Background: A sublingual misoprostol-alone regimen was used in 50 women requesting medical abortion at up to 12 weeks gestation. The efficacy and acceptability of this regimen were studied.
Methods: The women were given 600 microg misoprostol sublingually every 3 h for a maximum of 5 doses.
Results: The overall complete abortion rate was 86% (95% confidence interval: 74-93). The mean number of doses of misoprostol required was 4.1 +/- 1.1. There was no significant change in haemoglobin concentration and the median duration of vaginal bleeding was 15 days (range: 7-56). Diarrhoea, fever and chills were the most common side-effects. The acceptability of this regimen of misoprostol was good: 97.7% of the women who had a complete abortion would choose this method again and 88.4% would recommend it to others. They preferred sublingual misoprostol as it is convenient to take, avoids the painful vaginal administration and gives more privacy during the abortion process.
Conclusion: This regimen of sublingual misoprostol is an effective and acceptable method of medical abortion. Randomized controlled trials are required to compare the efficacy of various misoprostol-alone regimens of medical abortion. Pharmacokinetic studies and clinical trials are needed to find out the most appropriate dose, dosing interval and route of administration of misoprostol.
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Society of Family Planning Clinical Recommendation: Medication management for early pregnancy loss.
Contraception
December 2024
Planned Parenthood South Atlantic, Raleigh, NC, USA and McLeod Regional Medical Center, Florence, SC, USA; University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA 98005, USA; Pegasus Health Justice Center, Dallas, TX, 75207, USA; Washington University, St. Louis, MO, USA.
Early pregnancy loss (EPL), also known as miscarriage or spontaneous abortion, makes up 15-20% of all clinically recognized pregnancies. EPL is a broad term that includes intrauterine pregnancies (IUPs) with findings that suggest the pregnancy may not progress or definitely will not progress; pregnancies with a gestational sac (GS) in the lower endometrial cavity or endocervical canal in the process of expulsion; residual pregnancy tissue or persistent GS; and complete passage of the GS without residual tissue. This document addresses medication management of EPL in which the complete passage of the GS has not yet occurred, including pregnancies concerning for and diagnostic of EPL (sometimes called "missed abortion") and EPL in progress.
View Article and Find Full Text PDFEffectiveness and acceptability of a 24-h interval versus a 48-h interval between mifepristone intake and misoprostol administration for in-hospital abortion at 9-20 gestational weeks: an international, open-label, randomised, controlled, non-inferiority trial.
Lancet Glob Health
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Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
Background: Optimising management of second-trimester medical abortion is important, as complications increase with gestational age. We aimed to compare a 24-h interval with a 48-h interval between mifepristone intake and misoprostol administration in in-hospital, second-trimester medical abortion for effectiveness and acceptability.
Methods: This open-label, randomised, controlled, non-inferiority trial was conducted at nine hospitals in India, Sweden, Thailand, and Viet Nam among adults undergoing medical abortion for a singleton viable pregnancy at a gestation of between 9 weeks and 20 weeks.
Comparative study between the roles of intrauterine misoprostol versus the sublingual route for prevention of postpartum blood loss in elective cesarean sections: a randomized controlled trial.
BMC Pregnancy Childbirth
October 2024
Ob/gyn Department, Faculty of Medicine, Cairo University, Cairo University, Cairo, Egypt.
Background: The prostaglandin E1 analog "misoprostol" is a drug that has powerful ecbolic effects and can be beneficial in the prevention and treatment of postpartum hemorrhage, which is the leading cause of maternal mortality worldwide.
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Methods: A total of 192 pregnant women were counseled and recruited from the labor and delivery unit at Kasr Al Aini Hospital, Cairo University, and equally randomized into two groups.
Article Synopsis
- A combination of mifepristone and misoprostol is recommended for inducing labor, with specific dosing guidelines based on gestation week (Grade B).
- For women with a history of previous cesarean sections, the safety of labor induction is uncertain, especially for those with multiple or atypical scars (Grade D).
- Parents should receive comprehensive discussions about their birth options (vaginal vs. cesarean), with a focus on the physical and psychological impacts, while also ensuring a supportive environment for grief (Grade C).
Uterotonics for management of retained placenta.
Cochrane Database Syst Rev
October 2024
Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Rationale: Retained placenta is a significant cause of maternal death from postpartum haemorrhage. Traditionally, it is managed by manual removal under anaesthesia, which carries risks of haemorrhage, infection, and uterine perforation. Uterotonics may offer an alternative for delivering the retained placenta since they induce uterine contractions.
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