 50µg of oral misoprostol versus 25µg of intravaginal misoprostol for induction of labour at term and maternal, foetal outcomes. Methods: Two hundred women who were at term, with indication for induction of labour and Bishop scores of ≤5 were randomly assigned to receive misoprostol 50µg or 25µg intravaginal, every 4-6 hours, for a maximum of 5 doses. In either group, pregnant females with inadequate uterine contractions despite being given maximum 5 doses of misoprostol, were augmented using oxytocin. The primary outcome measure was time-interval from induction to vaginal delivery and vaginal delivery rate within 24 hours. Results: The median induction to vaginal delivery time in oral group (12.92h) and vaginal group (14.04 h) was not significant. Oral misoprostol resulted in more number of vaginal deliveries as compared to vaginal misoprostol (94% as compared to 86%), which was not significant. There was a significantly higher incidence of uterine tachysystole in the vaginal group, as compared to oral group. There were no significant differences between the groups with respect to oxytocin augmentation, caesarean section rate, analgesic requirement and neonatal outcome. Conclusion: Oral misoprostol is as efficacious as vaginal misoprostol because of shorter induction delivery interval, lower caesarean section rates, and lower incidence of failed induction rates. Lower incidence of foetal distress and easy intake are observed if the drug is administered orally.

Objectives: The aim of this study was to compare the efficacy of vaginal misoprostol with vaginal dinoprostone for term labor induction. Material and Methods: It was a randomized controlled trial done in the Obstetrics Department, Shifa Community Health Centre, Shifa International Hospital (Teaching Hospital of Shifa College of Medicine, Islamabad). All pregnant women at term pregnancy coming for induction of labor were enrolled. 246 women fulfilled the inclusion criteria. Out of them 208 women consented to be part of the study. These women were then randomized to receive either Treatment A (vaginal misoprostol) or Treatment B (vaginal dinoprostone). Data were completed for 200 women. These included induction labor and induction-delivery interval, fetal and maternal complications, and baby apgar score. Results: Out of 200 women in the study, 100 were in Group A and 100 in Group B. Labor commenced in a mean of 6.67 hours (±3.63) in Group A whereas it took a mean of 8.41 hours (±5.13) in Group B (p = 0.00). Actual induction to delivery (of the baby) interval was a mean of 11.68 hours (±4.55) for misoprostol and 15.37 hours (±5.30) for dinoprostone group (p = 0.00). There were no cases of uterine rupture in both groups; however, there were 10 cases of uterine hyperstimulation in Group A and 4 in Group B (p = 0.09). Conclusions: It is time to re-evaluate the role of misoprostol for term labor induction. It is an efficacious and cost-effective alternative to the presently licensed treatment.

Background: There are many different situations in obstetrics where there is the need for labor induction in women with unripe cervices. This indication stems from a situation where the continuation of pregnancy may be life-threatening for the mother and/or fetus. Objective: To compare maternal and neonatal outcomes of induction of labor with vaginal misoprostol versus intravenous oxytocin. Methods: A follow up study was conducted at the delivery unit of Ismailia University Hospital. The study subjects included two equal groups of women, group I (50) who received vaginal misoprostol and group II (50) who received oxytocin infusion. A structured interviewing schedule and an observation checklist were developed, validated and used to collect data related to maternal and neonatal outcomes. Results: Uterine contractions of longer duration (>70-90 seconds) and strong intensity were found to be significantly higher in the misoprostol group compared to the oxytocin group (p

Early pregnancy failure (EPF) occurs in 10-15% of clinically diagnosed pregnancies. 65% of these women are not willing for surgical evacuation. Medical evacuation is gaining acceptance as a treatment of option than surgical or expectant management. This is a prospective clinical trial of 150 pregnant women with EPF of

