Oral versus rectal misoprostol in the treatment of menorrhagia

Excessive menstrual loss is a major problem. Effective medical treatments exist and its increased use will improve patient choice and provide an alternative to surgery. Evaluation of the effects of oral and rectal misoprostol in the treatment of excessive blood loss in cases of menorrhagia and comparing between both routes. Sixty women complaining of regular but heavy periods [menorrhagia] were included in the study. They were divided into two equal groups. Both groups were evaluated in two consecutive menstrual cycles. First without treatment [basal value] and the second cycle by either rectal misoprostol tablets [three times daily for the first three days of the bleeding] or by oral misoprostol tablets [one tablet three times daily for the first three days of the bleeding]. For both groups the estimated menstrual blood loss [EBL] was assessed before and after treatment using subjective and objective assessment. A highly statistical significant reduction in menstrual blood loss occurred by treatment in both groups [p=0.000]. Rectal misoprostol produced the highest reduction in the menstrual blood loss with a percent change of 53.45%, while oral misoprostol was less effective in reducing the menstrual blood loss with a percent change of 36.15% Both routes were effective in improving dysmenorrhea and reducing the number of cycle days with no significant differences between them. Both rectal and oral misoprostol are save and effective routes for reducing excessive menstrual blood loss [menorrhagia], but rectal route is more effective

Comparative study between the use of rectal misoproostol versus intravenous syntometrine in the active management of the third stage of labour

Postpartum hemorrhage is one of the major maternal killers. The use of uterotonics reduces the occurance of atonic postpartum hemorrhage. Oral Misoprostol [prostaglandin E1 analogue] used for the prevention of peptic ulcer disease was reported to prevent postpartum hemorrhage The present study is to compare between the effectiveness and side effects of rectally administered PG E1 analogue [misoprostol] and IV Syntometrine [0.5 mg a methyl ergometrine plus 5 IU of syntocinon] for prevention of atonic postpartum hemorrhage minimizing blood loss during the early postpartum period. Prospective randomized study. Three hundred cases who attended in El-Shatby Maternity Hospital, Obstetrics and Gynecology Department, Alexandria University were included in the study. All patients had a fuliterm living single fetus, presenting by the vertex, with a smooth course of the 1st and 2nd stages of labour. Cases were categorized into 3 groups: Group A [100 cases]: received Syntometrine in intravenous infusion of 500 ml saline immediately after delivery of the baby. Group B [100 cases]: received 2 tablets of Mesotec [total of 400 ug] rectally immediately after delivery of the baby. Group C [100 cases]: received IV infusion of 500 ml saline without any medications and placebo tablets rectally immediately after delivery of the baby. The amount of blood lost was evaluated by visual estimation, calculation, and lab parameters. Misoprostol with its rapid onset of action was more effective than intravenous infusion of syntometrine and placebo in terms of minimization of the amount of blood loss, shortening the duration of the third stage, in addition to decreasing the rate of postpartum hemorrhage. It is also cheap, more stable, and has less side effects

Treatment of ovulatory dysfunctional uterine bleeding with oral misoprostol: a comparative study

