misoprostol and Uterine-Neoplasms

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 assess the effectiveness and safety of interventions to reduce blood loss during myomectomy.. Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, between 1966 and 2006 for randomized controlled trials (RCTs).. We found significant reductions in blood loss with vaginal misoprostol (weighted mean difference [WMD] -149.00 mL, 95% confidence interval [CI] -229.24 to -68.76); intramyometrial vasopressin and analogues (WMD -298.72 mL, 95% CI -593.10 to -4.34); intramyometrial bupivacaine plus epinephrine (WMD -68.60 mL, 95% CI -93.69 to -43.51); and pericervical tourniquet (WMD -1870.00 mL, 95% CI -2547.16 to -1192.84). There was no evidence of effect in blood loss with myoma enucleation by morcellation and oxytocin.. There is limited evidence from a few RCTs that some interventions may reduce bleeding during myomectomy. There is need for adequately powered RCTs to shed more light on the effectiveness, safety, and cost of different interventions to reduce blood loss during myomectomy.

Topics: Blood Loss, Surgical; Bupivacaine; Combined Modality Therapy; Female; Gynecologic Surgical Procedures; Humans; Leiomyomatosis; Misoprostol; Oxytocin; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

To assess the effect of pre-operative sublingual misoprostol on intra-operative blood loss in abdominal myomectomy as compared to placebo.. Double-blind randomised controlled pilot study. A single tertiary Gynaecology Unit in Melbourne, Australia. Women ≥ 18 years old undergoing laparoscopic or open myomectomy. Women undergoing laparoscopic or open myomectomy for symptomatic uterine leiomyomas were randomised to pre-operative sublingual 400mcg misoprostol or placebo. Intra-operative blood loss was measured via accurate record keeping of the post-operative volume in the suction canister and weighed packs, minus any irrigation fluid used.. Intraoperative blood loss in the misoprostol treatment group was 306 ml ± 281 ml, compared to 325 ± 352 ml in the placebo group; P = 0.83. Fibroid volume was a consistent predictor of intra-operative blood loss. For each 1 ml increase in fibroid volume there is an increase in blood loss by 0.26 ml (95 % CI: 0.07 - 0.46).. In this study, we found that there was no significant difference in blood loss between women who received and did not receive sublingual misoprostol before abdominal myomectomy. This is an exploratory study laying the foundation for further randomised clinical trials.

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Misoprostol; Pilot Projects; Uterine Myomectomy; Uterine Neoplasms

Uterine leiomyomas are the most common benign tumours in women. Misoprostol, which is widely used in the treatment and prevention of postpartum haemorrhage in obstetrics, may decrease intra-operative bleeding in abdominal myomectomies when haemorrhage constitutes a challenging problem.. To assess the effect on intra-operative blood loss of using a single pre-operative dose of rectal misoprostol in abdominal myomectomy surgeries.. In a randomised double-blind placebo-controlled trial, 50 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre-operative of rectal 400 μg misoprostol (n = 25) or placebo (n = 25) 1 h before the operation. The primary outcome was intra-operative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT02061657.. Intra-operative blood loss was significantly lower in those women randomised to receive rectal misoprostol versus the placebo group (574 ± 194.8 mL vs 874 ± 171.5 mL). Additionally, the drop in postoperative haemoglobin was significantly less in the misoprostol group (1.7 ± 0.4 g/dL) compared with the placebo group (2.1 ± 0.5 g/dL).. A single pre-operative dose of rectal misoprostol (400 μg) is a simple applicable method for reducing intra-operative blood loss and operative time in abdominal myomectomy.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Double-Blind Method; Drug Administration Schedule; Female; Humans; Leiomyoma; Middle Aged; Misoprostol; Oxytocics; Preoperative Care; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms

