Misoprostol and mid trimester termination of pregnancy in patients with two previous scars and more at Elwiya Maternity Teaching Hospital / Misoprostol e interrupção da gravidez no meio do trimestre em pacientes com duas cicatrizes anteriores e mais no Elwiya Maternity Teaching Hospital

Abstract Objectives: to determine efficiency and safety of three misoprostol regimens for 2nd trimester pregnancy termination in individuals with two or more cesarean section scars. Methods: a cross-sectional study included 100 pregnant ladies at 13th-26th weeks gestation with previous two cesarean sections (CSs) who were scheduled for pregnancy termination using misoprostol. Patients were conveniently assigned to 100µg/3h, 200µg/3h or 400 µg/3h regimens. Primary outcome was time to abortion, secondary outcomes were side effect and complications. Results: a significant association was found between number previous CSs and longer time to abortion (p=0.01). A highly significant association was identified between earlier gestational age and longer time to abortion (p<0.001). Lower side effects and complications were associated with 200 µg misoprostol every 3 hours of (p<0.001). Incomplete abortion was the most frequent recorded complication for the successive doses of misoprostol. Conclusions: misoprostol is an effective drug at low doses for pregnancy termination in women with prior two or more caesarean sections. However, its safety needs monitoring of the patient in the hospital to decrease morbidity and mortality behind its use.

Resumo Objetivos: determinar a eficiência e segurança de três regimes de misoprostol para interrupção da gravidez no segundo trimestre em indivíduos com duas ou mais cicatrizes de cesariana. Métodos: um estudo transversal incluiu 100 gestantes entre 13ª e 26ª semanas de gestação com duas cesarianas (CEs) anteriores que foram agendadas para interrupção da gravidez com uso de misoprostol. Os pacientes foram convenientemente designados para regimes de 100 µg/3 horas, 200 µg/3 horas ou 400 µg/3 horas. O desfecho primário foi o tempo para o aborto, os desfechos secundários foram efeitos colaterais e complicações. Resultados: foi encontrada associação significativa entre o número de cesáreas anteriores e o maior tempo até o aborto (p=0,01). Foi identificada associação altamente significativa entre idade gestacional mais precoce e maior tempo para abortar (p<0,001). Menores efeitos colaterais e complicações foram associados com 200 µg de misoprostol a cada 3 horas (p<0,001). O aborto incompleto foi a complicação mais frequente registrada para as doses sucessivas de misoprostol. Conclusões: o misoprostol é um medicamento eficaz em doses baixas para interrupção da gravidez em mulheres com duas ou mais cesarianas anteriores. Porém, sua segurança necessita de monitoramento do paciente no hospital para diminuir a morbimortalidade por trás de seu uso.

Application of a modified Poisson model in identifying factors associated with prevalence of pregnancy termination among women aged 15 ­ 49 years in Uganda

Background: Abortion in Uganda is illegal, only permitted when it places the pregnant mother at risk. This study aimed to apply the modified Poisson model in identifying factors associated with the prevalence of pregnancy termination among women of reproductive age in Uganda. Methods: The 2016 Uganda Demographic Health Survey (UDHS) data were used in this study. More than 18,000 women of the age of 15 ­ 49 years participated in this study. A modified Poisson model that incorporated sampling weights was used to establish the factors associated with pregnancy termination. Results: In Uganda, 18,506 (18.1%) had ever had a pregnancy terminated. The results revealed that, the woman's age [APR = 3.15, 95% CI: 2.72-3.63], being married [APR = 1.55, 95% CI: 1.40-1.71], mass media exposure [APR = 1.18, 95% CI: 1.08-1.29], working status [APR = 1.21, 95% CI: 1.09-1.35], and having visited a health facility [APR = 1.20, 95% CI: 1.10-1.31] were positively significantly associated with likelihood of pregnancy termination. Conclusion: There exists a significant proportion of women who have had their pregnancies terminated in Uganda. It is observed that woman's age, marital status, mass media exposure, having visited a health facility in the last 12 months and working status were main predictors. Based on these results, researchers concluded that the emphasis should be put on improving access to post-abortion care, contraceptive use and media exposure

Comparing the Clinical Efficacy of Mifepristone and Misoprostol Treatment Protocol for Induction of Parturition in Bitches

Successful management of parturition induction is a challenging task in canine. This study made to assess the efficacy of antiprogestagen mifepristone and prostaglandin misoprostol in induction of parturition in bitches. Total of 11 pregnant bitches with gestational age of more than 62 days confirmed by ultrasound scanning and not showing any sings of initiation of parturition were selected. Induction of parturition was initiated by mifepristone (3 mg/ kg b wt PO) twice a day or a combination of mifepristone (3 mg/kg b wt PO) and misoprostol (200 ?g for < 20 kg, 400 ?g for > 20 kg b wt, i/vg) 12 h after second dose of mifepristone. The combination of both drugs mifepristone and misoprostol was more effective for parturition induction.

