misoprostol and Uterine-Perforation

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

The study aims to compare the safety and effectiveness of 200 and 400 µg of oral misoprostol for cervical priming before hysteroscopy.. A double-blinded randomized study included 70 patients scheduled for hysteroscopy in a Lebanese University Hospital. Two dosages of oral misoprostol (200 or 400 µg) were randomly distributed to these patients 1 h before surgery under general anesthesia. Subjective assessment of the ease of dilatation, size of the first used Hegar, cervical injuries, bleeding or uterine perforation, duration of the procedure and misoprostol adverse effect were all noted and compared.. The difficulty of dilation until a Hegar 10 was similar for both treatment groups. Operative time was not reduced with a higher misoprostol dosage. We found 2 uterine perforations within the 200 µg group (6.7%), and none within the 400 µg group. Cervical lacerations and bleeding were similar (20%) for both treatment groups. A 2-fold increase in side effects (nausea, vomiting and cramps) is reported among the 400 µg group.. Increasing the dose of misoprostol from 200 to 400 mg doubled the rate of side effects while no clinical benefit was noted. Larger trials are needed to assess rates of uterine perforation with the 200 µg dosage.

Topics: Adult; Cervix Uteri; Colic; Dilatation; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Hysteroscopy; Lacerations; Middle Aged; Misoprostol; Nausea; Oxytocics; Pregnancy; Preoperative Care; Uterine Perforation; Vomiting

To compare the effectiveness of oral and vaginal misoprostol for preoperative cervical ripening in premenopausal women before hysteroscopic surgery.. Placebo-controlled, double blind, randomized trial.. University hospital.. Eighty-six premenopausal women eligible for operative hysteroscopy were recruited. Nine women were excluded from the study.. Patients were randomly assigned to receive 400 microg of misoprostol orally (n = 39) or vaginally (n = 38), 10-12 hours before operative hysteroscopy.. Extent of initial cervical width, percentage of patients requiring cervical dilatation, duration of cervical dilatation and surgical procedure, complications during procedure, and associated side effects.. Mean cervical widths in the vaginal and oral misoprostol groups after treatment were 7.3 +/- 1.6 mm and 6.0 +/- 1.5 mm, respectively, which was a statistically significant difference. Time required for cervical dilatation (98.6 +/- 88.7 s vs. 49.1 +/- 34.9 s) and duration of surgery (14.5 +/- 6 vs. 7.7 +/- 4.0 min) was statistically significantly shorter in the vaginal misoprostol group. The percentage of women with an initial cervical width of 9 mm was statistically significantly higher in the vaginal misoprostol group (36.8% vs. 5.1%). Uterine perforation occurred in two patients in the oral misoprostol group and in none in the vaginal misoprostol group. Side effects were comparable between the two treatment groups.. Vaginal administration of misoprostol is more effective than the oral route for preoperative cervical ripening in premenopausal women.

Topics: Administration, Intravaginal; Administration, Oral; Adult; Cervical Ripening; Double-Blind Method; Drug Administration Schedule; Female; Humans; Hysteroscopy; Labor Stage, First; Misoprostol; Oxytocics; Pregnancy; Premenopause; Preoperative Care; Prospective Studies; Time Factors; Treatment Outcome; Uterine Perforation; Uterus

Silent uterine rupture in an unscarred uterus during pregnancy is rare. We present a case of silent uterine rupture in an unscarred uterus at third-trimester abortion by use of mifepristone and misoprostol in a patient who had a history of intrauterine procedures. The absence of clinical symptoms suggests that this uterine rupture resulted from an unrecognized perforation in a previous intrauterine manipulation. Routine sonographic follow-up examinations and careful clinical observations are especially recommended for women with previous intrauterine manipulations.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, Third; Suture Techniques; Uterine Perforation; Uterine Rupture

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

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

The purpose of this study was to determine the rate of serious adverse events (SAEs) occurring during early second trimester surgical abortion performed following the use of misoprostol alone for cervical preparation.. A retrospective review was undertaken of 6620 elective surgical abortions performed between 12 and 16 weeks estimated gestational age during a 68-month period following cervical preparation with misoprostol alone. Information was obtained from a computer-based practice management system.. During the study period, four SAEs occurred: three uterine perforations and one case of hemorrhage secondary to placenta accreta. The perforation rate was 0.45 (95% CI=0.09-1.32) per 1000 abortions.. This review of our experience with surgical abortion performed from 12 to 16 weeks estimated gestational age following cervical preparation with misoprostol alone shows that the rate of SAEs, specifically uterine perforation, in this group was no greater than that previously reported in the literature.

Topics: Abortion, Induced; Adolescent; Adult; Cervical Ripening; Dilatation and Curettage; Female; Humans; Incidence; Los Angeles; Medical Audit; Misoprostol; Oxytocics; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Uterine Perforation; Voluntary Health Agencies; Young Adult