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Peer Reviewed

Title: ACOG Committee Opinion No. 427: Misoprostol for postabortion care.
Author: American College of Obstetricians and Gynecologists
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):465-8.
Abstract: The World Health Organization estimates that 67,000 women, mostly in developing countries, die each year from untreated or inadequately treated abortion complications. Postabortion care, a term commonly used by the international reproductive health community, refers to a specific set of services for women experiencing problems from all types of spontaneous or induced abortion. There is increasing evidence that misoprostol is a safe, effective, and acceptable method to achieve uterine evacuation for women needing postabortion care. To reduce maternal mortality, availability of postabortion care services must be increased. Misoprostol must be readily available especially for women who do not otherwise have access to postabortion care. Nurses and midwives can safely provide first-line postabortion care services, including in outpatient settings,provided they receive appropriate training and support. Access to contraception and safe abortion services prevents complications from unsafe abortion and decreases the need for postabortion care. It is much less expensive and far better for women's health to prevent the problem of unsafe abortion rather than to treat resulting complications.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | WOMEN | ABORTION | ABORTION, SPONTANEOUS | POSTABORTION CARE | MISOPROSTOL | HEALTH SERVICES | REPRODUCTIVE HEALTH | MATERNAL HEALTH | MATERNAL MORTALITY | PREVENTION AND CONTROL | NEEDS ASSESSMENT | PROGRAM ACCESSIBILITY | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Mortality | Population Dynamics | Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341050

Title: Interventions for pain with intrauterine device insertion.
Author: Allen RH; Bartz D; Grimes DA; Hubacher D; O'Brien P
Source: Cochrane Database of Systematic Reviews. 2009;(3):CD007373.
Abstract: BACKGROUND: Fear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol. OBJECTIVES: To review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain. SEARCH STRATEGY: We searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials. SELECTION CRITERIA: We included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed. MAIN RESULTS: Four trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion. AUTHORS' CONCLUSIONS: No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation.
Language: English
Keywords:
UNITED STATES OF AMERICA | CHILE | DENMARK | SWEDEN | LITERATURE REVIEW | CLINICAL TRIALS | IUD | INSERTION | PAIN | DRUGS | ADMINISTRATION AND DOSAGE | MISOPROSTOL | Developed Countries | North America | Americas | Developing Countries | South America, Southern | South America | Latin America | Europe, Northern | Europe | Clinical Research | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology
Document Number: 342475

Title: Misoprostol for pregnancy termination in grand multiparous women with three cesarean deliveries.
Author: Alsibiani SA
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3;
Abstract: In countries in which women have high parity, pregnancy termination is common in women who have had multiple cesarean deliveries. Although a combination of mifepristone and misoprostol is recommended for late abortion, in Saudi Arabia, mifepristone is not approved or available. There is little information about the safety of misoprostol for the termination of pregnancy or induction of labor in women with scarred uteri and multiple cesarean deliveries. Although there is no recommended dose or mode of administration for misoprostol in patients with scarred uteri and high parity, it is advisable to use a low dose. Misoprostol use in women with scarred uteri can lead to uterine rupture, but few incidences have been reported in the literature. However, caution is advisable. Misoprostol administered orally has a rapid onset of action and increases uterine tone, but contractions are not experienced unless repeated doses are administered. In addition, women usually prefer oral administration. Vaginal administration offers prolonged activity, greatest bioavailability, and a lower incidence of adverse effects. Use of misoprostol for termination of pregnancy in 2 grand multiparous (gravidity N10) women each with 3 previous cesarean deliveries is summarized in Table 1. According to the WHO expert dosage guidelines, the maximum dose was not exceeded in either patient. In patient 1 an intracervical Foley catheter with syntocinon infusion was used to ripen the cervix followed by oral administration of 800 �g of misoprostol. Patient 2 received a single dose of 800 �g of misoprostol vaginally. Favorable results were obtained in both women using a single high dose of misoprostol. The safety of using misoprostol in women with high parity and scarred uteri could not be ascertained from this study. A larger study is needed to confirm the effectiveness and safety of this regimen in patients with high parity who have had more than 2 previous cesarean deliveries. (full-text)
Language: English
Keywords:
SAUDI ARABIA | RESEARCH REPORT | SUMMARY REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | CESAREAN SECTION | ABORTION | MULTIPARITY | MISOPROSTOL | UTERUS | RU-486 | ADMINISTRATION AND DOSAGE | Middle East | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Parity | Fertility Measurements | Fertility | Population Dynamics | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Genitalia, Female | Genitalia | Urogenital System | Hormone Antagonists | Hormones | Drugs
Document Number: 341466

Peer Reviewed

Title: Medication abortion.
Author: Bartz D; Goldberg A
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):140-50.
Abstract: Medical methods for pregnancy termination in early gestation offer women an alternative to surgical evacuation and have the potential to improve access globally to safe abortion. Several drug regimens are used with varying efficacy including mifepristone plus misoprostol, misoprostol alone, and methotrexate plus misoprostol. Where available, a mifepristone plus misoprostol regimen is most frequently used and is highly effective for early abortion. We review these drug regimens along with clinical practice recommendations including patient counseling and selection, regimen administration location, expected side effects, and follow-up procedures. Overall, women who choose medical abortion report high levels of satisfaction.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | ABORTION | MISOPROSTOL | RU-486 | DRUGS | COUNSELING | Developed Countries | North America | Americas | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 342250 Notification

Peer Reviewed

Title: The management of failed second-trimester termination of pregnancy.
Author: Basu JK; Basu D
Source: Contraception. 2009 Aug;80(2):170-3.
Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery
Document Number: 342391 Notification

