Benefits of vaginal misoprostol prior to IUD insertion in women with previous caesarean delivery: a randomised controlled trial

Objective: The aim of the study was to evaluate the value of vaginal misoprostol 6?h prior to intrauterine device (IUD) insertion in women with previous Caesarean delivery.

Methods: A double-blind randomised controlled trial was conducted in 120 women who were eligible for IUD insertion. Participants were randomly divided to receive either 600?μg vaginal misoprostol or placebo 6?h before IUD insertion. The primary outcome measure was the pain score during the procedure. Secondary outcome measures were failure of insertion, insertion difficulty score, complications of IUD insertion and side effects related to misoprostol.

Results: Pain and insertion difficulty scores were significantly lower in the misoprostol group compared with the placebo group (5.7?±?1.4 vs. 6.5?±?0.9 and 4.1?±?1.1 vs. 5.4?±?2.2, respectively; p?p?=?.06) and cramps (10 vs. 0; p?Conclusions: The use of misoprostol before IUD insertion is associated with less painful and easier placement.     

The effect of early vs. delayed postpartum insertion of the LNG-IUS on breastfeeding continuation: a systematic review and meta-analysis of randomised controlled trials

Abstract

Objective: The aim of the study was to compare early vs. delayed postpartum insertion of the 52?mg levonorgestrel intrauterine system (LNG-IUS).

Methods: The databases of PubMed, Scopus, Web of Science and CENTRAL were searched to February 2019. The search comprised randomised controlled trials (RCTs) comparing early vs. delayed postpartum insertion of the LNG-IUS. Data were extracted and combined in a meta-analysis. Pooled results were expressed as the relative risk (RR) with 95% confidence interval (CI). The main outcome measures were breastfeeding continuation, LNG-IUS expulsion, uterine perforation, LNG-IUS use, satisfaction and number of pregnancies.

Results: Twelve RCTs were included, comprising 1006 women in total. Our analysis indicated no significant difference between early and delayed insertion of the LNG-IUS in terms of any breastfeeding continuation (RR 0.99; 95% CI 0.84, 1.16; p?=?0.88). After removal of heterogeneity, there was a statistically significant superiority in LNG-IUS use at the endpoint in the early insertion group compared with the delayed insertion group (RR 1.27; 95% CI 1.07, 1.51; p?=?0.006). LNG-IUS expulsion was significantly less in the delayed insertion group in comparison with the early insertion group (RR 5.32; 95% CI 2.68, 10.53; p?=?0.00001). No significant differences were found between the groups in satisfaction, number of pregnancies and risk of uterine perforation.

Conclusion: Early postpartum insertion of the LNG-IUS has no negative effects on breastfeeding continuation. Early postpartum insertion may be used as an alternative to delayed postpartum insertion.     

Mifepristone medical abortion in Albania: Results from a pilot clinical research study

Objective To explore the acceptability and feasibility of introducing mifepristone-misoprostol for early medical abortion in home and clinic settings in Albania.

Methods This was a prospective study testing a simplified mifepristone-misoprostol regimen in two tertiary-level government health facilities in Tirana, Albania. Women (n = 409) with amenorrhea of 8 weeks or less received 200 mg mifepristone in the clinic and then chose whether to take 400 μg of oral misoprostol 2 days later either at home or in the clinic.

Results Nearly 97% of women successfully terminated their pregnancies using the simplified regimen. Almost all women found the method either satisfactory (49.4%) or highly satisfactory (41.1%). Almost all women who were given the option selected the home use protocol. Women choosing home administration of misoprostol were able to manage the medical abortion process on their own.

Conclusion A reduced dose mifepristone medical abortion regimen with home administration of misoprostol is feasible for introduction into healthcare facilities in Albania.     

Ultrasound-guided intrauterine device insertion: a step closer to painless insertion: a randomized control trial

Aim of study: To reduce the pain and duration of the intrauterine device (IUD) insertion procedure through minimizing instrumentation and using trans-abdominal sonography (TAS).

