Intravaginal misoprostol for medical evacuation of first trimester missed abortion.

Objective: To evaluate the safety and efficacy of intravaginal misoprostol for medical evacuation of first trimester missed abortions.Methods: Seven women with a transvaginal ultrasound diagnosis of a first trimester missed abortion were treated with 800 µg of misoprostol. Four 200 µg misoprostol tablets were placed intravaginally, and a repeat dose of 800 µg was repeated if products of conception were not expelled in 12 hours.Results: Five of seven of the medical evacuations were successful. The average gestational age for the patients was 9 weeks with a range of 8 3/7 to 9 3/7 weeks. The average time from insertion to complete passage of products of conception was 18 hours with a range from 5 hours 10 minutes to 50 hours. Only one patient in the successful group required the second dose of misoprostol. One patient completely passed products of conception 2 weeks after the 2 doses of misoprostol and was considered a treatment failure. Another patient passed products of conception within 12 hours following insertion of the misoprostol but required a dilatation and curettage 3 days later and was also considered a treatment failure. Side effects included cramping in all patients, which was noted to be moderate in six and mild in one. One patient also had mild nausea, mild headache, and one episode of diarrhea. The average blood loss was estimated at 434 mL with a range from 171 to 871 mL.Conclusion: Intravaginal misoprostol for medical evacuation of first trimester missed abortions appears to be safe and effective and may be an alternative to dilatation and curettage.

The effect of peritoneal fluid from patients with endometriosis on human sperm function in vitro.

OBJECTIVE: Our purpose was to evaluate the effect of peritoneal fluid from women with endometriosis on sperm motility and function in an in vitro model. STUDY DESIGN: Peritoneal fluid was collected at laparoscopy from patients with and without endometriosis. Human donor sperm was diluted with this fluid, and its effect on sperm function and motility was measured was measured with the zona-free hamster egg sperm penetration assay and computer-assisted semen analysis. RESULTS: The mean number of eggs penetrated by the sperm mixed with peritoneal fluid from patients with endometriosis was significantly fewer than the number penetrated by the sperm mixed with fluid from control patients (22.9 +/- 5.31 vs 44.4 +/- 4.96, p < 0.01, Student t test, n = 20). When evaluated by computer-assisted semen analysis, sperm mixed with peritoneal fluid from patients with endometriosis showed a significant decrease in mean swimming velocity compared with sperm mixed with peritoneal fluid from control patients (54.0 +/- 1.77 vs 59.2 +/- 1.05, p = 0.02, Student t test, n = 20). A significant increase in the fraction of sperm swimming at slower velocities was also found. A trend toward a positive correlation between eggs penetrated and sperm velocity was seen, but statistical significance was not achieved (correlation coefficient 0.4392, p = 0.053, n = 20). CONCLUSION: These data suggest that substances found in the peritoneal fluid of patients with endometriosis could contribute to infertility through impairment of both sperm function and motion kinematics.