Comparison of side effects and complications of intravaginal misoprostol with extra-amniotic prostaglandin F 2 alpha for termination of second trimester pregnancy

The objective of the study is to compare the maternal side effects and complications of Misoprostol and prostaglandin F2alpha for termination of second trimester pregnancy. Non randomized controlled [Experimental] study. This comparative study was carried out in Gynae Unit 1, Lady Willingdon Hospital Lahore from 1[st] Oct 2009 to 31[st] Mar 2010. Sixty patients admitted to gynecology ward for termination of pregnancy through the outpatient department were selected according to inclusion criteria of the study. They were divided into two groups of 30 patients each. Group 1 was given Misoprostol and group 2 PGF2alpha for induction of labour. Induction failure was higher in PGF2alpha group. Side effects were more frequent in the women receiving PGF2a than those receiving Misoprostol [56.67% vs. 43.33%; p=0.96]; diarrhea [26.67% vs. 20%] and fever [16.67% vs. 10%]. Incidence of nausea and vomiting were 6.67% in both the groups. In the same way, the complication of post partum hemorrhage was seen more in PGF2a group than the Misoprostol group [6.67% vs. 3.33%]. The incidence of retained placentas was 6.67% in both the groups. The average cost per treatment was Rs. 619 for PGF2a as compared with Rs. 135 for Misoprostol. Misoprostol is cost effective has fewer complications and side effects as compared to PGF2alpha

Comparison of oral versus vaginal misoprostol for mid-trimester pregnancy termination

To compare the efficacy and safety of oral versus vaginal administration of misoprostol for second trimester pregnancy termination. Interventional, quasi experimental study. The Department of Obstetrics and Gynaecology Unit-II, Fatima Jinnah Medical College /Sir Ganga Ram Hospital, Lahore, from August, 2003 to October, 2004. Sixty pregnant women at second trimester of gestation who were candidates for therapeutic termination of pregnancy were recruited for the study. Grandmultipara, women who had scarred uterus and history of hypersensitivity to prostaglandins were excluded. The subjects were assigned into two groups. Group 1 [n=30] had misoprostol orally, while the group 2 [n=30] received the drug by the vaginal route. Dosage regimen was similar in both groups that was 200 micro g 4 hours apart till expulsion of fetus or maximum of up to 5 doses. Main outcome measures of the study were induction-expulsion interval, need for surgical evacuation and maternal complications. The mean induction-expulsion interval in the group 1 and 2 was 11.8 +/- 8.3 and 12.8 +/- 8.5 hours respectively, which was not different statistically. The process of expulsion was complete in 53.3% of subjects in both groups by misoprostol only, while 36.6% required surgical evacuation in oral group versus 33.3% in vaginal group. The rate of failed induction in groups 1 and 2 was 10% and 13.3% respectively. There was no reported case of nausea, diarrhea, headache, dizziness, shivering, pyrexia and hyperstimulation in both the groups. However, a case of vomiting [3.3%] was observed in the vaginal group. Oral and vaginal misoprostol for second trimester pregnancy termination is equally effective and safe agent

[Comparing the efficacy of intra-amniotic prostaglandin [PG] and oxytocin with rising induction in termination of second trimester pregnancy]

Termination of pregnancy in fetus with severe anomaly is legal in Iran. This study was done in order to compare the rate of effectiveness and complications of intra-amniotic PG and oxytocin, with rising induction in patient candidates for second trimester abortion, at Fatemieh Hospital, in Hamadan. In a randomized clinical trial study, 40 pregnant women in their second trimester with fetal CNS anomalies, were divided into two groups [N=20]. In the first group, one PG E2 Amp was injected intra-amniotic at first and then, 20 IU oxytocin was infused in 500 ml serum ringer for each patient. The infusion rate was increased up to induced effective concentrations every 15 to 30 minutes. In the second group, 50 IU oxytocin was infused with 1000 ml serum ringer and thereafter, another infusion of 50 IU oxytocin was added into the remaining 500 ml of serum. The rate of infusion was regulated on the basis of induced effective concentrations. Finally, both groups were compared for labor duration and probable side effects. The rate of success in both groups was 100%. The mean duration of labor was 19.75 +/- 5.9 hours and 30.2 +/- 6.49 hours in the group with intra-amniotic PG with oxytocin and rising induction group, respectively. This difference was statistically significant [P<0.00]. Diarrhea was seen in only one case with intra-amniotic PG injection. Differences between the frequency of side effects in both groups was not statistically significant. This study showed that the mean duration of laboring intra-amniotic PG with oxytocin method, is less than of rising induction method