Title: Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review.
Author: Berghella V; Airoldi J; O'Neill AM; Einhorn K; Hoffman M
Source: BJOG. 2009 Aug;116(9):1151-7.
Abstract: BACKGROUND: Second trimester pregnancy induction with misoprostol in women with prior caesarean delivery is not well studied. OBJECTIVE: To estimate the risk of uterine rupture using misoprostol as an induction agent for pregnancy termination in the second trimester of pregnancy in women with prior caesarean delivery. SEARCH STRATEGY: Cases of women with a history of prior caesarean delivery and subsequent misoprostol induction for pregnancy termination in the second trimester (16-28 weeks) were obtained from two main data sources. First, a retrospective chart analysis was performed at Thomas Jefferson University Hospital and Christiana Hospital between 1998 and 2004. Second, multiple Medline, Scopus and POPLINE literature searches were performed. SELECTION CRITERIA: Case series and cohort studies of women with one or more prior caesarean delivery (of any type), and with a subsequent pregnancy with induction of labour for pregnancy termination at 16-28 weeks using misoprostol as the initial primary agent were included. Case reports were analysed separately. DATA COLLECTION AND ANALYSIS: Total cases were analysed by type and number of prior caesarean delivery, for the primary outcome of uterine rupture. MAIN RESULTS: The incidence of uterine rupture associated with second trimester misoprostol termination was 0.4% (2/461) in women with one prior low transverse, 0% (0/46) in those with two prior low transverse and 50% (1/2) in those with a prior classical caesarean delivery. One of the cases of uterine rupture in a woman with a prior low transverse caesarean required transfusion. None of the total eight cases (including case reports) of uterine rupture was associated with hysterectomy. CONCLUSIONS: Second trimester misoprostol termination appears safe among women with one prior low transverse caesarean birth, as it is associated with incidences of uterine rupture of 0.4% (95% confidence interval 0.08-1.67%), of hysterectomy of 0% and of transfusion of 0.2%. There are insufficient data on risk with more than one prior caesarean birth or with prior classical caesarean birth.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | ABORTION | CESAREAN SECTION | UTERINE EFFECTS | RISK FACTORS | INCIDENCE | Developed Countries | North America | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Measurement
Document Number: 342794 Notification

Peer Reviewed

Title: Pharmacy worker practices related to use of misoprostol for abortion in one Mexican state.
Author: Billings DL; Walker D; Mainero del Paso G; Clark KA; Dayananda I
Source: Contraception. 2009 Jun;79(6):445-51.
Abstract: BACKGROUND: Pharmacies are important sites for access to health information and medications in Mexico. Most workers are not trained in health issues and may provide inaccurate information to consumers. Misoprostol is used by women throughout Mexico for early abortion and often is purchased from pharmacies. This study aims to understand the practices of pharmacy workers when asked for advice about and medications for abortion, in particular misoprostol. STUDY DESIGN: A random sample of pharmacies in both urban and rural areas of one state of Mexico included both chain and independent pharmacies (n=169). Two mystery clients (MCs) visited the pharmacies, requesting medication for "bringing down the period" and then asking for misoprostol. MCs recorded information about the interactions following each visit in standardized formats. Bivariate comparisons were made between spontaneous and prompted discussions of misoprostol. Associations were considered statistically significant at alpha<.05. RESULTS: Ninety percent of pharmacy workers attending to the MCs discussed misoprostol as an abortifacient, either spontaneously or after being prompted by the MCs. Misoprostol was for sale in most (61%) of these pharmacies. The majority of pharmacy workers (75%) did not request a prescription. Over 75% of all pharmacy workers provided the MCs referral to trained medical providers with whom they could seek a follow-up visit. Sixteen percent of pharmacy workers suggested a regimen consistent with evidence and recommendations for using misoprostol for early abortion. Regimens that were underdosages were common, and few workers recommended a potentially harmful overdosage. Instructions about side effects and risks were rare. The price of misoprostol ranged from 900 to 1800 pesos (US$83-167) for a bottle of 28 tablets (200 mcg each) or US$4.07 per tablet, on average. CONCLUSIONS: Pharmacy workers in both urban and rural areas of Mexico are increasingly becoming aware of misoprostol as an effective abortifacient and are willing to provide the information to consumers. However, their information is limited and often inaccurate. Strategies need to be developed so that they receive timely and correct information, consistent with evidence-based recommendations. The legal context of abortion in Mexico (with restrictions in every state, except Mexico City), the restricted registration of misoprostol as a therapeutic agent only for gastric ulcers and the fact that the majority of pharmacy workers are not considered to be health workers are among the most important barriers to advances in training pharmacy workers in the correct application of misoprostol.
Language: English
Keywords:
MEXICO | RESEARCH REPORT | CLIENTS | PHARMACY DISTRIBUTION | MISOPROSTOL | ABORTION | INFORMED CHOICE | INFORMATION | North America | Americas | Developing Countries | Program Activities | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Fertility Control, Postconception | Family Planning | Contraceptive Usage | Contraception
Document Number: 342599 Notification

Peer Reviewed

Title: Cervical obstruction complicating second-trimester abortion: treatment with misoprostol.
Author: Borgatta L; Sayegh R; Betstadt SJ; Stubblefield PG
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):548-50.
Abstract: BACKGROUND: Cervical cone biopsy or loop electrosurgical excision procedures (LEEP) may lead to cervical scarring, agglutination, or stenosis. Leiomyomas may also obstruct the lower uterine segment such that instruments cannot be passed from the vagina to the gestation. CASE: Two women requested second trimester abortion. Both women had undergone cervical LEEP. In addition, one woman had a 10-cm leiomyoma, which seemed to be obstructing the lower segment. In both, the external cervical os was essentially obliterated. After administration of misoprostol, the cervix softened markedly in 18-24 hours. In both women, the cervix dilated readily and allowed dilation and evacuation of the uterus. CONCLUSION: Misoprostol resulted in the ability to evacuate the uterus vaginally, in a situation that might have otherwise resulted in hysterotomy.
Language: English
Keywords:
MASSACHUSETTS | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | PREGNANT WOMEN | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL EFFECTS | CERVICAL LACERATION | GROWTH | TIME FACTORS | Developed Countries | United States of America | North America | Americas | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Diseases | Child Development | Population Dynamics
Document Number: 330357 Notification