To investigate whether use of preoperative misoprostol can reduce blood loss during total abdominal hysterectomy (TAH).. In a randomized double-blind placebo-controlled trial at a tertiary care hospital in Kolkata, India, between March 2011 and April 2012, women (n=132) undergoing TAH with or without bilateral salpingo-oophorectomy for symptomatic myomas were randomly allocated to receive either 400 μg of misoprostol or placebo 30 minutes before surgery. The primary outcome measure was intraoperative blood loss was. The secondary outcomes were postoperative drop in hemoglobin, need for blood transfusion, and incidence of adverse effects.. The 2 groups were similar with regard to demographic and clinical characteristics. There was a significant reduction of blood loss during TAH after sublingual administration of misoprostol compared with placebo before surgery (356 mL vs 435 mL; P=0.049). The mean postoperative hemoglobin concentration was higher (10.5 g/dL vs 9.5 g/dL; P<0.001) and the postoperative drop in hemoglobin was smaller (1.1g/dL vs 1.9 g/dL; P=0.004) in the misoprostol group than in the placebo group. No significant adverse effects occurred in either group.. The results showed that a single dose of misoprostol administered before abdominal hysterectomy resulted in a significant reduction of blood loss with minimal adverse effects. Clinical Trial Registry India (www.ctri.nic.in): CTRI/2011/091/000216.

Topics: Administration, Sublingual; Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Female; Follow-Up Studies; Hemoglobins; Humans; Hysterectomy; India; Leiomyoma; Middle Aged; Misoprostol; Ovariectomy; Oxytocics; Salpingectomy; Tertiary Care Centers; Treatment Outcome; Uterine Neoplasms

To compare the efficacy of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone as hemostatic agents for the reduction of blood loss during myomectomies.. Prospective, randomized, double-blind, controlled study.. University of the West Indies and Andrews Memorial Hospital.. Fifty women with symptomatic uterine fibroids, 25 receiving misoprostol and vasopressin and 25 receiving vasopressin alone before myomectomy.. Abdominal myomectomies on patients with symptomatic uterine fibroids.. Perioperative blood loss and febrile morbidity.. There were no statistically significant differences in sociodemographic, clinical, or myoma characteristics between the two groups at baseline. Postoperatively, there were no statistically significant differences in perioperative febrile morbidity or blood pressure between the groups. However, the group treated with misoprostol plus vasopressin had statistically significantly lower blood loss (geometric mean with 95% confidence interval, 334 mL [261 to 428] vs. 623 mL [354 to 1,094], a smaller change in hemoglobin (1.6 ± 1.5 vs. 3.0 ± 2.0), and a lower requirement for transfusion. In addition to treatment, significant determinants of blood loss were larger size of fibroids and greater number of fibroids.. We conclude that perivascular vasopressin plus misoprostol caused a significant reduction in blood loss compared with perivascular vasopressin alone.. NCT01700478.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Drug Therapy, Combination; Female; Hemostatic Techniques; Hemostatics; Humans; Jamaica; Leiomyoma; Misoprostol; Prospective Studies; Time Factors; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

We performed a randomized clinical trial to estimate whether preoperative use of misoprostol may reduce intraoperative blood loss of patients treated by minimally invasive surgery (MIS), such as laparoscopic (LM) or laparoscopically assisted myomectomy (LAM).. Sixty-seven menstruating patients with three or less myomas of a maximum diameter of 90 mm, scheduled for MIS, were randomly allocated to receive a preoperative single dose of intravaginal misoprostol or placebo. Sixty-four patients remained in the final analysis: 30 in the misoprostol (I) and 34 in the placebo group (II). Estimated blood loss (EBL), decline of postoperative hemoglobin (Hb) and side-effects of administered agent were the outcomes of main interest.. The EBL was significantly higher in the placebo versus misoprostol group (217 +/- 74 vs 126 +/- 41, respectively). Similarly, the decline of postoperative Hb was significantly higher in group II (1.6 +/- 0.43) compared to group I (1 +/- 0.33). The operative time was comparable in both groups, while the rate of side-effects was similar between groups.. The preoperative use of misoprostol in patients with uterine fibroids managed by minimally invasive surgery significantly reduces intraoperative blood loss. Misoprostol might be useful for the prevention of postoperative anemia in more extended minimal invasive interventions, such as myomectomy of large fibroids or laparoscopic hysterectomy.

