randomized controlled trial of oral misoprostol for the third stage of labor

To compare oral misoprostol with conventional oxytocics in the management of the third stage of labor. In a controlled trial, 1574 women were randomized into four groups, as follows: Group 1 received intravenous infusion of oxytocin 10 IU plus oral misoprostol 400 micro g. followed by two doses of oral misoprostol 100 micro g 4 hours apart: Group 2 received oral misoprostol 404 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 3 received intravenous infusion of oxytocin 10 lU; and group 4 received intravenous infusion of oxtytocin 10 lU plus intramuscular administration of methylergonovine maleate [Methergine] 0.2 ma. The incidence of postpartum hemorrhage and decrease in hemoglobin concentration from before delivery to 24 hours postpartum were the main outcome measures. The primary outcome measures were similar in groups 2 and 3. The incidence of postpartum hemorrhage was 9% in group 2. compared with 3.2% in group 1 and 3.5% in group 4 [P<.01, and P = .01, respectively]. There were no significant differences among the four groups regarding hemoglobin concentrations. Significantly more women needed additional oxytocin in group 2, when compared with group 4 [5.9%, versus 2.2%: P = .01]. The proportion of women requiring additional methylergonovine maleate was 4.8% in group 2, compared with 0.7% in group 1 and 1% in group 4 [P < .01 and P = .01, respectively]. Oral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage; it is less effective than oxytocin plus methylergonovine maleate and oral misoprostol plus oxytocin

comparative study of step-down dose, low-dose step-up and sequential step-up and step down regimens of human menopausal gonadotrophin for patients with polycystic ovary syndrome

To compare the efficacy and safety of the step-down dose, low-dose step up and sequential step-up and step-down regimens of human menopausal gonadotrophins [hMG] for women with poly cystic ovary syndrome [PCOS]. A prospective randomized study involved 68 stimulation cycles in 61 patients with PCOS divided as 24 cycles with step-down dose regimen, 25 cycles with low-dose step-up regimen and 19 cycles with sequential step-up and step-down protocol. The step-down regimen consisted of 225 IU/day of the hMG for the first 2 days, followed by 150 IU/day until the follicular diameter reached 9 mm after which the dose was decreased to 75 IU/day for the next 7 days. The low-dose step-up protocol consisted of 75 IU/dayof hMG for the first 7 days and if the follicular diameter did not increase to 9 mm. The dose was increased by 37.5 IU every 7 days. The sequential regimen was the same as the step up protocol but when follicular diameter reached 14 mm the daily dose was halved. Main outcome measures included the number of growing follicles and serum hormone levels. The number of intermediate sized follicles was significantly lower in the sequential regimen group and the low dose step up protocol compared with step-down dose regimen. Also, the maximum diameter of the ovaries was smaller in the same two groups. The luteal phase progesterone was significantly lower in the low dose step-up protocol and the sequential regimen. A pregnancy rate per cycle of 20%-21% was achieved in the 3 groups. The sequential step-up and step down regimen of hMG and low-dose step-up regimen may be the safest to avoid ovarian hyper stimulation syndrome and to ensure more rate of monofollicidar growth. However, they may be associated with higher risk of miscarriage