Peer Reviewed

Title: Sublingual misoprostol 100 microgram versus 200 microgram for second trimester abortion: a randomised trial.
Author: Caliskan E; Doger E; Cakiroglu Y; Corakci A; Yucesoy I
Source: European Journal of Contraception and Reproductive Health Care. 2009 Feb;14(1):55-60.
Abstract: OBJECTIVES: To compare the efficacy of repeated doses of 100 microg vs. 200 microg misoprostol given sublingually for induction of second trimester abortion. METHODS: One hundred and sixty-two women at 15-22 weeks' gestation were randomized to receive every 2 h either 100 microg (group 1; n = 81) or 200 microg (group 2; n = 81) misoprostol sublingually. The primary outcome measure was the abortion rate within 24 h. The secondary outcome measures were the induction-abortion interval, the total misoprostol dose required, and side effects of the regimen. RESULTS: There was no significant difference between the two groups with regard to the abortion rates within 12 h (43.2% in group 1 vs. 48.1% in group 2; p = 0.52; relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.4-1.5) and 24 h (92.6% in group 1 vs. 91.4% in group 2; p = 0.77; RR: 1.11; 95% CI: 0.37-3.6). The induction-abortion intervals in the two groups were of similar length (885 minutes in group 1 vs. 912 minutes in group 2; p = 0.72). When the total dose of misoprostol was compared between the two groups, women belonging to group 2 on average had received significantly more misoprostol than those in group 1 (1274 +/- 592 microg [7 +/- 3 doses] vs. 614 +/- 432 microg [6 +/- 4 doses], respectively; p = 0.000). CONCLUSIONS: Sublingual administration of repeated doses of 100 microg misoprostol for abortion induction appears to be equally effective to that of repeated doses of 200 microg.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | PREGNANT WOMEN | ABORTION | PREGNANCY, SECOND TRIMESTER | MISOPROSTOL | Europe, Southeastern | Europe | Developing Countries | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology
Document Number: 341234 Notification

10.

Peer Reviewed

Title: A randomized trial to compare two dosing intervals of misoprostol following mifepristone administration in second trimester medical abortion.
Author: Chai J; Tang OS; Hong QQ; Chen QF; Cheng LN; Ng E; Ho PC
Source: Human Reproduction. 2009 Feb;24(2):320-4.
Abstract: BACKGROUND: The conventional timing of misoprostol administration after mifepristone for second trimester medical abortion is 36-48 h, but simultaneous administration, which may make the regimen more convenient, has not been studied. The objective of this randomized comparison study is to compare two intervals of administration of misoprostol after pretreatment with mifepristone for second trimester medical abortion. METHODS: Eligible women with gestational age between 12 and 20 weeks were randomized to receive mifepristone 200 mg orally followed by 600 microg misoprostol vaginally either immediately or 36-38 h later, followed by 400 microg vaginal misoprostol every 3 h for a maximum of four doses. The primary outcome measure was the success rate at 24 h after the start of misoprostol treatment and the secondary outcome measures were the induction-to-abortion interval and the frequency of side effects. RESULTS: There was a significant difference in the success rate at 24 h (36-38 h: 100%; immediate: 91.5%). The median induction-to-abortion interval was significantly shorter in the 36-38 h regimen (4.9 h) compared with the immediate regimen (10 h). Side effects in terms of febrile episodes and chills/rigors were significantly higher in the immediate administration group. CONCLUSIONS: Simultaneous use of mifepristone and misoprostol for second trimester medical abortion is not as effective as the regimen using a 36-38 h dosing interval.
Language: English
Keywords:
CHINA | HONG KONG | RESEARCH REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | ABORTION | ADMINISTRATION AND DOSAGE | MISOPROSTOL | RU-486 | PREGNANCY, SECOND TRIMESTER | TIME FACTORS | SIDE EFFECTS | Asia, Eastern | Asia | Developing Countries | Developed Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Fertility Control, Postconception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Pregnancy | Reproduction | Population Dynamics
Document Number: 331075 Notification

11.

Title: Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial.
Author: Chawdhary R; Rana A; Pradhan N
Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):78-85.
Abstract: AIM: To compare the efficacy of mifepristone and vaginal misoprostol with misoprostol alone for pregnancy termination up to 63 days. METHOD: This exploratory study was conducted in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal as a part of a thesis study for a period of one year from April 2005-2006. After confirming a pregnancy < or =63 days gestation by transvaginal ultrasound, an equal number of women (50) were randomized into (i) group A, women who received 200 mg oral mifepristone (RU 486) on day 1 and vaginal misoprostol 800 microg on day 3; and (ii) group B, women who received vaginal misoprostol (800 microg) on day 1 and 3 (total dose 1600 microg). The primary study outcome measure was complete abortion without surgical intervention making comparisons between these two groups in terms of complete abortion rate, need for manual vacuum aspiration for incomplete abortion and pregnancy continuation after reconfirming the diagnosis on transvaginal ultrasound, besides comparing the side effects/complications. RESULTS: Fewer side effects and a more complete abortion rate (94%) was observed in group A (mifepristone and vaginal misoprostol) in comparison to vaginal misoprostol alone (total dose 1600 microg) giving a complete abortion rate of 86% along with a significant hematocrit drop on follow-up day 10 (P = 0.03) besides having increased duration of bleeding (P = 0.017). CONCLUSION: Mifepristone oral (200 mg) followed by vaginal misoprostol (800 microg) on day 3 provides a better success rate (94%) with fewer complications than vaginal misoprostol 800 microg used on days 1 and 3 for medical abortion of pregnancies up to 63 days.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RU-486 | MISOPROSTOL | ABORTION | VAGINA | ULTRASONICS | ADMINISTRATION AND DOSAGE | TIME FACTORS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | PREGNANCY, FIRST TRIMESTER | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Genitalia, Female | Genitalia | Urogenital System | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Population Dynamics | Contraceptive Agents | Contraception | Pregnancy | Reproduction
Document Number: 341125

12.