Topics: Administration, Intravaginal; Adult; Blood Loss, Surgical; Chi-Square Distribution; Female; Hemoglobins; Humans; Laparoscopy; Leiomyoma; Misoprostol; Oxytocics; Pilot Projects; Prospective Studies; Uterine Neoplasms

To investigate the effectiveness of a single pre-operative dose of sublingual misoprostol on reducing blood loss in abdominal hysterectomies performed for symptomatic uterine leiomyomas.. A cohort of 64 women undergoing total abdominal hysterectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of sublingual 400 mcg misoprostol (n=32) or placebo containing 20mg vitamin B(6) (n=32) 30 min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were requirement for blood transfusion, change in haemoglobin level after operation, and the incidence of side effects.. Women who had misoprostol were found to have similar operative blood loss to those who had placebo (570.9 ± 361.3 ml versus 521.4 ± 297.4 ml, for misoprostol and placebo group respectively; P=0.803). This study with a sample size of 64 was sufficient to have 80% power at the 5% level of significance to detect a reduction of blood loss greater than or equal to 30%. There were no observed differences in the need for post-operative blood transfusion (25% versus 15.6%, for misoprostol and placebo group respectively; P=0.536), the change in haemoglobin level after the operation, and the side effects profiles between the two groups.. A single pre-operative dose of sublingual misoprostol is not effective in reducing intra-operative blood loss and need for post-operative blood transfusion after total abdominal hysterectomies for symptomatic uterine leiomyomas.

Topics: Administration, Sublingual; Adult; Blood Loss, Surgical; Double-Blind Method; Female; Humans; Hysterectomy; Leiomyoma; Middle Aged; Misoprostol; Oxytocics; Pilot Projects; Preoperative Care; Uterine Neoplasms

To investigate the effectiveness of uterotonics misoprostol and oxytocin on reducing blood loss during laparoscopy-assisted vaginal hysterectomy (LAVH).. Randomised, double-blind placebo-controlled trial.. University hospital.. One hundred and seventy-three women underwent LAVH for symptomatic uterine myomas and were randomly allocated to uterotonics (n = 91) or placebo (n = 82).. Women underwent LAVH for symptomatic uterine myomas and were randomly assigned to receive either rectal misoprostol (400 microg) and intravenous oxytocin (10 IU/hour) or placebo during LAVH. Parameters related to surgical outcome were compared.. The main outcome measure was intra-operative blood loss.. Patient characteristics and indications for LAVH were similar in both groups. Mean [SD] for all continuous data estimated weight of blood loss (198.1 [123.2] vs 396 [337.6] g; P < 0.0001), mean operation time (106.2 [39.4] vs 116.6 [34.6] minutes; P = 0.02), mean change in haemoglobin (1.5 [1.0] vs 1.9 [1.2] g/dL; P = 0.02) and haematocrit levels (4.8 [2.9]% vs 5.8 [3.6]%; P = 0.04) and mean hospitalisation period (3.3 [0.8] vs 3.9 [1.1] days; P < 0.0001), which were significantly less in the group given rectal misoprostol and intravenous oxytocin than in the placebo group, respectively. There was no significant difference in complications and side effects between the two groups (P > 0.05).. Combined rectal misoprostol and intravenous oxytocin is a feasible and effective method of reducing blood loss and operation time in LAVH.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Drug Therapy, Combination; Female; Humans; Hysterectomy, Vaginal; Infusions, Intravenous; Laparoscopy; Leiomyoma; Length of Stay; Middle Aged; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Treatment Outcome; Uterine Neoplasms

