misoprostol and Uterine-Hemorrhage

With changing conditions affecting receipt of postabortion care, an updated estimate of the incidence of treatment for complications from unsafe pregnancy termination is needed to inform policies and programmes. National estimates of facility-based treatment for complications in 26 countries form the basis for estimating treatment rates in the developing world. An estimated seven million women were treated in the developing world for complications from unsafe pregnancy termination in 2012, a rate of 6.9 per 1000 women aged 15-44 years. Regionally, rates ranged from 5.3 in Latin America and the Caribbean to 8.2 in Asia. Results inform policies to improve women's health.. An estimated 7 million women were treated in the developing world for complications of unsafe TOP in 2012.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Aftercare; Asia; Caribbean Region; Developing Countries; Female; Health Facilities; Health Policy; Health Services Accessibility; Humans; Incidence; Latin America; Misoprostol; Pregnancy; Sepsis; Uterine Hemorrhage; Uterine Perforation; Women's Health

Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. Preventive measures for post-partum haemorrhage include routine active management of the third stage of labour. Treatment involves a cascade of increasingly invasive interventions in rapid sequence until the bleeding is stopped. These interventions include fluid resuscitation, removal of the placenta, bimanual uterine compression, uterotonics, tranexamic acid, suturing of lower genital tract injury, blood product replacement, balloon tamponade, laparotomy, stepwise uterine devascularization, uterine compression sutures and hysterectomy. Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.

Topics: Abruptio Placentae; Antifibrinolytic Agents; Blood Transfusion; Cesarean Section; Crystalloid Solutions; Ergonovine; Female; Fluid Therapy; Gravity Suits; Health Facilities; Home Childbirth; Humans; Hysterectomy; Isotonic Solutions; Labor, Induced; Massage; Maternal Death; Misoprostol; Oxytocics; Oxytocin; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Tourniquets; Tranexamic Acid; Uterine Artery Embolization; Uterine Balloon Tamponade; Uterine Hemorrhage; Uterine Rupture

To review the preoperative preparation, intraoperative equipment and techniques to facilitate hysteroscopic resection of submucous fibroids.. The use of preoperative ultrasound can guide safe resection of submucous fibroids and should be an integral part of a preoperative workup. The data regarding misoprostol use for cervical dilation prior to hysteroscopy is somewhat conflicting and the decision to preoperatively administer misoprostol should be on a case-by-case basis. Hysteroscopic resection of submucous intrauterine fibroids can now be performed under low-dose spinal anesthesia and with the development of smaller instruments and bipolar technology, in an office-based setting without any anesthesia and, sometimes, analgesia. Although the complete removal of type 1 and 2 submucous fibroids remain a challenge, the development of newer techniques such as office preparation of partially intramural myomas and cold-loop myomectomy can result in better removal of these submucous fibroids with an intramural component.. Hysteroscopic resection of submucous uterine fibroids should be a simple, well tolerated and effective procedure. Innovations to the existing hysteroscopic techniques and the development of the hysteroscopic morcellator will hopefully result in a greater number of gynecologic surgeons being able to safely perform hysteroscopic resection of submucous uterine fibroids.

Topics: Female; Humans; Hysteroscopy; Leiomyoma; Misoprostol; Oxytocics; Patient Selection; Treatment Outcome; Uterine Hemorrhage; Uterine Myomectomy; Uterine Neoplasms

To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage.. Systematic review and metaanalysis of randomized controlled trials.. Seventeen studies (3174 women) were included of which 7 evaluated misoprostol vs oxytocin and 8 evaluated misoprostol plus oxytocin vs oxytocin alone. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, -2.1%; 95% confidence interval, -3.4 to -0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% confidence interval, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia.. Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during cesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations.

Topics: Cesarean Section; Female; Humans; Intraoperative Complications; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Uterine Hemorrhage

Major obstetric hemorrhage is an extremely challenging obstetric emergency associated with significant morbidity and mortality. Pharmacological treatment of uterine atony has not altered much in recent years apart from the increasing use ofmisoprostol, although controversy surrounds its advantages over other uterotonics. Placenta accreta is becoming more common, a sequel to the rising caesarean section rate. Interventional radiology may reduce blood loss in these cases. Uterine compression sutures, intrauterine tamponade balloons and cell salvage have been introduced in the last decade.

Topics: Cesarean Section; Female; Humans; Misoprostol; Obstetric Labor Complications; Oxytocics; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Uterine Hemorrhage

Exhibiting a strong affinity to the progesterone and the glucocorticoid receptors, mifepristone exert competitive antagonism to these hormones both in in vitro and in animal experiments. Due to its antiprogesterone activity, it was proposed that mifepristone be used for the termination of early human pregnancy. Mifepristone, at a dose of 600 mg initially used alone, was then used with a subsequent low dose of prostaglandin that led to a success rate of 95% as a medical method for early termination of pregnancy (TOP), and the occurrence of continuing pregnancy was reduced to

Topics: Abortifacient Agents; Abortion, Induced; Animals; Clinical Trials as Topic; Female; Humans; Mifepristone; Misoprostol; Pelvic Infection; Pregnancy; Uterine Hemorrhage

Induced abortion is still a major health problem in the world and the most frequently performed intervention in obstetrics and gynecology with an estimated total of 46 million worldwide each year. Medical abortion with mifepristone and prostaglandin was first introduced in 1988 and is now approved in 31 countries. This combination of drugs has recently been included in the List of Essential Medicines by the World Health Organisation. The present review summarizes the development, physiology and the development of the currently used regimens.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Intravaginal; Administration, Sublingual; Analgesia, Obstetrical; Female; Gestational Age; Humans; Mifepristone; Misoprostol; Patient Satisfaction; Pregnancy; Prostaglandins; Time Factors; Uterine Contraction; Uterine Hemorrhage; World Health Organization

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Chills; Congenital Abnormalities; Diarrhea; Drug Administration Schedule; Female; Fever; Gestational Age; Humans; Milk, Human; Misoprostol; Muscle Cramp; Nausea; Pregnancy; Uterine Hemorrhage; Vomiting

Early pregnancy loss is a common event in the first trimester, occurring in 15%-20% of confirmed pregnancies. A common evidence-based medical regimen for early pregnancy loss uses misoprostol, a prostaglandin E1 analog, with a dosage of 800 μg, self-administered vaginally. The clinical utility of this regimen is limited by suboptimal effectiveness in patients with a closed cervical os, with 29% of patients experiencing early pregnancy loss requiring a second dose after 3 days and 16% of patients eventually requiring a uterine aspiration procedure.. This study aimed to evaluate clinical predictors associated with treatment success in patients receiving medical management with mifepristone-misoprostol or misoprostol alone for early pregnancy loss.. We performed a planned secondary analysis of a randomized trial comparing mifepristone-misoprostol with misoprostol alone for management of early pregnancy loss. The published prediction model for treatment success of single-dose misoprostol administered vaginally included the following variables: active bleeding, type of early pregnancy loss (anembryonic pregnancy or embryonic and/or fetal demise), parity, gestational age, and treatment site; previous significant predictors were vaginal bleeding within the past 24 hours and parity of 0 or 1 vs >1. To determine if these characteristics predicted differential proportions of patients with treatment success or failure, we performed bivariate analyses; given the small proportion of treatment failures in the combined treatment arm, both arms were combined for analysis. Thereafter, we performed a logistic regression analysis to assess the effect of these predictors collectively in each of the 2 treatment groups separately as well as in the full cohort as a proxy for the combined treatment arm. Finally, by using receiver operating characteristic curves, we tested the ability of these predictors in association with misoprostol treatment success to discriminate between treatment success and treatment failure. To quantify the ability of the score to discriminate between treatment success and treatment failure in each treatment arm as well as in the entire cohort, we calculated the area under the curve. Using multivariable logistic regression, we then assessed our study population for other predictors of treatment success in both treatment groups, with and without mifepristone pretreatment.. Overall, 297 evaluable participants were included in the primary study, with 148 in the mifepristone-misoprostol combined treatment group and 149 in the misoprostol-alone treatment group. Among patients who had vaginal bleeding at the time of treatment, 15 of 17 (88%) in the mifepristone-misoprostol combined treatment group and 12 of 17 (71%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. Among patients with a parity of 0 or 1, 94 of 108 (87%) in the mifepristone-misoprostol treatment group and 66 of 95 (69%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. These clinical characteristics did not predict treatment success in the combined cohort alone (area under the curve=0.56; 95% confidence interval, 0.48-0.64). No other baseline clinical factors predicted treatment success in the misoprostol-alone treatment arm or mifepristone pretreatment arm. In the full cohort, the significant predictors of treatment success were pretreatment with mifepristone (adjusted odds ratio=2.51; 95% confidence interval, 1.43-4.43) and smoking (adjusted odds ratio=2.15; 95% confidence interval, 1.03-4.49).. No baseline clinical factors predicted treatment success in women receiving medical management with misoprostol for early pregnancy loss. Adding mifepristone to the medical management regimen of early pregnancy loss improved treatment success; thus, mifepristone treatment should be considered for management of early pregnancy loss regardless of baseline clinical factors.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Spontaneous; Adult; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Parity; Pregnancy; Treatment Outcome; Uterine Hemorrhage

To compare vaginal misoprostol treatment with expectant management in early non-viable pregnancy with vaginal bleeding with regard to complete evacuation of the uterine cavity within 10 days after randomization.. This was a parallel randomized controlled, open-label trial conducted in Skåne University Hospital, Sweden. Patients with anembryonic pregnancy or early fetal demise (crown-rump length ≤ 33 mm) and vaginal bleeding were randomly allocated to either expectant management or treatment with a single dose of 800 μg misoprostol administered vaginally. Patients were evaluated clinically and by ultrasound until complete evacuation of the uterus was achieved (no gestational sac in the uterine cavity and maximum anteroposterior diameter of the intracavitary contents < 15 mm as measured by transvaginal ultrasound on midsagittal view). Follow-up visits were planned at 10, 17, 24 and 31 days. Dilatation and evacuation (D&E) was recommended if miscarriage was not complete within 31 days, but was performed earlier at patient's request, or if there was excessive bleeding as judged clinically. Analysis was by intention to treat. The main outcome measure was number of patients with complete miscarriage without D&E ≤ 10 days.. Ninety-four patients were randomized to misoprostol treatment and 95 to expectant management. After exclusion of three patients and withdrawal of consent by two patients in the expectant management group, 90 women were included in this group. Miscarriage was complete ≤ 10 days in 62/94 (66%) of the patients in the misoprostol group and in 39/90 (43%) of those in the group managed expectantly (risk difference (RD) = 23%; 95% CI, 8-37%). At 31 days, the corresponding figures were 81/94 (86%) and 55/90 (61%) (RD = 25%; 95% CI, 12-38%). Two patients from each group underwent emergency D&E because of excessive bleeding and one of these in each group received blood transfusion. The number of patients undergoing D&E at their own request was higher in the expectantly managed group, 15/90 (17%) vs 3/94 (3%) in the misoprostol group (RD = 14%; 95% CI, 4-23%), as was the number of patients making out-of-protocol visits, 50/90 (56%) vs 27/94 (29%) (RD = 27%; 95% CI, 12-40%). Compared with the expectant management group, more patients in the misoprostol group experienced pain (71/77 (92%) vs 91/91 (100%); RD = 8%; 95% CI, 1-17%) and used painkillers (59/77 (77%) vs 85/91 (93%); RD = 17%; 95% CI, 5-29%). No major side effect was reported in any group.. In women with early non-viable pregnancy and vaginal bleeding, misoprostol treatment is more effective than is expectant management for complete evacuation of the uterus. Both methods are safe but misoprostol treatment is associated with more pain than is expectant management. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Spontaneous; Adult; Conservative Treatment; Dilatation and Curettage; Female; Follow-Up Studies; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Sweden; Treatment Outcome; Uterine Hemorrhage

To study the effect of cervical priming with misoprostol on cervical entry in women undergoing diagnostic hysteroscopy for evaluation of abnormal uterine bleeding.. Randomized controlled trial conducted in teaching hospital and tertiary referral center on 122 women requiring diagnostic hysteroscopy for evaluation of abnormal uterine bleeding. Women were randomized into two equal groups (n = 122). Study group received 200-μg vaginal misoprostol, 3 h prior to vaginoscopic hysteroscopy. No drug was used in control group. No analgesia or anesthesia was used in either group. Outcome measure included (i) ease of cervical entry (Likert scale), and (ii) pain scoring (Visual Analog Scale) and procedural entry time.. Forty-six (75.41%) patients in the study group and 17 (27.87%) in control group had easy or very easy entry (Likert scale-4 and 5) (p < 0.001). Median pain scoring by VAS and the median procedural entry time was significantly lower in the study group compared to the control group (p < 0.001).. Use of 200-μg vaginal misoprostol, administered vaginally 3 h before diagnostic vaginoscopic hysteroscopy, was found to be simple and effective method of cervical priming in facilitating cervical entry with minimal side effects. Clinical Trial registry of India (CTRI): (CTRI/2015/04/005666) (website: http://ctri.nic.in ).

Topics: Administration, Intravaginal; Female; Humans; Hysteroscopy; Middle Aged; Misoprostol; Outcome Assessment, Health Care; Oxytocics; Pregnancy; Uterine Hemorrhage

To compare levonorgestrel (LNG) 52-mg intrauterine system (IUS) expulsion rates with fast-track (≤3 days) or delayed (2-4 weeks) insertion following mifepristone and misoprostol medical abortion.. In this pilot trial, we randomized 108 women at ≤63 days' gestation to fast-track (n=55) or delayed (n=53) insertion. Follow-up visits occurred at 2-4 weeks, 3 months and 1 year. We assessed total and partial expulsion at 3 months and 1 year, adverse effects and bleeding profiles.. We had follow-up data at 3 months and 1 year for 41 (74.5%) and 37 (69.8%) women in the fast-track group and 31 (56.4%) and 28 (52.8%) women in the delayed group. By 3 months, expulsion occurred in six (12.5%) women after fast-track and one (2.3%) woman after delayed insertion [risk ratio (RR) 5.50, 95% confidence interval (CI) 0.69-43.90]; most (n=5) of these were partial expulsions in the fast-track group. By 1 year, expulsion had occurred in seven (14.6%) and five (11.5%) women in the fast-track and delayed groups, respectively (RR 1.28, 95% CI 0.44-3.75). We found no differences in rates of vacuum aspiration, residual tissue, infection and bleeding or bleeding patterns within 3 months of insertion.. Fast-track insertion of the LNG 52-mg IUS after medical abortion is feasible but may result in higher expulsion rates compared to delayed insertion. Due to lack of statistical power and high lost-to-follow-up rates, we were unable to fully address this question.. Fast-tract initiation of LNG 52-mg IUS contraception after medical abortion is feasible. It results in higher expulsion rates than delayed insertion but may improve postabortal intrauterine contraception uptake.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Feasibility Studies; Female; Finland; Follow-Up Studies; Humans; Intention to Treat Analysis; Intrauterine Device Expulsion; Intrauterine Devices, Medicated; Mifepristone; Misoprostol; Patient Dropouts; Pilot Projects; Pregnancy; Pregnancy Trimester, First; Time Factors; Uterine Hemorrhage; Young Adult

The third stage of labour may be complicated by retained placenta, which should be managed promptly because it may cause severe bleeding and infection, with a potentially fatal outcome. This study evaluated the effectiveness of umbilical vein injection of misoprostol for the treatment of retained placenta in a hospital setting.. This hospital-based placebo-controlled trial was conducted at the Maternity Teaching Hospital, Erbil City, Kurdistan region, Northern Iraq from April 2011 to February 2012. The inclusion criteria were: gestational age of at least 28 weeks, vaginal delivery, and failure of the placenta to separate within 30 minutes after delivery of the infant despite active management of the third stage of labour. Forty-six women with retained placentas were eligible for inclusion. After informed consent was obtained, the women were alternately allocated to receive umbilical vein injection of either 800 mcg misoprostol dissolved in 20 mL of normal saline (misoprostol group) or 20 mL of normal saline only (saline group). The women were blinded to the group allocation, but the investigator who administered the injection was not. The trial was registered by the Research Ethics Committee of Hawler Medical University.. After umbilical vein injection, delivery of the placenta occurred in 91.3% of women in the misoprostol group and 69.5% of women in the saline group, which was not a significant difference between the two groups. The median vaginal blood loss from the time of injection until delivery of the placenta was significantly less in the misoprostol group (100 mL) than in the saline group (210 mL) (p value < 0.001).. Umbilical vein injection of misoprostol is an effective treatment for retained placenta, and reduces the volume of vaginal blood loss with few adverse effects.. Current Controlled Trial HMU: N252.1.2011.