Peer Reviewed

Title: Effect of previous live birth and prior route of delivery on the outcome of early medical abortion.
Author: Chien LW; Liu WM; Tzeng CR; Au HK
Source: Obstetrics and Gynecology. 2009 Mar;113(3):669-74.
Abstract: OBJECTIVE: To determine the association between type of previous delivery (vaginal compared with cesarean) on the success of medical abortion with mifepristone-misoprostol in early pregnancy. METHODS: The records of 879 women with intrauterine pregnancies at or before 56 days of gestation who underwent medical abortions were reviewed. Medical treatment consisted of 600 mg mifepristone orally followed 48 hours later with oral misoprostol. An ultrasound examination was performed 14-21 days after treatment, and a successful medical abortion was defined as an empty uterus without surgical intervention. Univariable and multivariable logistic regressions were used to determine risk factors for failure of medical abortion. RESULTS: A total of 797 (90.7%) women had successful medical abortions; 82 (9.3%) had failed medical abortions. Multivariable logistic regression indicated that women with gestational ages greater than 42 days (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.55-4.05) had higher odds of failed abortion compared with a gestational age less than 43 days. Parous women (OR> or =3.94, 95% CI 1.83-8.53) and those with prior cesarean delivery (OR 9.59, 95% CI 4.30-21.39) were more likely to have failed abortions compared with nulliparous women. Among 523 parous women (68 had failed abortion), those with gestational ages greater than 42 days (OR 2.07, 95% CI 1.22-3.50) and prior cesarean delivery (OR 3.33, 95% CI 1.95-5.69) were more likely to have failed abortions compared with those with gestational ages less than 43 days or with prior vaginal delivery. CONCLUSION: Parous women are at increased risk for failed medical abortion in comparison with nulliparous women. Prior cesarean delivery is significantly associated with failed medical abortion.
Language: English
Keywords:
TAIWAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COMPARATIVE STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREVALENCE | CHILDBIRTH | ABORTION | CESAREAN SECTION | RU-486 | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins
Document Number: 331067 Notification

13.

Title: Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality.
Author: Dickinson JE; Doherty DA
Source: Prenatal Diagnosis. 2009 May;29(5):520-4.
Abstract: OBJECTIVE: Evaluation of factors influencing the duration of second-trimester pregnancy interruption with vaginal misoprostol for fetal abnormality. METHODS: All medical terminations >or=13 weeks of gestation 1/1997 to 12/2007 were prospectively identified. Cases receiving vaginal misoprostol 400 microg 6-hourly were extracted from the database and outcomes reviewed. RESULTS: This consecutive case series comprised 1066 women. Median maternal age was 31 years [interquartile range (IQR) 26, 36] and 15.4% had at least one prior cesarean delivery. Principal indications for termination were aneuploidy (37.6%), neural tube defects (15.9%) and cardiac anomalies (9.4%). Median gestation at termination was 19.5 weeks (IQR 17.9, 21). Median abortion interval was 16.1 h (IQR 12, 23.5). Lower maternal age (median duration 17.6 vs 15.2 vs 13.6 h, age < 30 vs 30-39 vs > 40 years, p < 0.001), nulliparity (median duration 19 vs 14.3 h, nulliparous vs parous, p < 0.001) and increasing gestation (median duration 13 vs 17.8 h, <16 vs >20 weeks, p < 0.001) were associated with abortion prolongation. Controlling for gestation, age and parity, apart from musculoskeletal abnormalities (associated with abortion prolongation, p = 0.03), the specific fetal anomaly did not influence duration. CONCLUSIONS: Three factors: nulliparity, younger maternal age and increasing gestation, were associated with abortion prolongation. Apart from musculoskeletal abnormalities, the fetal anomaly had no impact on abortion duration.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | CONGENITAL ABNORMALITIES | ABORTION | MISOPROSTOL | TIME FACTORS | AGE FACTORS | NULLIPARITY | Oceania | Developed Countries | Neonatal Diseases and Abnormalities | Diseases | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Population Dynamics | Demographic Factors | Population | Population Characteristics | Parity | Fertility Measurements | Fertility
Document Number: 342614 Notification

14.

Title: Evaluation of postpartum blood loss after misoprostol-induced labour.
Author: Elsedeek MS; Awad EE; Elsebaey SM
Source: International Journal of Obstetrics and Gynaecology. 2009;116:431-435.
Abstract: Objective: To objectively evaluate postpartum blood loss after successful misoprostol induction and compare it with blood loss after oxytocin induction of labour. Design Prospective randomised study. Setting: Labour ward in university maternity hospital. Population A total of 150 women up to third parity with completed 40 weeks of singleton normal pregnancy, average size cephalic fetus. Methods: Cases were randomised between oxytocin induction and misoprostol induction. Blood was collected in suction set and measured in the delivery room starting after delivery of the fetus and was evaluated by pad weighing in the following 6 hours. Pre- and postdelivery haematocrit were measured and difference between the two values was assessed and analysed. Main outcome measures Success of induction, induction delivery interval, postpartum blood loss, and difference between pre- and postdelivery haematocrit. Results: Induced labour was significantly faster with misoprostol induction (P < 0.001). Blood loss and haematocrit difference was significantly greater in the misoprostol group than in oxytocin group (P < 0.02 and 0.001, respectively). Blood loss in both groups was significantly correlated with higher initial Bishop score (P < 0.001 and 0.024, respectively) and short labour duration (P < 0.0002 and 0.0001, respectively). Conclusions Misoprostol induction is associated with increased blood loss especially when used in women with high Bishop score; therefore, it is better reserved for cases requiring cervical ripening.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PROSPECTIVE STUDIES | MISOPROSTOL | POSTPARTUM | BLEEDING | EVALUATION | Developed Countries | North America | Americas | Studies | Research Methodology | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Puerperium | Reproduction | Signs and Symptoms | Diseases
Document Number: 340207

15.

