جستجوی مقالات مرتبط با کلیدواژه « misoprostol » در نشریات گروه « پزشکی »

The purpose of this study was to compare the effectiveness of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy.

The research was done as an RCT from 2017 to 2018. About 300 participants were randomly allocated to obtain 50 µg Buccal, 25 µg Vaginal, and 50 µg Sublingual misoprostol in Kosar Hospital, Qazvin, Iran. The maternal and fetal complications, Bishop score hour 1, and hour 6 were observed.

There were no differences between fetal complications (p>0.05) and maternal complications (p>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among these groups. Our study found a difference between the three groups (P = 0.015) in achieving standard vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were performed respectively. The use of Oxytocin in the Buccal group was higher than that of other groups (P = 0.022).

This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.

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. 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. 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. Foley's with vaginal misoprostol results in a shortened time between induction and delivery than misoprostol alone.

 To determine the safety and adequacy of intravenous (IV) carbetocin compared to IV tranexamic acid (TA) plus sublingual misoprostol in reducing hemorrhage during and following cesarean delivery (CD) in women with at least one risk factor for postpartum hemorrhage.

 This clinical study was randomized. We randomly assigned 400 term pregnant women who were candidates for elective CD to receive either a 100 μg intravenous infusion of carbetocin or 1gm. IV TA along with 400 μg of sublingual misoprostol after delivery. Comparing the quantity of blood loss at and six hours following a CD was the primary result. We also disclosed the necessity for any extra medications and any adverse drug reactions.

 When compared to the misoprostol plus tranexamic acid group, the carbetocin group's total mean blood loss was considerably higher (829.7 293.3 mL vs. 609.33 211.5 mL; P = 0.0001). Following the administration of carbetocin and misoprostol with TA, respectively, 9.5% and 26.5% of patients required further uterotonics treatment (P = 0.0001). When compared to the carbetocin group, the misoprostol group's side effects, such as a bad taste in the mouth and fever, were much greater (P = 0.0001).

 When it comes to minimizing overall blood loss during and after CD, IV tranexamic acid combined with sublingual misoprostol is superior to IV carbetocin.

Despite the advancement in thanatological research, stillbirth remains one of the most proscribed and misunderstood types of losses. Aim of our study was to compare the efficacy and safety of the combination of mifepristone and Misoprostol vs. Misoprostol alone for the induction of labor in antepartum stillbirth.

This study recruited fifty-two pregnant individuals at a gestational age beyond 28 weeks who had been diagnosed with antepartum stillbirth. Participants allocated to group I received an oral dose of 200 mg of Mifepristone. Subsequently, after a 24-hour interval, patients were administered 50 mcg of Misoprostol orally every 4 hours, up to a maximum of four doses. In contrast, participants in group II were provided with a placebo of Tablet Calcium (500mg). Following the same 24-hour interval, they received a dose of 50 mcg of Misoprostol orally every 4 hours, for a maximum of four doses.

The mean (standard deviation) induction-to-delivery interval (IDI) in group I and group II were 8.6 (1.9) and 11.9 (3.7) hours, respectively (p <0.001). In group I, the mean (SD) total dosage of Misoprostol was 65.4 (30.9) milligrams, whereas in group II, it was 126.9 (45.2) milligrams. A significant difference was observed between the two groups in terms of the total dosage of Misoprostol (p <0.001).

These results underscore the potential benefits of Mifepristone and Misoprostol in improving outcomes for individuals experiencing antepartum stillbirth. Further research is warranted to validate and expand upon these findings, with the ultimate goal of enhancing care and support for those affected by stillbirth.

 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.

 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.

 The percentage of CR in the misoprostol group (67.9%) was significantly higher than in the TNG group (32.2%) (P<0.001). Therefore, the need for mechanical dilatation in the TNG group (66.7%) was significantly higher compared with the misoprostol group (32.1%) (P<0.001). Also, the rate of complications like diarrhea (9.9%) and abdominal pain (7.4%) in the misoprostol group was significantly higher than in the TNG group (0%). However, headache in the TNG group (34.5%) was significantly higher than in the misoprostol group (0%) (P>0.001). Generally, the rate of complications in the TNG group (35.6%) was significantly higher compared with the misoprostol group (13.6%) (P>0.001).

 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.

This study aimed to compare sublingual misoprostol alone or combined with vaginal Isoniazid (INH) for first-trimester abortion.  