Methods: This randomized control trial was conducted in a university hospital and included 102 eligible females, fulfilling the inclusion criteria. They were randomly assigned into two groups via 1:1 computer-based randomization program; the trans-abdominal guided IUD insertion group (n?=?51), and the traditional IUD insertion group (n?=?51). The main outcomes were the pain experienced during the procedure as scored by the visual analogue score and the duration of the procedure.

Results: The trans-abdominal guided IUD insertion was found to be statistically superior to the traditional technique for IUD insertion regarding the pain scores (according to the Visual Analogue Scale, from 0 to 10) recorded by the candidates (2.4?±?2.1 vs. 5.0?±?1.7, p?p?Conclusions: Due to the decrease in pain and time taken for IUD insertion, the trans-abdominal guided technique can be used as a modified technique for IUD insertion.

ClinicalTrials.gov Identifier: NCT02582268.     

Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy: magnetic resonance imaging findings and neurological outcomes in a Brazilian cohort

Objective: To determine the neurodevelopment outcomes after therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE) and identify the neonatal magnetic resonance imaging (MRI) findings associated with neurological outcome in a middle-income country.

Study design: All infants born after 35 completed weeks’ gestation with signs of moderate to severe encephalopathy and evidence of perinatal asphyxia before 6?hours of life were submitted to whole-body hypothermia and were imaged at 18?±?8.4 days of life (range 7–33 days) after birth. Surviving infants had the neurodevelopment outcome assessed at 12 to 18 months of age by trained professional masked to MRI findings.

Results: Forty-eight infants included, MRI scans were obtained from 34 infants; 14 (29.1%) patients died during hospitalization before MRI was performed. Nine (64.3%) of 14 patients were classified as severe encephalopathy presented Posterior Limb Internal Capsule (PLIC) sign at the MRI, 10 (71.4%) thalamus and basal ganglia (TBG) lesion, 9 (64.3%) white matter (WM) lesion, and 7 (50.0%) cortical lesion. Severe encephalopathy was associated with the motor delay at 12–18 months by Bayley III, Alberta Infant Motor Scale (AIMS), and Gross Motor Function Classification System (GMFCS) scores (p?=?.020, p?=?.048, p?=?.033, respectively), but not for the cognitive (p?=?.167) or language skills (p?=?.309). Lower BSID-III motor, cognitive, and language composite scores were associated with PLIC sign (p?=?.047; p?=?.006 and p?=?.003, respectively). TBG lesion (p?=?.051) and cortical lesion (p?=?.030) were associated with lower language composite score. Motor delay by AIMS and the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI were observed (p?p?=?.002; p?=?.001 and p?=?.027, respectively); as well as higher GMFCS score were associated with the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI (p?p?=?.001; p?=?.001, and p?=?.011, respectively).

Conclusions: Brain MRI in neonates with HIE after therapeutic hypothermia is a valuable tool for diagnosis of encephalopathy cerebral abnormalities and is an early predictor of outcome in infants treated with whole body hypothermia for HIE in the Brazilian experience.     

Different analgesics prior to intrauterine device insertion: is there any evidence of efficacy?

Objectives: The aims of this study were to compare three different interventions to reduce pain related to insertion of the intrauterine device (IUD), namely, lidocaine, misoprostol and a non-steroidal anti-inflammatory drug, against a placebo, and to assess the advantages of one drug over another, if any.

Methods: This was an open-label randomised placebo-controlled trial of 200 women assigned to receive one of the following medications prior to IUD insertion: 10?ml 1% lidocaine paracervical block, 400?μg oral misoprostol, oral naproxen or placebo tablets. The primary outcome measure was the level of pain experienced at different steps of IUD insertion and 15?min after the procedure, measured by a visual analogue scale (VAS).