Title: Termination of missed abortion in a combined procedure: a randomized controlled trial.
Author: Fang AF; Chen QF; Zheng W; Li YH; Chen RY
Source: Journal of Reproduction and Contraception. 2009 Mar;20(1):45-49.
Abstract: Objective To access an ideal procedure terminating missed abortion within 12 weeks of gestational age. Methods Women with intrauterine fetal death were randomized into 3 groups. Group A (n=30): vaginal misoprostol (MP) 0.4 mg, 3 h before vacuum aspiration; group B(n=15): vaginal MP 0.4 mg every 3 h, up to 5 doses; group C(n=30): oral mifepristone (MF) 200 mg 36-48 h before vaginal MP 0.4 mg, MP was given every 3 h, up to 5 doses. Results Women in group A had the shortest interval of gestation tissue expulsion (3.2 - 0.5 h) and the bleeding (3.2 + 5.7 ml) during medical procedure, which were statistically significant in comparison with the other two groups (P<0.001, P<0.01, respectively). Success rates of groups A, B and C were 100%, 33.3% and 90.0%, respectively. Percentages of women need surgical interventions were similar in group B and group C(80.0%,76.7%, respectively). Bleeding during operation, pain after medical procedure and satisfaction presented no statistical significance among the 3 groups. Conclusion Vaginal MP followed by vacuum aspiration was valuable in safety, and efficacy, which led to less bleeding and a faster recovery.
Language: English
Keywords:
CHINA | RESEARCH REPORT | CLIENTS | CLINICAL TRIALS | FETAL DEATH | ABORTION | MISOPROSTOL | RU-486 | ADMINISTRATION AND DOSAGE | Asia, Eastern | Asia | Developing Countries | Program Activities | Programs | Organization and Administration | Clinical Research | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341510

16.

Peer Reviewed

Title: Rates of serious infection after changes in regimens for medical abortion.
Author: Fjerstad M; Trussell J; Sivin I; Lichtenberg ES; Cullins V
Source: New England Journal of Medicine. 2009 Jul 9;361(2):145-51.
Abstract: BACKGROUND: From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concern about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration from vaginal to buccal and required either routine provision of antibiotics or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine treatment with antibiotics for all medical abortions. METHODS: We performed a retrospective analysis assessing the rates of serious infection after medical abortion during a time when misoprostol was administered vaginally (through March 2006), as compared with rates after a change to buccal administration of misoprostol and after initiation of additional infection-reduction measures. RESULTS: Rates of serious infection dropped significantly after the joint change to buccal misoprostol from vaginal misoprostol and to either testing for sexually transmitted infection or routine provision of antibiotics as part of the medical abortion regimen. The rate declined 73%, from 0.93 per 1000 abortions to 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidence interval [CI], 0.44 to 0.94; P<0.001). The subsequent change to routine provision of antibiotics led to a further significant reduction in the rate of serious infection - a 76% decline, from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction, 0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03). CONCLUSIONS: The rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with routine administration of antibiotics.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | STATISTICAL STUDIES | ABORTION | RU-486 | MISOPROSTOL | ADMINISTRATION AND DOSAGE | STANDARDS | INFECTION PREVENTION | ANTIBIOTICS | MONITORING | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Evaluation
Document Number: 342147 Notification

17.

Title: Choosing medical or surgical terminations of pregnancy in the first trimester: what is the difference?
Author: Goodyear-Smith F; Knowles A
Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Apr;49(2):211-5.
Abstract: BACKGROUND: Women seeking termination of pregnancy in Auckland, New Zealand can chose between medical and surgical options up to eight weeks gestation. AIMS: To assess demographic differences or changes over time between proportions of women choosing medical or surgical abortions at a single centre and determine whether changing the mifepristone-misoprostol interval from two to one day impacted on outcomes. METHODS: Retrospective audit of two consecutive years (December 2005-November 2006 and December 2006-November 2007) of first-trimester surgical and medical terminations where the mifepristone-misoprostol interval was reduced from two to one day between years. Analysis using descriptive statistics and assessment of probability of observed differences between groups. RESULTS: A total of 1495 terminations were performed in 2005-2006 and 1588 in 2006-2007. No significant difference (P = 0.4) of eligible women choosing medical (21% and 23%) or surgical abortion between years. Ethnicity, age and residency status did not influence choice. Medical termination of pregnancy was more likely in women who were without previous children (P = 0.009), pregnancies (P = 0.02) or terminations (P = 0.04). Medical termination was similarly effective within six hours with either two- or one-day intervals. CONCLUSIONS: Both medical and surgical first-trimester abortions are safe and effective. It is optimal to be able to offer women choice. Reducing the medical interval to one day does not increase adverse outcomes.
Language: English
Keywords:
NEW ZEALAND | RESEARCH REPORT | RETROSPECTIVE STUDIES | ABORTION | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | RU-486 | ADMINISTRATION AND DOSAGE | ANALGESIA | Oceania | Developed Countries | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342383 Notification

18.

Peer Reviewed

Title: Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review.
Author: Goyal V
Source: Obstetrics and Gynecology. 2009 May;113(5):1117-23.
Abstract: OBJECTIVE: To determine the risk of uterine rupture when using misoprostol for second-trimester abortion in women with a history of cesarean delivery. DATA SOURCES: MEDLINE, EMBASE, CINAHL, LILACS, and the Cochrane Library were searched systematically for all articles published before September 2008. METHODS OF STUDY SELECTION: Sixty-three articles were found using the above data sources. I excluded case reports, narrative reviews or commentaries, studies that excluded women with a history of cesarean delivery, studies with unrelated outcomes, studies not conducted in humans, and studies that were not available in English. The remaining 16 studies that described misoprostol use for second-trimester abortion in women with a history of cesarean delivery were examined. TABULATION, INTEGRATION, AND RESULTS: The number of participants with and without cesarean delivery, regimen of medical abortion used, and cases of uterine rupture were reviewed. To estimate the risk of uterine rupture in women with prior cesarean delivery undergoing second-trimester abortion with misoprostol and number needed to harm, I pooled the results of all 16 studies. The risk of uterine rupture in women with prior cesarean delivery was 0.28% (95% confidence interval [CI] 0.08-1.00%). The risk of uterine rupture in women without prior cesarean delivery was 0.04% (95% CI 0.01-0.20%). Based on these risks, if 414 women with a history of cesarean delivery were given misoprostol for second-trimester abortion, one would experience uterine rupture. CONCLUSION: The risk of uterine rupture among women with a prior cesarean delivery undergoing second-trimester abortion using misoprostol is less than 0.3%. This may be acceptable to both patients and providers.
Language: English
Keywords:
UNITED STATES OF AMERICA | NORTH CAROLINA | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | MISOPROSTOL | CESAREAN SECTION | ABORTION | RISK FACTORS | CONTRACEPTIVE METHOD ACCEPTABILITY | Developed Countries | North America | Americas | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Contraceptive Usage | Contraception
Document Number: 341341

19.

