misoprostol and Endometritis

Trial and meta-analysis data revealed a reduction in time to delivery for Foley and prostaglandins or Foley and oxytocin vs Foley alone. However, there are limited data for the comparison of the 2 combination methods against each other.. This study aimed to determine whether Foley and prostaglandins or Foley and oxytocin decrease the time to vaginal delivery using a network meta-analysis.. A network meta-analysis (PROSPERO CRD42018081948) was performed comparing Foley and prostaglandins (prostaglandin E1 or prostaglandin E2) vs Foley and oxytocin for cervical ripening. Foley alone and prostaglandins alone were used as nodes for indirect comparison. Database searches were performed from inception to March 2020 with data abstracted from published manuscripts. Eligibility criteria included randomized trials comparing Foley and oxytocin with Foley and prostaglandins (misoprostol or dinoprostone). Trials that compared Foley catheter or prostaglandins with a combination of Foley and prostaglandins or Foley and concurrent oxytocin were also included. Nulliparous and multiparous women were analyzed together. Foley catheters of any catheter material or size and >24 weeks' gestational age with a live fetus were included. Quasi-randomized, cohorts, and other combination methods for cervical ripening were not included. Prostaglandin E1 and prostaglandin E2 combined methods were analyzed separately in a planned subanalysis. The primary outcome was the mean time from induction to vaginal delivery in hours. Secondary outcomes included time from induction to delivery, delivery within 24 hours, cesarean delivery, chorioamnionitis, endometritis, epidural use, tachysystole, postpartum hemorrhage, meconium, neonatal intensive care unit admission, and 5-minute appearance, pulse, grimace, activity, and respiration score of <7. Data were analyzed as a network meta-analysis using multivariate meta-regression.. A total of 30 randomized controlled trials with a total of 6465 women were considered eligible for inclusion in this network meta-analysis. When compared with Foley alone, the use of Foley-oxytocin reduced the time to vaginal delivery by 4.2 hours (mean duration, -4.2 hours; 95% confidence interval, -6.5 to -1.9). Foley-prostaglandins reduced the time to vaginal delivery compared with Foley but did not meet statistical significance (mean duration, -2.9 hours; 95% confidence interval, -5.7 to 0.0; P=.05). When compared head-to-head, there was no difference in the time to vaginal delivery between Foley-prostaglandins and Foley-oxytocin (mean duration, 1.3 hours; 95% confidence interval, -2.0 to 4.7). There was no difference in the rate of cesarean delivery, chorioamnionitis, epidural, tachysystole, postpartum hemorrhage, meconium, neonatal intensive care unit admissions, or 5-minute appearance, pulse, grimace, activity, and respiration score of <7 for Foley-prostaglandins vs Foley-oxytocin, although the rate of endometritis was high for Foley-prostaglandins. In the subanalysis by prostaglandin type, there was no difference in the time to vaginal delivery for Foley-misoprostol vs Foley-dinoprostone vs Foley-oxytocin. However, Foley-dinoprostone had a definite trend toward longer time to all deliveries compared with that of both Foley-misoprostol and Foley-oxytocin (P=.05).. Time to vaginal delivery was similar when comparing Foley with combined misoprostol, combined dinoprostone, and combined oxytocin. Dinoprostone comparisons are limited by small sample size but suggest longer time to delivery compared with Foley and misoprostol or oxytocin. No significant differences were observed in maternal or neonatal adverse events except for endometritis, but this was limited by the sample size, varied reporting of studies used in the indirect comparisons, and definitions of infectious morbidity use in the studies.

Topics: Anesthesia, Epidural; Apgar Score; Catheters; Cervical Ripening; Cervix Uteri; Cesarean Section; Chorioamnionitis; Delivery, Obstetric; Dinoprostone; Endometritis; Female; Humans; Intensive Care Units, Neonatal; Labor, Induced; Misoprostol; Network Meta-Analysis; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Time Factors

Misoprostol is increasingly used to treat women who have a failed pregnancy in the first trimester. We assessed the efficacy, safety, and acceptability of this treatment in a large, randomized trial.. A total of 652 women with a first-trimester pregnancy failure (anembryonic gestation, embryonic or fetal death, or incomplete or inevitable spontaneous abortion) were randomly assigned to receive 800 microg of misoprostol vaginally or to undergo vacuum aspiration (standard of care) in a 3:1 ratio. The misoprostol group received treatment on day 1, a second dose on day 3 if expulsion was incomplete, and vacuum aspiration on day 8 if expulsion was still incomplete. Surgical treatment (for the misoprostol group) or repeated aspiration (for the vacuum-aspiration group) within 30 days after the initial treatment constituted treatment failure.. Of the 491 women assigned to receive misoprostol, 71 percent had complete expulsion by day 3 and 84 percent by day 8 (95 percent confidence interval, 81 to 87 percent). Treatment failed in 16 percent of the misoprostol group and 3 percent of the surgical group (absolute difference, 12 percent; 95 percent confidence interval, 9 to 16 percent) by day 30. Hemorrhage or endometritis requiring hospitalization was rare (1 percent or less in each group), with no significant differences between the groups. In the misoprostol group, 78 percent of the women stated that they would use misoprostol again if the need arose and 83 percent stated that they would recommend it to others.. Treatment of early pregnancy failure with 800 microg of misoprostol vaginally is a safe and acceptable approach, with a success rate of approximately 84 percent.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Adult; Endometritis; Female; Fetal Death; Hemorrhage; Humans; Misoprostol; Postoperative Complications; Pregnancy; Pregnancy Trimester, First; Vacuum Curettage