Topics: Administration, Intravenous; Adult; Blood Volume; Female; Humans; Misoprostol; Oxytocics; Placebos; Placenta, Retained; Pregnancy; Single-Blind Method; Sodium Chloride; Time Factors; Umbilical Veins; Uterine Hemorrhage; Young Adult

The management of first-trimester miscarriage has been studied extensively in recent years. However, relatively little attention has been focussed on woman's satisfaction and psychological impact from different treatment modalities.. To investigate the clinical and psychological outcomes of surgical, medical and expectant management of first-trimester miscarriage.. A prospective randomised controlled trial of 180 women suffering miscarriage managed by either surgical evacuation, medical evacuation or expectant management was conducted in a university-affiliated, tertiary referral hospital. The complete miscarriage rate, clinical symptomatology, complications, women's satisfaction and the psychological impact were evaluated.. Women in surgical evacuation (98.1%) had a significantly higher complete miscarriage rate when compared with medical evacuation (70%) and expectant management (79.3%). Women who had surgical evacuation had significantly shorter duration of vaginal bleeding, but higher rate of infection. Women who had medical evacuation had significantly more gastrointestinal symptoms. Despite differences in efficacy and complication profile, there was no significant difference in satisfaction among groups. There were no significant differences in terms of psychological well-being, depression scores, anxiety level, fatigue symptoms as measured in General Health Questionnaire-12, Beck Depression Inventory, Spielberger's State Anxiety Inventory and fatigue scale at treatment and four weeks after treatment. However, women with active intervention had greater post-traumatic stress symptoms as measured in Chinese version of Impact of Event Scale-Revised at the time of treatment when compared with women in expectant management.. Without substantial differences in the clinical and psychological impact between different treatment modalities, a more conservative approach with expectant management for miscarriage may be an option for women.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Spontaneous; Adult; Dilatation and Curettage; Female; Humans; Misoprostol; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; Uterine Hemorrhage; Watchful Waiting

To study the effectiveness of sublingual misoprostol for cervical ripening before MVA in women aged between 35 and 55 years old.. Women aged between 35 and 55 years old who had indications for endometrial sampling were recruited. Exclusion criteria were gross pathology of cervix, pregnancy, allergy to misoprostol, and abnormal coagulopathy. Eighty women who had indication for MVA were then assigned by randomization (block of four). Participants were treated with either sublingual 200 microg of misoprostol (study group) or placebo (controlled group) for cervical priming at two hours before procedure. The largest diameter of the Hegar's dilator through internal so without any resistance before MVA was the primary collected data. Secondary data were operating time, immediate pain score, satisfactory score, complications, and side effects.. Mean age of misoprostol and controlled group were 44.8 +/- 5.2 and 45.5 +/- 5.0 years old, respectively. One third of both groups had previously experienced uterine curettage. The initial cervical diameter before MVA of individuals receiving misoprostol and controlled group were 6.9 +/- 2.0 and 5.5 +/- 2.4 mm, respectively. The MVA time in misoprostol group was significantly shorter than controlled group (5.1 +/- 1.7 vs. 8.0 +/- 3.9 min, p < 0.001). The additional analgesia was not different in both groups. Side effect before MVA were more significantly found in misoprostol group (p = 0.001). Lower post MVA pain and satisfactory score were better reported in misoprostol group than placebo's (p < 0.001).. Two hundred micrograms of sublingual misoprostol administration prior to MVA gave significantly effective result of cervical priming. Satisfactory and pain scores were more favorable in misoprostol group with manageable side effects.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Sublingual; Adult; Cervical Ripening; Double-Blind Method; Female; Humans; Middle Aged; Misoprostol; Pain Measurement; Pregnancy; Prospective Studies; Treatment Outcome; Uterine Hemorrhage; Vacuum Curettage

To compare the efficacy of Laminaria tents with Misoprostol for cervical ripening before surgical process in missed abortion.. In a prospective study, 70 women with missed abortion were assigned to have either insertion of a 3 mm intracervical Laminaria tent (n = 35) or vaginal Misoprostol 400 μg (n = 35) on the day prior to suction dilation and curettage (D/C). The women were interviewed just prior to the D/C with regard to pain, vaginal bleeding, and cervical dilator preference.. Cervical dilation was greater in the Laminaria group but not significantly different from that in the Misoprostol group. However, additional cervical dilation before D/C was required in more patients in the Misoprostol group (45.7 vs 14.3%, P = 0.001). Women who received Laminaria reported significantly more pain at the time of insertion (62.8% in Laminaria group vs 22.8% in Misoprostol group) compared with women who received Misoprostol. Conversely, Misoprostol was associated with more nausea, vomiting, diarrhea and vaginal bleeding.. Laminaria tents are more effective cervical dilators than vaginal Misoprostol when inserted the day prior to suction D and C. Vaginal Misoprostol insertion is more comfortable, although it is associated with an increased risk of vaginal bleeding.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Cervical Ripening; Diarrhea; Dilatation and Curettage; Female; Humans; Labor Stage, First; Laminaria; Misoprostol; Nausea; Pain; Pregnancy; Uterine Hemorrhage; Vomiting; Young Adult

To explore the lowest effective dosage of mifepristone combined with misoprostol in terminating ultra-early pregnancy.. All the cases of ultra-early pregnancy classified by amenorrhea days, β-hCG and vaginal B-ultrasonic were randomly divided into two groups. One hundred cases in G1 group (minimized dosage) were orally administered 25 mg mifepristone once a day for 2 days and combined with 200 µg misoprostol 48 hours later, while 150 mg mifepristone combined with 600 µg misoprostol 48 hours later were given to 100 cases in G2 group (normal dosage). All cases were observed for 6 hours after taking misoprostol and returned for assessment three days later.. None missing. Expulsion of conceptus: G1 and G2 group were 22 (22.0%, 22/100) and 25 (25.0%, 25/100; P > 0.05). Failure rate: cases with incomplete abortion were 1 (1.0%, 1/100) and 2 (2.0%, 2/100) in G1 and G2 group, hospitalization for suspected ectopic pregnancies both was 1 (1.0%). Bleeding: bleeding cases during the administration of mifepristone in G1 and G2 group were 71 (71.0%, 71/100) and 78 (78.0%, 78/100; P > 0.05); the mean bleeding time were (5.3 ± 1.4) days and (6.0 ± 1.5) days (P < 0.01). Other side effects: in G1 group, majority showed light nausea (7.0%, 7/100) and light abdominal pain (20.0%, 20/100). Menses recovery: 99 (99.0%, 99/100) for G1 group and 98 (98.0%, 98/100) for G2 group to recovery on scheduled time. Satisfactions: both were 99 (99.0%, 99/100). Except mean bleeding days and side-effects, the differences above showed no significance (P > 0.05).. It is safe and effective treatment with the lowest dosages of mifepristone and misoprostol to terminate ultra-early pregnancies.

Topics: Abdominal Pain; Abortifacient Agents; Abortion, Induced; Administration, Oral; Adult; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Mifepristone; Misoprostol; Nausea; Patient Satisfaction; Pregnancy; Treatment Outcome; Uterine Hemorrhage; Young Adult

To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion.. A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded.. The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious.. Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Spontaneous; Adult; Anxiety; Female; Follow-Up Studies; Humans; Misoprostol; Patient Satisfaction; Pelvic Pain; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Treatment Outcome; Ultrasonography; Uterine Hemorrhage; Young Adult

To assess the effectiveness and tolerability of misoprostol to reduce the amount and duration of vaginal bleeding following surgical evacuation for first trimester spontaneous abortion.. A total of 160 patients who underwent surgical evacuation for first trimester spontaneous abortion between 8 and 12 weeks of pregnancy were randomized into 2 groups to receive either 200 microg of oral misoprostol immediately after evacuation followed every 6 hours for 48 hours or no misoprostol. Pain scores, duration and amount of bleeding, and endometrial thickness were assessed over 10 days.. Women who received misoprostol had significantly fewer bleeding days after evacuation (4.11+/-2.69 vs 5.89+/-3.06; P<0.001), fewer patients reported vaginal bleeding lasting 10 days or more (3.8% vs 15.0%; P=0.014), and endometrial thickness 10 days after evacuation was less (6.25+/-2.38 vs 7.23+/-1.94; P=0.05). Pain scores were comparable in both groups (1.54+/-0.65 vs 1.63+/-0.83; P=0.40) after 10 days.. Oral misoprostol is effective in reducing the prevalence and amount of vaginal bleeding after surgical evacuation for first trimester spontaneous abortion.

Topics: Abortion, Spontaneous; Administration, Oral; Adult; Endometrium; Female; Follow-Up Studies; Humans; Misoprostol; Oxytocics; Pain; Pain Measurement; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Treatment Outcome; Uterine Hemorrhage; Young Adult

Because seminal prostaglandins play a role at natural fertilization, it was hypothesized that vaginal supplementation of prostaglandins at the time of intrauterine insemination (IUI) might enhance chances of conception. We investigated the effect of misoprostol, a prostaglandin analogue, on the success rate of IUI.. A multi-center double-blind randomized controlled trial, using a cross-over design with alternating sequence, was designed. Vaginal tablets of misoprostol or placebo were used in conjunction to intrauterine insemination. In total, 199 women, comprising 466 cycles, were analyzed. Main outcome measures were pregnancy rate and prevalence of vaginal bleeding and uterine cramps.. The misoprostol group accounted for 146 cycles with 19 pregnancies, whereas the placebo group cycles totaled 164 cycles with 21 pregnancies (13.0 vs. 12.8%, not significant). There was a statistically significant increase in vaginal bleeding (12.3 vs. 1.8%; OR 7.55; 95% CI 2.31-24.48) and abdominal cramping rates (15.1 vs. 4.3%; OR 3.98; 95% CI 1.68-9.39) after application of misoprostol. Due to these severe adverse events the study was prematurely terminated.. Although prostaglandins surely play a role in natural human reproduction, vaginal administration of misoprostol at the time of IUI is associated with a high rate of side effects and does not seem to enhance the outcome.

Topics: Abdominal Pain; Administration, Intravaginal; Adult; Cross-Over Studies; Double-Blind Method; Female; Humans; Insemination, Artificial; Male; Misoprostol; Pregnancy; Prospective Studies; Prostaglandins, Synthetic; Uterine Hemorrhage; Young Adult

The purpose of this study was to describe bleeding patterns after misoprostol or curettage for early pregnancy failure (EPF).. This was a randomized trial that included women (n = 652) with EPF. Participants were assigned to vaginal misoprostol (800 microg) or curettage in a 3:1 ratio. Participants completed a bleeding diary. We measured hemoglobin levels at baseline and 2 weeks after the treatment.. Decreases in hemoglobin levels were greater after misoprostol (-0.7 g/dL; SD, 1.2) than curettage (-0.2 g/dL; SD, 0.9; P < .001). Large changes in hemoglobin levels (at least 2 g/dL) or low nadir hemoglobin levels (< 10 g/dL) were more frequent after misoprostol (55/428 women; 12.8%) than after curettage (6/135 women; 4.4%; P = .02). More participants in the misoprostol group reported "any bleeding" or "heavy bleeding" every study day. Four women who were treated with misoprostol required blood transfusion.. Bleeding is heavier and more prolonged after medical treatment with misoprostol than with curettage for EPF; however, bleeding rarely requires intervention.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Adult; Curettage; Female; Humans; Misoprostol; Pregnancy; Uterine Hemorrhage

We evaluated the sociodemographic and clinical factors, including expectations, associated with satisfaction with medication abortion.. Four sites enrolled 1080 subjects in a randomized trial of misoprostol 6-8 h versus misoprostol 24 h after mifepristone treatment for abortion at up to 63 days' gestation. Method acceptability was evaluated by preabortion and postabortion interviews and with visual analog scales examining subject factors, side effects, preferences and dislikes with the experience, pain, bleeding and stated as well as measured differences from expectations.. Nulliparity and increasing gestational age (GA) were independently associated with experiencing more pain than expected. Higher GA was associated with heavier and longer bleeding than expected. Although 89.7% of the subjects would choose medication abortion again, only 58% rated the experience as positive. Independent predictors of a positive experience included older subject age, clinic site, efficacy and less pain and bleeding than expected. Significant predictors of not choosing medication abortion again were procedure failure and more pain and bleeding than expected. All outcomes were independent of the randomization group in the main study.. Satisfaction with medication abortion may be limited by differences between patients' expectations of pain and bleeding and their experienced symptoms. These differences between expectations and experience and the actual symptoms of pain and bleeding are associated with increasing GA and nulliparity. Pain, bleeding and method failure independently predict method dissatisfaction. More information regarding severity of symptoms should be incorporated into patient counseling.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Female; Gestational Age; Humans; Mifepristone; Misoprostol; Pain; Parity; Patient Acceptance of Health Care; Pregnancy; Treatment Failure; Uterine Hemorrhage

Vaginal administration of prostaglandin analogues as well as nitric oxide donors before first-trimester surgical abortion has been shown to induce effective cervical ripening. In addition, nitric oxide donors, such as isosorbide mononitrate and nitroglycerin, have been associated with a patient-friendly side-effect profile when administered 3 h before the surgical procedure. We wanted to compare the cervical ripening effect and possible side effects of isosorbide mononitrate and the prostaglandin analogue misoprostol when self-administered at bedtime the evening before surgical abortion.. One hundred and twenty nulliparous women scheduled for suction termination of pregnancy in the first trimester were randomly assigned to receive per vaginam either 40 mg of isosorbide mononitrate or 200 microg of misoprostol. Sixty of the women were included for assessment of cervical ripening as well as evaluation of side effects. The other 60 women were recruited for assessment of side effects only. Cervical ripening was evaluated by measuring baseline cervical dilation and the cumulative force to dilate the cervix to 9 mm by means of a cervical tonometer. For assessment of side effects, the women were asked to complete a symptom questionnaire.. Cervical resistance was significantly higher in women treated with isosorbide mononitrate compared to misoprostol (median cumulative force 73 versus 15 N). Common side effects of misoprostol were abdominal pain (69%), nausea (44%), and vaginal bleeding (66%), while in the isosorbide mononitrate group headache was frequently experienced (79%). In both treatment groups, the frequency and intensity of side effects gradually increased during the treatment interval.. Misoprostol induced a more pronounced cervical ripening than isosorbide mononitrate, but both regimens were associated with a high frequency of side effects.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Ambulatory Care; Cervical Ripening; Double-Blind Method; Female; Humans; Isosorbide Dinitrate; Misoprostol; Nausea; Nitric Oxide Donors; Pregnancy; Pregnancy Trimester, First; Self Administration; Surveys and Questionnaires; Uterine Hemorrhage

This study examines bleeding pattern following medication-induced termination of pregnancy, comparing two different dosing schedules of mifepristone and misoprostol.. Diary information was analyzed from a randomized, multicenter trial in which women used vaginal misoprostol 800 mug either 6-8 or 24 h following 200 mg of oral mifepristone.. One thousand eighty women with pregnancies up to 63 days' gestation were recruited for the study; 540 were randomized to the 6- to 8-h dosing schedule, and 540 were randomized to the 24-h dosing schedule. Subjects recorded daily bleeding in a diary over 5 weeks.. Total duration of bleeding ranged from 1 to 54 days, with a median of 7 days. Duration of spotting ranged from 1 to 80 days, with a median of 5 and 6 days (NS) in each of the two groups. Neither duration of bleeding nor duration of spotting were related to interval between mifepristone and misoprostol. Bleeding and spotting durations were not correlated with maternal age or smoking. Increased gestational age was correlated with longer bleeding and spotting times. Nulliparity was associated with longer bleeding time.. Varying the interval between mifepristone and misoprostol in medication abortion does not affect duration or quantity of bleeding.