20.

Title: Acceptability and feasibility of medical abortion in Nepal.
Author: Karki C; Pokharel H; Kushwaha A; Manandhar D; Bracken H; Winikoff B
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3;
Abstract: OBJECTIVE: To test the feasibility and acceptability of a simplified mifepristone-misoprostol regimen for early abortion in 2 tertiary teaching hospitals and 2 family planning clinics in Nepal. METHODS: Consenting pregnant women (n=400) with amenorrhea of 56 days or less seeking termination of pregnancy received 200 mg of oral mifepristone followed 48 hours later with 400 microg of oral misoprostol, administered either at home or at the clinic. Prospective data were collected to determine the women's experience, abortion outcome, and the operational requirements for providing the method. RESULTS: Most (91.3%) of the 367 women with known outcomes had successful medical abortions. Given the option, most (89.7%) women elected to administer the misoprostol at home. CONCLUSION: A simplified medical abortion protocol, including home administration of misoprostol, can be successfully integrated into clinical services in Nepal, where abortion services were recently legalized.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | PROSPECTIVE STUDIES | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | ABORTION | RU-486 | MISOPROSTOL | PREGNANCY, FIRST TRIMESTER | ADMINISTRATION AND DOSAGE | TIME FACTORS | ORAL CONTRACEPTIVES | HOME CARE | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Surveys | Sampling Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Pregnancy | Reproduction | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Contraceptive Methods | Contraception | Care and Support
Document Number: 341464

21.

Title: Abnormal expression of MMP-9 and imbalance of MMP-9/TIMP-1 is associated with prolonged uterine bleeding after a medical abortion with mifepristone and misoprostol.
Author: Li L; Zhou Z; Huang L
Source: Acta Obstetricia et Gynecologica Scandinavica. 2009;88(6):673-9.
Abstract: OBJECTIVE: To investigate the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitory of metalloproteinase-1 (TIMP-1) in women who had undergone a medical abortion and explore their possible role in the mechanism of prolonged uterine bleeding after a mifepristone-misoprostol abortion. DESIGN: Cross-sectional study. SETTING: Tertiary referral university hospital. SAMPLE: Forty women were recruited following a medical abortion with mifepristone and misoprostol, 20 with duration of bleeding >14 days and 20 with duration of bleeding 14 days after a medical abortion (bleeding group), whereas each sample of women with duration of bleeding Language: English
Keywords:
CHINA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | RU-486 | MISOPROSTOL | ABORTION | BLEEDING | ENDOMETRIUM | UTERINE EFFECTS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System
Document Number: 341611

22.

Peer Reviewed

Title: Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study.
Author: Livshits A; Machtinger R; David LB; Spira M; Moshe-Zahav A; Seidman DS
Source: Fertility and Sterility. 2009 May;91(5):1877-80.
Abstract: OBJECTIVE: To determine the efficacy of a nonsteroidal anti-inflammatory drug vs. paracetamol in pain relief during medical abortion and to evaluate whether nonsteroidal anti-inflammatory drugs interfere with the action of misoprostol. DESIGN: A prospective double-blind controlled study. SETTING: University-affiliated tertiary hospital. PATIENT(S): One hundred twenty women who underwent first-trimester termination of pregnancy. INTERVENTION(S): Patients received 600 mg mifepristone orally, followed by 400 microg of oral misoprostol 2 days later. They were randomized to receive ibuprofen or paracetamol when pain relief was necessary. Patients completed a questionnaire about side effects and pain score and returned for an ultrasound follow-up examination 10-14 days after medical abortion. MAIN OUTCOME MEASURE(S): Success rates, as defined by no surgical intervention, and pain scores were assessed. RESULT(S): Ibuprofen was found to be statistically significantly more effective for pain relief after medical abortion compared with paracetamol. There was no difference in the failure rate of medical abortion, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% vs. 8.5%). CONCLUSION(S): Ibuprofen was found to be more effective than paracetamol for pain reduction during medical abortion. A history of surgical or medical abortion was predictive for high pain scores. Despite its anti-prostaglandin effects, ibuprofen use did not interfere with the action of misoprostol.
Language: English
Keywords:
ISRAEL | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | ABORTION | MISOPROSTOL | PAIN | TREATMENT | Developed Countries | Middle East | Studies | Research Methodology | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Signs and Symptoms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341247 Notification

23.

Peer Reviewed

Title: Medical treatment with misoprostol for early failure of pregnancies after assisted reproductive technology: a promising treatment option.
Author: Machtinger R; Stockheim D; Seidman DS; Lerner-Geva L; Dor J; Schiff E; Shulman A
Source: Fertility and Sterility. 2009 May;91(5):1881-5.
Abstract: OBJECTIVE: To assess the success rate of misoprostol to induce abortion in early pregnancy failure and to define the factors associated with success of treatment. DESIGN: Prospective study. SETTING: University-affiliated tertiary medical center. PATIENT(S): Two hundred twenty women with the diagnosis of blighted ovum or missed abortion with a crown-rump length (CRL) up to 25 mm (<9 w). INTERVENTION(S): Treatment protocol included two doses of 800 microg misoprostol given vaginally and orally in intervals of 24 to 72 hours. MAIN OUTCOME MEASURE(S): Failure was defined as surgical intervention because of retained gestational sac, severe pain or bleeding, or suspected retained products of gestation after menstruation. RESULT(S): The treatment was successful in 77.2% (170/220) of the patients. Success rate was 72.5% (121/167) for pregnancies achieved spontaneously and 92.4% (49/53) among women who conceived after assisted reproductive technology (relative risk = 3.65: 95% confidence interval 1.378 to 9.667). Multivariate analysis showed that the risk of failure of medical abortion increased significantly for patients who had had at least five previous pregnancies (of them, three or more abortions) as compared with patients with one or two previous pregnancies only, and for those who conceived spontaneously as compared with pregnancies after ovulation induction. CONCLUSION(S): Medical treatment in early missed abortion is recommended especially for women with low gravidity and for those who conceived after assisted reproductive technology.
Language: English
Keywords:
ISRAEL | RESEARCH REPORT | PROSPECTIVE STUDIES | ABORTION | MISOPROSTOL | TREATMENT | REPRODUCTIVE TECHNOLOGIES | Developed Countries | Middle East | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction
Document Number: 341246 Notification

24.