Results: Between July 2015 and March 2016, 208 women were invited to participate in the study: eight refused and the remaining 200 women were randomised equally into four treatment groups (50 participants in each group). All characteristics were similar between the groups. The mean pain scores recorded during speculum placement, tenaculum application, uterine sounding, IUD insertion and 15?min after insertion were similar among the four groups (p?>?.05). Adjuvant methods to facilitate insertion, insertion failure or device expulsion were similar between the groups (p?>?.05). Complications were reported in 17 participants (8.5%); all resolved spontaneously with no further management (p?>?.05).

Conclusion: Despite finding that none of the study drugs seemed effective prior to IUD insertion, insertion did not cause severe pain. The negative findings indicate the need for future research into new strategies to decrease pain during IUD placement.     

Acceptability and feasibility of 400 μg buccal misoprostol after 200 mg mifepristone for early medical abortion in Georgia

Objectives: The aim of the study was to examine the acceptability and feasibility of early medical abortion using 200?mg mifepristone and 400?μg buccal misoprostol in Georgia, outside the capital city of Tbilisi.

Methods: A total of 622 women in four regions of western and eastern Georgia who presented for termination of pregnancy at up to 63?d of gestation were enrolled in the study. In the western regions, women took one 200?mg pill of mifepristone in the clinic and were given the option of administering 400?μg misoprostol buccally, either at the clinic or at home, 24–48?h later. In the eastern region, women were given the option to take both drugs at home. Abortion status was determined 2 weeks after mifepristone administration.

Results: Ninety-five percent of participants had a successful abortion. Twenty-one percent of women in the eastern region elected to take mifepristone at home; nearly all participants in both regions (98%) chose to take misoprostol at home. Ninety-five percent of women were very satisfied or satisfied with the method, and 95% said they would prefer medical abortion for a future procedure.

Conclusions: Medical abortion with mifepristone and 400?μg buccal misoprostol is an acceptable and feasible option for women in Georgia, outside the capital city of Tbilisi.     

Second trimester abortion in women with and without previous uterine scar: Eleven years experience from a developing country

ABSTRACT

Objectives To study the safety of second trimester abortion in women with previous uterine scar.

Methods We screened the records of 518 women who underwent an abortion between 12 and 20 weeks’ gestation at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, from January 2000 to December 2010. Methods used for abortion were: (i) vaginal misoprostol with or without pre-treatment with mifepristone, and (ii) intracervical dinoprostol gel or vaginal misoprostol ± extra-amniotic saline ± oxytocin infusion. Seventeen women, aborted by means of a hysterotomy, were excluded from further analysis.

Results Of the remaining 501 women, 44 had a uterine scar (Group 1) and 457 had none (Group 2). In Group 1, 40/44 (91%) and in Group 2, 452/457 (99%) women aborted successfully. The mean induction-abortion interval (IAI) was similar in the two groups (15.03 ± 10.69 hours and 12.52 ± 9.0 hours in Groups 1 and 2, respectively; p = 0.083). There were three uterine ruptures, 1/44 (2%) in group 1 and 2/457 (0.4%) in group 2 (p = 0.132, NS); all three women had received mifepristone followed by vaginal misoprostol.

Conclusion In women with a scarred uterus, midtrimester abortion may be successfully achieved using any of the aforementioned regimens.     

Early versus delayed amniotomy during labor induction with oxytocin in women with Bishop’s score of ≥6: a randomized trial

Objective: To study the effect of “early amniotomy” {initiating induction of labor (IOL) with amniotomy followed by oxytocin} versus “late amniotomy” (initiating IOL with oxytocin followed by amniotomy 4–8?h later) in induced labor.

Methods and Materials: One hundred and fifty women with Bishop’s score of ≥6 undergoing IOL were randomized into “early amniotomy” and “delayed amniotomy”.