In this randomized controlled trial, 80 pregnant women with missed abortion candidates for first-trimester abortion were randomly assigned to two groups. The first group received 800 μg sublingual misoprostol every three hours maximum for three doses and the second group received 1500 mg vaginal INH followed by the same dose of misoprostol. Vaginal sonography was performed after 24 hours on both groups to observe any retained product of conception. In case of no response or incomplete abortion, the  second course of misoprostol (with the same dose) was administered. The abortion (complete or incomplete) rate was reported within 48 hours after the first dose of misoprostol.  

The rate of successful intervention (either complete or incomplete) abortion within 48 hours of misoprostol administration was 75% in both groups and was not significantly different (P value = 1). Also, hospitalization duration, abortion time, total misoprostol dosage, and the rate of side effects were similar in the two groups. Five patients in the misoprostol group and three in the misoprostol plus isoniazid group underwent emergent D&C because of heavy bleeding.  

A combined regimen of sublingual Misoprostol plus vaginal Isoniazid with the prescribed dosage has similar efficacy to sublingual misoprostol alone in first-trimester abortion.

To determine whether addition of evening primrose to a misoprostol-based abortion regimen can increase the success of abortion.

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.

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).

Administration of vaginal evening primrose before vaginal misoprostol was found to be more effective compared to misoprostol alone in missed abortion.

Outpatient use of misoprostol is assessed in a few studies and usually in low doses and vaginal routes. This study aimed to evaluate cervical ripening by outpatient administration of misoprostol to prevent post-term pregnancy. This randomized clinical trial study was performed on 140 patients that were randomly allocated into two groups: 25 μg sublingual SL (group A) and 50 μg PO misoprostol (group B). The patients were primigravid with a gestational age of 40 weeks, with an amniotic fluid index (AFI) of ≥5 cm, a reactive non-stress test (NST) with no evident uterine contraction, Bishop Score of <8, and no notable past medical history. Patients who had a normal vaginal delivery before 41 weeks were considered successful delivery. Maternal age, the number of misoprostol doses, vaginal examination, type of interventions before delivery, the indication of hospitalization, delivery route, the indication of cesarean section, delivery complications, and neonatal outcomes were compared using SPSS software. P<0.05 was considered statistically significant. group A had mean age of 23.27±4.03 years and Group B had a mean age of 24.61±5.46 years with no significant difference (P=0.223). The number of misoprostol doses (P=0.001), extra misoprostol, and oxytocin application were significantly lower in group B (P=0.003). Maternal and neonatal complications showed no significant difference between the two groups (P>0.05). Outpatient cervical ripening with misoprostol appears to be an optimal method. More prospective studies with higher sample sizes are required to ensure its safety for routine recommendations for cervical ripening to prevent post-term pregnancy.

 Ripening is the process of preparing the cervix for induction of labor and is crucial to identify a low-complication, low-cost, and safe method of inducing labor before spontaneous labor begins. Therefore, this study aimed to demonstrate the impact of the evening primrose capsule on inducing labor, as well as to compare its effect to that of misoprostol.

 This prospective clinical trial study was performed on 200 low-risk pregnant women candidate for delivery in an academic hospital in Tehran from 2018 to 2020. Patients were randomly divided into two groups to receive 25 µg misoprostol vaginally or 500 mg evening primrose vaginal capsule to induce labor and repeated every three hours until reaching the bishop score > 4 in case of no effective up to three doses. The total drug dose, as well as maternal and neonatal outcomes evaluated and compared between groups.

 Although misoprostol was significantly more effective than evening primrose in increasing cervical bishop score in the inactive phase of labor, the active phase and delivery time were not different between the groups. Also, there was no significant difference between the two groups in the cesarean section rate. Maternal complications, including uterine hyperstimulation, headache, or gastrointestinal complications in the group receiving misoprostol were significantly higher in misoprostol group, but fetal complications, including Apgar score, pH, hospitalization, and meconium excretion, were not significantly different between the two groups.

 Evening primrose capsules are safe and can be used to induce labor because of the lower risk of hyperstimulation of the uterus and the higher tolerance. There should be more research done to see if this medicine can be used alone or in conjunction with misoprostol or mechanical dilators or if it can be administered at home rather than in the hospital.

 Cervical ripening is the process of initiating labor in women with an unripe cervix. Vaginally administered prostaglandin E1 analog (misoprostol) has been promising in cervical ripening and labor induction. However, optimal dosage and dose-dependent adverse effects in this administration route need further clarification.