Topics: Abortifacient Agents; Abortion, Induced; Adult; Female; Gestational Age; Humans; Mifepristone; Misoprostol; Parity; Pregnancy; Time Factors; Uterine Hemorrhage

To compare the efficacy, adverse effects and acceptability of the three most common misoprostol regimens used with mifepristone for medical abortion.. Randomised nonblinded trial.. Three clinics associated with major research universities in Canada; two in major urban areas and one in a periurban area.. Women of reproductive age.. Consenting women presenting for abortion services with gestations less than 56 days and who met inclusion criteria were given 200 mg mifepristone orally and then randomised into three misoprostol study groups: (group I) 400 micrograms of oral misoprostol, (group II) 600 micrograms of oral misoprostol, and (group III) 800 micrograms of vaginal misoprostol. Misoprostol was self-administered at home 24-48 hours following mifepristone, and participants were instructed to take a second similar misoprostol dose at 24 hours after the initial dose if bleeding was less than a normal menstrual period.. Successful abortion without surgery was 94.1%, with no significant differences across the three study groups (94.7% in group I, 93.4% in group II, and 94.3% in group III; P= 0.975).. Efficacy and adverse effects did not differ significantly across the three study groups. Pain increased significantly across the study and the gestational age groups and was associated with lower acceptability.. There appears to be a range of safe and effective options for early medical abortion with mifepristone including a choice between oral and vaginal administration of misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adolescent; Adult; Female; Humans; Mifepristone; Misoprostol; Pain; Patient Satisfaction; Pregnancy; Treatment Outcome; Uterine Hemorrhage

That a 6-hour drug administration interval has similar efficacy and greater patient satisfaction as a 36- to 48-hour interval.. Four hundred and fifty patients.. A two-arm parallel design unblended randomised controlled trial in a single hospital. Eligible women up to 63 days of gestation will be invited to participate. Those willing will be randomised to either the experimental group (6 hours administration of misoprostol) or the control group (36-48 hours administration of misoprostol). All participants will take 200 mg mifepristone orally. At the time determined by study group allocation 800 microg misoprostol will be given intravaginally together with 100 mg diclofenac pr. Antibiotic prophylaxis as per the usual protocol will be given to each group. The control group will remain in hospital for 6 hours as per current policy and the study group will return home in 1 to 3 hours.. Complete medical abortion without need for further misoprostol or surgical evacuation.. Duration of bleeding, side effects and acceptability based on questionnaire.. None.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Oral; Adolescent; Adult; Clinical Protocols; Female; Humans; Mifepristone; Misoprostol; Patient Satisfaction; Pregnancy; Treatment Outcome; Uterine Hemorrhage

To compare the experience of pain, need of analgesic interventions, preference and acceptability in medical abortion up to 49 days of amenorrhea with mifepristone and orally versus vaginally administered misoprostol.. Ninety-seven women were randomised to oral misoprostol, n=48, or vaginal misoprostol, n=49. On day 1 of the study, both the groups received 600 mg of mifepristone. On day 3 of the study, one group received 0.4 mg of misoprostol orally and the other group received 0.8 mg of misoprostol vaginally.. Even though oral administration of misoprostol seemed to be associated with a higher rate of gastrointestinal side effects, women in both the groups showed a clear preference towards the oral route of administration. The willingness to administer the misoprostol at home was also higher among the women in the oral group, which may in part depend on a more positive/less negative experience of the abortion.. A majority of women prefer oral administration of misoprostol in early medical abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Oral; Administration, Topical; Analgesics; Female; Humans; Mifepristone; Misoprostol; Nausea; Pain; Patient Acceptance of Health Care; Patient Satisfaction; Pregnancy; Uterine Hemorrhage; Vagina; Vomiting

Although a number of studies have shown misoprostol's promise as a nonsurgical treatment for incomplete abortion, few have systematically examined treatment protocols. This study documents the effectiveness of 600 versus 1,200 microg oral misoprostol for this indication.. From May 2002 to January 2003, 300 women with incomplete abortion were recruited at a large tertiary facility in Vietnam and randomized to either a single-dose (600 microg) or a repeated-dose (600 microg x 2) regimen of oral misoprostol for the treatment of their condition.. Misoprostol effectively evacuated the uterus for nearly all women (94.6%; n=279), with most reporting bleeding for 4 days (+/-2.3) and pain/cramps lasting 1 day (+/-1.0). Women indicated that the side effects were tolerable (96%) and that their experience was satisfactory (95%).. Oral misoprostol (600 or 1,200 microg) offers a safe, effective and acceptable treatment for incomplete abortion. Larger studies to assess the advantages and disadvantages of misoprostol as compared with standard surgical care are needed to assess its role in postabortion care programs worldwide.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Adolescent; Adult; Female; Humans; Middle Aged; Misoprostol; Pain; Patient Satisfaction; Pregnancy; Uterine Hemorrhage; Vietnam

Dilatation and curettage (D&C) has been the usual treatment for early pregnancy failure (EPF). Medical management with misoprostol may be an effective alternative. Bleeding patterns during and after medical management of EPF are unknown.. A prospective cohort study was conducted at University-based clinics and physician offices. Eighty women <11 weeks estimated gestational age with a diagnosis of missed abortion or fetal demise were enrolled. Treatment consisted of either 800 micro g of moistened (2 ml of saline) or dry vaginal misoprostol. Self-reported bleeding and sanitary product usage were recorded in a daily 2 week diary. Haemoglobin was assessed at enrollment and 2 weeks later.. After misoprostol treatment, patients reported bleeding or spotting every day for the 14 days observed. Self-assessed heavy bleeding days were few (median 3) and usually occurred immediately after treatment. Sanitary pad use was highly variable (mean 30.5, range 2-125 pads over the 2 week period) and not related to changes in haemoglobin. The mean decrease in haemoglobin was 0.5 g/dl (SD 1.2). Complete expulsion without D&C occurred in 85% of subjects.. Bleeding for at least 2 weeks after vaginal misoprostol for EPF is common. Heavy bleeding is usually limited to a few days after treatment. Clinically important changes in haemoglobin are rare.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Administration, Intravaginal; Adult; Female; Hemoglobins; Humans; Medical Records; Misoprostol; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Time Factors; Uterine Hemorrhage

To assess if there was any potential relationship between endometrial thickness and final treatment outcome in women successfully treated with misoprostol for a first trimester anembryonic gestation, embryonic demise or fetal demise.. Eighty women were treated with up to two doses of misoprostol 800 microg vaginally for early pregnancy failure. Subjects were scheduled to return 2 (range 1-4), 7 (range 5-9) and 14 (range 12-17) days after treatment. Transvaginal ultrasonography was performed at each follow-up visit.. The median endometrial thickness at each of the follow-up visits for women who had expelled the gestational sac was 14 mm, 10 mm, and 7 mm, respectively. The endometrial thickness at the first follow-up visit exceeded 15 mm in 20 subjects (36%) and 30 mm in four subjects (7%). Only three women had a suction aspiration for bleeding after documented expulsion. The endometrial thickness for these women was 11, 13, and 14 mm at the first follow-up visit.. There is no obvious relationship between increasing endometrial thickness and the need for surgical intervention in women treated with misoprostol for early pregnancy failure.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Induced; Abortion, Spontaneous; Administration, Intravaginal; Endometrium; Female; Follow-Up Studies; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Treatment Outcome; Ultrasonography; Uterine Hemorrhage

The objective of the study was to evaluate the efficacy and safety of 800 microg misoprostol every 12 h, up to three doses, for pharmacological second-trimester abortion. The misoprostol doses were always administered by doctors into the vagina. Two-hundred and sixty-nine women with gestations within 12 and 20 weeks were recruited into the study. The main outcomes measured were successful abortion (passage of fetus and placenta without surgery), side effects and mean drop in hemoglobin, vaginal bleeding and mean time of return of menstruation. Complete abortion occurred in 245/269 (91.1%, 95% confidence interval 87-94%) patients. Vaginal bleeding lasted 15.7 +/- 4.1 days. The mean drop in hemoglobin, calculated 24 h after abortion, were statistically significant (p = 0.0001), as also was the mean hemoglobin measured 14 days after abortion, but without clinical relevance. According to the results obtained, 800 microg of misoprostol administered every 12 h, up to a maximum of three doses, could be a valid method for abortion within 12 and 20 weeks of gestation.

Topics: Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Contraceptive Agents, Female; Drug Administration Schedule; Erythrocyte Transfusion; Female; Hemoglobins; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Treatment Outcome; Uterine Hemorrhage

This randomized trial compares the efficacy and side effects of sublingual and vaginal misoprostol for cervical priming before first-trimester pregnancy termination. One-hundred pregnant women between 6 and 12 weeks of gestation opting for termination of pregnancy by suction evacuation were included in this study. The women were randomly allocated into two groups. Group 1 received 400 microg of sublingual misoprostol and group 2 received 400 microg of vaginal misoprostol 2 h prior to suction evacuation. The abortion was carried out by suction evacuation using a Karman's cannula attached to an electrically operated suction machine under intravenous analgesia. Baseline cervical dilatation, duration of the procedure, operative blood loss, side effects and complications were noted in both groups. There was a significant difference between the sublingual and vaginal misoprostol groups with respect to mean cervical dilatation (8.6 mm vs. 6.8 mm, p < 0.05). However, the duration of the procedure (3.03 min vs. 3.16 min) and the amount of blood loss (29 mL vs. 31.2 mL) were not significantly different between the two groups. The women in the sublingual group experienced significantly more shivering and preoperative vaginal bleeding (68% vs. 56%, p < 0.05). None of the women in the two groups had either uterine perforation or excessive hemorrhage. In our study, sublingual misoprostol (400 microg) was significantly more effective in facilitating cervical dilation prior to surgical abortion than vaginal misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Administration, Sublingual; Adult; Female; Gastrointestinal Diseases; Gestational Age; Humans; Labor Stage, First; Misoprostol; Pregnancy; Suction; Surveys and Questionnaires; Uterine Hemorrhage

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Dilatation and Curettage; Dinoprostone; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Length of Stay; Misoprostol; Oxytocics; Patient Satisfaction; Pregnancy; Prospective Studies; Tablets; Uterine Hemorrhage

To compare rectal misoprostol with oxytocin for routine management of the third stage of labour.. A total of 240 parturient women were randomized, at three University of Toronto teaching hospitals, to receive either rectal misoprostol (400 microg) after delivery of the infant or parenteral oxytocin (5 units i.v. or 10 units i.m.) with the delivery of the anterior shoulder, when possible, or 5 units i.v. or i.m after the delivery of the placenta. The primary outcome measure was change in hemoglobin (Delta[Hgb]) from admission in early labour to day one postpartum.. The labour ward of three University of Toronto teaching hospitals: St. Michael's, Toronto General, and Mount Sinai.. Labouring women either nulliparous or multiparous with no known risk for excessive third stage blood loss; vertex presentation; no previous Caesarean delivery; induced, spontaneous, or augmented labour.. No difference in Delta[Hgb] was observed between the two groups; the Delta[Hgb] in the oxytocin and misoprostol groups were 1.43 g/L (95% confidence interval [CI], 1.2-1.6 g/L) and 1.59 g/L (95% CI, 1.4-1.8 g/L) respectively (p = 0.35). Secondary outcome measures (excessive third stage bleeding, duration of third stage of labour, need for manual removal of the placenta or the need for additional oxytocics) did not differ between the two groups.. Rectal misoprostol is of equivalent efficacy to parenteral oxytocin for the prevention of primary postpartum hemorrhage. Rectal misoprostol is an appropriate uterotonic agent for routine management of the third stage of labour.

Topics: Administration, Rectal; Female; Hematocrit; Hemoglobins; Humans; Infusions, Intravenous; Injections, Intravenous; Labor Stage, Third; Misoprostol; Obstetric Labor Complications; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Risk Factors; Treatment Outcome; Uterine Hemorrhage

Prolonged vaginal bleeding is a common complaint after medical abortion. The effect of a 1 week course of daily oral misoprostol after medical abortion with mifepristone and misoprostol on the amount of post-abortal blood loss was studied.. A total of 150 women (gestation

Topics: Abortifacient Agents, Steroidal; Adult; Diarrhea; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Treatment Failure; Uterine Hemorrhage

This prospective, open-label, randomized trial of healthy adult women up to 9 weeks pregnant compared mifepristone 200 mg followed 2 days later with misoprostol 400 microg orally versus misoprostol 800 microg vaginally. The study was interrupted after the oral misoprostol group experienced a higher than expected failure rate. This treatment was discontinued and another substituted consisting of oral misoprostol 800 microg divided into two doses two hours apart. Women returned for a follow-up visit from Day 4 to 8. All women with a continuing pregnancy received a repeat dose of misoprostol vaginally and returned before Day 15. The primary outcome measure was a complete medical abortion without surgical intervention at the first visit. Of the 1045 women enrolled, 1011 had complete data: Group 1 (220) used oral misoprostol 400 microg, Group 2 (269) used oral misoprostol 800 microg, and Group 3 (522) used vaginal misoprostol 800 microg. At first follow-up visit, the primary outcome, that is, a complete abortion, was 84% for Group 1, 92% for Group 2, and 96% for Group 3, p < 0.001. After a second dose of vaginal misoprostol in women with on-going pregnancies at their first follow-up visit, the complete abortion rates were 91%, 95%, and 98%, respectively, p < 0.001. There were minimal differences in side effects, onset of bleeding and overall acceptability in the three groups. Mifepristone 200 mg followed by vaginal misoprostol 2 days later was more effective at inducing an abortion up to 9 weeks of pregnancy than the same dose of mifepristone followed by oral misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adult; Female; Gestational Age; Humans; Mifepristone; Misoprostol; Pain; Pregnancy; Treatment Outcome; Uterine Hemorrhage

A prospective randomized placebo controlled trial was performed to assess the immediate use of oral contraceptive (OC) on the amount of blood loss in the post-abortion period in women undergoing medical abortion by mifepristone and misoprostol.. One hundred women were randomized by computer to receive either OC pills or placebo, immediately after medical abortion.. There was no difference in the complete abortion rate between the two groups. The complete abortion rate was 98 and 92% in the OC and placebo groups respectively. The side-effects and duration of bleeding were also similar. The median days of vaginal bleeding were 17 (range: 3-41) and 15 (range: 5-48) in the OC and placebo groups respectively. There was a statistically significant decrease in the mean haemoglobin level on day 15 in the OC group (from 12.0 to 11.5 g/dl) whereas the mean haemoglobin level in the placebo group remained stable. The median measured blood loss was 69.9 ml in the OC group and 72.8 ml in the placebo group and there was no statistically significant difference between the two groups.. We conclude that it is safe to offer women combined OC pills immediately after medical abortion as an option of contraception, as it does not affect the duration or amount of vaginal bleeding or the complete abortion rate.

Topics: Abortifacient Agents; Abortion, Induced; Adult; Contraceptives, Oral; Female; Hemoglobins; Humans; Mifepristone; Misoprostol; Placebos; Pregnancy; Uterine Hemorrhage

To estimate the efficacy of vaginal misoprostol for medical management of missed abortion.. Fifty women with missed abortion were randomized to treatment with up to two 800 microg [DOSAGE ERROR CORRECTED] doses of misoprostol vaginally or a placebo. Participants were reviewed daily for 2 days, then again at 1 week. A blood sample for hemoglobin and serum beta-human chorionic gonadotropin (beta hCG) was obtained on day 1 and the hemoglobin level checked again on day 7. Complete abortion was defined as expulsion of the products of conception without dilation and curettage (D&C) and a negative follow-up urine beta hCG test after 4 weeks, or as no products of conception obtained at D&C in cases of suspected incomplete abortion.. The rate of complete abortion was 80% (20 of 25) in the misoprostol group and 16% (four of 25) in the placebo group, relative risk 0.20 (0.08, 0.50), P <.001. The rate of D&C was 28% (seven of 25) in the misoprostol group and 84% (21 of 25) in the placebo group, relative risk 0.33 (0.17, 0.64), P <.001. One participant in the misoprostol group had an emergency D&C for heavy bleeding. No participants required blood transfusion. The mean reduction in hemoglobin from day 1 to day 7 was 3.2 g/L in the misoprostol group versus 4.3 g/L in the placebo group, P = .72. Patient satisfaction with misoprostol treatment was high with 19 of 21 participants reporting they would try medical management again if they experienced another missed abortion.. Medical management of missed abortion is effective, reduces the need for D&C, and is associated with high levels of patient satisfaction.