Results: Early amniotomy resulted in a reduced induction-delivery interval (IDI) (7.35 versus 11.66?h with delayed amniotomy, p?=?.000) but higher the caesarean section (CS) rate was observed (10.7 versus 2.7% with delayed amniotomy, p?=?.049). With early amniotomy, the proportion of women delivering within 12?h was higher (86.7 versus 60%, p?=?.000) and the maximum oxytocin concentration used was lower (30.05 versus 39.68?mU/min, p?=?.001) as compared to delayed amniotomy. The neonatal outcomes were similar in the two groups. Early amniotomy detected meconium prior to initiating uterine contractions with oxytocin in three women who underwent CS for meconium.

Conclusion: Initiating IOL with amniotomy in women with a favorable cervix was efficacious in expediting delivery, but it resulted in a higher CS rate. The higher CS rate was partly due to CS for meconium detected as a result of early amniotomy.

Clinical Trials Registry (CTRI), India: Registration number CTRI/2015/01/005418     

Rates of continuation and satisfaction of immediate intrauterine device insertion following first- or second-trimester surgical abortion: a French prospective cohort study

Background

Immediate postsurgical abortion insertion of intrauterine devices (IUDs) could substantially reduce the risk of repeat abortion. Studies have demonstrated efficacy and safety, and postabortum insertion would likely increase rates of usage. There are few data in the literature concerning rates of continuation and satisfaction after immediate postabortion IUD insertion.

Study design

We performed a prospective cohort study of women undergoing surgical abortion and choosing immediate insertion of IUD for contraception. We followed at six months rates of continuation, expulsion, removal and pregnancy, and reasons for discontinuation of IUD postinsertion.

Results

137 patients were included. At 6 months, we were able to contact 112 of them. The continuation rate was 78.6% (95% confidence intervals (CI) [69.8, 85.8]) and the satisfaction rate was high at 85.2% (95%CI [76.1, 91.1]). Three (2.7%) expulsions occurred. Removals occurred in 18.75%.

Conclusions

We found that women choosing immediate postsurgical abortion IUD insertion had high rates of continuation and satisfaction.     

Is early cord clamping,delayed cord clamping or cord milking best?

Purpose: To compare the antioxidant status of three cord clamping procedures (early clamping, delayed clamping and milking) by analyzing the thiol–disulfide balance.

Patients and methods: This randomized controlled study enrolled 189 term infants who were divided into three groups according to the cord clamping procedure: early clamping, delayed clamping and milking. Blood samples were collected from the umbilical arteries immediately after clamping, and the thiol/disulfide homeostasis was analyzed.

Results: The native and total thiol levels were significantly (p?p?=?.026) lower in the delayed cord clamping and milking groups compared with the early clamping groups. Early cord clamping causes the production of more disulfide bonds and lower thiol levels, indicating that oxidation reactions are increased in the early cord clamping procedure compared with the delayed cord clamping and milking procedures.

Conclusion: The oxidant capacity is greater with early cord clamping than with delayed clamping or cord milking. Delayed cord clamping or milking are beneficial in neonatal care, and we suggest that they be performed routinely in all deliveries.     

US trends in abortion and preterm birth

Background: A recent large meta-analysis concluded that prior surgical abortion was an independent risk factor for spontaneous preterm birth (PTB), while they found no significant correlation between PTB and medical abortion.

Objective: To evaluate the potential impact of changes in US abortion rates and practices on US incidence of PTB rate.

Study design: This was an epidemiologic analysis of legal abortion and PTB data in the USA from 2003 to 2012. Birth data (annual total birth, annual number and incidence of PTB, defined as PTB <37 weeks) are from National Vital Statistics Reports from the National Center for Health Statistics, Center of Disease Control and Prevention (CDC). Abortion data were collected using Abortion Surveillance provided by the CDC. Abortion incidence was reported overall, and by type: surgical, medical method and procedures reported as “other” such as intrauterine instillation and hysterectomy/hysterotomy. To test for the trend of abortion and of PTB over time, we used the chi-squared test for trend. The primary outcome of our study was the correlation trend analysis between abortion rate and PTB rate. Pearson correlation test was used. A two-tailed p value of 0.05 or less was considered significant.