A comparative study of ethacridine lactate with vaginal misoprostol versus vaginal misoprostol alone for mid trimester abortion

Introduction: Mid-trimester termination of pregnancy is one of the most controversial areas of gynaecological practice. It has moral, emotional, social and technical issues. There is continuous need for termination of pregnancy in second trimester, more recently due to increase in the use of antenatal diagnostic procedures. The objective of the present study is to compare acceptability, safety, efficacy, complications and induction-abortion interval of ethacridine lactate with vaginal misoprostol versus vaginal misoprostol alone for mid trimester abortion Materials and methods: This was a comparative study s200 women of 13-20 weeks pregnancy were randomized in two groups. Out of these 100 patients were selected at random for intravaginal misoprostol 400 μg stat followed by 200 μg misoprostol P/V 4th hourly and 100 cases for extra amniotic ethacridine lactate instillation with tablet misoprostol 400 μg Stat followed by tablet misoprostol 200 μg 4th hourly. The relative efficacy, induction- abortion interval, complications of each was studied. Results: The patients studied belong to all categories of marital status, married, and unmarried, widowed. The age ranged from 15-34 years. The gestational age from 14-20 weeks most of them were primi para. Mean induction abortion interval with misoprostol is 15.2 hours while that of emcredil with misoprostol is 16.44 hours. Success rate with misoprostol is 94% while that of emcredil with misoprostol is 95%. Incomplete abortion with misoprostol 2% while that of emcredil with misoprostol 1%. No major complications are noted in both the methods. Yashvardhini Siddareddy, Himabindu Sangabathula. A comparative study of ethacridine lactate with vaginal misoprostol versus vaginal misoprostol alone for mid trimester abortion. IAIM, 2017; 4(6): 38-44. Page 39 Conclusion: Misoprostol is safer, more effective and acceptable than ethacridine for mid trimester termination of pregnancy

Effects Foley catheter placement to expedite the process of delivery.

Background: Finding a suitable procedure in cases requiring termination of pregnancy without having a ready cervix to induction of labor, is a considerable problem in midwifery. The aim of this study was to compare the effect of Foley catheter placement with oxytocin to expedite the process of delivery. Methods: This is an interventional study. In this study, patient information including age, gestational age, residence place, education, induction time, induction complications, cesarean delivery after induction were entered in a checklist. Collected data analyzed by descriptive and analytical statistical methods in SPSS.16. Results: In this study 100 pregnant women were enrolled in two equal size groups, case (receiving a Foley catheter and oxytocin) and control (receiving oxytocin), each with 50 patient. The mean age of cases was 24.7±3.4 years and controls were 23.9±2.3 years and the most prevalent age group in both was 20-30. In cases 14 % and in controls 12 % were with underlying disease and 14% of women in case group and 24% of women in control group had narrowing of vaginal canal. The most common reason for starting induction in cases was lack of progress in labor and in controls dilation of delivery. The mean gestational age in cases was 39.9±1.9 and in control 39.2±1.8 weeks. In relation to dilatation progress, results showed that in cases individuals reached to full dilatation early and this difference was, in cases 14 % and in controls 22% of deliveries are ended to caesarean. 14% of deliveries in cases and 22% in controls are ended to Caesarean section. There was no significant difference between two groups in birth time Apgar score and 5 minutes after birth time. Conclusions: Results showed that, Foley catheter could significantly reduce induction time significantly and resulted to faster labor but did not reduce the rate of caesarean.

Psychological effects of nursing interference on systemic lupus erythematosus patients after pregnancy termination / 中国实用护理杂志

Objective To study the psychological features of systemic lupus erythematosus (SLE) women who underwent pregnancy termination and to investigate the effects of nursing interference on their psychological state.Methods Psychological nursing and symptomatic nursing were performed in 12 patients.The psychological state was evaluated by Self Rating Anxiety Scale (SAS)and Self-rating Depression Scale (SDS) before and after the interference.Results SAS and SDS score were remarkably reduced after nursing interference.Conclusions Nursing interference can reduce the negative effects caused by psychological state,reduce their psychological pressure,increase compliance to medical orders and promote recovery.