To investigate the effectiveness of a single preoperative dose of misoprostol in abdominal myomectomies.. Placebo-controlled randomized prospective study.. Department of obstetrics and gynecology in a university hospital.. Twenty-five women with symptomatic uterine leiomyomas.. Among patients undergoing abdominal myomectomies, an hour before the operation women in the study group (n = 13) were given a single dose of vaginal misoprostol (400 microg); those in the control group (n = 12) were given placebo.. Intraoperative blood loss, duration of operation, duration of postoperative hospitalization, and the need for blood transfusion were compared between the control and study groups.. Blood loss, operation time, and need for postoperative blood transfusion were significantly reduced in the group given vaginal misoprostol. No difference was observed among patients in terms of the time of hospitalization.. A single preoperative dose of vaginal misoprostol is a simple, reliable method for reducing intraoperative blood loss and need for postoperative blood transfusion after abdominal myomectomies.

Topics: Administration, Intravaginal; Adult; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Leiomyoma; Misoprostol; Prospective Studies; Uterine Neoplasms

Topics: Administration, Intravaginal; Blood Pressure; Double-Blind Method; Female; Functional Laterality; Humans; Leiomyoma; Misoprostol; Oxytocics; Premenopause; Regional Blood Flow; Uterine Neoplasms; Uterus; Vascular Resistance

To investigate the effectiveness of vaginal misoprostol for cervical priming before operative hysteroscopy and to assess the cervicouterine complications related to cervical dilatation and hysteroscopic surgery in nulliparous women.. One hundred fifty-two women with definite intrauterine lesions were randomly assigned to receive either 200 microg vaginal misoprostol or placebo. Cervical response and outcome and complications of operative hysteroscopy were assessed.. Thirty-five subjects were needed in each arm to detect a type I error of 0.01 with a power of 0.99. The mean cervical dilatation estimated by Hegar dilator was significantly different between the treated group (7.3 +/- 0.7 mm) and the control group (3.8 +/- 1.1 mm, P <.001). In the misoprostol group, 55 (75.3%) patients needed cervical dilation, compared with 75 (94.9%, P =.001) in the placebo group. The median time of cervical dilation to Hegar number 9 was significantly shorter in the treated group (40 seconds) compared with the control group (120 seconds, P <.001). The mean operative time was significantly shorter in the treated group (36.4 +/- 10.9 minutes) compared with the control group (45.9 +/- 14.2 minutes, P <.001). Cervical tears occurred in nine (11.4%) patients in the control group and in one (1.4%, P =.018) in the misoprostol group. Creation of a false tract was more common in the control group. Two uterine perforations occurred in the placebo group.. Vaginal misoprostol applied before operative hysteroscopy reduced the need for cervical dilation, facilitated hysteroscopic surgery, and minimized cervical complications.

Topics: Administration, Intravaginal; Adolescent; Adult; Aged; Cervix Uteri; Female; Humans; Hysteroscopy; Leiomyoma; Middle Aged; Misoprostol; Polyps; Premedication; Tissue Adhesions; Uterine Diseases; Uterine Neoplasms

In this study, we aimed to evaluate the effect of using two doses of rectal misoprostol on postoperative results in hysteroscopic myomectomy.. This retrospective study was carried out at two hospitals in which the medical records of patients who underwent hysteroscopic myomectomy between November 2017 and April 2022 were evaluated, and subjects were grouped depending on the administration of misoprostol before hysteroscopy. In recipients, two rectal doses of misoprostol (400 μg) were administered, 12 h and 1 h before the planned operation. Outcomes evaluated were: postoperative reduction in hemoglobin (Hb), pain at 12 and 24 h (VAS score), and length of hospital stay.. The mean age of 47 women in the study group was 27.38 ± 5.12 (range 20-38) years. Hb levels reduced significantly in both groups after hysteroscopic myomectomy (p < 0.001). In misoprostol recipients, VAS score was found to be significantly lower at 12 h (p < 0.001) and 24 h after the operation (p = 0.004). Multiple linear regression analyses for each of the outcomes revealed the following: greater myoma size was associated with greater Hb decrease (p = 0.010), misoprostol use was associated with lower 12th and 24th hour VAS scores (p < 0.001), longer duration of operation was associated with higher 12th and 24th hour VAS scores (p < 0.001), and finally, longer duration of operation was associated with prolonged hospital stay (p = 0.001).. The use of two doses of rectal misoprostol before hysteroscopic myomectomy was effective in reducing postoperative pain. Prospective, population-based studies evaluating different uses of misoprostol in hysteroscopic myomectomy are needed.