Results: From 2003 to 2012 there were 41 206 315 births in USA, of which 5 042 982 (12.2%) were <37 weeks. The PTB rate declined significantly from 12.3% in 2003 to 11.5% in 2012 (p value test for trend <.04). Out of the 6 122 649 legal abortions, reported by type of procedure, performed from 2003 to 2012 in USA, 5 132 789 were surgical abortion (82.8%) and 860 288 (14.0%) were medical. Chi-squared test for trend showed that the rate of surgical abortion significantly decreased from 88.9 to 78.0% (p?p?p?=?.01) and of surgical abortion (p?=?.02) over time. The higher the surgical abortion rate, the higher the incidence of PTB (Pearson correlation 0.712); the higher the medical abortion rate, the lower the incidence of PTB (Pearson correlation ?0.731).

Conclusion: Recent changes in abortion practices may be associated with the current decrease in US incidence of PTB. Further study on the effect of surgical versus medical abortion is warranted regarding a possible effect on the incidence of PTB.     

“In patient” medical abortion versus surgical abortion: patient’s satisfaction

Objective: To compare patients’ satisfaction with medical and surgical abortion, implementing the Italian guidelines on medical abortion entailing an “in patient” procedure.

Methods: A total of 1832 pregnant chose between surgical (vacuum aspiration) or medical abortion (mifepristone p.o. followed after 3 days by sublingual misoprostol) and expressed their expected satisfaction on a visual analog scale (VAS). A total of 885 women chose surgical and 947 medical abortion. The primary end-point was satisfaction VAS score 20 days after the procedure. Secondary end-points were: difference between pre- and post-abortion VAS score; difference in satisfaction VAS scores according to parity and previous abortion; incidence of side effects.

Results: VAS score was high in each group but significantly higher for the 1-day surgical than for the 3-day medical abortion procedure (7.9?±?1.0 versus 7.2?±?1.2; p?p?p?Conclusions: Both procedures are considered satisfactory by the patients. Performing medical abortion as a 3-day “in patient” procedure, decreased women’s satisfaction scores from their baseline expectations.     

Programmatic experience of post-partum IUD use in Zambia: an observational study on continuation and satisfaction

Objectives: The aim of the study was to assess continuation rates and satisfaction among post-partum intrauterine device (PPIUD) accepters.

Methods: This prospective observational study comprised 591 Zambian women who underwent PPIUD insertion at sites of the Society for Family Health, Lusaka, Zambia. The women were contacted 6–12 months after PPIUD insertion and asked to return to the clinic for interview and examination. If the IUD strings were not visible, an ultrasound was performed. Participants were asked about their satisfaction with the PPIUD. Main outcome measures were short-term PPIUD continuation and reported complications according to time of insertion.

Results: Of 591 women enrolled, 305 women attended the follow-up appointment for interview and examination, giving a power of 80% to estimate an expulsion rate of 10?±?5%. The IUD was inserted within 10?min of placental delivery (post-placental insertion) in 24.3% of participants (n?=?74) and within 48?h (immediate post-partum insertion) in 71.1% of participants (n?=?217). The total expulsion rate was 5.6%. Expulsion rates for post-placental and immediate post-partum insertions were 10.8% and 4.1%, respectively. No significant difference in expulsion rates was found (p?=?0.10). Of those with an expulsion, 76.5% (n?=?13) recognised that it had occurred. There were no reported complications, and 94.1% of women reported being satisfied or very satisfied with their PPIUD (n?=?287).

Conclusions: Overall, expulsion rates were lower than previously reported, particularly for immediate post-partum insertions. Attention to high fundal placement at insertion is a likely explanation for the low expulsion rates. Contrary to conventional wisdom, these low expulsion rates indicate that previous notions regarding insertion timing may not be accurate. Satisfaction levels were also favourable. PPIUD can be safe, acceptable and feasible in an African setting.     