Topics: Abortion, Missed; Administration, Intravaginal; Adult; Blood Transfusion; Chorionic Gonadotropin, beta Subunit, Human; Dilatation and Curettage; Female; Gestational Age; Hemoglobins; Humans; Misoprostol; Patient Satisfaction; Pregnancy; Ultrasonography; Uterine Hemorrhage

The objective of this study was to evaluate the safety and efficacy of 1000 microg misoprostol vaginally (Cytotec) self-administered into the vagina for medical abortion. Three-hundred women with gestations between 42 and 63 days, with previous written consent, received vaginal misoprostol every 24 h up to a maximum of three doses for abortion. Outcome measures assessed included: successful abortion (complete abortion without surgery), side effects, decrease in hemoglobin, mean time of vaginal bleeding, mean expulsion time and mean time of returning of menses. Complete abortion occurred in 279/300 (93.0%, 95% CI 90, 96) patients. Medication to relieve symptoms was administered to all subjects after every misoprostol dose. Vaginal bleeding lasted 14.7 +/- 5.4 days. Mean expulsion time was 8.1 +/- 3.0 h for those who aborted after the first misoprostol dose. The mean drop in hemoglobin was statistically significant (p = 0.0001) but without clinical relevance. The frequencies of nausea and diarrhea were high. According to the observed outcomes, 1000-microg misoprostol vaginally could be a valid method to terminate pregnancies up to nine weeks gestation.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Diarrhea; Female; Gestational Age; Hemoglobins; Humans; Menstruation; Misoprostol; Nausea; Pregnancy; Self Administration; Time Factors; Uterine Hemorrhage

Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination. This is the first randomized study to compare vaginal misoprostol versus expectant treatment in women presenting with spontaneous miscarriage.. Sixty women presenting with spontaneous miscarriage were recruited to the study at the Queen Mary Hospital between 1998 and 1999. They were randomized to group 1: misoprostol; and group 2: expectant management. Women in the misoprostol group received vaginal misoprostol 400 microg on days 1, 3 and 5. The expectant group was followed up according to the same schedule. Suction evacuation was performed if there was excessive bleeding or abdominal pain; or if a gestational sac was detected by transvaginal scan on day 15.. Fifty-nine women completed the trial. Those who did not require suction evacuation up to the time of return of normal menstruation were considered to be successful. The incidence of side-effects was comparable between the two groups. Three women in the expectant group and one in the misoprostol group underwent emergency suction evacuation because of excessive bleeding. The mean duration of vaginal bleeding was similar for both groups (14.6 days in the misoprostol group versus 15.0 days in the expectant group). The successful rate in the misoprostol group was significantly higher than that of the expectant group (83.3 versus 48.3%, P < 0.05).. We recommend repeated vaginal misoprostol 400 microg given on days 1, 3 and 5 as a treatment option for women with first trimester spontaneous miscarriage.

Topics: Abortion, Spontaneous; Administration, Intravaginal; Adult; Emergency Treatment; Female; Humans; Misoprostol; Oxytocics; Pregnancy; Pregnancy Trimester, First; Treatment Outcome; Uterine Hemorrhage; Vacuum Extraction, Obstetrical

The objective of this trial was to investigate whether 500 microg oral misoprostol given immediately after delivery of the neonate at Caesarean section is as effective as a bolus intravenous injection of 10 iu Syntocinon in stimulating uterine contractions and thereby reducing blood loss. Forty women undergoing elective or emergency Caesarean section were included in a placebo-controlled randomised trial. Group 1 received oral misoprostol and a placebo intravenous bolus and Group 2 received intravenous Syntocinon and oral placebo tablets. The main outcome measures were estimated blood loss at Caesarean section, drop in serum haemoglobin, and the need for additional uterotonic agents. We found that there was no significant difference (p = 0.75) in estimated blood loss between the two groups. No differences were observed in the decrease in haemoglobin, requirement for additional oxytocics, the need for blood transfusion or the degree of shivering in each group (p > 0.05 in each case). We concluded that oral misoprostol could be used as an alternative oxytocic agent for the third stage at Caesarean section. However, there is an obvious need for a larger randomised controlled trial to be undertaken. Previous published studies have concentrated on vaginal births and further studies should be extended to Caesarean deliveries.

Topics: Administration, Oral; Adult; Cesarean Section; Female; Humans; Injections, Intravenous; Labor Stage, Third; Misoprostol; Oxytocics; Oxytocin; Pilot Projects; Postoperative Hemorrhage; Pregnancy; Treatment Outcome; Uterine Hemorrhage

To prospectively determine patterns and predictors of bleeding after early abortion with mifepristone and misoprostol or manual vacuum aspiration (MVA).. Women fewer than 63 days from the last menstrual period and desiring termination of pregnancy were offered medical abortion with 200 mg oral mifepristone and 800 micrograms oral misoprostol or MVA under local anesthesia. Women completed a bleeding diary during the six weeks after abortion. Telephone calls were used to encourage diary completion and determine contraception use.. 212 women were enrolled, 80% of whom completed diaries. Mean days of bleeding was higher in the medical (14 days) than MVA (9 days) group, but days of spotting (about 10) was similar in both groups. Increasing gestational age predicted more bleeding or spotting days after medical, but not MVA, abortion. Prolonged bleeding was not rare and was more common in the medical than the surgical abortion group. Combined oral contraceptive (COC) users and non-COC users had similar bleeding patterns after medical or surgical abortion.. Bleeding after early medical abortion persists longer than after MVA and continues longer than previously appreciated regardless of method. Oral contraceptive use does not decrease bleeding after early medical or surgical abortion.

Topics: Abortion, Induced; Adult; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Uterine Hemorrhage; Vacuum Curettage; Vacuum Extraction, Obstetrical

Previous studies of medical abortion with mifepristone and a prostaglandin have reported percentages of subjects who experience cramping and/or bleeding relative to prostaglandin use. This is the first analysis of cramping and bleeding onset patterns in subjects treated with low-dose (200 mg) mifepristone and 800 microg vaginal misoprostol at 24, 48, or 72 h after mifepristone. We analyzed the cramping and bleeding onset patterns in subjects up to 8 weeks pregnant who used 800 microg vaginal misoprostol at 24, 48, or 72 h after 200 mg of oral mifepristone. We collected data from subjects' symptom diaries and divided symptom onset into 3 categories: before misoprostol use, 0--12 h following misoprostol, and more than 12 h after misoprostol. Of the 2,302 subjects, cramping and bleeding onset data were available for 2,030 (88%) and 2,123 (92%), respectively. Across all groups, 230 (11%) experienced cramping and 445 (21%) experienced bleeding before misoprostol use. There was a significantly higher percentage of subjects who experienced early cramping and/or early bleeding between the three treatment groups, and this was related to the interval between mifepristone and misoprostol. In the 12 h following misoprostol administration, cramping and bleeding patterns were similar in the three groups. The longer subjects waited to insert misoprostol, the more likely they were to experience early cramping and/or bleeding. After misoprostol insertion, cramping and bleeding patterns are similar regardless of treatment group. Patients and providers cannot rely on symptom onset to predict treatment success.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Drug Administration Schedule; Dysmenorrhea; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Statistics, Nonparametric; Time Factors; Uterine Hemorrhage

To find out the optimal doses regimen of mifepristone with misoprostol for termination early pregnancy.. A randomized comparative study in 1,621 women requesting medical abortion at < or = 49 days from 9 hospitals was conducted in Hebei, women were randomly divided into 2 groups by 2:1 ratio. Study group (n = 1,118) women took mifepristone 50 mg immediately, then 25 mg b. i. d(total amount of 300 mg), plus misoprostol 600 micrograms at 8:00 in the morning on 3th day, and plus misoprostol 200 micrograms respectively at 8:00 in the morning on 4th, 5th, 6th day. In control group (n = 494), mifepristone 50 mg immediately, then, 25 mg b. i. d (total amount of 150 mg), plus misoprostol 600 micrograms at 8:00 in the morning on 3th day.. In study group and control group, the complete abortion rate was 98.39% and 88.06% respectively, bleeding duration was (8.2 +/- 2.8) days and (12.3 +/- 3.9) days. There was no difference of side effects between the two groups.. Mifepristone taken 300 mg plus misoprostol 1,200 micrograms orally for 6 days is an optimal dose regimen for termination of early pregnancy.

Topics: Abortion, Induced; Female; Humans; Menstruation; Mifepristone; Misoprostol; Time Factors; Uterine Hemorrhage

This was a randomized double-blind placebo-controlled trial to determine the effect of oral contraceptive (OC) pills taken immediately after medical abortion on the duration of bleeding and complete abortion rate. Two hundred women in the first 49 days of pregnancy were given 200 mg mifepristone orally followed by 400 microg misoprostol vaginally 48 h later. One day later, they were randomized to receive either OC pills (30 microg of ethinyl oestradiol and 0.15 mg of levonorgestrel per tablet) or placebo for 21 days. The complete abortion rates were 98% in the OC group and 99% in the placebo group. The median duration of bleeding was similar: 17 (range: 5-57) days in the OC group and 16 (range: 6-55) days in the placebo group. In the OC group there was a small but significant fall in the haemoglobin concentration by 14 days (5.3 g/dl) after administration of mifepristone. The incidence of side-effects was similar in the two groups. We conclude that the use of OC pills does not decrease the duration of bleeding after medical abortion nor does it affect the abortion rate.

Topics: Abortifacient Agents, Steroidal; Abortion, Induced; Abortion, Missed; Adult; Contraceptives, Oral; Double-Blind Method; Female; Hemoglobins; Humans; Mifepristone; Misoprostol; Placebos; Pregnancy; Time Factors; Uterine Hemorrhage

The objective of this study was to confirm the effectiveness and safety of self-administration of misoprostol every 24 h, for abortion up to 9 weeks of gestation. A group of 720 volunteer subjects with gestations from 35 to 63 days received 800 micrograms of vaginal misoprostol every 24 h up to a maximum of three main doses for abortion. Outcome measures assessed included successful abortion (complete abortion without requiring surgery), side effects, decrease in hemoglobin, mean time of vaginal bleeding, and mean time of return of menses. Complete abortion occurred in 644 of 720 (89.4%, 95% CI 87, 92) subjects. The mean decrease in hemoglobin was statistically significant (p = 0.0001). There were 14 subjects with clinically significant decreases in hemoglobin, but only two required transfusions. Vaginal bleeding lasted 6.7 +/- 3.9 days, spotting 8.1 +/- 4 days, and total bleeding 14 +/- 5.3 days. Mean expulsion time was 8.0 +/- 3.4 h. Although mifepristone remains unavailable, given the low price and availability of misoprostol in > 72 countries of the world, this latter drug constitutes an abortion alternative, provided that a minimum clinical network is nearby or accessible.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Female; Gestational Age; Humans; Kinetics; Middle Aged; Misoprostol; Pain; Pregnancy; Treatment Outcome; Uterine Hemorrhage

A study was undertaken to determine whether the combination of oral tamoxifen and moistened misoprostol administered vaginally was superior to that of placebo and moistened misoprostol administered vaginally for elective termination of early pregnancies.A clinical trial was conducted with a study group of 150 healthy women with pregnancies of

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Diarrhea; Double-Blind Method; Estrogen Antagonists; Female; Hemoglobins; Humans; Misoprostol; Patient Satisfaction; Pelvic Pain; Pregnancy; Prospective Studies; Tamoxifen; Ultrasonography, Prenatal; Uterine Hemorrhage; Vomiting

Mifepristone and a prostaglandin have been used successfully to terminate pregnancy in Europe and China. We report the results of a large U.S. study of mifepristone and misoprostol in women with pregnancies of up to nine weeks' duration.. We administered 600 mg of mifepristone and then 400 microg of misoprostol two days later to 2121 women seeking termination of their pregnancies at 17 centers. The women were observed for four hours after the administration of misoprostol and returned on day 15 for final assessment.. Two thousand fifteen women completed the final assessment. Among them, pregnancy was terminated in 762 of the 827 women pregnant for < or =49 days (92 percent), 563 of the 678 women pregnant for 50 to 56 days (83 percent), and 395 of the 510 women pregnant for 57 to 63 days (77 percent) (P<0.001). Termination occurred within 4 hours after the administration of misoprostol in 49 percent of the women and within 24 hours in 75 percent. Failures, defined as cases requiring surgical intervention for medical reasons or because the patient requested it, the abortion was incomplete, or the pregnancy was ongoing, increased with increasing duration of pregnancy. The largest increase was in failures representing ongoing pregnancy, which increased from 1 percent in the < or =49-days group to 9 percent in the 57-to-63-days group (P<0.001). Abdominal pain, nausea, vomiting, diarrhea, and vaginal bleeding also increased with advancing gestational age. Two percent of the women in the < or =49-days group, as compared with 4 percent in each of the other two groups, were hospitalized, underwent surgical interventions, and received intravenous fluids (P=0.008).. This mifepristone-misoprostol regimen is effective in terminating pregnancies, especially in women with pregnancies of 49 days' duration or less.. The availability of medical abortion in the US and elsewhere could lead to greater access to safer abortion services. This study assessed the capability of mifepristone (600 mg) and misoprostol (400 mcg 2 days later) to terminate pregnancies of up to 63 days' duration. Enrolled were 2121 US women recruited from 17 Planned Parenthood, university hospital, and free-standing abortion clinics. Among the 2015 women who returned for the follow-up visit at day 15, the rates of pregnancy termination were 92% in women with pregnancies of durations of 49 days or under, 83% in the 50-56 days group, and 77% in the 57-63 days group (p 0.001). Abortion occurred within 4 hours of misoprostol administration in 49% of women and within 24 hours in 75%. Termination rates were higher for women with no previous induced abortions. Side effects such as abdominal pain, nausea, vomiting, diarrhea, and vaginal bleeding were frequent and increased with gestational age. 2% of women with pregnancies of 49 days' gestation or less, compared with 4% in both the 50-56 days and 57-63 days groups, were hospitalized, underwent surgical intervention, and received intravenous fluids. The success rate in this study was lower than that reported by other researchers. This may be related, in part, to the lack of experience with medical abortion in the US.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Drug Therapy, Combination; Female; Gestational Age; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Receptors, Progesterone; Treatment Failure; United States; Uterine Hemorrhage

To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre-operative cervical dilatation.. Prospective double-blind randomised study.. Fertility Control Centre, National University Hospital, Singapore.. Women were randomly allocated to either the 200 microg or the 400 microg misoprostol group. Vacuum aspiration was performed at either three or four hours after the insertion of misoprostol tablets. Using Hegar's dilatator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if it was < Hegar 8), pre-operative and intra-operative blood loss, and associated side effects.. For the 200 microg misoprostol group, only seven (23.3%) achieved a dilatation of > or = 8 mm compared with 29 women (96.7%) in the 400 microg misoprostol group. The odds ratio was 95.3 (95% CI 10.9-830.9) for 400 microg misoprostol for successful pre-operative cervical dilatation of > or = 8 mm. The mean cervical dilatation for 400 microg and 200 microg misoprostol was 8.2 mm and 6.4 mm, respectively (P < 0.001). The use of 400 microg misoprostol with an evacuation interval of three hours appears to be the optimal dosage and evacuation time interval. Increasing the time interval beyond three hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increase in side effects such as vaginal bleeding, lower abdominal pain and the appearance of products of conception at the cervical os. However, besides vaginal bleeding, no significant differences in the frequency of these side effects were demonstrated.. This first report on the comparison of differing dosages and time intervals to determine the optimal dosage treatment schedule shows that the vaginal application of 400 microg misoprostol for at least three hours is optimal for pre-operative cervical dilatation before vacuum aspiration in first trimester nulliparae.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Labor Stage, First; Misoprostol; Parity; Pregnancy; Pregnancy Trimester, First; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Hemorrhage; Vacuum Extraction, Obstetrical

We compared bleeding patterns following early mifepristone-misoprostol abortion with those following early surgical abortions ( < or = 56 days gestation LMP). We analyzed women's reports of their bleeding and clinical measures of blood loss, and modeled the relationships between different bleeding measures and indicators of success and satisfaction.. Using data from a multicenter trial held in China, Cuba and India, we fit bivariate and multivariate models to analyze bleeding patterns, controlling for a range of demographic, experiential and medical factors (n = 1373).. Medical abortion patients perceived their bleeding to be heavier than did the surgical patients; however, there were few statistically significant differences in clinical measures of blood loss between the two groups, and blood loss rarely represented a medical problem. Nationality, far more than actual levels of bleeding, influenced women's impressions about blood loss. Although medical abortion patients saw their bleeding as heavier than did the surgical patients, their perceptions of heavier bleeding did not prevent them from having higher satisfaction levels. One exception was that if bleeding exceeded prior expectations, women with the medical method were more likely to be dissatisfied. Pain and cramps, which often accompanied bleeding, were an independently significant factor in predicting satisfaction with the method.. In order for women to know what to expect with medical abortion, they must be informed beforehand about the level of bleeding that generally accompanies the procedure vs. excessive bleeding that would signal a clinical problem.