Topics: Adult; Female; Humans; Hysteroscopy; Leiomyoma; Misoprostol; Pain, Postoperative; Pregnancy; Prospective Studies; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms; Young Adult

Uterine fibroids (UFs) are very common benign tumors of the female reproductive tract. According to recent reports, magnetic resonance-guided high-intensity ultrasound (MR-HIFU) appears to be a well-tolerated and efficient treatment option for UFs. However, MR-HIFU still presents several limitations. The treatment is rarely associated with achieving complete non-perfused volume (NPV). Not all patients are qualified for a final procedure, and selected women obtain very good results in such treatment. The primary objective of this experimental study was to assess the effect of transvaginal misoprostol and intravenous oxytocin preparation on UF volume change, sonication time and NPV after MR-HIFU procedure in women of reproductive age with symptomatic UFs. Secondary outcomes included the effect on the peri-procedural effectiveness of misoprostol and oxytocin. This study enrolled 247 women with symptomatic UFs; based on gynecologic examinations and magnetic resonance imaging (MRI) scans, 128 women qualified for MR-HIFU without pharmacologic treatment, 57 women qualified for the misoprostol/diclofenac group and 62 women qualified for the oxytocin group. Pharmacologic pre-treatment improved NPV compared with non-pharmacologic treatment (average NPV: controls 61.9% ± 25.8%; oxytocin 76.8% ± 20.7%; misoprostol/diclofenac 85.2% ± 15.1%; average sonication time: controls 120 min ± 56.4%; oxytocin 111 min ± 45.4%; misoprostol/diclofenac 80 min ± 47.7%). Statistical analysis did not reveal significant intergroup differences in UF volume changes after 6 mo (controls: n = 40, 37.4% ± 27.5%; oxytocin n = 25, 45.8% ± 31%; misoprostol/diclofenac n = 19, 33.4% ± 23.2%). The misoprostol/diclofenac group, which achieved the highest NPV immediately after the MR-HIFU procedure, was characterized by the lowest UF volume change percentages 6 mo later. The administration of vasoconstrictor drugs (oxytocin and misoprostol/diclofenac) to support MR-HIFU in UF treatment is a new issue that may improve the total effectiveness of this method. Randomized controlled trials are necessary to estimate the real effect of vasoconstrictors on MR-HIFU.

Topics: Adult; Cohort Studies; Combined Modality Therapy; Diclofenac; Drug Combinations; Female; High-Intensity Focused Ultrasound Ablation; Humans; Leiomyoma; Magnetic Resonance Imaging, Interventional; Misoprostol; Oxytocin; Preoperative Period; Prospective Studies; Surgery, Computer-Assisted; Uterine Neoplasms; Young Adult

