Comparison of Manual Vacuum Aspiration and Misoprostol in the Management of Incomplete Abortion

Background: Incomplete abortions can be managed expectantly; surgically and medically (using misoprostol). Expectant management is safe in places where women have access to information; appropriate care and follow-up; however; in isolated and poor areas women who come for help need an intervention.Objective: To compare the efficiency of manual vacuum aspiration (MVA) and misoprostol in the treatment of incomplete abortion.Patients and method: This was a prospective study over five months from March to August 2015. All patients admitted with a diagnosis of incomplete abortion were recruited into the study.Results: 308 patients with incomplete abortion were randomized into two treatment groups - MVA (done under local anaesthesia) and misoprostol (400 micrograms by the vaginal route). MVA was successfully performed for all patients. Two patients presented with anaemia. In the misoprostol group; 23 patients had vaginal bleeding; and 10 persistence of incomplete abortion. Conclusion: MVA is more effective than misoprostol with less complications in the treatment of incomplete abortion when it is done by a trained person

Comparison of 25 and 50 Microgram of Misoprostol for Induction of Labour in Nulliparous Women with Postdate Pregnancy in Port Harcourt

Background: Induction of labor for postdate pregnancy using misoprostol is one of the most common interventions in pregnancy. However; the optimal dose of misoprostol is yet to be determined with previous reports utilizing different dosages. Objective: The main objective of this study was to compare the effectiveness and safety of 25 ?g versus 50 ?g of intravaginal misoprostol for induction of labor in nulliparous women with postdate pregnancy. Methodology: This was a prospective study in which 88 nulliparous women with postdate pregnancy were randomly selected to receive either 25 ?g or 50 ?g of misoprostol for induction of labor. Student's t-test and Chi-square test were used to compare proportions. Results: There was no significant difference between the two groups with regard to the induction-vaginal delivery interval between the two doses. The proportion of women delivering vaginally with a single dose of misoprostol (11/40 vs. 23/43; P = 0.01) and vomiting were significantly greater in the 50 ?g group. However; there was no significant difference between both groups in terms of the need for augmentation of labor; caesarean section; tachysystole and hyperstimulation syndrome. Conclusion: Intravaginal administration of 25 ?g of misoprostol appears to be as effective; but safer than 50 ?g for induction of labor in nulliparous women with postdate pregnancy

A comparison of orally administered misoprostol and membrane sweeping for labour induction in uncomplicated singleton post-term pregnancies

Objectives. This study assessed the efficacy of the two outpatient processes of single-dose 50 µg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/labour induction in uncomplicated post-term singleton pregnancies at a tertiary health institution in south-western Nigeria. Methods. A total of 100 patients were equally randomised into the two groups between April 2007 and March 2010. Primary outcome measures were delivery within 48 hours after the start of induction and route of delivery. Secondary outcome measures were time interval from induction to onset of labour (latency period), time interval from start of induction to delivery (duration of labour), need for oxytocin augmentation, labour complications, Apgar scores at 1 and 5 minutes, and need for neonatal intensive care unit (NICU) admission. Results. Both groups were similar at the baseline with regard to age, parity and days beyond 40 weeks' gestation. There was a significantly shorter induction to onset of labour (latency) interval in the OM group, with a mean of 17.0 hours compared with 31.9 hours in the MS group (p=0.005), with 82.0% of the patients in the OM group in spontaneous labour within the latency period of 18 hours as opposed to 32.6% of the MS group (p<0.005). Forty-two patients in the OM group and 40 in the MS group had a vaginal delivery (84.0% v. 87.0%, p=0.361), with 12 and 20 patients in the OM and MS groups, respectively, requiring oxytocin augmentation (p=0.023). The duration of labour was significantly shorter in the OM group, in which 78.6% of those who had a vaginal delivery achieved it within 9 hours, compared with 57.5% in the MS group (p=0.036). Overall, neonatal outcomes and need for NICU admission were similar and comparable in the two groups. On a preference scale, 43% of the women in the MS group felt positive about the intervention, compared with 92% of the women in the OM group. Conclusion. The study demonstrated a shorter latency period, less need for oxytocin augmentation and shorter duration of labour in patients who received OM. The two induction agents were similar with regard to neonatal outcomes and need for NICU admission. Both showed good safety profiles for outpatient care, although further assessment of the safety profile with larger studies will be needed. More patients felt positive about the intervention in the OM group than in the MS group

Prevention of postpartum hemorrhage: options for home births in rural Ethiopia

This paper sought to determine the safety and feasibility of home-based prophylaxis of postpartum hemorrhage (PPH) with misoprostol, including assessment of the need for referrals and additional interventions. In rural Tigray, Ethiopia, traditional birth attendants (TBAs) in intervention areas were trained to administer 600mcg of oral misoprostol. In non-intervention areas women were referred to the nearest health facility. Of the 966 vaginal deliveries attended by TBAs, only 8.9% of those who took misoprostol prophylactically (n=485) needed additional intervention due to excessive bleeding compared to 18.9% of those who did not take misoprostol (n=481).The experience of symptoms among those who used misoprostol can be considered of minor relevance and self-contained. This study found that prophylactic use of misoprostol in home births is a safe and feasible intervention. Community health care workers trained in its use can correctly and effectively administer misoprostol and be a champion in reducing PPH morbidity and mortality (Afr J Reprod Health 2009; 13[2]:87-95)

Methods of Induction of Labour at the University of Maiduguri Teaching Hospital, Maiduguri: A 4-Year Review

Background: Induction of labour is an important intervention in obstetrics. Misoprostol is increasingly being used for induction of labour in many obstetric units and it may replace the traditional Foleys catheter/oxytocin protocol. Method: This was a retrospective study of the 3 methods of induction of labour used at the University of Maiduguri Teaching Hospital (UMTH). A total of 468 women had induction of labour during the study period. Two hundred and twenty eight of them had induction with 50?g of misoprostol; 57 women had 100?g of misoprostol while 183 women had extra-amniotic Foleys catheter with oxytocin infusion. Result: Induction of labour constituted 6.6(468/7086) of all deliveries during the study period. The commonest indication for induction of labour was prolonged pregnancy in 46.8; followed by pregnancy induced hypertension in 33.5. There was no difference in the achievement of vaginal delivery between the 3 methods of induction of labour (x2=1.13; p=0.57). The mean induction delivery time was shortest for those induced with 100?g of misoprostol (6.38+2.25 hours); followed by 8.16+3.58 hours in those induced with 50ug of misoprostol and 9.73+4.32.43 hours in those induced with Foleys catheter/oxytocin (p

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness; low cost; stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect; uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use.Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100?g of isoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously; then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness; low cost; stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect; uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use.Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100?g of isoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously; then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC