Comparative Efficacy of Vaginal Misoprostol vs Vaginal Dinoprostone Administered 3 Hours Prior to Copper T380A Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial

Study ObjectiveTo compare the effectiveness of misoprostol and dinoprostone tablets administered vaginally 3 hours before copper intrauterine device (IUD) insertion vs placebo in reducing pain and increasing ease of insertion among nulliparous women.DesignRandomized controlled trial.SettingTertiary referral hospital.ParticipantsA total of 129 nulliparous women requesting a Copper T380A IUD insertion.InterventionsWomen were randomized to receive 200 μg misoprostol or 3 mg dinoprostone or placebo 3 hours before IUD insertion.Main Outcome Measure(s)Primary outcome was patient-reported pain during IUD insertion using a 10-cm visual analog scale (VAS). Secondary outcomes include provider ease of insertion, women satisfaction level, and side effects.ResultsParticipants' baseline characteristics were comparable between the study groups. Mean pain score during IUD insertion was lower with misoprostol than placebo (3.1 ± 2.3 vs 4.4 ± 2.2; P = .02) and dinoprostone compared to placebo (2.4 ± 1.8 vs 4.4 ± 2.2; P < .001). Clinicians reported easier IUD insertion with misoprostol than placebo (2.4 ± 1.7 vs 4.0 ± 2.4; P = .001) and dinoprostone compared to placebo (2.0 ± 1.5 vs 4.0 ± 2.4; P < .001). Women's satisfaction levels were higher with both misoprostol and dinoprostone than placebo (P < .001). Side effects did not differ among the 3 study groups.ConclusionsPremedication with vaginal misoprostol or dinoprostone effectively lowered pain during copper IUD insertion. However, the reduction in pain scores was clinically significant only in women who received dinoprostone. In both the misoprostol and dinoprostone groups, clinicians found the procedure easier, and women were more satisfied with IUD insertion. Side effects and complications were similar in all groups.     

Online access to abortion medications: a review of utilization and clinical outcomes

We performed a search in PubMed and Web of Science on the self-use of abortion medication after online access. Studies published between January 1, 1995, and March 31, 2019, were considered. We included studies of online services that were (i) led by healthcare staff (n = 14), (ii) led by non-healthcare staff (n = 4), and (iii) providing noninteractive access (n = 17). Our outcomes were utilization (frequency and demand for services), acceptability for women, safety, and success rate. Key findings: Women are increasingly using the Internet to access abortion medication. Available services are of varying quality. Women accessing noninteractive services report feelings of distress related to the lack of medical guidance, and the demand for interactive guidance through the abortion process is high. Women using services led by healthcare staff report high rates of satisfaction and similar rates of clinical outcomes as those of in-person abortion care.     

米索前列醇促宫颈成熟1天后低宫颈评分的处理方法比较

目的对应用米索前列醇促宫颈成熟治疗1天后,宫颈Bishop评分仍低于6分的孕妇,比较3种不同处理方法的有效性和安全性。方法选取2016年1月至2019年5月海淀区妇幼保健院诊治的162例孕妇作为研究对象。均具有引产指征且已应用米索前列醇阴道上药促宫颈成熟1天。将其随机分为甲、乙、丙三组,甲组继续应用米索前列醇阴道上药1天,共59人,乙组改用宫颈水囊促宫颈成熟1天,共60人,丙组直接缩宫素静点1天,共43人。结果①三组宫颈评分比较,差异具有统计学意义(P<0.05)。三组干预前后宫颈条件比较,甲组及乙组干预后宫颈评分明显高于入组前宫颈评分,差异具有统计学意义(P<0.05),丙组干预后宫颈评分与干预前宫颈评分比较差异无统计学意义(P>0.05)。②三组阴道分娩率比较,差异具有统计学意义(P<0.05)。三组引产失败率比较,差异具有统计学意义(P<0.05)。阴道分娩出血量、产后出血≥500mL的产妇数、宫腔感染/产褥感染的产妇数、新生儿感染数、1min Apgar评分及新生儿体重三组比较,差异无统计学意义(P>0.05)。结论对于应用米索前列醇促宫颈成熟1天后宫颈评分低的孕妇,继续应用宫颈水囊有效且安全。     

不同药物干预对无痛人工流产术后阴道出血时间的影响

目的 探讨单纯应用异丙酚与异丙酚＋阿托品和单纯应用笑气与笑气联合米索前列醇对无痛人工流产术后阴道出血时间的影响.方法 随机选择400例早孕自愿要求进行无痛人工流产术者,将400例孕妇随机分为4组每组100人,异丙酚＋阿托品组在静推异丙酚之前静推阿托品;异丙酚组直接静脉推注异丙酚注射液;笑气联合米索前列醇组在术前2小时空腹口服米索前列醇,术中给予笑气吸入;笑气组仅在术中给与笑气吸入.结果 异丙酚＋阿托品组和异丙酚组比较（x2 =0.4134,P＜0.05）有显著差异,笑气联合米索前列醇组和笑气组比较有显著差异（x2=14.22,P＜0.05）,异丙酚＋阿托品组和笑气联合米索前列醇组比较两组有显著差异（x2 =4.7138,P＜0.05）.结论 无痛人工流产术前加用阿托品或米索前列醇,这两种方法弥补了单纯静脉麻醉和吸入麻醉的不足,缩短了术后阴道出血时间,在这4种方法中笑气联合米索前列醇在缩短无痛人工流产术后阴道出血时间效果最佳.     