Impact of pregnancy terminations before 28 weeks of gestation on the overall prevalence of neural tube defects in two counties of Shanxi province / 中华流行病学杂志

Objective To examine the impact of pregnancy termination before 28 weeks of gestation on the overall prevalence of neural tube defects (NTDs).Methods Data collected during the period of 2004 and 2010 from a birth defects surveillance system in Pingding county and Talgu county of Shanxi province were used.Number of births ≥28 weeks of gestation and number of cases with major birth defects among the births were collected.Terminations of pregnancies before 28 weeks of gestation due to prenatal diagnosis were also collected.The total prevalence of neural tube defects,prevalence before 28 weeks of gestation,and prevalenee of ≥28 weeks gestation were calculated using the total number of pregnancies of ≥28 weeks of gestation as denominator.The prevalence data were compared to examine the impact of pregnancy termination on the total prevalence.The proportions of pregnancy terminations before 28 weeks of gestation due to prenatal diagnosis of an NTD against the total number of NTD cases were also calculated.Results During 2004-2010,52 366 births were recorded,and 485 NTD cases were ascertained.The overall prevalence of NTDs was 92.6 per 10 000 births,with prevalence of ＜28 weeks gestation due to pregnancy terminations as 60.9 per 10 000 births,while the prevalence of ≥28 weeks of gestation was 31.7 per 10 000 births.NTD prevalence of ≥28 weeks gestation was 66.0％ lower than the total NTD prevalence.In the last two years,the proportion of NTDs ascertained ≥28 weeks gestation accounted for about 40.0％ of the total NTD cases.Conclusion A birth-defect-surveillance program that covered only tregnancies ≥28 weeks of gestation resulted in a severe underestimation of the total birth prevalence of NTDs,especially for anencephaly.We would recommend that the current national birth defects surveillance system should include pregnancy terminations before 28 weeks of gestation and the calculation of total NTD prevalence should also include these cases into the numerator,so as to better estimate true population NTD prevalence,upon which the related public health policy is based.

Comparison of Misoprostol vaginal application and Sulprostone with cervical laminaria tent insertion in mid-trimester termination of pregnancy / 대한산부인과학회잡지

OBJECTIVE: To compare the abortion time, success rate and efficiency of application of intravaginal misoprostol versus intracervical laminaria insertion and intravenous sulprostone administration for mid-trimester pregnancy termination. MATERIAL: Patients requesting termination of second trimester pregnancy were randomized into two groups. In Group I, the women were given 200 microg tablet of misoprostol placed in the posterior vaginal fornix. In Group II, the women were given laminaria insertion in cervical canal with intravenous sulprostone administration. Altogether 50 subjects were recruited with 25 women in each group. RESULTS: The mean interval from start of induction to vaginal delivery was 1480.84+/-37.73 minutes in Group I and 1236.16+/-77.59 minutes in Group II(p=0.232). The success rate of termination within 48 hours in Group I and Group II were 84%, 92%(p=0.384). There were no significant differences in the mean interval time and success rates. Measurement of blood loss(differs in hemoglobin between the admission and postabortive 24 hours) shows in Group I(1.0352+/-0.5774) and in Group II(1.5640+/-0.8976). Mean changes in hemoglobin level were significantly lesser in the misoprostol group(p=0.017). No serious complication occurred. CONCLUSION: Intravaginal misoprostol appears to be acceptably safe and effective agents for second trimester pregnancy termination.

Comparison of between Live and Dead Fetuses: Efficacy of Intravaginal Misoprostol in Termination of Second Trimester Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To compare the efficiency, success rate and abortion time between the live and the dead fetus in second trimester pregnancy termination with intravag-inal misoprostol. SUBJECTS AND METHODS: A total of 45 pregnant women between 18-29 weeks of gestation with medical, obstetric, or genetic reasons for termination were recruited to receive 50 ug misoprostol inserted intravaginally (posterior fornix) every 4 hours. RESULTS: The success rate of complete termination(abortion) within 12 and 24 hours in dead fetuses were 78.2% and 95.6%, respectively, while in live fetuses were 36.3% and 90.9%, respectively. The mean abortion time of the dead fetus group (10.31+/-3.43 hours) was significantly less than that of the live fetus group (14.20+/-3.31 hours). No serious complications occurred in terms of hemorrhage, diarrhea, nausea and vomiting. CONELUSION: Intracervicovaginal misoprostol is a safe and effective method for second trimester pregnancy termination. The abortion time is less in dead fetus pregnancy than that in the live fetus pregnancy.We used 50 ug tablets of misoprastol every four hours. But, we suspect that the regimen of 100ug misoprostol inserted intracervicovaginally every eight hours will beis the proper and optimal method for pregnancy termination.