Medical abortion is not recognized as a high-risk factor for invasive pelvic infection. Here, we report two cases of group A Streptococcus (GAS; Streptococcus pyogenes) endometritis following medical abortions with a protocol of oral mifepristone and misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Endometritis; Female; Humans; Mifepristone; Misoprostol; Streptococcal Infections; Streptococcus pyogenes

To compile and compare data on the abortions performed surgically and medically between January 1, 2006, and December 31, 2008, at the Gynecology and Obstetrics Clinic of the University Clinical Center of Kosovo.. The information for this retrospective, descriptive study was collected from the abortion register and the register of operative protocols. The variables used were age, number of births, number of abortions, duration of the terminated pregnancy, method of abortion, complications during and/or after the procedure, and attendance at consultations about family planning.. A total of 1329 abortions were performed during the study period in women with a mean age of 30.12 years (range, 15-46 years). Of these abortions, 923 were performed by curettage, 108 by vacuum aspiration, and 250 using misoprostol. The rates of retained products of conception were 6.39%, 23.15%, and 8%, respectively, in these 3 groups. Heavy bleeding occurred in the 3 groups and there was 1 case of postabortion endometritis in both the curettage and the misoprostol group. However, no transfusions were needed and no uterine perforations occurred in the misoprostol group, whereas there were 9 transfusions in the vacuum aspiration group and 2 uterine perforations in the curettage group-1 followed by a hysterectomy.. Misoprostol was very successful in all cases, with no serious adverse effects. It is much easier to administer than to perform a surgical abortion, with less severe postabortion complications and lesser costs.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Blood Transfusion; Dilatation and Curettage; Endometritis; Female; Humans; Middle Aged; Misoprostol; Postoperative Complications; Pregnancy; Retrospective Studies; Uterine Hemorrhage; Uterine Perforation; Vacuum Curettage; Young Adult; Yugoslavia

The objectives of this study were to determine the prevalence of illegal abortion in Libreville and to describe abortive methods used. It is a cross sectional and descriptive survey carried out at the maternity hospital of Libreville (MHL) during one year, from 1 January 2008 to 31 December 2008. 750 abortions were performed during this period and 651 cases were illegal abortions. Prevalence was of 86.7%. The women undergoing illegal abortion were most often pupils (67.1%), with an average age of 22.4 +/- 5.3 years old and a mean parity of 1.2 +/- 1.50. The average gestational term was of 7.4 +/- 1.9 weeks. Misoprostol (63.1%) was the most frequent abortive product used. 2 maternal deaths were notified. Prevalence of illegal abortions is increasing at the MHL. Up to now, misoprostol is the most frequent abortive product used.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Adolescent; Adult; Cross-Sectional Studies; Endometritis; Female; Gabon; Gestational Age; Hospitals, Maternity; Humans; Intestinal Perforation; Medicine, African Traditional; Misoprostol; Parity; Pregnancy; Prevalence; Uterine Hemorrhage; Uterus; Young Adult

Fatal cases of acute shock complicating Clostridium sordellii endometritis following medical abortion with mifepristone (also known as RU-486) used with misoprostol were reported. The pathogenesis of this unexpected complication remains enigmatic. Misoprostol is a pharmacomimetic of PGE(2), an endogenous suppressor of innate immunity. Clinical C. sordellii infections were associated with intravaginal misoprostol administration, suggesting that high misoprostol concentrations within the uterus impair immune responses against C. sordellii. We modeled C. sordellii endometritis in rats to test this hypothesis. The intrauterine but not the intragastric delivery of misoprostol significantly worsened mortality from C. sordellii uterine infection, and impaired bacterial clearance in vivo. Misoprostol also reduced TNF-alpha production within the uterus during infection. The intrauterine injection of misoprostol did not enhance mortality from infection by the vaginal commensal bacterium Lactobacillus crispatus. In vitro, misoprostol suppressed macrophage TNF-alpha and chemokine generation following C. sordellii or peptidoglycan challenge, impaired leukocyte phagocytosis of C. sordellii, and inhibited uterine epithelial cell human beta-defensin expression. These immunosuppressive effects of misoprostol, which were not shared by mifepristone, correlated with the activation of the G(s) protein-coupled E prostanoid (EP) receptors EP2 and EP4 (macrophages) or EP4 alone (uterine epithelial cells). Our data provide a novel explanation for postabortion sepsis leading to death and also suggest that PGE(2), in which production is exaggerated within the reproductive tract during pregnancy, might be an important causal determinant in the pathogenesis of more common infections of the gravid uterus.

Topics: Animals; Cell Line; Clostridium Infections; Clostridium sordellii; Disease Models, Animal; Endometritis; Female; Humans; Immunity, Innate; Immunosuppressive Agents; Inflammation Mediators; Macrophages, Peritoneal; Mice; Mice, Inbred CBA; Misoprostol; Rats; Rats, Wistar; Virulence

Topics: Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Antibiotic Prophylaxis; Clostridium Infections; Clostridium sordellii; Endometritis; Female; France; Humans; Mifepristone; Misoprostol; Pregnancy

Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.

Topics: Abdominal Pain; Abortifacient Agents; Abortion, Induced; Adolescent; Adult; Clostridium Infections; Clostridium sordellii; Diagnosis, Differential; Endometritis; Fatal Outcome; Female; Humans; Hypotension; Mifepristone; Misoprostol; Polymerase Chain Reaction; Pregnancy; Pregnancy Trimester, First; RNA, Ribosomal, 16S; Shock, Septic; Tachycardia; Uterus; Vomiting

Topics: Abortifacient Agents; Abortion, Induced; Abortion, Spontaneous; Clostridium Infections; Clostridium sordellii; Endometritis; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Shock, Septic