misoprostol and Stillbirth

Stillbirth is a common adverse outcome of pregnancy. Management should be individualized based on gestational age, maternal condition, prior uterine surgery, availability of skilled professionals, and maternal desires. This article discusses available data on management by gestational age and prior uterine surgery. Expectant management is a viable option for women and families who desire it and do not have any contraindications. In the second trimester, misoprostol induction and dilatation and evacuation are effective in the evacuation of the uterus. In the third trimester, induction of labor with prostaglandins, mechanical dilators, and augmentation with oxytocin is appropriate. Care should be taken with women with prior cesarean delivery; prostaglandins ideally should be avoided. Delivery by cesarean section should be performed selectively, i.e., when there is a maternal indication.

Topics: Abortion, Induced; Adult; Cesarean Section; Contraindications; Directive Counseling; Female; Gestational Age; Humans; Misoprostol; Mothers; Oxytocics; Oxytocin; Practice Guidelines as Topic; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prostaglandins; Stillbirth; Time Factors; Urinary Catheterization; Vaginal Birth after Cesarean

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.. 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.. 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).. 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.. IRCT20181207041873N3. Dated 16/2/2021 prospectively registered https://en.irct.ir/user/trial/53681/view .

Topics: Abortion, Induced; Adult; Female; Fetal Death; Humans; Infant; Linoleic Acids; Misoprostol; Pregnancy; Stillbirth

To assess complication rates of patients undergoing a second-trimester medical termination for intrauterine fetal demise compared with fetal anomalies.. We performed a retrospective cohort study comparing patients undergoing medical termination for a fetal anomaly versus medical termination for intrauterine fetal demise (IUFD) before 24 weeks of gestation. Data were collected from two urban academic medical centers from 2009 to 2019. Institutional review board approval was obtained from both institutions and patient consent was not required. We included singleton gestations between 14.0 weeks and 23.6 weeks undergoing induction with mifepristone and misoprostol or misoprostol alone. Groups were matched based on gestational age with a 1:1 ratio. The primary outcome was composite complication rate (retained placenta requiring dilation and curettage, suspected infection, hemorrhage, failed induction requiring dilation and evacuation, intensive care unit admission, and readmission).. Ninety-five patients were in each group. The groups differed in patient mean age (fetal anomaly 34 years versus 31 years for IUFD, P = 0.005) and mifepristone pretreatment (fetal anomaly 55% versus IUFD 5%, P < 0.001). Composite complication rate was similar (fetal anomaly 14% versus IUFD 17%), and specific complications did not differ.. Second-trimester medical termination for IUFDs have similar complication rates as those undergoing induction terminations for fetal anomalies.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Female; Fetal Death; Fetal Diseases; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Stillbirth

The aim of this study was to identify the factors and frequencies of induced termination of pregnancies.. This is a retrospective study of 488 terminations of pregnancies (TOPs) between January 2011 and December 2021 to demonstrate the factors affecting the decision to terminate the pregnancy. All cases had been hospitalized to manage the induction of labor. Methods included serial multiple laminaria dilation of the cervix and administration of a cervical misoprostol suppository. After induction of labor, the subject may experience amniotomy, instrumental evacuation of the uterus, and even hysterotomy. Pre-procedure counseling included an agreement to share medical records (paper-based and electronic). We verified the indications for all patients seeking TOPs. All cases were performed according to known diagnostic classifications and divided into seven groups for analysis.. The patient ages ranged from 12 to 46 years. The median maternal age was 34 years [interquartile range (IQR) 30, 37]; 52.2% had at least one prior delivery. The pre-procedure diagnosis was divided into seven groups including the following: chromosomal and genetic abnormalities (146/488, 29.9%), no intrauterine heartbeats (126/488, 25.8%), structural anomalies (84/488, 17.2%), elective termination (56/488, 11.5%), preterm premature rupture of membranes (PPROM) (42/488, 8.6%), cervical incompetence (32/488, 6.6%), and other conditions (2/488, 0.4%). After excluding elective terminations, the eleven-year rate of fetal death and stillbirth to births did not show significant changes from 2011 to 2021.. Knowing the factors underlying the decision to induce intrauterine fetal death (IUFD) including reasons for objecting to pregnancy are important for obstetricians-they can offer better planning and medical counseling. It is important to educate all women about family planning to prevent large numbers of unwanted and unsafe pregnancy terminations.

Topics: Abortion, Induced; Adolescent; Adult; Child; Female; Fetal Death; Humans; Infant, Newborn; Middle Aged; Misoprostol; Pregnancy; Retrospective Studies; Stillbirth; Young Adult

Topics: Abortifacient Agents, Nonsteroidal; Adult; Delivery, Obstetric; Female; Fetal Death; Humans; Influenza A Virus, H7N9 Subtype; Influenza, Human; Misoprostol; Pneumonia, Viral; Pregnancy; Respiratory Distress Syndrome; Stillbirth

To describe the management of third-trimester stillbirth at a single institution, stratifying induction intervals and adverse outcomes by method.. Women diagnosed with fetal demise at 28weeks or later and admitted to an academic hospital between January 2007 and September 2010 were identified. A chart review extracted demographics, history, induction method, delivery interval, and adverse outcomes.. Seventy-four women were included, with a median gestational age of 35.5weeks (range, 28-40weeks). Ten women had undergone at least 1 prior cesarean. Induction methods included misoprostol alone or for cervical ripening; oxytocin and amniotomy; transcervical Foley catheter; and mifepristone. Overall, 88% of patients delivered within 24hours; median time to fetal delivery was 11hours 20minutes (range, 7minutes to 57hours 12minutes). Adverse outcomes included intrapartum fever and postpartum hemorrhage. In total, 98% of patients, including those with prior cesarean, had a successful vaginal delivery.. Regardless of third-trimester induction method for management of stillbirth, the majority of women experience safe delivery within 24hours. The descriptive data imply that misoprostol-only inductions might confer the shortest induction intervals; however, further prospective trials are needed to identify the optimal misoprostol regimen for women with third-trimester stillbirth.

Topics: Adolescent; Adult; Amnion; Cervical Ripening; Delivery, Obstetric; Female; Humans; Labor, Induced; Mifepristone; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, Third; Retrospective Studies; Stillbirth; Time Factors; Urinary Catheterization; Young Adult

Topics: Adult; Antibodies; Blood Group Antigens; Blood Group Incompatibility; Female; Humans; Hyaluronan Receptors; Labor, Induced; Misoprostol; Pregnancy; Pregnancy Complications, Hematologic; Stillbirth

Topics: Adult; Female; Humans; Labor, Induced; Live Birth; Misoprostol; Oxytocics; Parity; Pregnancy; Stillbirth; Uterine Rupture