米索前列醇与HCG促排卵效果的临床比较研究

目的比较米索前列醇和人绒毛膜促性腺激素（HCG）这两种药物在临床的促排卵效果及妊娠结局。方法选取2009年4月-2011年4月在内蒙古妇幼保健医院生殖内分泌门诊就诊的Ⅱ型生殖内分泌异常的不育妇女90例,在月经周期第3日起开始口服来曲唑促排卵,连服5日,剂量为5mg/日。于月经周期的10日开始阴道B超监测卵泡,直至优势卵泡直径≥18mm,共85例。无卵巢高反应性者为A组,共70例,给予肌注HCG 6000U;出现卵巢高反应性或预测可能出现卵巢过度刺激综合征（OHSS）者为B组,共15例,给予口服米索前列醇0.2 mg。通过阴道B超监测排卵征象,测定基础体温及超声最终明确早孕。结果 HCG组与米索前列醇组排卵成功率与无显著性差异（P〉0.05）,两组的妊娠率亦无显著性差异（P〉0.05）。结论米索前列醇与HCG的临床促排卵效果无显著性差异,米索前列醇作用温和,对于促排卵过程中出现卵巢高反应性或过度刺激综合征倾向者,在HCG日应用米索前列醇诱发排卵,是较为理想的替代选择。     

曲马多联合米索前列醇应用于无痛人流分析

目的:探讨曲马多联合米索前列醇应用于无痛人流的镇痛效果.方法:回顾性分析我院近年来收治的248例早孕且要求进行无痛人流术的患者的临床资料,将患者随机分为2组,比较2组的镇痛效果差异.结果:对照组139例患者,有效镇痛115例,无效24例,镇痛的有效率为82.73%,治疗组109例患者,有效镇痛106例,无效3例,镇痛的有效率为97.25%,两组患者的镇痛效果经X2检验,P<0.05,具有统计学差异,由此可见,曲马多联合米索前列醇应用于无痛人流的镇痛效果明显强于单独使用米索前列醇的镇痛效果.结论:曲马多联合米索前列醇应用于无痛人流术,既发挥了盐酸曲马多的镇痛作于又发挥了米索前列醇促进子宫收缩的作用,减轻手术者的痛苦及手术并发症的发生,值得临床推广使用.     

Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria

BACKGROUND: Although supported by research evidence, misoprostol for induction of labour remains contentious. OBJECTIVE: To assess perception and practice of obstetricians regarding use of misoprostol for labour induction. METHODOLOGY: Cross-sectional questionnaire-based survey of Senior Registrars and Consultant Obstetricians in southwestern Nigeria. RESULTS: One hundred and six questionnaires were completed (52.8% Consultants; 47.2% Senior Registrars). Most respondents (96, 90.6%) employ misoprostol for induction in both live and dead fetuses with majority having personally prescribed misoprostol for cervical ripening or induction of labour (97.2 and 79.3%, respectively). Fetal tachycardia, hyperstimulation and ruptured uterus were the commonly reported complications. Twenty-six respondents (24.5%) reported being aware of maternal death in relation to misoprostol use. Only 52.9% of the respondents have protocols guiding misoprostol use in their hospitals. More than half of respondents administer misoprostol 50 mug or higher 6 hourly. Most (92, 87.6%) believe that research evidence backs use of misoprostol for the indication; 89.5% of respondents support use of misoprostol. Most respondents (90, 86.5%) disagree with the notion that misoprostol is too dangerous for induction; only 26 respondents (25.1%) considered oxytocin a better choice for induction; 93 respondents (88.6%) agreed that, given cautious use, misoprostol is safe for induction, while 86 respondents (81.9%) considered misoprostol a cost-effective intervention for labour induction in developing countries. Though senior registrars and younger consultants tended to report side effects more frequently than older consultants, they were more likely to support misoprostol for induction of labour than older consultants. This differences were however not statistically significant (P > 0.05). CONCLUSION: Misoprostol is widely utilized by obstetricians for induction of labour in southwestern Nigeria. Fetal and maternal side effects are commonly experienced. We recommend urgent adoption of evidence-based guidelines in every unit using the drug to prevent complications.     

三种方法用于终止10～16周妊娠的临床观察

目的:探讨三种方法用于终止10～16周妊娠的效果.方法:利凡诺、米非司酮配伍米索前列醇口服、米非司酮口服配伍米索前列醇阴道给药三种方法随机应用于孕10～16周要求终止妊娠的妇女,随机分成A、B、C三组,观察其有效率,阴道出血量,米索前列醇用量,用药次数,引流产时间,胎盘残留率及副作用.结果:米非司酮配伍米索前列醇组引流产有效率明显高于利凡诺组,BC组与A组比较差异有显著性,P<0.05,B、C两组相比无差异性,P>0.05,阴道出血量三组比较无差异,C组米索用量、流产时间少于B组,两组比较差异有显著性,P<0.05,给药次数、胎盘残留率无明显差异,P>0.05,副反应以阴道给药为最少.结论:米非司酮米索前列醇应用于终止孕10～16周妊娠效果良好,尤其以米索前列醇阴道给药效果佳,副作用少,值得临床推广使用.     

米非司酮配伍米索前列醇终止早孕临床观察

目的观察米非司酮联合米索前列醇终止5—7周早孕的治疗效果。方法对2007年6月-2010年6月来蚌埠市计划生育服务站自愿选择药物流产健康育龄妇女100例的临床资料进行回顾性分析。选择需要终止妊娠的孕期在5～7周的孕妇100例，给予米非司酮早8点50mg，晚8点25mg，连续口服2d，第3日上午给予顿服米索前列醇0．6mg。结果本组100例中，92例孕妇顺利分娩出胚胎组织，成功率为92％。8例服药失败后改为清官术。药物不良反应轻微，无因副反应而停止服药者。结论米非司酮配伍米索前列醇终止5～7周早孕宫内妊娠安全有效，易于被患者接受，值得推广。