Evaluation of the effects of oral misoprostol in the control of excessive menstrual blood loss in cases of ovulatory dysfunctional uterine bleeding in comparison to antiflbrinolytic and antiprostaglandin therapy. Eighty-six patients with objective menorrhagia secondary to ovulatory dysfunctional uterine bleeding completed this prospective randomized comparative clinical trial of treatment with tranexamic acid [31 patients-group I], misoprostol [29 patients-group II], and mefenamic acid [26 patients-group III]. Treatment was given during menorrhagia for three cycles. Treatment started on day one of menstruation for five days. Menstrual blood loss was assessed before and after treatment using subjective and objective assessment. Pulsatility index [PI] and resistance index [RI] were measured from the uterine arteries before starting treatment and during the third cycle of treatment in all patients. A highly statistical significant reduction in menstrual blood loss occurred by treatment in the three groups [P=0.000]. Tranexamic acid produced the highest reduction in menstrual blood loss [reduced menstrual blood loss by a mean of 125.87 ml which represents a reduction of 48%]. Oral misoprostol was less effective than tranexamic acid [a mean reduction of 91.58 ml which represents a reduction of 35.85%] but more effective than mefenamic acid [a mean reduction of 83.66 ml which represents a reduction of 30.75], however the only significant statistical difference was between tranexamic acid and mefenamic acid [P=0.03]. Patient satisfaction as shown by the desire to continue treatment after the end of the study was high in groups I [71%] and II [62%]. On the other hand, only 15 [57.7%] of patients taking mefenamic acid [group III] wished to continue the treatment. There was no significant statistical difference between the three groups concerning the PI and RI before and after treatment. Oral misoprostol can be added to the medical lines of treatment of ovulatory menorrhagia

Optimization of the time and dose of intravenous syntocinon in cases of elective caesarean section under general anesthesia

Oxytocics are routinely used in an attempt to prevent excessive blood loss during cesarean section [cs]. Several investigators have evaluated the use of different doses of oxytocin during cesarean section under regional anesthesia. Since oxytocin has dose-dependent side effects, it appears prudent to use the minimal effective dose. The objective of the study is to optimize the dose and time of syntocinon infusion to prevent postpartum hemorrhage in patients undergoing elective cesarean section under general anesthesia. 504 full term pregnant women undergoing elective cesarean section under general anesthesia were randomized either to receive 5IUsyntocinon [R] [Synthetic oxytocin, Novartis-pharma] [before cs, at the start of cs,or after closure of the uterus], 10 IU syntocinon [before cs, at the start of cs, or after closure of the uterus], 20 IU syntocinon [before cs, at the start of cs, or after closure of the uterus], or infusion containing no syntocinon [control group]. The primary outcome measures were estimated blood loss [EBL], changes in hemoglobin [Hb] and in hematocrit [Hct]. Baseline characteristics in terms of age, gravidity, parity, weight, height, preoperative blood pressure, preoperative Hb and preoperative Hct were similar in all groups. The EBL was high in the control group but it was similar in all study groups and subgroups. Giving 5 IU syntocinon before or during cesarean section is preferred on giving it after in terms of significant reductions in both Hb and Hct. The results of this randomized, controlled, double blind study have demonstrated that there is no benefit on uterine tone and blood loss of administering more than 5 IU oxytocin during elective cesarean section under general anesthesia

Etiological factors in urinary incontinence in elderly female patients

Thirty incontinent women [above 60 years] were evaluated by full history, physical examination, voiding diary and full urodynamic studies. Another, 10 post menopausal women were studied as a control. Urodynamic data did not correlate with patient's symptomatology. No significant abnormal urodynamic data were encountered in control group. Females with urge incontinence showed detrusor instability in 53.8%, hypocompliance in 46.2% and higher level of infravesical urethral resistance than other types of incontinence, genuine stress incontinence was present in only 13.3% of patients, the above data point to the importance of studying elderly incontinent females urodynamically to establish the exact underlying defect

Induction of labour in cases of postmaturity by the use of the atad catheter

Our aim was to compare the safety and efficacy of the Atad's double balloon device versus the Foley's catheter for induction of labour in cases of postmaturity. Randomized prospective study performed in Shatby maternity Hospital. The study included sixty patients with postmaturity. The cases were randomly assigned into two groups. In the first group [30 cases] the Atad double balloon device was inserted. In the second group [30 cases] the Foley's catheter was inserted. Prophylactic antibiotic was given to all cases. Although the Atad double balloon device insertion was associated with more discomfort than Foley's catheter insertion, it was associated with shorter induction delivery interval, lower failure rate and lower Caesarean section rate. The Atad's catheter is superior to foly's catheter for labour induction in postmaturity