Associations between neural injury markers of intrauterine growth-restricted infants and neurodevelopment at 2 years of age

Objectives: The aim of this study was to evaluate the relationships between brain injury biomarkers in intrauterine growth-restricted (IUGR) infants (S100B and neuron-specific enolase (NSE)) and neurodevelopment at 2 years of age.

Methods: This prospective case-control study was a cooperative effort among Spanish Maternal and Child Health Network (Retic SAMID) hospitals. At inclusion, biometry for estimated fetal weight and feto-placental Doppler variables were measured for each infant. Maternal venous blood and fetal umbilical arterial blood samples were collected at the time of delivery and neural injury markers S100B and NSE concentrations were measured. Neurodevelopment was evaluated at 2 years of age using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III).

Results: Fifty six pregnancies were included. Thirty-one infants were classified as IUGR and 25 as non-IUGR. Neurodevelopmental evaluation at 2 years of age indicated that there were no between-group differences for any of the tests. For all patients in both groups, we found statistically significant inverse relationships between the concentrations of NSE in the cord blood and the results of the cognitive test (r?=??271, p?=?.042), fine motor subtest (r?=??280, p?=?.036), and social-emotional test (r?=??349, p?=?.015). We also found statistically significant differences between the concentrations of S100B in the cord blood and the results of the cognitive test (r?=??306, p?=?.022) and expressive communication subtest (r?=??304, p?=?.023). For the IUGR group, we found a significant inverse relationship between the concentrations of S100B in the maternal serum and the results of adaptive behavior test (p?p?=?.025) and social-emotional test (r?=??489, p?=?.021). The difference between the concentration of S100B in the cord blood and the language composite score was also statistically significant (p?=?.038).

Conclusions: At 2 years of age, the concentrations of NSE and S100B were higher in the non-IUGR and IUGR groups with the worst scores for some areas of neurodevelopmental evaluation. The value of these biomarkers for prognostic neurodevelopmental use requires further investigation for both non-IUGR and IUGR infants.     

IUD in first-trimester abortion: immediate intrauterine contraceptive devices insertion vs delayed insertion following the next menstruation bleeding

Purpose

Approximately 21 days after an abortion, ovulation occurs in 50 % of women. Installation of an IUD directly after induced or spontaneous abortion offers immediate contraceptive protection. The purpose of the present study was to weigh up contraceptive safety and adverse reactions of IUD inserted directly after first-trimester abortion under general or paracervical anesthesia as against the fitting of IUD in the days of the next menstrual cycle without anesthesia.

Method

During the period May 1987 to October 2010, 73 women (Group A) underwent an immediate post-abortion insertion IUD after a first-trimester spontaneous or induced abortion under general or local paracervical anesthesia and 69 participants (Group B) received IUD during the next menstrual cycle without anesthesia. Questionnaires were completed by all the women of the study with respect to the effects of IUD. The women were examined every 3 months for 1 year after the fitting of the IUD in the out-patient department of the University Obstetrics Gynecological Department of Alexandroupolis, Democritus University of Thrace, Greece.

Results

The demographic characteristics of the women of the two groups were similar. The age of the women ranged between 19 and 44 years, while 61.98 % were women with one or two children and 38.02 % were women with three or more children. During the first menstrual cycles, with the exception of vaginal hemorrhages (5 %) and adnexitis (1 %), no serious adverse reactions were noted. During the transvaginal ultrasonography checks in both groups, no observation was made of any dislocation of the IUD, except for two cases in the subgroup of those women with paracervical anesthesia and one case in the women of Group B. As concerns the questionnaire with regard to the women’s subjective evaluation of IUD, satisfactory answers were given.

Conclusions

There were no differences between the two groups either with respect to the security of the supplied contraceptive methods or to the development of side effects.     

Misoprostol Vs Mifepristone and Misoprostol in Second Trimester Termination of Pregnancy

Objective

The present study was conducted with the aim to assess and comparatively evaluate the safety and efficacy of misoprostol alone and mifepristone with misoprostol for second trimester termination of pregnancy.