Use of intravenous sulprostone for the termination of pregnancy with fetal death in second and early third trimester of pregnancy

To study the efficacy of intravenous sulprostone [Nalador] for the termination of pregnancy with fetal death in second and early third trimester of pregnancy. This is a retrospective collection and analysis of data from a cohort of 97 women with fetal death between 12-30 weeks gestation treated with intravenous infusion of a prostaglandin analogue, sulprostone, to achieve expulsion of the products of conception. It was conducted in the Department of Obstetrics and Gynaecology, Sultan Qaboos University Hospital, Oman. The data collected was from January 2000 to December 2005. Sulprostone was started as an intravenous infusion of 15 micro gm/hr and titrated to a maximum of 240 micro gm/hr to a total dose of 1500 micro gm/day, as per the departmental protocol. The patients- demographic data, gestational age, induction-expulsion interval, the need for evacuation, side effects and complications were studied. Out of the 97 women who received sulprostone, 90 aborted within 24 hours. The average induction-expulsion interval was 11.9 +/- 8.0 hours. Sulprostone use was associated with few side effects and was well tolerated by patients. Although most of the patients required evacuation and curettage, the blood loss was minimal. Only six out of 97 women required blood transfusions and two patients needed hysterotomy. We found sulprostone an efficient drug for termination of pregnancy with fetal death in second and early third trimester of pregnancy

Therapeutic termination of second trimester pregnancies with low dose misoprostol

To determine the effectiveness of 50micro g misoprostol for midtrimester termination of pregnancies. Experimental, cross-sectional study. Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005. The study subjects were 54 pregnant women admitted during the 2nd trimester [14-26 weeks] of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder [hypertension or diabetes] or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50micro g misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 [range 4-48 hours]. Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4 +/- 15.9 hours in alive fetuses [t -value:1.9, p: 0.05]. Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 micro g misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect

Comparative study of oral misoprostol versus vaginal misoprostol for induction of second trimesteric abortion

The aim of this work was to compare the safety and efficacy of oral misoprostol with that of vaginal misoprostol for termination of second trimester pregnancy. one hundred twenty women requiring second trimester pregnancy termination were randomly allocated to receive either oral or vaginal misoprostol 400 ug/8 hours, this dose was used for 24 hours after which the attending physician was allowed to either increase dose, decrease frequency of dosing, change route of misoprostol use or use oxytocin, the two groups were comparable with respect to maternal age, parity, indication of abortion and gestational age. Compared with women receiving oral misoprostol, a greater percentage of women receiving vaginal misoprostol aborted within 24 hours [88.33% versus 66.66%]. The induction-abortion interval was significantly shorter in vaginal group [18 +/- 15.5 hours versus 32 + 18 hours, P < 0.001]. Complications namely nausea, vomiting, fever and severe pain were significantly higher in oral misoprostol group. 7 cases [11.66%] in group 1 [Oral misoprostol] shift to vaginal misoprostol after failure to abort within 24 hours from the start of induction. The need for oxytocin augmentation was significantly higher in-group 1[oral misoprostol]. Compared with oral misoprostol, vaginal misoprostol resulted in shorter induction to abortion interval, shorter duration of hospital stay and less side effects from misoprostol

Linfoma no Hodgkin y quimioterapia en embarazo: caso clínico / Non Hodgkin lymphoma and chemotherapy in pregnancy: clinical case

Se presenta una paciente embarazada de segundo trimeestre con un linfoma no Hodgkin