Laparoscopic myomectomy may be associated with considerable blood loss, especially in patients in whom no specific hemostatic measures are used. We conducted this retrospective comparative study to investigate whether misoprosol is an effective and safe alternative to vasopressin when used as single hemostatic agent in laparoscopic myomectomy.. Two hundred cases undergoing laparoscopic myomectomy (-ies), were included. Of these, 50 pre-treated with vaginal misoprostol 400mcg 1 h before surgery (group 1), were compared with two historic consecutive groups: 100 patients treated with intraoperative intra-myometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2), and 50 treated without use of any hemostatic agent (group3).. Mean procedure length did not differ significantly between the three groups (127.9 vs 100.6 vs 130.8 min). Mean estimated blood loss (EBL) was 179.7 ± 200.0 mL in group 1, compared with 147.8 ± 171.8 mL in group 2 (P = 0.793) and 321.8 ± 246.0 mL in group 3, respectively (P < 0.001). EBL was lower in group 2 in most of the study's subgroups of patients stratified according to size and number of fibroids compared with group 1, with the exception of patients with ≥4 fibroids, and ≥7 cm in size. In these subgroups, misoprostol appeared more effective. Neither agent was associated with serious adverse events.. Vaginal misoprostol can be effective in reducing blood loss during laparoscopic myomectomy. Although rates of EBL are, in general, higher compared with those obtained with vasopressin, they are significantly reduced compared with those observed when no hemostatic agent is used. In extended procedures, vaginal misoprostol, due to its prolonged uterotonic action, may be associated with reduced blood loss compared with vasopressin.

Topics: Blood Loss, Surgical; Female; Hemostatics; Humans; Laparoscopy; Misoprostol; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Women with fibroid uteri seeking surgical abortion often represent a unique challenge. When the uterine cavity is significantly enlarged or distorted making surgical evacuation difficult or impossible, we offer medical abortion using mifepristone followed by misoprostol beyond the standard 63- to 70-day gestational age cutoff that is typically recommended. This case series describes our regimen and outcomes for 6 patients from 10 to 13 weeks gestation underdoing outpatient medical abortion and 6 patients from 14 to 20 weeks gestation undergoing inpatient medical abortion. Three patients required evacuation for retained products and all others had successful medical abortions without complications.

Topics: Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Adult; Drug Administration Schedule; Female; Gestational Age; Humans; Leiomyoma; Maryland; Mifepristone; Misoprostol; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimester, First; Pregnancy Trimester, Second; Uterine Neoplasms

Medical abortion in women with the scar of a classical caesarean section (CS) and a large uterine leiomyoma is rarely attempted; it carries the risk of uterine rupture and haemorrhage.. A 34-year-old multiparous woman with prior classical CS and a 14 × 10 × 9 cm leiomyoma arising from the uterine isthmus had an induced abortion at 14 weeks' gestation. Mechanical cervical priming with Dilapan(®)-S followed by vaginal misoprostol administration resulted in the uncomplicated expulsion of the uterine contents.. An early second trimester medical abortion with misoprostol was successfully performed in a woman with prior classical CS and a large uterine leiomyoma.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Adult; Cesarean Section; Cicatrix; Female; Humans; Leiomyoma; Misoprostol; Polymers; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimester, Second; Ultrasonography; Uterine Neoplasms

Triploidy is a highly lethal condition, and is thus very rarely observed in live births. It may result in significant medical risk to the pregnant woman.. A 32-year-old multigravid woman presented for prenatal care. Ultrasound examination at 14+3 weeks of gestation revealed a viable fetus with appropriate fetal biometry, but with evidence of chorioamniotic separation (CAS) and persistence of the yolk sac. Two weeks later, repeat ultrasound showed a large multicystic placenta and early fetal symmetrical growth restriction with persistence of CAS and yolk sac, raising the suspicion of fetal aneuploidy. Amniocentesis showed a fetal karyotype of 69,XXX. The histology of the placental tissue was a partial hydatidiform mole.. Persistence of chorioamniotic separation and yolk sac during the early second trimester cannot be considered a reassuring finding. In such cases, fetal karyotyping should be considered, especially when an additional abnormality is found.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Chorion; Female; Humans; Hydatidiform Mole; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Triploidy; Ultrasonography; Uterine Neoplasms; Yolk Sac