Methods and Materials

The study was conducted on 200 selected cases, divided in two groups of 100 cases each. In the study group mifepristone was given 200 mg 12 h before intravaginal insertion of 600 μg of misoprostol followed by 400 μg every 3 h up to a maximum of 5 doses or until the abortion occurs, whichever occurs early. In the control group only misoprostol was inserted in the same dose regime. The results were analyzed.

Results

The success rate in both regimens was 100%. Mean induction abortion interval from the insertion of the first misoprostol tablet was significantly shorter in the mifepristone pretreated group 6.72 ± 2.26 h as compared to 12.93 ± 3.4 h in the misoprostol alone group (P < 0.001). The mean blood loss was slightly higher in the control group. The mean dose of the misoprostol required was significantly less in the study group 1,186 ± 291.64 μg as against 1,736 ± 320.20 μg (P < 0.001). The side effects observed in both the groups were similar mainly nausea vomiting, fever, abdominal cramps.

Conclusion

Pretreatment with mifepristone 12 h before intravaginal misoprostol significantly improves the induction abortion interval.     

The effect of zinc and vitamin E cosupplementation on metabolic status and its related gene expression in patients with gestational diabetes

Abstract

Objective: The aim of this study was to determine the effects of zinc and vitamin E cosupplementation on metabolic status and gene expression related to insulin and lipid metabolism in women with gestational diabetes mellitus (GDM).

Methods: Fifty-four women, in the age range of 18–40 years, diagnosed with GDM were recruited for this randomized, double-blinded, placebo-controlled trial. Subjects were randomly allocated into two intervention groups to either taking 233?mg/day Zinc Gluconate plus 400-IU/day vitamin E supplements or placebo (n?=?27 each group) for 6 weeks. Gene expression related to insulin and lipid metabolism was evaluated in peripheral blood mononuclear cells (PBMCs) of women with GDM using RT-PCR method.

Results: Participants who received zinc plus vitamin E supplements had significantly lower serum insulin levels (β?=??3.81; 95% CI, ?5.90, ?1.72; p?=?.001), homeostasis model of assessment-insulin resistance (β?=??0.96; 95% CI, ?1.54, ?0.38; p?=?.002), serum total-cholesterol (β?=??8.56; 95% CI, ?16.69, ?0.43; p?=?.03) and low density lipoprotein-cholesterol (LDL)-cholesterol (β?=??8.72; 95% CI, ?15.27, ?2.16; p?=?.01), and higher quantitative insulin sensitivity check index (β?=?0.01; 95% CI, 0.005, 0.02; p?=?.007) compared with the placebo. Moreover, zinc and vitamin E cosupplementation upregulated gene expression of peroxisome proliferator-activated receptor gamma (PPAR-γ; p?=?.03) and low-density lipoprotein receptor (LDLR; p?=?.04) compared with the placebo. Though, zinc and vitamin E combination did not affect other metabolic parameters.

Conclusions: Overall, zinc and vitamin E cosupplementation for 6 weeks in women with GDM significantly improved insulin metabolism, lipid profile, and the gene expression levels of PPAR-γ and LDLR.     

Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curaçao

Objective?To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curaçao, where induced abortion is severely restricted by law.

Methods?In a prospective study 330 women received 200?mg mifepristone and were instructed to take four tablets (800?μg) of misoprostol via the buccal route 24–36?h later, at home. One week later, follow-up took place.

Results?The outcome could be evaluated in 307 of the 330 women. The efficacy of the mifepristone-buccal misoprostol procedure was 97.7% (300/307). In seven women vacuum aspirations for continuing pregnancy or incomplete abortion following treatment were required. Success rates at 64–70 days' gestation were the same as for gestations of less than 64 days duration. The main adverse effects were nausea and diarrhoea.

Conclusion?Home administration of buccal misoprostol 24–36?h after mifepristone is a safe and effective method of medical abortion up to 70 days. It could be applied in a general practice in Curaçao, where induced abortion is legally restricted.