Background: Induction of labor is a common intervention in obstetrics worldwide. Foley catheter is a commonly used mechanical method for labor induction in nulliparous women with an unfavorable cervix at term. We hypothesize that a higher volume of Foley catheter (80 mL vs 60 mL) will shorten the induction-delivery interval for labor induction in nulliparous women at term with an unfavorable cervix with simultaneous use of vaginal misoprostol., Objective: This study aimed to evaluate the effect of transcervical Foley catheter (80 mL vs 60 mL) with simultaneous use of vaginal misoprostol on the induction-delivery interval in nulliparous women at term with an unfavorable cervix for induction of labor., Study Design: In this double-blind, single-center, randomized controlled trial, nulliparous women with a term singleton gestation with unfavorable cervix were randomized to either group 1 (Foley catheter [80 mL] simultaneously with vaginal misoprostol 25 µg every 4h) or group 2 (Foley catheter [60 mL] with vaginal misoprostol 25 µg every 4h). The primary outcome was induction-delivery interval. Secondary outcomes were duration of the latent phase of labor, number of doses of vaginal misoprostol required, mode of delivery, as well as maternal and neonatal morbidity. Analyses were based on the intention-to-treat method. A sample size of 100 women per group (N=200) was selected., Results: Between September 2021 to September 2022, 200 nulliparous women at term with an unfavorable cervix were randomized to labor induction with either FC (80 mL vs 60 mL) and vaginal misoprostol. Induction delivery interval (in minutes) was statistically significantly shorter in Foley catheter (80 mL) (median [interquartile range], 604 [524-719] vs 846 [596-990]; [P<.001]). Median time to labor onset (in minutes) (240 [120-300] vs 360 [180-600]; P<.001) was also shorter in group 1 (80 mL). The number of doses of misoprostol required for labor induction was statistically significantly less than with 80 mL (mean±standard deviation, 1.4±0.7 vs 2.4±1.3; P<.001). There was no statistically significant difference in the mode of delivery (vaginal delivery: 69 vs 80; odds ratio, 0.55 [1.1-0.3]; P=.104 and cesarean delivery: 29 vs 17; odds ratio, 0.99 [0.9-1.1]; P=.063, respectively). The relative risk of delivery within 12 hours with 80 mL was 2.4 [95% confidence interval, 1.68-3.43], P<.001. Maternal and neonatal morbidity were similar across the 2 groups., Conclusion: FC (80 mL) simultaneously with vaginal misoprostol significantly shortens the induction-delivery interval (P<.001) in nulliparous women at term with an unfavorable cervix, as compared with Foley catheter 60 mL and vaginal misoprostol., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Missed Abortion is a important obstetric and gynecology complication because of its serious outcomes such as DIC, infection, shock, hemorrhage & death. There are various medical and surgical methods for treatment of missed abortion. Medical treatment of missed abortion is safe, effective, acceptable and an inexpensive alternative. Misoprostal is a synthetic prostaglandin (E1) and recommended by FDA for treatment of missed abortion. There are different views about its safety, dosage and effectiveness. Methods: This study was designed in order to determine the efficacy of vaginal misoprostol for termination of pregnancy in women with missed abortions admitted in Shahid Sadoughi, Madar and Mojibian hospitals of Yazd from 2003 to 2004. The method of study was semi-experimental. (Clinical trial without control group) 50 women with missed abortion and the required criteria (age 15 – 45 years, gestational age ≤ 25 weeks, no previous medical or surgical complication and confirmation of missed abortion on sonography) were selected. The data was collected by a questionnaire filled at the onset of study and after treatment (Misoprostol, (200 micrograms/dose) repeated every 4 hours till expulsion of pregnancy products for maximum of 4 doses).The data analysis was done by statistical tests such as x2 and ANOVA. Results: The mean duration of medical treatment in the group with complete expulsion (44%) and incomplete expulsion (56%) was 12.63± 9.13 hours and 8.81± 2.9 hours, respectively, which was significantly different. (P value = 0.037). Of the total, 29 women had received two tablets of misoprostol, but the highest rate of complete expulsion was observed in women who had received four tablets. This difference in result was statistically significant. (p ≈ 0.000 ). Observed side effects included headache (26%), nausea (16%), uterine cramps (12%) and diarrhea. (6%) There was no serious complication such as uterine rupture, excessive vaginal bleeding, DIC, prolonged PT or PTT. Conclusion: This study confirmed that medical evacuation of missed abortion with vaginal misoprostol is an effective, safe and cost efficient method without any serious complications and can be a suitable alternative to surgery.