Title: Outcomes for subsequent pregnancy in women who have undergone misoprostol mid-trimester termination of pregnancy.
Author: Mirmilstein V; Rowlands S; King JF
Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Apr;49(2):195-7.
Abstract: In Australia, the most common method of mid-trimester termination of pregnancy (TOP) is by medical induction with the prostaglandin E 1 analog misoprostol. This study was undertaken to compare the pregnancy outcomes of women who had undergone a misoprostol mid-trimester TOP in their last pregnancy with those of a similar cohort of women without a history of misoprostol TOP. This study suggests a possibility that medical mid-trimester TOP with misoprostol increases the risk of preterm or very preterm delivery in a subsequent pregnancy but larger studies are needed to confirm or dismiss this.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CONTROL GROUPS | WOMEN | PREGNANCY OUTCOMES | ABORTION | MISOPROSTOL | PREMATURE BIRTH | RISK FACTORS | Oceania | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Health
Document Number: 342384 Notification

25.

Title: Misoprostol priming prior to second trimester medical abortion.
Author: Moreno-Ruiz NL; Vesona JL; Betstadt SJ; Feng KT; Borgatta L
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 7;
Abstract: Priming refers to the use of medication or procedures to ready the cervix and uterus, producing more effective uterine contractions and shortening the course of labor. Priming is used extensively before induction of labor for term pregnancy. Effective pharmacologic agents used for cervical priming at term include 10-mg dinoprostone vaginal inserts, 0.5-mg dinoprostone vaginal gel, misoprostol 25-50 �g vaginally, and mifepristone 200 mg orally. In the United States, neither misoprostol nor mifepristone is approved for priming. Our experience suggests that misoprostol has potential as a priming agent for women who undergo induction termination of pregnancy. In our small sample, it appeared that the effect was more marked in multiparous women. Further evaluation, including comparison with mifepristone, would be useful.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | ABORTION | CERVICAL DILATATION | ADMINISTRATION AND DOSAGE | TIME FACTORS | COST EFFECTIVENESS | Developed Countries | North America | Americas | Research Methodology | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Population Dynamics | Evaluation Indexes | Quantitative Evaluation | Evaluation
Document Number: 341462

26.

Peer Reviewed

Title: Sublingual misoprostol after surgical management of early termination of pregnancy.
Author: Mulayim B; Celik NY; Onalan G; Zeyneloglu HB; Kuscu E
Source: Fertility and Sterility. 2009 Aug;92(2):678-81.
Abstract: OBJECTIVE: To assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy (ETP) regarding duration and amount of bleeding, presence of retained products of conception (RPOC), and endometrial thickness. DESIGN: Prospective, randomized clinical trial. SETTING: University hospital. PATIENT(S): One hundred five patients admitted for possible management of early pregnancy failure and unwanted pregnancy. INTERVENTION(S): Manual vacuum aspiration (control and study groups) plus 400 microg sublingual misoprostol (study group) at pregnancy termination, and transvaginal ultrasonography (both groups) 10 days after the procedure. MAIN OUTCOME MEASURE(S): Duration and amount of bleeding and presence of RPOC and endometrial thickness 10 days after the procedure. RESULT(S): Bleeding lasted 3.2 and 5.1 days in the study and control groups. Severe vaginal bleeding occurred in two patients in the study group and in six patients in the control group. Mean endometrial thickness was 5.5 mm in the study group and 6.9 mm in the control group. These differences were statistically significant. No cases of RPOC occurred in the study group; two cases occurred in the control group. CONCLUSION(S): In countries in which surgical management of ETP is still done, using sublingual misoprostol postoperatively may reduce the duration and amount of bleeding.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CLINICAL TRIALS | CLIENTS | ABORTION | PREGNANCY, UNWANTED | BLEEDING | MISOPROSTOL | ULTRASONICS | TIME FACTORS | SURGERY | MANAGEMENT | TREATMENT | Europe, Southeastern | Europe | Developing Countries | Clinical Research | Research Methodology | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Signs and Symptoms | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342616 Notification

27.

Title: Serious adverse events associated with the use of misoprostol alone for cervical preparation prior to early second trimester abortions (12-16 weeks) [letter]
Author: Nucatola D; Saulsberry V; Gatter M; Roth N
Source: Contraception. 2009 Feb;79(2):158.
Abstract: We write to correct an inadvertent misstatement in our recent article. In it, we stated that "patients generally prefer a 1-day procedure which can be performed with misoprostol, but not with laminaria." Use of same-day laminaria is an option. While it is true that patients generally prefer a 1-day procedure, it is not true that this can only be achieved with same-day misoprostol. The use of same-day laminaria for this purpose is also available, safe and effective. Indeed, the Society for Family Planning guidelines for cervical preparation before abortions at 20 weeks state that early in the second trimester, overnight dilation is not required. In our clinical setting, we have chosen not to utilize single-day cervical preparation with laminaria for reasons related to procedure pain and cost as well as staffing and patient flow. We apologize for any confusion this may have caused. (full-text)
Language: English
Keywords:
UNITED STATES OF AMERICA | CALIFORNIA | CRITIQUE | MISOPROSTOL | ABORTION | PROGRAM EFFECTIVENESS | Developed Countries | North America | Americas | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Fertility Control, Postconception | Family Planning | Program Evaluation | Programs | Organization and Administration
Document Number: 331058 Notification

28.