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

Early elective medical abortion is performed frequently in different countries of the world. Serious complications like gestational trophoblastic neoplasia (GTN) are uncommon and mostly nonmetastatic. High risk metastatic GTN following medical abortion is a rare event which may occur coincidentally.. A 26 year-old-woman, gravida 2 para 1, 6 weeks after misoprostol abortion presented with sever nausea, vomiting, and right upper abdominal pain. Human chorionic gonadotropin (hCG) level was 2,500,000 mIU/ml and metastatic work up revealed multiple liver metastases. She totally received nine cycles of EMA-CO (ethoposide- methotrexate- actinomycin- cyclophosphamide, vincristine) regimen for treatment and consolidation. Six months after treatment she is in complete remission.. Follow up of patients after medical abortion by means of single serum hCG measurement is highly recommended for early diagnosis of complications including gestational trophoblastic tumor. EMA-CO regimen seems to be an effective and safe treatment for liver metastatic gestational trophoblastic neoplasia.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Dactinomycin; Etoposide; Female; Gestational Trophoblastic Disease; Humans; Liver Neoplasms; Methotrexate; Misoprostol; Pregnancy; Uterine Neoplasms; Vincristine

Office hysteroscopy may be performed without anaesthesia. Endometrial biopsy can be performed during hysteroscopy. Antalgics or other treatment to reduce discomfort are not indicated. Prophylactic antibiotics are not indicated. Diagnostic value of hysteroscopy for endometrial pathology is interesting. Pipelle is the most appropriate instrument for endometrial biopsy.

Topics: Anesthesia, Local; Antibiotic Prophylaxis; Biopsy; Endometrial Hyperplasia; Endometriosis; Endometrium; Female; Humans; Hysteroscopy; Leiomyoma; Metrorrhagia; Misoprostol; Sensitivity and Specificity; Uterine Neoplasms

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Misoprostol; Preoperative Care; Uterine Neoplasms

Topics: Administration, Intravaginal; Blood Loss, Surgical; Female; Humans; Leiomyoma; Misoprostol; Preoperative Care; Time Factors; Uterine Neoplasms

We report an unusual pregnancy with a complete hydatiform mole coexisting with a normal fetus and placenta. This report stresses the importance of a correct diagnosis and the dilemmas the clinician is faced with when managing such a case. Malignant trophoblastic disease occurs in 55% of complete hydatiform mole and fetus. Two-thirds require combination chemotherapy.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Antimetabolites, Antineoplastic; Diagnosis, Differential; Female; Humans; Hydatidiform Mole, Invasive; Methotrexate; Misoprostol; Pregnancy; Pregnancy, Multiple; Trophoblastic Neoplasms; Twins; Uterine Neoplasms

For women with abnormal uterine anatomy that would make operative abortion technically difficult or impossible, a medically induced abortion may be the only option for pregnancy termination. Methotrexate and misoprostol were used to effect an early abortion in a woman with a markedly enlarged leiomyomatous uterus.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Female; Humans; Leiomyoma; Methotrexate; Misoprostol; Pregnancy; Pregnancy Complications, Neoplastic; Uterine Neoplasms

We have studied the use of sulprostone in evacuating uterine contents in 32 patients, the majority of whom were in the second trimester of their pregnancies. There are three ways to administer the drug (continuous intravenous, intermittent intravenous, and intramuscular); the best results were obtained when the drug was administered continuously intravenously. It was well tolerated, the use of Nalbuphine reducing pain. There were few side effects. The use of this product is discussed in connection with a few of the cases as well as the possible alternative treatments in difficult cases.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Cicatrix; Contraindications; Dinoprostone; Drug Tolerance; Female; France; Gestational Age; Humans; Hydatidiform Mole; Infusions, Intravenous; Injections, Intramuscular; Injections, Intravenous; Mifepristone; Misoprostol; Polyhydramnios; Pregnancy; Retrospective Studies; Time Factors; Uterine Diseases; Uterine Neoplasms