Topics: Abortifacient Agents; Abortion, Therapeutic; Adult; Blood Loss, Surgical; Cuba; Feasibility Studies; Female; Humans; India; Logistic Models; Mifepristone; Misoprostol; Patient Satisfaction; Pregnancy; Software; Uterine Hemorrhage

To verify the efficacy and safety of misoprostol for abortion at < or = 63 days' gestation.. A total of 175 women seeking elective abortion at < or = 63 days' gestation received 800 micrograms of misoprostol vaginally. This dose was repeated at 48 and 96 h if abortion did not occur. Afterwards, up to three additional 600- or 400-micrograms doses of misoprostol were administered if the uterus was not empty, as judged by ultrasound. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), side-effects and vaginal bleeding.. Complete abortion occurred in 161/175 (92.0%; 95% CI 87-96%) subjects and 14/175 (8.0%; 95% CI 4-13%) cases failed. The immediate success rate was 77.7% with the first dose, 13.7% with the second dose and 0.6% with the third dose. The decrease in hemoglobin was statistically significant (p = 0.009) but without clinical relevance; before treatment: 11.94 mg/dl (SD 1.60) and after treatment: 11.64 mg/dl (SD 1.08). No significant differences were obtained between success rates and failures in relation to age, gravidity, parity, previous abortions, race, gestational age and side-effects. The third main dose of misoprostol showed very little efficacy. Vaginal bleeding lasted 5.5 +/- 2.8 days, spotting 5.7 +/- 3.1 days and total bleeding 11.2 +/- 3.0 days.. The success percentage attained shows that 800 micrograms of misoprostol administered vaginally effectively causes abortion at < or = 63 days' gestation.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Female; Gestational Age; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Self Administration; Time Factors; Ultrasonography; Uterine Hemorrhage; Uterus

To compare the effectiveness of oral misoprostol and mifepristone for cervical priming before first trimester termination of nulliparous pregnancy.. Prospective double blind randomised study.. Department of Obstetrics and Gynaecology, University of Hong Kong.. One hundred nulliparous women undergoing termination of pregnancy between 8 and 12 weeks of gestation were recruited for this prospective randomised trial. The women were allocated to either the oral misoprostol or mifepristone group. Subjects in misoprostol group were given placebo and misoprostol 400 micrograms 36 h and 12 h respectively before vacuum aspiration. Subjects in mifepristone group were given 200 mg mifepristone and placebo 36 h and 12 h respectively prior to operation.. Baseline pre-operative cervical dilatation, the incidence of side-effects, the amount of blood loss and duration of procedure.. There were no significant differences in the baseline cervical dilatation, incidence of side-effects, amount of blood loss and duration of procedure.. Misoprostol and mifepristone are of similar effectiveness for cervical priming prior to vacuum aspiration in nulliparous women. Misoprostol has additional advantages of being widely available and inexpensive.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Oral; Adult; Double-Blind Method; Female; Humans; Mifepristone; Misoprostol; Parity; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Tablets; Uterine Hemorrhage; Vacuum Extraction, Obstetrical

The efficacy and tolerability of mifepristone in combination with misoprostol for termination of early pregnancy (up to 49 days of amenorrhea) are established. We studied the efficacy and tolerability of this combination therapy for termination of pregnancy in women up to 63 days of amenorrhea. We also examined the effect of an additional dose of misoprostol in cases of nonexpulsion within 3 hours after the first dose. The multicenter trial included 1,108 women, mean age 27.9 +/- 6.2 years. The mean duration of pregnancy was 51.7 +/- 9.2 days. On day 1, the women received an oral dose of mifepristone, 600 mg. On day 3, they received an oral dose of misoprostol, 400 micrograms, and were monitored for up to 3 hours. If they did not expel the conceptus within 3 hours, an additional dose of 200 micrograms of misoprostol was given and they were monitored for 2 more hours. From days 10 to 18, the women were followed up with clinical examination, human chorionic gonadotropin measurement, or ultrasound examination. Overall, the procedure was successful in 92.9% of women. Efficacy decreased with the duration of pregnancy, especially after 56 days of amenorrhea. Up to 42 days of amenorrhea, the success rate was 97.6%; between days 42 and 49, 94.8%; between days 50 and 56, 93.4%; between days 57 and 63, 86.8%; and after day 63, 83.3%. The most common side effects were moderate uterine cramps (80.5%) and gastrointestinal (GI) symptoms (34.9%), especially vomiting (18.3%) and diarrhea (10.5%). GI symptoms were generally mild. A second dose of misoprostol was given to 61.6% of the women. In a subgroup analysis, we assessed the efficacy of 600 mg of mifepristone plus 400 or 600 micrograms of misoprostol (one or two doses) in women with up to 49 days of amenorrhea and compared it with the efficacy in women who received mifepristone plus only 400 micrograms (one dose) of misoprostol in a previous study. The overall rate of success (termination of pregnancy) was 95.5% in the current study compared with 95.4% in the previous study. The additional dose of misoprostol did not significantly increase the overall rate of success, but did increase the rate of termination within the monitoring period (69.7% versus 64.9% (and within 72 hours after administration of mifepristone (92.7% versus 90.4%). We have confirmed that the combination of mifepristone and misoprostol was effective, safe, and well tolerated for termination of pregnancies at 49 or fewer days of amenorrhea. The effi

Topics: Abortifacient Agents; Adolescent; Adult; Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; France; Hemostatic Techniques; Humans; Incidence; Menstruation-Inducing Agents; Mifepristone; Misoprostol; Pregnancy; Pregnancy, Ectopic; Time Factors; Ultrasonography; Uterine Hemorrhage; Uterus

A multicentre randomized open clinical trial was conducted to compare the efficacy and side effects of two regimens of mifepristone with misoprostol, and mifepristone with PG05 for termination of early pregnancy (amenorrhoea < = 49 days). Six-hundred women in early pregnancy, who requested medical abortion were randomly allocated into 3 groups. In group 1 (n = 301), an initial dose of mifepristone 50 mg was given, followed by 25 mg every 12 hours up to a total dose of 150 mg mifepristone, plus a single oral dose of misoprostol 600 micrograms in the morning of the third day. In group 2 (n = 150), the same regimen of mifepristone was given, but dl-15-methyl PGF2 alpha (PG05) 1 mg vaginal suppository was inserted on the third day. In group 3 (n = 149), a single dose of mifepristone 200 mg was given and misoprostol 600 micrograms was used as in group 1. The complete abortion rate were 94.4%, 97.3%, and 94.6% for group 1, 2 and 3, respectively. 3.0, 2.0 and 2.7% of women had incomplete abortion, and 1.7, 0.7 and 2.0% of women in the 3 groups were treatment failures; in the remaining 1% in group 1 and 0.7% in group 3, treatment outcome could not be determined. There were no significant differences among the 3 groups. Lower abdominal pain was the main complaint which was reported by 82% of the subjects after PGs administration. The incidence of diarrhoea in PG05 group (38.7%) was significantly higher than that in the other two groups (21.6 and 20.1%) (P < 0.001), and so was vomiting. It was concluded that misoprostol, as an orally effective prostaglandin, in combination with mifepristone for induced abortion of early pregnancy was as effective as PG05 vaginal suppository. Besides, it has advantages of convenience of use, less side effects, easy storage and transfer, and low cost.

Topics: Abdominal Pain; Abortion, Induced; Administration, Oral; Adolescent; Adult; China; Diarrhea; Dinoprost; Dose-Response Relationship, Drug; Female; Humans; Mifepristone; Misoprostol; Pessaries; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage

RU486 (mifepristone) followed by a prostaglandin (PG) analogue has been marketed in France since April 1990 as a medical alternative to surgery for early pregnancy termination. By law, the drug is used only in the centres approved for voluntary pregnancy termination, and its distribution is strictly controlled. Before being marketed, it was distributed to more than 20,000 women, as part of a training programme for the prescribers. Analysis confirmed an efficacy rate of 95.3%. Failures included incomplete ovular expulsion (2.8%), premature vacuum aspiration (0.7%) and ongoing pregnancy (1.2%). Pelvic pain and malaise were reported as side-effects in 1.6 and 1.2% of the cases respectively. Infectious complications were reported in 0.2% of the cases. Three severe adverse events (one of which was fatal) occurred, including myocardial infarction and ventricular arhythmia, in the hours following PG administration and justify a careful medical monitoring in the centre 3-4 h after administration of PG. For this reason, a trial was undertaken to evaluate the efficacy of an oral form of a PGE1 analogue (misoprostol). When RU486 was followed 36-48 h later by 400 micrograms of misoprostol, the efficacy rate was 96.9%, indicating an efficacy equivalent to that obtained with the other PG analogues. The distribution procedures were adequately followed by the prescribers and by the patients. In summary, RU486 constitutes a safe and efficient medical means of pregnancy termination, provided that the manufacturer's recommendations are properly followed.

Topics: Abdominal Pain; Abortion, Induced; Adult; Alprostadil; Contraindications; Dinoprostone; Female; France; Humans; Hypotension; Mifepristone; Misoprostol; Myocardial Infarction; Pilot Projects; Pregnancy; Uterine Hemorrhage

To compare the reproductive outcome after early miscarriage between women managed expectantly and those treated with vaginal misoprostol.. This study was a planned secondary analysis of data collected prospectively in a randomized controlled trial comparing expectant management with vaginal misoprostol treatment (single dose of 800 µg) in women with early embryonic or anembryonic miscarriage and vaginal bleeding. The outcome measures were the number of women with a clinical pregnancy conceived within 14 months after complete miscarriage and the outcome of these pregnancies in terms of live birth, miscarriage, ectopic pregnancy and legal termination of pregnancy. The participants replied to a questionnaire sent by post covering their reproductive history ≤ 14 months after the index miscarriage was complete. Supplementary information and data for women who did not return their questionnaire were retrieved from medical records.. Of 94 women randomized to misoprostol treatment and 95 allocated to expectant management, 94 and 90 women, respectively, were included for analysis. Information on reproductive outcome was available for 89/94 (95%) and 83/90 (92%) women, respectively. Complete miscarriage without surgical evacuation was achieved within 31 days in 85% (76/89) of the women in the misoprostol group and in 65% (54/83) of those managed expectantly. The proportion of women treated with surgical evacuation was 33% (27/83) in the expectant-management group vs 12% (11/89) in the misoprostol group. At 14 months after the index miscarriage was complete, 75% (67/89) of women treated with misoprostol and 75% (62/83) of those managed expectantly had achieved at least one clinical pregnancy, while 40% (36/89) and 35% (29/83), respectively, had had at least one live birth (mean difference, 5.5% (95% CI, -9.7 to 20.3%)). When considering the outcome of all pregnancies conceived within 14 months after the index miscarriage was complete, 63% (56/89) of women in the misoprostol group and 55% (46/83) of those in the expectant-management group delivered a live baby after a pregnancy (mean difference, 7.5% (95% CI, -7.9 to 22.4%)).. Women with early miscarriage can be reassured that fertility is similar after misoprostol treatment and expectant management. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Administration, Intravaginal; Adult; Birth Intervals; Female; Humans; Misoprostol; Pregnancy; Prospective Studies; Randomized Controlled Trials as Topic; Reproduction; Reproductive History; Treatment Outcome; Uterine Hemorrhage; Watchful Waiting

To improve counseling of women by reporting bleeding characteristics at home after medical management of an early pregnancy loss (EPL) with mifepristone and misoprostol, and to evaluate occurring bleeding patterns as a prognostic tool.. This prospective two-center observational cohort study enrolled 197 women who presented with an EPL (embryonic or anembryonic miscarriage) from December 2017 to April 2019 and chose a home-based medical management with 200 mg mifepristone and 800 mcg misoprostol. From the day of mifepristone intake, the strength of vaginal bleeding was recorded daily for 2 weeks by the patient herself using a diary sheet. Treatment success was defined as no histologically confirmed retained products of conception (RPOC) within 3 months. After considering all drop-out criteria, 154 women were included in the analysis.. 40.0% of patients (95% CI 30.4-49.6) already reported bleeding onset in the time period between the intake of mifepristone and misoprostol. The median duration of vaginal bleeding including spotting was 13 days. The chance of RPOC was about sixfold (OR 6.06, 95% CI 2.15-17.10) in the group of persistent bleeding after 2 weeks compared to the group with a terminated bleeding at that time. Exploratory regression analysis indicated association of higher serum levels of leukocytes at treatment start with RPOC (p = 0.013).. Terminated bleeding after 2 weeks is a useful indicator for successful medical induction of EPL. Women undergoing medical treatment with mifepristone must be informed about the high frequency of bleeding onset before misoprostol intake.. DRKS-German Clinical Trials Register, ID: DRKS00013515, registration date 05.12.2017. http://www.drks.de/DRKS00013515 .

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Prognosis; Prospective Studies; Uterine Hemorrhage

 To evaluate the use of misoprostol prior to hysteroscopy procedures regarding technical ease, the presence of side effects, and the occurrence of complications..  This is a retrospective, observational, analytical, case-control study, with the review of medical records of 266 patients followed-up at the Gynecological Videoendoscopy Sector of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the Universidade de São Paulo (HCFMRP - USP, in the Portuguese acronym) from 2014 to 2019, comparing 133 patients who used the drug before the procedure with 133 patients who did not..  The occurrence of postmenopausal uterine bleeding was the main indication for hysteroscopy and revealed a statistical difference between groups (.  The use of misoprostol prior to hysteroscopy in our service indicated that the drug can facilitate the performance of the procedure, but not without side effects and presenting higher complication rates..  Avaliação do misoprostol prévio à histeroscopia quanto à facilidade técnica, efeitos colaterais e a ocorrência de complicações durante o procedimento. MéTODOS:  Estudo analítico observacional retrospectivo tipo caso controle com revisão de prontuários de 266 pacientes do Setor de Videoendoscopia Ginecológica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (HCFMRP – USP), de 2014 a 2019, sendo comparadas 133 pacientes que utilizaram o medicamento prévio ao procedimento com 133 pacientes que não o utilizaram..  Sangramento uterino após a menopausa foi a principal indicação de histeroscopia, apresentando diferença estatística (

Topics: Brazil; Case-Control Studies; Cervix Uteri; Female; Humans; Hysteroscopy; Misoprostol; Oxytocics; Pregnancy; Retrospective Studies; Uterine Hemorrhage

Clinopodium chinense, a traditional folk medicinal herb, has been used to treat abnormal uterine bleeding(AUB) for many years. Saponins and flavonoids are the main active components in C. chinense. To study the pharmacokine-tics of multiple components from the total extract of C. chinense(TEC), we established a sensitive and rapid method of ultra-perfor-mance liquid chromatography coupled with tandem mass spectrometry(UPLC-MS/MS) for simultaneous determination of five compounds in the plasma of AUB rats. After validation, the AUB model was established with SD female rats which got pregnant on the same day by gavage with mifepristone(12.4 mg·kg~(-1)) and misoprostol(130 μg·kg~(-1)). The established method was applied to the detection of hesperidin, naringenin, apigenin, saikosaponin a, and buddlejasaponin Ⅳb in AUB rats after the administration of TEC. The pharmacokinetic parameters were calculated by DAS 2.0. The five compounds showed good linear relationship within the detection range. The specificity, accuracy, precision, recovery, matrix effect, and stability of the method all matched the requirements of biolo-gical sample detection. The above 5 compounds were detected in the plasma of AUB rats after the administration of TEC. The C_(max) va-lues of hesperidin, naringenin, apigenin, saikosaponin a, and clinoposide A were 701.6, 429.5, 860.7, 75.1, and 304.1 ng·mL~(-1), respectively. All the compounds owned short half-life and quick elimination rate in vivo, and the large apparent volume of distribution indicated that they were widely distributed in tissues. Being rapid, accurate, and sensitive, this method is suitable for the pharmacokinetic study of extracts of Chinese herbal medicines and provides a reference for the study of pharmacodynamic material basis of C. chinense in treating AUB.