Peer Reviewed

Title: Support for provision of early medical abortion by mid-level providers in Bihar and Jharkhand, India.
Author: Patel L; Bennett TA; Halpern CT; Johnston HB; Suchindran CM
Source: Reproductive Health Matters. 2009 May;17(33):70-79.
Abstract: Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India.
Spanish Abstract: Los servicios de aborto con medicamentos tienden a aumentar el n�mero, tipo y distribuci�n geogr�fica de prestadores de servicios de aborto seguro en la India. Este estudio informa sobre una muestra de proveedores de planificaci�n familiar (263 de nivel intermedio, 54 gineco-obstetras y 88 m�dicos generales), de una encuesta realizada en 2004 con personal y establecimientos de salud en Bihar y Jharkhand, en la India. Se identificaron los factores asociados con el inter�s de los profesionales de nivel intermedio en recibir capacitaci�n en la prestaci�n de servicios de aborto con medicamentos temprano, y se examin� si los gineco-obstetras y m�dicos generales apoyaban la capacitaci�n del personal no m�dico en estos servicios, as� como los factores que influyeron en sus actitudes. Los resultados demuestran altos niveles de inter�s por parte de los prestadores de nivel intermedio y considerable apoyo de los m�dicos. Entre los prestadores de nivel intermedio, ser hombre, tener una actitud m�s permisiva hacia el aborto y proporcionar servicios de aborto con f�rmacos, se asociaron con mayor inter�s en la capacitaci�n. Los prestadores de nivel intermedio en establecimientos privados tend�an a mostrar menos inter�s. Las actitudes m�s permisivas hacia el aborto y la pr�ctica de abortos con mifepristona-misoprostol estaban asociadas inversamente con el apoyo de los gineco-obstetras a la pr�ctica de abortos con medicamentos por personal no m�dico. Los m�dicos generales en establecimientos privados brindaron menos apoyo que aqu�llos en establecimientos p�blicos. Estos resultados confirman que los formuladores de pol�ticas deben ampliar el grupo de prestadores de servicios de aborto seguro y legal en la India.
French Abstract: L'avortement m�dicamenteux peut accro�tre le nombre, le type et la distribution g�ographique des prestataires de services d'avortement m�dicalis� en Inde. Cette �tude porte sur un �chantillon de prestataires de planification familiale (263 cadres moyens, 54 gyn�cologues-obst�triciens et 88 m�decins g�n�ralistes) interrog�s pour une enqu�te de 2004 sur les �tablissements de sant� et leur personnel au Bihar et Jharkhand, Inde. Elle a r�pertori� les facteurs associ�s avec l'int�r�t des cadres moyens pour une formation � l'avortement m�dicamenteux pr�coce et a examin� si les gyn�cologues-obst�triciens et les m�decins g�n�ralistes soutenaient la formation de non-m�decins � ces services et quels facteurs influen�aient leurs attitudes. Les conclusions montrent des niveaux �lev�s d'int�r�t de la part des cadres moyens et un soutien raisonnable des m�decins. Le fait d'�tre un homme, d'avoir une attitude plus permissive � l'�gard de l'avortement et de pratiquer des avortements pharmaceutiques �tait associ� � un plus grand int�r�t des cadres moyens pour la formation. Les cadres moyens bas�s dans des �tablissements priv�s avaient moins de probabilit�s d'�tre int�ress�s. Une attitude plus permissive � l'�gard de l'avortement et la pratique d'avortements avec la mif�pristone et le misoprostol �tait inversement associ�e au soutien que les gyn�cologues-obst�triciens apportaient � la pratique d'avortements m�dicamenteux par des non-m�decins. Les m�decins g�n�ralistes bas�s dans des �tablissements priv�s ou autres �taient moins favorables que ceux des centres publics. Les conclusions de l'�tude confirment que les d�cideurs doivent �largir le groupe de prestataires qui peuvent l�galement pratiquer des avortements m�dicalis�s en Inde.
Language: English
Keywords:
INDIA | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | FIELD WORKERS | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | PHYSICIANS | ABORTION | RU-486 | MISOPROSTOL | TRAINING PROGRAMS | ATTITUDES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Data Analysis | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Education | Psychological Factors | Behavior
Document Number: 342016 Notification

29.

Title: Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomised controlled trial in rural India.
Author: Patted SS; Goudar SS; Naik VA; Bellad MB; Edlavitch SA; Kodkany BS; Patel A; Chakraborty H; Derman RJ; Geller SE
Source: Journal of Maternal-Fetal and Neonatal Medicine. 2009 Jan;22(1):24-8.
Abstract: OBJECTIVE: To investigate the side effects of 600 microg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH). METHODS: One thousand six hundred twenty women delivering at home or subcentres in rural India were randomised to receive misoprostol or placebo in the third stage of labour. Women were evaluated for shivering, fever, nausea, vomiting and diarrhea at 2 and 24 h postpartum. Newborns were evaluated within 24 h for diarrhea, vomiting and fever. Symptoms were graded as absent, mild-to-moderate or severe. RESULTS: Women who received misoprostol had a significantly greater incidence of shivering (52%vs. 17%, p < 0.001) and fever (4.2%vs. 1.1%, p < 0.001) at 2 h postpartum compared with women who received placebo. At 24 h, women in the misoprostol group experienced significantly more shivering (4.6%vs. 1.4%, p < 0.001) and fever (1.4%vs. 0.4%, p < 0.03). There were no differences in nausea, vomiting or diarrhea between the two groups. There were no differences in the incidence of vomiting, diarrhea or fever for newborns. CONCLUSIONS: Misoprostol is associated with a significant increase in postpartum maternal shivering and fever with no side effects for the newborn. Given its proven efficacy for the prevention of PPH, the benefits of misoprostol are greater than the associated risks.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | RURAL POPULATION | COMMUNITY HEALTH SERVICES | SIDE EFFECTS | MISOPROSTOL | BLEEDING | PREVENTION AND CONTROL |