 This trial aimed to compare the efficacy and adverse effects of 50 mcg vs. 25 mcg of vaginal misoprostol in low-risk term pregnant women.

 This double-blind, single-center, randomized clinical trial included 200 low-risk term pregnancies undergoing labor induction with a Bishop score of 2 or less. Patients were assigned randomly to receive 25 mcg or 50 mcg of vaginal misoprostol every six hours up to four times until the active phase of labor was reached. The primary outcome included time to vaginal delivery (latent and active phase of labor), and secondary outcomes included the total dosage of prescribed misoprostol, the need for oxytocin for labor augmentation, and the cesarean section rate.

 Misoprostol 50 micrograms resulted in a significantly shorter time in the first phase of labor (P-value = 0.002), the second phase of labor (P-value = 0.030), and the third phase of labor (P-value = 0.020). The number of administered misoprostol, the need for additional oxytocin, uterine hyperstimulation, cesarean delivery rate, Apgar score, umbilical artery pH, and neonatal intensive care unit (NICU) administration were statistically similar between the two groups.

 This study showed that 50 mcg of vaginal misoprostol (vs. 25 mcg) for cervical ripening could reduce labor phase duration without significantly increasing adverse maternal and neonatal outcomes.

Comparison of two different intervals of misoprostol administration after mifepristone in second trimester abortions.

This 12-month prospective study was conducted at a tertiary care facility. Only pregnancies with congenital deformity or sterilisation failure were included in the study's recruitment of 100 women who visited the hospital for a second trimester abortion between 12 and 20 weeks; cases with scarred uteri were omitted. In a systematic random selection of 50 women in each group, the administration of 200 mg of mifepristone orally was followed by two distinct intervals of intravaginal misoprostol administration at 24- and 48-hour intervals. After 24 hours, group A women received intravaginal 400 mcg misoprostol three hourly, up to a maximum of five doses, while group B received the same doses after 48 hours. Induction abortion interval noted on various parameters and paired t test and chi square test applied.

The mean IAI following misoprostol administration was 8.14 2±.03 hours in group A and
7.71 ±2.56 hours in group B. This difference was statistically insignificant. Average misoprostol doses for group A were 1.68±0.71 and for the group, B were 1.68±0.84; both doses were found to be statistically insignificant when used to induce abortion. All women aborted successfully in each group. There was no significant difference in side effects in both groups.

Based on the results it was observed that shorter interval between mifepristone and misoprostol i.e., 24 hours can be chosen to decrease the hospital stay as there was no significant difference was seen after intravaginal misoprostol in terms of  induction abortion interval, number of doses and side effects.

Redo syndrome or acute hematometra is a rare complication after abortion or cesarean section.A-32- year-old woman with previous cesarean section, term pregnancy, and labor pain referred to hospital.She delivered a healthy baby with a good Apgar score and discharge 2 days later without complications after a cesarean section. She came back to the hospital with the severe abdominal pain, weakness, without abnormal bleeding, at 6 days postpartum. Abdominopelvic sonography showed a large hematometra in the uterus. She took misoprostol 200 μg intra vaginal and 200μg sublingual, plus serum oxytocin and cefazolin. After about 1.5 hours, she passed a large hematoma, her pain gradually relieved, and she was discharged three days later. This report show that misoprostol is useful in the management of acute hematometra.

The aim of this study was to compare the efficacy of vaginal misoprostol with Foley balloon catheter for cervical ripening in women with singleton pregnancies and an unfavorable cervix. Eighty pregnant women with unfavorable cervix were randomly divided in two groups of Foley catheter or misoprostol modes. Cervical ripening in Foley catheter group was done with transcervical Foley catheter 18, and in misoprostol group with 25 μg single dose vaginal misoprostol(The maximum allowed dose for patients was 6 doses.). Bishop score, Apgar score, active phase duration, stage 2 duration and insertion to birth time were the main outcomes. The mean of time between ripening and the active phase in vaginal misoprostol group was significantly shorter than in Foley catheter group (2.32 versus 5.11 hour respectively, P-value = 0.0001). After intervention Bishop score in vaginal misoprostol group was significantly more than Foley catheter group (8.70 versus 6.68 respectively, P-value = 0.0001). Time from insertion to birth in vaginal misoprostol group was 9.54 hours and in Foley catheter group was 12.88 hours (P-value = 0.0001). The hospitalization time in Foley catheter group was significantly more than vaginal misoprostol group (P-value = 0.0001). other outcomes were similar between groups. By the decreasing in the total time from insertion to birth, vaginal misoprostol was more effective than Foley catheter as a cervical ripening method in our study.