Topics: Administration, Oral; Animals; Apigenin; Chromatography, High Pressure Liquid; Chromatography, Liquid; Drugs, Chinese Herbal; Female; Flavonoids; Hesperidin; Lamiaceae; Mifepristone; Misoprostol; Oleanolic Acid; Plant Extracts; Rats; Saponins; Tandem Mass Spectrometry; Uterine Hemorrhage

To evaluate the approach to diagnosis and management of caesarean scar pregnancy (CSP) at a regional New Zealand hospital.. A retrospective case series of ten patients between June 2015 and May 2020. The data review included demographic information, ultrasound findings, human chorionic gonadotropin (HCG) levels, primary and subsequent treatment, outcomes and complications.. Nine women were diagnosed with CSP at a gestational age between four and ten weeks. One of these women was treated twice for two separate CSP within the study period. Treatment varied according to clinical presentation, HCG levels, gestational age, ultrasound findings and patient preference. Two thirds of women were successfully treated with primary management, with one third requiring multiple treatment modalities. We report one severe life-threatening haemorrhage and three cases resulting in hysterectomy. We also show a disproportionate number of Māori women presenting with CSP.. We present a series of ten cases of CSP and demonstrate similar challenges in regional New Zealand to those reported elsewhere. Management is heterogeneous with little guidance from the literature, and primary management was successful in seven out of ten cases. We report a disproportionately high number of cases in Māori women. Our results would support the development of a national register for caesarean scar pregnancy to improve diagnosis and management across New Zealand.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Adult; Cesarean Section; Cicatrix; Dilatation and Curettage; Female; Humans; Hysterectomy; Methotrexate; Misoprostol; Native Hawaiian or Other Pacific Islander; New Zealand; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Ultrasonography, Prenatal; Uterine Hemorrhage

To identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding.. This was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables-serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space-were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior-posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression.. Variables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment.. Complete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Spontaneous; Administration, Intravaginal; Adult; Chorionic Gonadotropin, beta Subunit, Human; Crown-Rump Length; Female; Gestational Age; Gestational Sac; Humans; Misoprostol; Oxytocics; Placenta; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Treatment Outcome; Uterine Hemorrhage; Watchful Waiting

Our aim of the study was to evaluate the efficacy and complication rate of our inpatient medical management protocol for missed miscarriages. Three-hundred and ninety women hospitalised at our tertiary centre because of a missed miscarriage/anembryonic pregnancy in 2012-2013 were included in this retrospective study. The women underwent either a low (until 9 + 0 weeks of gestation) or high gestational age (from 9 + 1 until 15 + 6 weeks of gestation) management protocol. The success rate, curettage in the first 48 hours after the procedure, the complication rate and the factors that might influence these outcomes were evaluated. The overall success rate was 83.3%. The curettage in the first 48 hours after the procedure was performed in 7.4% of the patients and was more often in the high gestational age protocol. Complications that required another outpatient visit or hospitalisation occurred in 9% of the patients. Higher beta-hCG values 14 days after the procedure and the absence of evacuation of products of conception during hospitalisation were associated with a higher complication rate. IMPACT STATEMENT What is already known on this subject? As much as 10-20% of clinically recognised pregnancies end in a spontaneous abortion. A missed miscarriage and a blighted ovum represent a form of spontaneous abortion, which has long been treated with surgical evacuation. However, nowadays, medical management represents a well-established alternative with very high success rates and is considered as an equivalent and safe method that is also very well accepted by patients. What do the results of this study add? According to our results, a medical management of a first trimester missed miscarriage and a blighted ovum is very effective with an overall success rate of 83.3% and a very low percentage of curettage in the first 48 hours after the procedure (7.4%). Our study was also able to identify higher beta-hCG values 14 days after procedure and absence of evacuation of products of conception during hospitalisation as risk factors for complication occurrence. What are the implications of these findings for clinical practice and/or further research? Our study helps to identify patients who are at greater risk for developing complications after the medical management of a first trimester missed miscarriage.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Missed; Adolescent; Adult; Chorionic Gonadotropin, beta Subunit, Human; Curettage; Female; Gestational Age; Humans; Middle Aged; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Uterine Hemorrhage; Young Adult

The objective was to learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post misoprostol use.. This was a qualitative study in 2015-2016 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion; what information they received before use; what dosage and regimens they used; what complications they experienced; and what treatment they received postuse. We initially conducted in-depth, semistructured interviews with 60 women who had undergone an abortion that resulted in complications. The results presented here are based on interviews with the subset of 19 women who had used misoprostol.. The 19 women were aged 16-40, with an average age of 21-26 at interview and average age of 18-21 at abortion. To obtain an abortion, they sought advice from partners, friends, family members, and/or traditional practitioners and health care providers. Misoprostol was easily accessible through the formal and informal sectors, but the dosages and regimens the women used on the advice of others were extremely variable, did not match WHO guidelines and were apparently ineffective, resulting in failed abortion, incomplete abortion, heavy bleeding/hemorrhage, strong pain and/or infection.. This study provides data on complications from the use of misoprostol as an abortifacient in Madagascar. Health care providers need training in correct misoprostol use and how to treat complications. Law and policy reforms are needed to support such training and to ensure the provision of safe abortion services in the public health system.. Health care providers who provide abortion care and treatment of abortion complications need training in correct misoprostol use and treatment of complications. Women and pharmacy workers also need this information. Law and policy reforms are needed to allow training and provision of safe services. Further research is needed on the extent and impact of incorrect misoprostol administration.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Induced; Adolescent; Adult; Female; Humans; Madagascar; Misoprostol; Patient Acceptance of Health Care; Pregnancy; Qualitative Research; Uterine Hemorrhage; Young Adult

Many Patients with persistent retained products of conception prefers to avoid surgical interventions, such as a dilatation and curettage (D&C) that might pose an additional future risk to their already compromised fertility or obstetric performance. The aim of this study was to the possibility of induced withdrawal bleeding following oral contraceptive administration as a non-surgical treatment for patients with persistent retained products of conception (RPOC). A retrospective study of patients presenting with retained products of conception (RPOC) after failed expectant management or after treatment with PGE1 was performed. Twelve women presenting with RPOC at ≤8 weeks gestation with minimal to mild vaginal bleeding and no signs of infection were treated with oral contraceptive pill (OCP) containing 0.03 mg ethinylestradiol and 0.15 mg of desogestrel for 3 weeks. Out of the 12 patients treated, nine women (75%) successfully expelled the RPOC after completing the three-week course of OCPs. The three cases (25%) that did not resolve following OCP treatment had pregnancy products with positive blood flow on Doppler examination. We conclude that OCPs may be a useful medical treatment option for persisting RPOC in selected patients with absence blood flow on Doppler examination wishing to avoid surgical intervention.

Topics: Abortion, Incomplete; Abortion, Induced; Abortion, Spontaneous; Adult; Choice Behavior; Contraceptives, Oral, Combined; Desogestrel; Dilatation and Curettage; Ethinyl Estradiol; Female; Humans; Misoprostol; Pilot Projects; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Tablets; Treatment Failure; Uterine Hemorrhage

Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion.. We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion.. One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol.. We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion.. We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Blood Loss, Surgical; Family Planning Services; Female; Gestational Age; Gynecology; Hemostatics; Humans; Methylergonovine; Misoprostol; Obstetrics; Oxytocics; Practice Patterns, Physicians'; Pregnancy; Surveys and Questionnaires; United States; Uterine Hemorrhage; Vasopressins

In Papua New Guinea induced abortion is restricted under the Criminal Code Law. Unsafe abortions are known to be widely practiced and sepsis due to unsafe abortion is a leading cause of maternal mortality.. We undertook a six month, prospective, mixed methods study at the Eastern Highlands Provincial Hospital. Semi structured and in depth interviews were undertaken with women presenting following induced abortion. This paper describes the reasons why women resorted to unsafe abortion, the techniques used, decision to seek post abortion care and women's reflections post abortion.. 28 women were admitted to hospital following an induced abortion. Reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors. Misoprostol was the most frequently used method to end the pregnancy. Physical and mechanical means, traditional herbs and spiritual beliefs were also reported. Women sought care post abortion due to excessive vaginal bleeding, and severe abdominal pain with some afraid they would die if they did not seek help.. In the absence of contraceptive information and services to avoid, postpone or space pregnancies, women in this setting are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk. Women need access to safe, effective means of abortion.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Abortion, Induced; Adolescent; Adult; Female; Gestational Age; Health Personnel; Health Services Accessibility; Hospitalization; Humans; Maternal Mortality; Medicine, Traditional; Misoprostol; Papua New Guinea; Plant Preparations; Pregnancy; Pregnancy, Unwanted; Prospective Studies; Socioeconomic Factors; Uterine Hemorrhage; Women's Health; Young Adult

The aim of the present study was to assess patient acceptability and satisfaction with medical treatment (vaginal misoprostol) of non-viable first trimester pregnancy.. A total of 64 women, treated with vaginal misoprostol for non-viable first trimester pregnancy between October 2012 and December 2012 at the First Department of Obstetrics and Gynecology Medical University of Warsaw, were included in this questionnaire-based study. Questions pertaining to advantages and disadvantages of misoprostol treatment as compared to potential surgical intervention were used. The respondents also determined whether they would choose medical treatment if they were to decide again. The Visual Analogue Scale (VAS) was used to assess pain and bleeding intensity.. Medical treatment was successful in 57 and surgical treatment was needed in 7 women. Average pain and bleeding intensity were 5.8 and 5.3, respectively. The most common side effects included diarrhea (27%), dizziness (22.2%), nausea (15.9%), and chills (15.6%). The most important advantages of misoprostol therapy were avoidance of the risk of uterine perforation (96.4%) and formation of intrauterine adhesions (74.6%), whereas the most significant disadvantages were prolonged bleeding (21.4%), pain (21.4%), and longer treatment duration (42.9%). Overall, 95.6% of the patients with successful treatment outcome declared they would choose this procedure if they were to decide again, as compared to 85.6% of women with treatment failure (p > 0.05).. Medical treatment with vaginal misoprostol is acceptable and well-tolerated by the vast majority of women with non-viable first trimester pregnancy. Satisfaction is expressed by both, respondents with successful as well as unsuccessful treatment outcome.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Dizziness; Female; Humans; Misoprostol; Nausea; Patient Acceptance of Health Care; Patient Satisfaction; Poland; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage; Women's Health

The purpose of this study was to evaluate the success rate and complications of medical termination of pregnancy up to 49 days of amenorrhea and present the outcome of our phone questionaire of satisfaction of patients.. Retrospective analysis.. Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno.. The analysis of 111 patients, who underwent medical termination of pregnancy at the Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno from 1. 6. 2014 to 30. 6. 2015 using 600 mg of mifepristone (Mifegyne) and 400 µg of misoprostol (Mispregnol). In our set of patients we monitored subjective perception of medical termination of pregnancy (pain, nausea, vomiting, satisfaction with this method) and objective process (hospitalisation, surgical intervention). The view of patients was found out by the phone questionnaire. Complete abortion without a surgical intervention underwent 103 patients. Nausea, pelvic pain, and intensity of bleeding were evaluated as suitable. Only 1 patient (0.9%) was hospitalised for nausea and 1 patient (0.9%) was hospitalised in case of need for an emergency curretage and transfusions. Some kind of contraception after the medical termination of pregnancy started using 98.0% of women. The satisfaction rate of this method was high - 101 patients declared themselves satisfied - 66.7% very satisfied, 24.3% rather satisfied.. Medical termination of pregnancy has good efficiency, we consider it safe with minimum side-effects and is well evaluated by patients.

Topics: Abortifacient Agents; Abortion, Induced; Adult; Cohort Studies; Dilatation and Curettage; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Nausea; Personal Satisfaction; Pregnancy; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Uterine Hemorrhage; Vomiting

To evaluate the acceptability and efficacy of medical abortion at home up to 63 days' gestation without limits on travel distance to a registered institution.. Observational prospective study.. Haukeland University Hospital between May 2006 and May 2009.. A total of 1018 women requesting abortion before 63 days' gestation who chose medical termination with mifepristone and home administration of misoprostol.. The women took 200 mg mifepristone under nurse supervision and self-administered 800 μg misoprostol vaginally 36-48 h later at home. All were contacted by phone for follow-up and assessment of bleeding, pain and acceptability.. Evacuation rate, pain, bleeding, acceptability, influence of distance on treatment.. Median gestational age was 50 (range 35-63) days and 70 (7.1%) of the women lived more than 60 min travel from the clinic. The rate of completed abortion was 93.6% and surgical evacuation was performed in 50 (4.9%) cases. Two women requested treatment on the day of misoprostol use. Moderate to strong pain was experienced by 68.4%, and 74.7% reported moderate to heavy bleeding. Parous women experienced less pain than nulliparous women (odds ratio 0.27; 95% confidence interval 0.19-0.34). In all, 95.1% of the women were satisfied with staying at home. Travel distance did not influence treatment outcome variables.. In our experience, home administration of misoprostol is an effective and acceptable method for abortion up to 63 days of gestation and women should be eligible for this treatment option regardless of their travel distance from hospital.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Drug Therapy, Combination; Female; Gestational Age; Health Services Accessibility; Humans; Mifepristone; Misoprostol; Odds Ratio; Pain; Patient Acceptance of Health Care; Patient Satisfaction; Pregnancy; Prospective Studies; Self Administration; Travel; Uterine Hemorrhage

Misoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana.. This was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher's exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.. Overall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p < 0.001), single (p < 0.001), nulliparous (p = 0.001), of higher educational background (p = 0.001), and unemployed (p < 0.001), than misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p < 0.001) or were not earning regular income to support a family (p = 0.001). Overall, 182 (72.2%) of the women (79.4% misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks' gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06).. Self-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Age Factors; Case-Control Studies; Cross-Sectional Studies; Educational Status; Employment; Female; Gestational Age; Ghana; Hospitals, Public; Humans; Kidney Diseases; Length of Stay; Liver Diseases; Misoprostol; Multivariate Analysis; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Self Care; Sepsis; Tertiary Care Centers; Uterine Hemorrhage; Young Adult

The aim of this prospective study was to assess the efficacy of intra-cervical misoprostol in the management of early pregnancy failure. Twenty women with early pregnancy failure received intra-cervical misoprostol via an endometrial sampling cannula. The first dose was 50 μg of misoprostol dissolved in 5 ml of normal saline. The administration was repeated after 12 h if there was no vaginal bleeding or pain. Nine (45%) women received 1 dose and 11 (55%) women received 2 doses of intra-cervical misoprostol. Abortion within 24 h occurred in 16 (80%) women, and complete abortion was achieved in 14 (70%) cases. Two women with incomplete abortion were managed with 600 μg of misoprostol orally (1 case) and surgical intervention (1 case). The mean time interval between the first dose and the abortion was 10.6 ± 6.3 h. Two women did not respond within 24 h of treatment initiation, 1 woman withdrew consent after the first treatment, and 1 woman developed heavy vaginal bleeding after the first dose and underwent surgical management. Intra-cervical misoprostol is a promising method of medical treatment of early pregnancy failure. Further randomized clinical trials are needed to validate its safety and efficacy.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Administration, Intravaginal; Administration, Oral; Adult; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Uterine Hemorrhage

The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We evaluate serum Angiopoietin-2 (Ang-2) and β human chorionic gonadotropin (β-hCG) in women who had undergone a medical abortion as markers of prolonged uterine bleeding (PUB).. Prospective trial involving 2843 women attending an gynecology outpatient clinic who following a medical abortion with mifepristone and misoprostol, the study cohort was divided into women with duration of uterine bleeding >14 days (PUB) and women with duration of uterine bleeding ≤14 days (normal uterine bleeding, NUB). Serum determinations of Ang-2 levels by ELISA and β-hCG levels by electrochemiluminiscence immunoassay. Receiver Operating Characteristics (ROC) analyses were calculated and plotted for the diagnostic accuracy of serum β-hCG and Ang-2 concentration to discriminate PUB and NUB.. Baseline characteristics for both groups were similar, Only duration of bleeding showed a significant difference between the PUB group and NUB group. Ang-2 serum levels moderately correlated with serum β-hCG levels with statistically significant correlation coefficients of 0.536. Serum β-hCG and Ang-2 levels on day 7 and on day 14 after medical abortion were signifcantly higher in PUB group than in NUB group. Plotted as ROC curves, β-hCG area under curve (AUC) was 0.65 (95% CI, 0.53-0.76) on day 7, rising to AUC = 0.83 (95% CI, 0.75-0.92) on day 14. Using Ang-2 on day 7 and day 14 as predictive parameter resulted in an analogous AUC (AUC = 0.61 on day 7, AUC = 0.78 on day 14).. Both parameters are clinically useful as a diagnostic test in predicting PUB after medical abortion, and can be helpful in uncertain clinical situations, but should be considered as supplementary to a general clinical evaluation.

