ABSTRACT
We want to compare the efficacy and safety of vaginal versus sublingual misoprostol for cervical ripening and induction of labor. This randomized clinical trial was performed on 140 women with medical or obstetric indications for labor induction. The patients were randomly divided into two groups: vaginal and sublingual administration of misoprostol. In first group, 25 Micro g misoprostol was placed in the posterior fornix of the vagina and second group received 25 Micro g misoprostol sublingually, every 6 hours for 24 h. Maternal and neonatal outcomes were analyzed. There was no significant difference in the demographic characteristics between two groups. The main indication for cesarean section in both groups was fetal distress, followed by absence of active labor progress. Evaluation of cesarean indication was not significantly different in two groups; including fetal distress, absence of active labor, uterine over activity and failure to progress. The maternal complication in sublingual group included residual placenta [2%], tachysystole [2%], vomiting [12%], atoni [3.3%] and abdominal pain [5.5%], although there was no significant difference between two groups. Sublingual misoprostol is as effective as vaginal misoprostol for induction of labor at term. However, sublingual misoprostol has the advantage of easy administration and may be more suitable than vaginal misoprostol
ABSTRACT
Concurrent chemoradiotherapy [EBRT + cisplatin] plus intracavitary brachytherapy is the standard of care in patients with advanced cervical cancer. However, a number of patients could not undergone brachytherapy due to massive residual tumor or anatomical distortion. In this study, we have evaluated the treatment outcome in patients with locally advanced cervical cancer, undergone conventional EBRT plus cisplatin based chemotherapy. In this study, we have selected patients with locally advanced cervical carcinoma [stage: IIB to IIIB] undergone external beam radiotherapy and chemotherapy without brachytherapy at our institute between October of 2007 and October of 2009. The patients have received 50 Gy within 5 weeks to whole pelvic that has followed by a localized boost dose on tumor to 70 Gy concurrently with cisplatin 35 mg/m2 weekly. The treatment has related toxicities, and survival [overall and disease free] have evaluated. 30 cases with a median age of 55 [range; 40 to 73] have been studied. According to FIGO classification, the clinical stages were as follows: stage: IIB 23, IIIA 4, and IIIB 3 cases. Three months after treatment, 19 patients [63.3%] have achieved complete response. With a median follow up time of 18 months [range; 10-33 months], 8/23 cases [34.7%] with stage IIB and 2/7 [28.5%] among stage IIIA-IIIB remained disease free at the end of follow up. Data have shown a 2- year overall survival rate of 58.7% +/- 9% and 2- year disease free survival of 37.7% +/- 9% . Most toxicities were grade I and II. 2 [6.6%] grade III diarrhea and 4 [13.3%] grade III neutropenia have recorded. Although a considerable number of patients have achieved complete response using concurrent chemoradiotherapy without brachytherapy, the overall treatment outcomes especially for stage IIIA-IIIB were unsatisfactory. Using modern radiation therapy techniques with increased delivered boost dose could improve treatment results