Vaginal misoprostol for cervical ripening

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اشترك في: الخميس إبريل 04, 2013 10:28 pm

Vaginal misoprostol for cervical ripening

مشاركةبواسطة دكتور كمال سيد » الأربعاء يناير 23, 2019 8:09 pm

Vaginal misoprostol for cervical ripening and induction of labour.

Misoprostol (Cytotec, Searle) is a prostaglandin E1 analogue marketed for use in the prevention and treatment of peptic ulcer disease.
It is inexpensive, easily stored at room temperature and has few systemic side effects.
It is rapidly absorbed orally and vaginally.
Although not registered for such use, misoprostol has been widely used for obstetric and gynaecological indications, such as induction of abortion and of labour.
This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

In first- and second-trimester abortion, combined treatment with misoprostol and mifepristone is more effective than treatment with misoprostol alone, and thus are considered the gold standard for medical abortion.
However, misoprostol-alone regimens may be the treatment of choice in settings in which mifepristone is not available or is too costly.
In particular, misoprostol is commonly used as a single agent for second trimester induced abortion in the United States and many other parts of the world

Misoprostol administration in pregnancy :
1induces cervical softening
2and dilation
3and uterine contractions at all gestational ages,
4thereby facilitating uterine evacuation.
The potency of misoprostol's effect, however, varies with gestational age, as well as with route of administration, dose, dosing interval, and cumulative dose.

Four clinic visits were scheduled.:
At visit 1 (day 1), the women received a vaginal administration of 800 μg misoprostol (Cytotec, Searle, USA), by digital insertion (four tablets of 200 μg misoprostol previously moistened with 2–3 drops of normal saline).
The women remained recumbent for 15 min in the clinic prior to discharge.
All participants were given prophylactic medication for possible side-effects (pain, nausea and vomiting), administered 30 min after the insertion of misoprostol : (i) 10 mg of metoclopramide (Primperan; up to 3 tablets/day if necessary) and (ii) a
combination of 400 mg of paracetamol + 50 mg of caffeine + 10 mg of codeine phosphate
(Lonarid N, Boehriger Ingelheim depening on
pain intensity). Hellas; up to 3 tablets/day,

At visits 2 (day 2) and 3 (day 3), participants returned for a TVS examination and a CBC determination. During this period, the women were monitored for expulsion of the conceptus.
If an intrauterine pregnancy was still present or the abortion was incomplete, an additional 800 μg misoprostol was administered vaginally along with the prophylactic medications.
At visit 4 (day 4), the treatment outcome was assessed. Efficacy was defined as the termination of pregnancy with complete expulsion of the conceptus without the need for a surgical intervention.
If the pregnancy continued or was incompletely aborted, the procedure was defined as failed and a surgical evacuation/curettage was scheduled within 1 week.
In addition, surgical intervention was performed at any time if it was medically indicated or at a woman’s request (Winikoff et al., 1996). Women with Rh-negative blood received Rh(D) immunoglobulin within 72 h after the first application of misoprostol.

On the day of TVS confirmation of abortion, all women who successfully aborted (i.e., after the first, second or third dose of misoprostol) were given an additional 600 μg of vaginal misoprostol followed by 400 μg of oral misoprostol 24 h later.

Early pregnancy termination with vaginal misoprostol before and after 42 days gestation

Medical termination was performed using 800 μg of vaginal misoprostol, repeated every 24 h for a maximum of three doses.
(side-effects (pain, bleeding, nausea, diarrhoea, fever and headache

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