Topics: Abortion, Induced; Adult; Angiopoietin-2; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Uterine Hemorrhage; Young Adult

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Legal; Abortion, Spontaneous; Adult; Arteriovenous Malformations; Colombia; Female; Gestational Age; Humans; Magnetic Resonance Imaging; Misoprostol; Pregnancy; Pregnancy Complications, Cardiovascular; Ultrasonography, Doppler; Uterine Artery; Uterine Hemorrhage

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

Intraoperative blood loss is a concern in the surgical treatment of myomatous uteri. Misoprostol causes the myometrium and isolated uterine arteries to contract and has blood-saving effects in myomectomy.. To assess the efficacy of rectal misoprostol in reducing haemorrhage during laparoscopy-assisted vaginal hysterectomy (LAVH).. Retrospective case-control study. Women who had undergone LAVH for leiomyoma were enrolled (n=117). Forty-nine women who used 400 μg of misoprostol rectally 1 h before LAVH were compared with 68 women who did not. The surgical outcomes were compared statistically with Mann-Whitney rank sum test, χ(2) test, or Fisher's exact test.. The demographic variables were similarly distributed in both groups. There were no significant differences in the estimated blood loss, reduction in haemoglobin, operation time, or uterine weight between the two groups (P>0.05). The rates of operative complications (4.1 vs 10.3% for the misoprostol and control groups, respectively, P=0.21) were not different. There was no febrile morbidity (>38°C) within 24 h of the misoprostol insertion.. These data do not support the use of rectal misoprostol to reduce blood loss during LAVH. The pharmacoclinical effects of misoprostol in the uterus should be clarified.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Blood Loss, Surgical; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Middle Aged; Misoprostol; Retrospective Studies; Treatment Outcome; Uterine Hemorrhage; Uterine Neoplasms

Twin gestation is not considered a contraindication to medical abortion with mifepristone and misoprostol. However, data comparing the efficacy of medical abortion for singleton gestations as compared with multiple gestations are limited. We examined medical abortion outcomes for twin gestations through 63 days.. We performed a secondary analysis of treatment efficacy and side effects using pooled data from two randomized medical abortion trials. All subjects received mifepristone 200 mg orally and misoprostol 800 mcg vaginally. Outcomes in women with singleton and twin gestations were compared.. Of 2208 subjects, 24 (1.1%) women had twins. Treatment success was not statistically different for twin and singleton gestations (91% vs. 97%, p=.19). Perceived bleeding and pain were not significantly different between groups.. Treatment success of medical abortion for twins is not significantly different than for singletons, although small differences cannot be excluded due to the limited number of twins.

Topics: Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adult; Female; Humans; Mifepristone; Misoprostol; Pain Measurement; Postoperative Complications; Pregnancy; Pregnancy, Multiple; Randomized Controlled Trials as Topic; Treatment Outcome; Twins; Uterine Hemorrhage

To determine the effect of leonurine hydrochloride (LH) on abnormal bleeding induced by medical abortion.. Rats had incomplete abortions induced in early pregnancy using mifepristone in combination with misoprostol. After abortion, rats were treated with LH for 7 days, and the duration and volume of uterine bleeding were observed. Approximately 30min after the last treatment, the animals were killed and the uterine shape was observed. The sinistro-uteri were suspended in organ baths to record the contraction curves, including the frequency and tension for 10min; the dextro-uteri were fixed with formaldehyde for pathologic evaluation. In addition, blood samples were collected from the femoral artery for the measurement of estradiol (E₂) and progesterone (P) levels by radioimmunoassay.. In in vivo experiments, compared with the model group, LH treatment markedly reduced the volume of bleeding and intrauterine residual, and significantly shortened the duration of bleeding. From the contraction curve, LH notably reinforced the frequency and tension of uterine contractions. LH remarkably elevated the serum estradiol level in rats, but had no obvious effect on progesterone level.. LH has an inhibitory effect on bleeding caused by incomplete abortion; the mechanism may be related to up-regulation of the E₂ level, leading to an increase in uterine contractions and evacuation of intrauterine residuum.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Incomplete; Abortion, Induced; Animals; Dose-Response Relationship, Drug; Drugs, Chinese Herbal; Estradiol; Female; Gallic Acid; In Vitro Techniques; Mifepristone; Misoprostol; Organ Size; Pregnancy; Random Allocation; Rats; Rats, Sprague-Dawley; Uterine Contraction; Uterine Hemorrhage; Uterus

To investigate the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitory of metalloproteinase-1 (TIMP-1) in women who had undergone a medical abortion and explore their possible role in the mechanism of prolonged uterine bleeding after a mifepristone-misoprostol abortion.. Cross-sectional study.. Tertiary referral university hospital.. Forty women were recruited following a medical abortion with mifepristone and misoprostol, 20 with duration of bleeding >14 days and 20 with duration of bleeding 14 days after a medical abortion (bleeding group), whereas each sample of women with duration of bleeding

Topics: Abortifacient Agents; Abortion, Induced; Adult; Cross-Sectional Studies; Female; Humans; Matrix Metalloproteinase 9; Mifepristone; Misoprostol; Pregnancy; Tissue Inhibitor of Metalloproteinase-1; Uterine Hemorrhage

Vaginal bleeding in the first trimester occurs in about one fourth of pregnancies. About one half of those who bleed will miscarry. Guarded reassurance and watchful waiting are appropriate if fetal heart sounds are detected, if the patient is medically stable, and if there is no adnexal mass or clinical sign of intraperitoneal bleeding. Discriminatory criteria using transvaginal ultrasonography and beta subunit of human chorionic gonadotropin testing aid in distinguishing among the many conditions of first trimester bleeding. Possible causes of bleeding include subchorionic hemorrhage, embryonic demise, anembryonic pregnancy, incomplete abortion, ectopic pregnancy, and gestational trophoblastic disease. When beta subunit of human chorionic gonadotropin reaches levels of 1,500 to 2,000 mIU per mL (1,500 to 2,000 IU per L), a normal pregnancy should exhibit a gestational sac by transvaginal ultrasonography. When the gestational sac is greater than 10 mm in diameter, a yolk sac must be present. A live embryo must exhibit cardiac activity when the crown-rump length is greater than 5 mm. In a normal pregnancy, beta subunit of human chorionic gonadotropin levels increase by 80 percent every 48 hours. The absence of any normal discriminatory findings is consistent with early pregnancy failure, but does not distinguish between ectopic pregnancy and failed intrauterine pregnancy. The presence of an adnexal mass or free pelvic fluid represents ectopic pregnancy until proven otherwise. Medical management with misoprostol is highly effective for early intrauterine pregnancy failure with the exception of gestational trophoblastic disease, which must be surgically evacuated. Expectant treatment is effective for many patients with incomplete abortion. Medical management with methotrexate is highly effective for properly selected patients with ectopic pregnancy. Follow-up after early pregnancy loss should include attention to future pregnancy planning, contraception, and psychological aspects of care.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Chorionic Gonadotropin; Counseling; Diagnosis, Differential; Evidence-Based Medicine; Female; Gestational Trophoblastic Disease; Grief; Humans; Methotrexate; Misoprostol; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Ectopic; Risk Factors; Ultrasonography, Prenatal; Uterine Hemorrhage

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

The aim of this study was to determine the complete abortion rate for the vaginal administration of high-dose misoprostol after a failed medical abortion.. When their medical abortions failed after the conventional oral administration of mifepristone and misoprostol, participants then received 1,000 microg of misoprostol vaginally. The efficacy and side effects of this treatment were evaluated.. Twenty-seven women who failed to abort after the conventional administration of mifepristone and misoprostol were enrolled in this trial. Fourteen days after the vaginal administration of 1,000 microg misoprostol, the overall complete expulsion rate had reached 88.8% (24/27). Most adverse effects were mild to moderate and did not require treatment.. The vaginal administration of 1,000 microg misoprostol as a salvage therapy after a failed medical abortion appears to be a safe and highly effective alternative to surgical intervention.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Female; Gestational Age; Humans; Misoprostol; Pregnancy; Time Factors; Treatment Outcome; Uterine Hemorrhage

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Adult; Female; Fetal Death; Humans; Hysterectomy; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Uterine Hemorrhage; Uterine Rupture

There is currently no consensus on how success should be defined after medical management of first-trimester missed abortion. The aim of this study was to determine the transvaginal ultrasound criterion associated with highest success rate and, at the same time, lowest long-term complications.. Prospective observational study of consecutively enrolled patients.. A tertiary care university hospital in northern Portugal.. Forty-four women submitted to medical management of first-trimester missed abortion using a regimen of vaginal misoprostol, with histologically confirmed conception products passed vaginally. A transvaginal ultrasound scan was performed by an experienced sonographer in the morning after treatment, to characterise uterine content. Patients were provided with a chart for daily registration of axillary temperature, vaginal bleeding and lower abdominal pain. Transvaginal ultrasound was repeated 2-3 weeks later, and again after the following menses.. Success rates of medical management when post-treatment transvaginal ultrasound criteria for subsequent expectant management were: absence of intra-uterine sac, largest anteroposterior diameter of hyperechogenic content, and maximum area of hyperechogenic intra-uterine content in a sagittal view. Self-reported duration of vaginal bleeding and abdominal pain after medical treatment.. Success rate was 86% (38/44) when absence of gestational sac on the 12 h transvaginal ultrasound was used as the main criterion for subsequent expectant management and there was no need for further intervention. The success rate using the ultrasound criterion anteroposterior diameter < or = 15 mm was 51% (22/43), and with maximum sagittal plane area under 7.5 cm(2), 72% (31/43). Mean duration of vaginal haemorrhage was 9 days (minimum 2 days, maximum 14 days) and of lower abdominal pain 6 days (minimum 0 days, maximum 14 days). No patient recorded an axillary temperature exceeding 37 degrees C. No apparent relationship between the size of ultrasound-estimated intra-uterine content and duration of symptoms was observed.. Absence of gestational sac on transvaginal ultrasound should be the criterion used to document success after medical management of first-trimester missed abortion, as it is associated with the highest short and long-term success rates, as well as mild and self-limited symptoms in the days following treatment.

Topics: Abdominal Pain; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Extraction, Obstetrical; Female; Gestational Age; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Treatment Outcome; Ultrasonography; Uterine Hemorrhage

In the first 18 months since mifepristone was approved by the Food and Drug Administration (FDA) for use with misoprostol for early medical abortion, approximately 80,000 women have been treated. One-hundred thirty-nine adverse events were reported to Danco Laboratories LLC and subsequently reported to the FDA. Thirteen patients required blood transfusions, 10 patients were treated with antibiotics for infection and 6 had a generalized allergic reaction. Fifty patients had an ongoing pregnancy, with 48 having suction curettage, leaving 2 ongoing pregnancies. Thirty-nine patients had a suction curettage for heavy or prolonged vaginal bleeding. The overall national experience has been highly favorable.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Anti-Bacterial Agents; Blood Transfusion; Female; Gestational Age; Humans; Hypersensitivity; Infections; Mifepristone; Misoprostol; Pregnancy; United States; Uterine Hemorrhage; Vacuum Curettage

Misoprostol is a prostaglandin E(1) analogue that has been used for medical abortion. We conducted this prospective study to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <42 days and in women at a gestational age of 42-56 days.. A total of 160 women seeking medical termination of a pregnancy of <56 days were enrolled in the study. Medical termination was performed using 800 micro g of vaginal misoprostol, repeated every 24 h for a maximum of three doses.. The overall complete abortion rate was 91.3%. In group A (gestation <42 days) complete abortion occurred in 96.3% of women, whereas in group B (gestation = 42-56 days) complete abortion occurred in 86.3% of women (P < 0.025). The two groups did not differ significantly with respect to side-effects (incidence of pain, bleeding, nausea, diarrhoea, fever and headache). Women who had aborted successfully were significantly more satisfied with the method compared with women who did not (P < 0.001).. The vaginal misoprostol-alone regimen is highly effective for women seeking medical abortion of pregnancies of

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Diarrhea; Female; Fever; Gestational Age; Headache; Humans; Misoprostol; Nausea; Pain; Patient Satisfaction; Pregnancy; Treatment Outcome; Uterine Hemorrhage

To study the effect of total glycoside from Clinopodium polycephalum (Vaniot) C. Y. Wu et Hsuan on uterine bleeding quantity in drug abortion model rats.. Mifepristone and misoprostol were given to early-pregnancy rats orally. The change of uterine bleeding quantity was observed in uncompletive abortion model rats.. TGCP (20 mg/kg) could markedly reduce uterine bleeding quantity in drug abortion model rats.. TGCP has the hemostatic effect on uterine bleeding in drug abortion model rats.

Topics: Abortion, Induced; Animals; Drugs, Chinese Herbal; Female; Glycosides; Hemostatics; Lamiaceae; Male; Mifepristone; Misoprostol; Phytotherapy; Plants, Medicinal; Pregnancy; Rats; Rats, Wistar; Uterine Hemorrhage

Topics: Abortifacient Agents; Abortion, Induced; Clinical Trials as Topic; Female; Fetal Death; Humans; Malpractice; Misoprostol; New South Wales; Obstetrics; Patient Selection; Placenta Previa; Pregnancy; Pregnancy Trimester, Second; Uterine Hemorrhage

This study aims to assess the efficacy of a combination of mifepristone and misoprostol in the management of missed miscarriage and anembryonic pregnancy.. Data of 220 consecutive women with miscarriage, undergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 microg. Three hours following the first dose, two further doses of misoprostol, 400 microg each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were offered repeat medical regime with misoprostol. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation.. The overall success rate of medical management was 84.1%. Mifepristone alone induced natural expulsion of products of conception in 18.1% of women. The median dose of misoprostol required was 1600 microg and the median induction miscarriage interval after first prostaglandin administration was 8.04 h (range: 0.58-50.54 h). Of the 142 women who were symptomatic at presentation the medical regime failed in 30 (21.1%), compared with five (6.4%) failures of the 78 who were asymptomatic (P = 0.007). Of the 35 women who had surgical evacuation, eight required an emergency curettage for bleeding.. The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early fetal demise, although it is not as effective as surgery.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Adult; Curettage; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Fetal Death; Humans; Mifepristone; Misoprostol; Pregnancy; Uterine Hemorrhage

An equivalence trial is appropriate when it is desired to demonstrate equivalence between two treatments, regimens or interventions (methods) or non-inferiority of a new one compared to a standard one. The conduct of an equivalence trial requires different techniques during design and analysis compared to a superiority trial. The existing formulae for sample size calculation to demonstrate equivalence between two methods using the confidence interval approach are reviewed. The establishment of the margin of equivalence and the choice of the type of test are discussed. Plots of sample sizes required to demonstrate equivalence in the case of binary outcomes are presented for values of proportions and margins of equivalence common in the reproductive health field. Examples are given of method comparisons in the reproductive health field in which the relevant question is to demonstrate non-inferiority. The approach to equivalence is described in the trials included in three published systematic reviews in which these comparisons were conducted, addressing the statement of hypotheses, sample size calculation and the interpretation of results. The use of the conventional superiority approach to design equivalence trials has led to underpowered trials to show equivalence within clinical relevant margins. The analysis and interpretation of results from such trials has resulted in conclusions of equivalence based on lack of significance. We draw attention to the lack of awareness of the appropriate techniques for equivalence trials among researchers in the field of reproductive health. Finally, the issue of interim analyses and stopping rules in equivalence trials is addressed.