Abortion is the medical or surgical termination of pregnancy before the 20th week. However, dilation and curettage have been associated with hazards such as uterine rupture, heavy bleeding, and infection. Therefore, in recent decades, pharmacological therapies have become more widely accepted.

This research compared the medical abortion success rates of misoprostol/letrozole versus misoprostol/placebo.

This randomized clinical study was conducted at Mashhad University of Medical Sciences hospitals between 2018 and 2019, involving pregnant women who were candidates for medical abortion. The study population was divided into two groups based on whether they had undergone cesarean section (CS). Each group was randomly assigned to either a control or an intervention group. In the CS group, there were 52 patients in the intervention group and 52 in the control group. The control group received a regimen of misoprostol and placebo, while the intervention group received a combination of misoprostol and letrozole.

There was no statistically significant difference in age (31.59 ± 5.6 vs. 31.06 ± 4.6, P value = 0.605), gestational age by ultrasound (11.20 ± 3.3 vs. 10.29 ± 2.6, P value = 0.135), or blood pressure between the control and intervention groups. However, the analysis showed a statistically significant difference in the rate of complete abortion (12 (23.5%) vs. 28 (54.9%), P value = 0.001) between the two groups. In the non-CS group, there was a significant difference in age between the control and intervention groups. The study analyses also revealed a significant difference in the rate of complete abortion between the two groups (24 (46.2%) vs. 36 (72.0%), P value = 0.008).

Letrozole isrecommendedin combination with misoprostol for medical abortions because it increases the likelihood of complete abortion and reduces the duration of the abortion process.

Background:

 Therapeutic abortion in the second trimester of pregnancy is the treatment of choice in cases such as severe anomalies or fetal death, and both medical and mechanical methods are used to prepare the cervix. One of the various medical methods is the use of misoprostol (Miso) and one of the various mechanical methods is the use of laminaria (Lam).

Objectives:

 This study aimed to compare the use of Miso alone and its combination with Lam in therapeutic abortion in the second trimester of pregnancy.

Methods:

 In this clinical trial study, pregnant women between 14 and 20 weeks of gestation who were admitted to Ali-Ibn Abitaleb Hospital in Zahedan from July 2019 to September 2020 and were candidates for pregnancy termination due to severe anomalies or fetal death were investigated. After obtaining consent, patients were randomly divided into two groups of 45 receiving Miso alone and Miso + Lam. Then, in addition to demographic variables, the number of hospitalization days, the need for curettage, blood transfusions, analgesics, and the symptoms and complications of drugs were investigated.

Results:

 In this study, none of the demographic factors were significantly different between the two groups (P > 0.05). However, the need for curettage (P = 0.05), labor time (P = 0.04), and hospitalization days (P = 0.003) in the Miso + Lam group were less than the group of Miso alone.

Conclusions:

 Our results showed that curettage cases, labor duration, and length of hospital stay decreased in the Miso + Lam group.

Pyrexia and shivering are the most popular side effects of postpartum administration of misoprostol, but other side effects of this drug are very rare. A 27-year-old pregnant female patient was admitted to Ayatollah Mousavi hospital (Zanjan, Iran), complaining about severe headache and the primary diagnosis of cerebral venous thrombosis. Treatment was successful after primary investigations and planed therapy for Cerebral Venous Thrombosis (CVT). Following the decision on terminating the pregnancy, five tablets of Sublingual misoprostol (200 mg) was used once evacuation of pregnancy remnants was done. About thirty minutes after the administration of misoprostol, onset of severe shivering and tachycardia (201/min) with high fever (about 41°C) and hypertension (182/123 mmHg) was observed. National Adverse Drug Reaction (ADR) form was completed. All of symptoms were alleviated 30 minutes after administration of Paracetamol 1gram (Intravenous infusion) followed by Metoprolol 50 mg (orally). According to the literature, we listed the various side effects of misoprostol. Even though the side effects of misoprostol are diverse and rare, the simultaneous occurrence of these side effects is not cited till date. These incidents are reported to the authorities as per ADR policy; nonetheless, no preventive measures are implemented. This necessitates medical educational policies to be taken into consideration to educate healthcare providers throughout their professional career as well as research.