Comparison of Intravaginal Misoprostol and Prostaglandin E2 Vaginal Tablet in Termination of Mid - Trimester Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To compsre the efficiency, success rate, and abortion time of applications of intravaginal misoprostol versus prostaglandin E2 vaginal tablet for mid-trimester pregnancy termination Subjects and methods: Eighty four patients between 17-29 weeks of gestation with medical, obstetric, or genetic reasons far termination were randomized to receive either 50 ug tablets of misoprostol placed in the posterior vaginal fornix or prostaglandin E2 3mg in tables placed into the endocervix. RESULTS: Among eighty four patients recruited, fourty five patients received misoprostol and thirty nine patients received prostaglandin E2 vaginal tablets. The average interval hom start of induction to vaginal delivery was 13.35 +/- 3.34 hours in misoprostol poup and 19.14 +/- 10.64 hours in the prostaglandin E2 group. The success rate of complete termination within 12 and 24 hours in misopr-ostol group were 57.7%, 93.3%, respectively, while in prostaglandin E2 group were 20.5%, 82.1% repectively. Oxytocin augumentation was 6.7% in misoprostol group and 17.9% in the prostaglardin E2 group. No serious complication occumd. CONCLUSION: Intracervicovaginal misoprostol appears to be acceptably safe and effective agents for second trimester pregnancy termination. The abortion time is less in misoprostol group than those in the prostaglandin E2 group. Misoprostol has the advantage of being expensive, easily stored and readily available. We used 50 ug tablets of misoprostol every four hours. But, we suspect that the regimen of 100ug misopostol inserted intracervico-vaginally every eight hours will beis the proper and optimal method for pregnancy termination.

Intravaginal Misoprostol for the Termination of Second and Third Trimester Pregnancy / 대한주산의학회잡지

OBJECTIVE: The purpose was to evaluate the effect of the intravaginal misoprostol(prostaglandin E1,) for termination after second trimester. METHODS: Thirty pregnant women with intrauterine fetal death and with indications for therapeutic termination of intrauterine pregnancy at least fourteen weeks of gestation were recruited. They were evaluated the mean time from induction to termination, maternal side effects, and total dose of the powdered 100ug misoprostol adminstered in the posterior vaginal fornix every six hours. RESULTS: The mean time from induction to termination was 21.1+/-8.2 hours after administration of the intravaginal misoprostol. Only two patients had not been delivered within 48hours. Vomiting, diarrhea, and fever were not accompanied except nausea. The total dosage of misoprostol was 412.5+/-156.1ug. CONCLUSION: This study shows that intravaginal misoprostol appears to be safe, effective and inexpensive method for the labor induction for termination of pregnancy in the second or third trimester of pregnancy.

Comparison of between Efficacy of Intravaginal Misoprostol and Intravenous Sulprostone in Termination of Second Trimester Pregnancy / 대한주산의학회잡지

To compare the efficiency, success rate and abortion time of applications of intravaginal misoprostol versus intravenous Sulprostone(Nalador) for mid-trimester pregnancy termination. Eighty three patients between 17-29 weeks of gestation with medical, obstetric, or genetic reasons for termination of pregnancy were randomized to receive either 50 ug tablets of misoprostol placed in the posterior vaginal fomix or 1,000ug sulprostone intravenously diluted I L of isotonic saline solution given as a 12-h infusion. Among eighty three patients recruited, fourty five patients received misoprostol and thirty eight patients received sulprostone intravenously. The average interval from start of induction to vaginal delivery was 13.35+/-3.34 hours in misoprostol group and 21.14+/-6.64 hours in the sulprostone group. The success rate of complete termination within 12 and 24 hours in misoprostol group were 57.7%, 93.3%, respectively, while in sulprostone group were 15.8%, 92.1% respectively. Oxytocin augumentation was 6.7% in misoprostol group and 7.9% in the sulprostone group. No serious complication occurred. Intravaginal misoprostol appears to be acceptably safe and effective agents for second trimester pregnancy termination. Misoprostol has the advantage of being inexpensive, easily stored and readily available. The regimen of 100 ug misoprostol inserted intracervicovaginally every 8 hours is the optimal method for pregnancy termination.

Induction of riboflavin-carrier protein in the immature male rat by estrogen: kinetic and hormonal specificity.

The kinetics of estrogen-induced accumulation of riboflavin-carrier protein in the plasma was investigated in immature male rats using a specific and sensitive homologous radioimmunoassay procedure developed for this purpose. Following a single injection of the steroid hormone, plasma riboflavin-carrier protein levels increased markedly after an initial lag period of approximately 24 h, reaching peak levels around 96 h and declining thereafter. A 1.5 fold amplification of the inductive response was evident on secondary stimulation with the hormone. The magnitude of the response was dependent on hormonal dose, whereas the initial lag phase and the time of peak riboflavin-carrier protein induction were unaltered within the range of the steroid doses (0.1-10 mg/ kg body wt.) tested. Simultaneous administration of progesterone did not affect either the kinetics or the maximum level of the protein induced. The hormonal specificity of this induction was further adduced by the effect of administration of antiestrogens viz., En and Zu chlomiphene citrates, which effectively curtailed hormonal induction of the protein. That the induction involved de novo-protein synthesis was evident from the complete inhibition obtained upon administration of cycloheximide. Passive immunoneutralization of endogenous riboflavin-carrier protein with antiserum to the homologous protein terminated pregnancy in rats confirming the earlier results with antiserum to chicken riboflavin-carrier protein.