Topics: Confidence Intervals; Contraception; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Levonorgestrel; Misoprostol; Oxytocics; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; Reproductive Medicine; Sample Size; Statistics as Topic; Therapeutic Equivalency; Uterine Hemorrhage

International experience compels us to revisit how we define and assess the safety and efficacy of medical abortifacients such as misoprostol. In some countries where safe abortion is neither accessible nor legal, even unsupervised, off-protocol use of misoprostol can provide women with a means to safely terminate pregnancy. This is due primarily to misoprostol-induced uterine contractions that cause bleeding, which in turn provides access to existing reasonable quality health services that would otherwise be unavailable. Several studies have suggested that an increase in the underground use of misoprostol in Brazil has already reduced serious complications from unsafe abortion. Thus, the availability of medical abortifacients combined with strengthened postabortion care services can legitimately be considered a public health success in countries in which safe abortion services do not exist and law reform is unlikely.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Legal; Female; Global Health; Health Services Accessibility; Humans; Misoprostol; Pregnancy; Public Health; Uterine Hemorrhage

To evaluate the efficacy of a regimen of vaginal misoprostol in causing the complete expulsion of first-trimester missed abortions, or alternatively dilating the cervix for surgical evacuation.. Seventy-four women with a transvaginal ultrasound diagnosis of a first-trimester missed abortion and no more than slight vaginal bleeding were consecutively enrolled. Misoprostol (600 microg) was administered vaginally and repeated 4 h later if necessary. Surgical evacuation was performed when complete expulsion was not documented on the ultrasound 10-12 h after treatment.. Complete medical evacuation occurred in 42 women (56.8%), 11 (14.9%) of which required only one dose. Seventy women (94.6%) experienced abdominal pain, 73 (98.6%) vaginal bleeding, 10 (13.5%) nausea, 4 (5.4%) vomiting, 5 (6.8%) diarrhea, and 4 (5.4%) transient hyperthermia. There was one case of heavy vaginal bleeding requiring emergency surgical evacuation, and one re-admission for incomplete abortion at 30 days. All but 4 (5.4%) women had permeable cervices at the time of surgery.. The described regimen of vaginal misoprostol is safe and reasonably effective in inducing complete evacuation in missed abortions. When this does not occur, it almost always provides adequate cervical dilatation for surgery.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Diarrhea; Drug Administration Schedule; Female; Fever; Humans; Misoprostol; Nausea; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Ultrasonography; Uterine Hemorrhage; Vomiting

Seven cases of uterine arteriovenous malformations associated with pregnancy were initially suspected by the history of prolonged bleeding after a medical abortion and then confirmed by color Doppler scanning. All cases were managed expectantly and resolved spontaneously. When AVMs required diagnosis by pathology or angiography, only the most severe cases would have been reported. Now that they can be recognized on ultrasound, it is possible that mild cases such as these will be found to be much more common.

Topics: Abortion, Induced; Adult; Arteriovenous Malformations; Diagnosis, Differential; Female; Humans; Methotrexate; Misoprostol; Postoperative Complications; Pregnancy; Tamoxifen; Ultrasonography, Doppler; Uterine Hemorrhage; Uterus

To explore the causes of abnormal uterine bleeding following termination of early pregnancy using mifepristone.. 19 specimens were obtained by curettage on the day immediately after expulsion of gestational sac, 40 specimens on the 7th postabortal day and 20 specimens during 2-12 weeks after induced abortion using mifepristone respectively. The histopathologic changes of the specimens were observed by HE staining, and the expression of human choronic gonadotropin (hCG) and human placental lactogen (hPL) by immunohistochemical studies as well as phloxine-tartrazine staining and Gordon Sweets staining.. It showed that decidua shedding retarded, especially basal decidua. Immunohistochemical studies demonstrated the trophoblasts were still active and might affect pathological changes of local endometrium. The specific granules of endometrial granulocytes disappeared, together with disintegration of the reticular fibers. But in the group which curettage was indicated for abnormal bleeding 2 weeks after abortion, the main cause was incomplete abortion.. In addition to incomplete abortion, the retardation of decidua shedding and the impairment of endometrium regeneration were responsible for the abnormal uterine bleeding following termination of early pregnancy using mifepristone. The incomplete dissolution of the reticular fibers in basal decidua may induce decidua shedding retardation and incomplete abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Endometrium; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Missed; Female; Humans; Mifepristone; Misoprostol; Pain; Pregnancy; Uterine Hemorrhage

A group of 120 women with gestations from 64 to 84 days received 800 micrograms of vaginal misoprostol every 24 h for a maximum of three doses without performing postexpulsion systematic preventive curettage. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), side effects, and mean time of expulsion and vaginal bleeding. Complete abortion occurred in 104 of 120 (87%, 95% CI 79, 92) subjects. The decrease of hemoglobin was statistically significant (p = 0.0001) but clinically unimportant: 12.2 mg/dL (SD 1.1) before treatment and 11.6 mg/dL (SD 1.0) after treatment. Statistically significant differences were found only between the success rates for white women in comparison with nonwhite women, in which case the success rates were higher for white than for nonwhite women. Vaginal bleeding lasted 8 +/- 5 days, spotting 4 +/- 3, and total bleeding 12 +/- 4 days. The acceptable expulsion time, the fact that postabortion systematic curettage was not needed, the clinically insignificant hemoglobin loss, and the success rate obtained show that misoprostol administered vaginally may be a valid method for interrupting gestations of 10-12 weeks.. The effectiveness and safety of vaginal misoprostol, without the need for postexpulsion systematic curettage, were investigated in 120 Cuban women seeking late first-trimester abortion (10-12 weeks). Women received 800 mcg of misoprostol vaginally every 24 hours, for a maximum of three doses. Complete abortion occurred in 104 women (87%); 87 women (73%) aborted after a single dose, 11 (9%) required two doses, and 6 (5%) received a third dose. The remaining 16 women (13%) underwent surgical abortion. Mean hemoglobin decreased from 12.2 mg/dl before treatment to 11.6 mg/dl after abortion--a difference that was statistically but not clinically significant. Side effects--which disappeared within 2 hours--included nausea (22%), vomiting (17%), diarrhea (54%), dizziness (25%), headache (19%), and chills (72%). Although 99% of subjects reported pelvic pain (99%), only 10% requested an analgesic for pain relief. Vaginal bleeding persisted for a mean of 8 days. According to logistic regression analysis, the only variable significantly associated with treatment success was race. The success rate was 94% among White women compared with 73% among Black and Black Cuban women. The acceptable expulsion period, the fact that a postabortion systematic curettage was not required, the clinically insignificant hemoglobin loss, and the high success rate all demonstrate that misoprostol administered vaginally may be a valid method for interrupting late first-trimester pregnancies.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Black People; Female; Gestational Age; Hemoglobins; Humans; Misoprostol; Pregnancy; Regression Analysis; Time Factors; Treatment Outcome; Uterine Hemorrhage; White People

The effectiveness of a combined regimen of mifepristone and vaginal misoprostol for termination of pregnancies of 9-13 weeks of gestation was investigated in 120 UK abortion patients (median age, 22.1 years; median duration of amenorrhea, 10.3 weeks). Each woman received a single oral dose of 200 mg of mifepristone 36-48 hours before admission, at which time 800 mcg of misoprostol was administered vaginally. Where indicated, a further two doses of 400 mcg of misoprostol (vaginal or oral) were provided every 3 hours. All 120 women aborted on the day of prostaglandin administration; however, 6 women (5%) required exploratory curettage after the procedure for retained placenta. The median prostaglandin dose was 1200 mcg (range, 800-1600 mcg). The median time from misoprostol administration to abortion was 4.33 hours (range, 1.3-16.0 hours). 60 women (50%) required oral analgesics and 26 (22%) received parenteral analgesia. Diarrhea occurred in 38 women (32%). The median duration of bleeding after abortion was 12.5 days (range, 3-43 days). In questionnaires administered to 73 women, only 3 (4%) expressed dissatisfaction with medical abortion, because of pain or prolonged bleeding. The relatively high dose of misoprostol used in this study and the vaginal route of administration are presumed to account for the 95% success rate. Extension of medical abortion to later gestation times would decrease the need for surgery and expand women's choice of methods of pregnancy termination.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adolescent; Adult; Analgesics; Diarrhea; Female; Follow-Up Studies; Gestational Age; Humans; Mifepristone; Misoprostol; Pain; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage; Vomiting

There have been no US studies published on the effectiveness, safety, time to bleeding, and acceptability of misoprostol administered by vagina at home and repeated, if needed, after mifepristone was administered for abortion in women up to 8 weeks pregnant.. A prospective trial was conducted with women up to 8 weeks pregnant wanting an abortion. After receiving mifepristone 600 mg orally, subjects self-administered vaginal misoprostol 800 micrograms at home 2 days later. Subjects returned within 7 days, and if the gestational sac was still present on ultrasound, a repeat dose of misoprostol was administered in the office. Subjects completed a daily symptom log and a questionnaire on the acceptability of the procedures.. Of the 166 subjects, 163 (98%) had a complete medical abortion. Three subjects presented with persistent bleeding and an incomplete abortion from 27 to 35 days after taking mifepristone and required surgical intervention. Vaginal spotting or bleeding occurred in 104 (62%) subjects before taking misoprostol, and 18 (11%) did not use misoprostol. Bleeding occurred on average 3.5 hours (SD, 3.2) after taking misoprostol. Six (4%) subjects required a second dose of misoprostol. Gastrointestinal side effects were common, mild, and brief. One hundred fifty-nine (96%) subjects agreed that the procedure went well, and 146 (90%) agreed that home administration of misoprostol was acceptable.. Two days after taking mifepristone, misoprostol administered by vagina was found to be safe, highly effective, and acceptable to women. Since only 6 subjects needed a second dose of misoprostol, conclusions about repeat doses are not possible. This procedure is a promising alternative to surgical abortion.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Female; Humans; Mifepristone; Misoprostol; Patient Satisfaction; Pregnancy; Prospective Studies; Self Administration; United States; Uterine Hemorrhage

Although medical termination of pregnancy is available in Europe and China as an alternative to surgical termination, political and social factors have blocked medical approaches to pregnancy termination in the United States. Methotrexate, which is toxic to trophoblastic tissue, has been used safely to treat unruptured ectopic pregnancies. This report describes the use of a single low dose of methotrexate followed by intravaginal misoprostol for the medical termination of early pregnancy.. Women seeking termination of pregnancy were selected for this study on the basis of their good general health, emotional stability, and a pregnancy of 63 days or less in duration. Each woman received an intramuscular dose of methotrexate (50 mg per square meter of body-surface area). Five to seven days later, 800 micrograms of misoprostol was administered intravaginally. If abortion did not occur after seven days, the women was offered a second dose of misoprostol or vacuum aspiration. Successful abortion was defined as a complete termination of pregnancy within seven days after the first or second administration of misoprostol.. A total of 171 of the 178 women enrolled in the study (96 percent) had successful medical abortions. Twenty-five women (14 percent) did not have an abortion after the first dose of misoprostol and received a second dose. Eighteen subsequently had complete abortions, but seven required suction curettage. In all seven women who required suction curettage, there was histologic evidence of disruption in the conceptus. No important side effects or complications were noted.. The combination of methotrexate and misoprostol represents a safe and effective alternative to invasive methods for the termination of early pregnancy.. Methotrexate, which is toxic to trophoblastic tissue, has been used safely to treat unruptured ectopic pregnancies. This report describes the use of a single low dose of methotrexate followed by intravaginal misoprostol for the medical termination of early pregnancy. Women seeking termination of pregnancy at the Mount Sinai Medical Center, New York City, were selected on the basis of their good general health, emotional stability, and a pregnancy of 63 days or less in duration. Each woman received an intramuscular dose of methotrexate (50 mg per square meter of body-surface area). 5-7 days later, 800 mcg of misoprostol (4 x 200 mcg) was administered intravaginally. If abortion did not occur after 7 days, the woman was offered a 2nd dose of misoprostol or vacuum aspiration. Successful abortion was defined as a complete termination of pregnancy within 7 days after the 1st or 2nd administration of misoprostol. A total of 171 of the 178 women enrolled in the study (96%) had successful medical abortions. 25 women (14%) did not have an abortion after the 1st dose of misoprostol and received a 2nd dose. 18 subsequently had complete abortions, but 7 required suction curettage. In all 7 women who required suction curettage, there was histologic evidence of disruption in the conceptus: trophoblastic changes that ranged from mild hydropic degeneration to almost complete dissolution of the trophoblast. On the basis of the women's reports, 88% appeared to have had abortions within 24 hours, which claim was confirmed by vaginal ultrasound examination. More than 75% of the women had little pain or only moderate pain (or= 2 on a scale from 0 to 4+). No important side effects or complications occurred. The patients overwhelmingly preferred the medical termination of pregnancy to the surgical method. The combination of methotrexate and misoprostol represents a safe and effective alternative to invasive methods for the termination of early pregnancy.

Topics: Abortion, Legal; Administration, Intravaginal; Adolescent; Adult; Female; Humans; Methotrexate; Middle Aged; Misoprostol; Pregnancy; Time Factors; Uterine Hemorrhage; Vacuum Curettage

Four hundred and fifty pregnant women were recruited for termination of early gestation by mifepristone combined with dl-15-methyl PGF2 alpha or misoprostol. Eight-four out of 450 subjects received curettage because of heavy or prolonged vaginal bleeding and slow decline of urinary hCG levels. Histopathology examinations of specimens obtained during curettage revealed denatured, necrotic and obscure villi and trophoblasts in 77 specimens, which accounted for 91.7%. Among them, 68 samples were mingled with inflammatory cell infiltration, and 15 with decidual cells, only 3 were villi and trophoblasts alone. The remaining 7 specimens were decidua in 6 and inflammatory infiltration in 1, which accounted for 7.1% and 1.2% respectively. This study suggested that the major cause resulting in heavy or prolonged vaginal bleeding after medical abortion by mifepristone and prostaglandin analogue was residual villi and trophoblasts with inflammatory cell infiltration.

Topics: Abortion, Induced; Carboprost; Dilatation and Curettage; Drug Synergism; Endometrium; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage

This paper addresses itself to comparing the findings from more recent studies on the termination of early pregnancy in women by a medical method involving a combination of RU486 and gemeprost (a PGE1 analog which is administered as a vaginal pessary) or RU486 and misoprostol (an orally active PGE1 analog). In particular, the data in these studies relating to (i) time to expulsion of the conceptus and (ii) duration of vaginal bleeding have been compared by statistical tests. It was shown that the shortest time to expulsion after PGE1 was when gemeprost was administered at 48hr following RU486. There was also an increased duration of bleeding with this treatment. These findings are discussed in relation to women's attitudes toward abortion methods especially in regard to preferring a decreased induction-abortion interval and a duration of bleeding of less than 14 days.

Topics: Abortion, Induced; Adult; Alprostadil; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Retrospective Studies; Time Factors; Uterine Hemorrhage

We report on the determinants and consequences of induced abortion among 803 women admitted to hospital with abortion complications in Rio de Janeiro, Brazil, in 1991. 458 (57%) women reported using misoprostol to induce abortion, 74% in the first 4 months of pregnancy. Doses of 200-16,800 micrograms were reported, with a median of 800 micrograms. 65% of the women took the drug orally, 29% used a combination of oral and vaginal routes, and 6% administered it intravaginally. Vaginal bleeding and uterine cramps were the commonest reasons for seeking hospital care. Only 8% of women reported gastrointestinal side-effects. Misoprostol induced vaginal bleeding within 12 h of administration in 52% of the women, but 16% waited 10 days or more for onset of bleeding. 4% were admitted to hospital with complete abortion. The likelihood of bleeding starting within 12 h increased with duration of gestation and it was greater when the drug was used both orally and intravaginally. A significantly smaller proportion of women taking misoprostol than of those who induced abortion by catheter insertion presented signs of infection or physical injuries or required blood transfusion (< 0.0005). Among 803 women interviewed at delivery as controls, 6% had taken misoprostol but abortion had not ensued. Misoprostol has an important role as an abortifacient among the women studied.

Topics: Abortion, Criminal; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adolescent; Adult; Brazil; Female; Gestational Age; Hospitalization; Humans; Misoprostol; Muscle Cramp; Pregnancy; Risk Assessment; Socioeconomic Factors; Uterine Hemorrhage

Methotrexate is cytotoxic to trophoblast and, in low doses, has minimal side effects. It is used to treat both gestational trophoblastic neoplasia and ectopic pregnancy. The cytotoxic effects of methotrexate on intrauterine trophoblast should be equivalent. To test this hypothesis, ten pregnant women, < 8 weeks' gestation were treated with methotrexate 50 mg/m2 intramuscularly followed 3 days later by misoprostol, a prostaglandin E1 analogue. The first 4 patients received misoprostol 600 micrograms orally; none aborted soon after the misoprostol. Two patients aborted 25 and 26 days after the methotrexate injection and two elected a suction abortion after 14 days (one by choice and one because the pregnancy was still viable). The last 6 patients received misoprostol 800 micrograms vaginally and aborted within 3-8 hours. One patient had an incomplete abortion requiring a suction curettage 34 days after the misoprostol. Vaginal bleeding for these 6 patients lasted an average of 29 +/- 11 days (range, 12-42 days). No methotrexate side effects were observed. Vaginal misoprostol (800 micrograms) was significantly more effective (p = 0.005) than oral misoprostol (600 micrograms) in effecting abortion after intramuscular methotrexate.

Topics: Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adult; Female; Humans; Methotrexate; Misoprostol; Pilot Projects; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage