Clinical Observation on Termination of Early Pregnancy of 213 Cases after Caesarian Section with Repeated Use of Mifepristone and Misoprostol

Objective To investigate the efficacy and safety in women after caesarian section for termination of early pregnancies by treatment, or repeated treatment with mifepristone and misoprostol. Subjects and Methods A total of 213 pregnant women with amenorrhea of 34~69 d after caesarian section who asked for medical abortion were recruited, including 63 cases undergoing their second medical abortion. A total amount of mifeprisstone of 150 mg given in separate doses (25 mg×4 and 50 mg at the first time) was administered orally within 3 d, followed by misoprostol of 0.6 mg orally in the morning of d 3. Results The complete abortion rate was 92.5%, incomplete abortion was 4.7% and failure was 2.8%. Conclusion The sequential use of mifepristone and misoprostol could be successfully and repeatedly used for induced abortion in those women with a caesarian section history. Its efficacy was similar to that for ordinary population. Its safety and effectiveness were satisfactory.

Mifepristone in Combination with Misoprostol vs. Low Dose Mifepristone Alone in Emergency Contraception: a Multi-center Double-blind Randomized Clinical Trial

To compare the effectiveness and side effects of various low dose of Mifepristone in combination with Misoprostol and low doses Mifepristone alone in emergency contraception Materials & Methods This is a multi center double blind randomized controlled clinical trial. A total of 899 healthy women were allocated into this study and were randomly divided into 3 groups. They were orally administrated with different emergency contraceptives with 120 h after unprotected intercourse. Group I (n=300) was given 25 mg Mifepristone plus 0.2 mg Misoprostol after 24 h. Group II (n=299) was given 10 mg Mifepristone plus 0.2 mg Misoprostol after 24 h. Group III (n=300) was administrated with 10 mg Mifepristone alone. The effective rates in different groups were calculated with Dixon method. Results Altogether 11 pregnancies occurred, among which 2 cases were in Group I, 2 cases in Group II, and 7 cases were in Group III. After correction with method failure, there was only one case in Group I, 0 case in Group II, and 5 cases in Group III. The contraceptive effectiveness in these groups was 95.5%, 100% and 76.9% respectively. The pregnancy rate was significantly lower in Group I and Group II than that of Group III (P<0.01). The side effects were slight and tolerable, and there was no significant difference between different groups (P>0.05). Conclusion Use of low dose Mifepristone (25 mg or 10 mg) in combination with 0.2 mg Misoprostol was an effective, low side effects and safe treatment regimen for emergency contraception.

The Clinical Study on Effect of a Combination of Mifepristone with Misoprostol on Late Luteal Fertility Regulation

Objective To investigate the efficacy, safety and acceptability of mifepristone combined with misoprostol used for late luteal fertility regulationMaterials & Methods Sixty-one female volunteers were recruited and there were 261 treatment cycles in total. Subjects were planned to receive treatment with 25 mg of mifepristone, Q12 h × 4 orally for five days prior to expected menstruation followed by 400 μg of misoprostol 48 h later for up to six cycles.Results There were 13 pregnancies in the 267 treatment cycles and among them complete abortion and continuing pregnancy occurred in 7 and 6 cycles respectively. So the overall pregnancy rate was 4. 87% (13/267) and the rate of continuing pregnancy was 2. 25% (6/267) , while the failure rate per pregnant cycle was 46. 15% (6/13). In treatment cycles the vaginal bleeding patterns changed insignificantly as compared with those in control cycles.Conclusion The efficacy, compliance and acceptability of the regimen should be further improved when it was administered for late luteal fertility regulation.

Clinical Effects of Lithospermum Ruderale Dosage and Using-time on Medicinal Abortion Induced by Mifepristone and Misoprostol

The clinical effects of dosage during the period of treatment of Lithospermum Ruderale extract-a kind of Chinese traditional herbal medicine-on medicinal abortion induced by mifepristone and misoprostol were studied. Lithospermum Ruderale extract was administrated 3 d before, 3 d after or 3 d before plus 3 d after the administration of misoprostol respectively. The dose of Lithospermum Ruderale extract was 50 g, 75 g or 100 g respectively. Thus 1 350 women of early pregnancy were grouped into 9 groups and observed. The results showed that the effects of Lithospermum Ruderale used 3 d before, and 3 d before plus 3 d after (6 days misoprostol were significantly better than those only used 3 d after misoprostol both for complete abortion and bleeding (P<0.05). The dosage between 50 g and 100 g made no significant difference in clinical effects. Therefore it is reasonable to use 50 g Lithospermum Ruderale before misoprostol to improve medicinal abortion.

A prospective randomized, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy

A prospective randomized, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy. Author: Dr Roopa Malik, Assistant Professor, Obstetrics and gynaecology department Pt BDS PGIMS Rohtak BACKGROUND: Vaginal misoprostol has been shown to be an effective single agent for medical agent for medical abortion. This randomized, placebo controlled trial compared a regimen of mefipristone and misoprostol with misoprostol alone for termination of early pregnancy. METHODS: 200 women with gestation <56 days were randomized by a random number table to receive either 200 mg mifepristone orally or placebo followed 48 h later by 800 ug vaginal misoprostol. Abortion success was defined as complete abortion without the use of surgical aspiration. RESULTS: Successful medical abortions occurred in 96 out of 100 subjects (96%) after mifepristone followed by vaginal misoprostol. In all, 79 out of 100 subjects (79%) successfully aborted after placebo and vaginal misoprostol. The higher success rate of complete abortion with mifepristone and misoprostol regimen was statistically significant compared with the placebo and misoprostol regimen (p < 0.05). CONCLUSION: A regimen of mifepristone and misoprostol was significantly more effective for termination of pregnancies <56 days than misoprostol alone. The misoprostol alone regimen for termination of early pregnancy is not a very good method for medical abortion but 79% efficacy obtained with vaginal misoprostol alone may clinically acceptable when mifepristone is not available.

Clinical Study on the Termination of 388 High-risk Early Pregnancies with Mifepristone and Misoprostol

To inverstgate the safety, effectiveness and acceptability Of conbination Of mifepristone and misoproslol for termination of high-risk pregnancy (amenorrhea≤ 70 days ).Three hundred and eighty-eight high-risk pregnant women, complicated with scarreduterus, or reproductive tract malformation, or uterus fibromyoma, or histories of recentabortion or repeated abortions, or pregnancy during lactation, and having duration of gestation ranging from 34 to 69 days, were administered orally 150 mg mifepristone (50 mgat the first time, and then 25 mg q 12 h × 4), and 600 μg misoprostol on the third day.The complete abortion rate ωas 92. 3%, while the incomplete abortion rate was 6. 2%, ongoing and pregnancy rate was 1. 5%. It was shown that combination of mifepristone andmisoprostol was effective in inducing abortion Of those high-risk pregnancies. Theregimen's effectiveness for high-risk population was similar to that for general population. Its safety, effectiveness and acceptability were satifactory. In addition, the softenedand dilated cervix made it easier and less painful to make vacuum aspiration in case offailure of the abortion.

Comparative Study on Effects of Arnebia Euchroma (Royle) Johnst Granular and Decoction Forms on Medical AbortionwithMifepristone andMisoprostol

Objective To compare the effects of 2 dosage-forms (granular and decoction) of Arnebia euchroma (royle) Johnst (Arnebia EJ in short below) on medical abortion with that of mifepristone combined with misoprostol Methods Totally 648 women, who had pregnancy of 38-45 d and were willing to terminate pregnancy with mifepristone and misoprostol, were randomly divided into 3 groups, each of which was respectively given granular of Arnebia EJ, placebo granular, or decoction of Arnebia EJ besides mifepristone and misoprostol. The abortion results, bleeding duration, menstruation recovery and side-effects were observed. Results Neither complete abortion rates nor average bleeding durations of the granular group and the decoction group were significantly different (P>0.05). The complete abortion rate and bleeding duration of the two groups were respectively higher and shorter than those of the placebo group (P<0.05). However, the menstruation recov- ery was not significantly different among the three groups (P>0.05). The decoction of Arnebia EJ caused significantly more nausea and vomiting than the other groups (P<0.05). Conclusion The granular form did not have the odor of Arnebia EJ, and caused much less nausea and vomiting compared with the decoction form. The granular and decoc- tion forms were equally effective in improving the results of medical abortion. There- fore it is necessary to conduct further studies on the granular form of Arnebia EJ.

Clinical Effects of Lithospermum Ruderal on Medical Abortion by Mifepristone with Misoprostol

Early pregnancies(<42d)in 600 women were terminated respectively by mifepristone and Lithospermum Ruderal with misoprostol or mifepristone with misoprostol. The results showed that the rate of complete abortion(99.00%)of 300 women by mifepristone and Lithospermum Ruderal with misoprostol was significantly higher than that (92. 33%)of the other 300 women by mifepristone with misoprostol(P<0.01).The average length of time of embryo removal(54.01±7.55 h)and the rate of embryo removal (82.33%)within 6 hours after administration of misoprostol of the former were significantly shorter and higher than those(56.41±9.93 h and 72.67%) of the latter(P<0.05 respectively).The average length of the bleeding time of the former(7.01±3.11d)was significantly shorter than that(8.09±5.63d)of the latter(P<0.05).The recovery of the menstruation of both was not significantly different from each other(P>0.05).In all, the medical abortion by mifepristone and Lithospermum Ruderal with misoprostol was even more successful,with less bleeding time.Therefore it is essential to make researches on the auxiliary effects of Lithospermum Ruderal on the medical abortion by mifepristone with misoprostol.

A randomized clinical trial of mifepristone plus different routes of administration of misoprostol for terminating a pregnancy up to 37 days

<正>Objective:To explore the efficacy of 400μg of misoprostol administered sublingually on medical abortion for early pregnancy by comparing with routine administration of misoprostol. Methods;Women presenting for termination of early pregnancy,whose gestational ages were not more than 37 days,were randomly allocated into two groups.Women in group A were given 50 mg of mifepristone orally on the first day and 25 mg of mifepristone 8 to 12 hours later.The schedule on the second day was as the same as above followed by 400μg of misoprostol orally on the third day.Women in group B were given a dose of 150 mg of mifepristone orally followed by 400μg of misoprostol sublingually 36 to 48 hours later.Both completed abortion rates and side effects were evaluated. Results:The completed abortion rates were 93.4%in group A and 91.0%in group B,showing no significant difference(χ~2 =2.3846,P>0.05).About 80%of the women experienced nausea,vomit,dizziness,headache and breast tenderness.There were no significant differences in side effects of the two groups(P all>0.05).The duration of vaginal bleeding in the two groups were(9.08 + 3.49) days and(9.04 + 3.43) days,showing no significant difference(t= 0.15,P>0.05).About 97.3%of validated questionnaires on patient satisfaction were recovered.The proportions of patient satisfaction were 88.1%in group A and 92.0%in group B,showing no significant difference (P>0.05). Conclusion:Administration of 150 mg mifepristone orally followed by 400μg of misoprostol sublingually could be more suitable for termination of early pregnancy due to its higher complete abortion rate and less side effects.

Comparative Study of the Efficacy of Misoprostol and Oxytocin Im in the Prevention of Post-Partum haemorrhage in a Low-Resource Setting

Background: In developing countries, postpartum hemorrhage is responsible for 30% of maternal deaths. Although the World Health Organization recommends the use of oxytocin for the prevention of postpartum hemorrhage, the use of misoprostol is increasingly common. The objective of this study was to determine the frequency of postpartum hemorrhage in parturients delivering at Saint-Vincent Hospital and to compare the effectiveness of misoprostol use versus oxytocin in preventing postpartum hemorrhage. Material and Methods: We conducted a comparative longitudinal study at the Saint Vincent Hospital comparing 10 units of intramuscular oxytocin with 600 micrograms of sublingual misoprostol. The study was conducted from 01 January 2017 to 31 December 2019, a period of 3 years. The study population consisted of 2161 consenting women. Of these, 1289 received 10 IU of intramuscular oxytocin and 872 received 600 micrograms of misoprostol. The collected data were entered using Microsoft Excel 2013 and analysed using SPSS version 21 software. Results: The frequency of administration of Misoprostol and oxytocin in parturients was 40.4% and 59.6% respectively in this study. One hundred and fourteen cases of postpartum hemorrhage (114/2161 or 5.3%) were noted among the parturients. The average age of parturients who received oxytocin was 24.36 ± 4.45 years vs 24.63 ± 5.11 years among parturients who received Misoprostol;(p = 0.190). The mean parity was 2.52 ± 1.46 vs 2.66 ± 1.44;(p = 0.020). We noted a high proportion (78.3%) of postpartum hemorrhage from the oxytocin group vs. 21.7% from the Misoprostol group (OR 2.5-fold), with a statistically significant difference (p 0.001). We noted high proportions of uterine atony (92.3%) from the oxytocin group vs 7.7% from the Misoprostol group (p = 0.004). Uterine atony was the actual factor associated with postpartum hemorrhage (OR = 10.0895% CI: 1.78 - 57.10;p = 0.009). Conclusion: Misoprostol 600 Microgram administered sublingually immediately after neonatal expulsion and before delivery was 2.5 times more effective than oxytocin 10 IU/IM. Misoprostol is therefore a good alternative to oxytocin and offers more advantages in management, use and outcome than oxytocin.

Knowledge and Level of Use of Misoprostol by Health Care Providers in the Maternity Wards of South Kivu in the Practice of Obstetrics

Post-partum haemorrhage (PPH) is one of the leading causes of maternal death in sub-Saharan Africa. In developing countries, PPH is responsible for about 30% of maternal deaths. The main causes of PPH are uterine atony, placental implantation anomalies and coagulation disorders. Acting on the causes of post-partum haemorrhage would significantly reduce maternal mortality. To prevent PPH, the World Health Organization (WHO) recommends the use of uterotonics as a preventive measure. Although parenteral Oxytocin is recommended as the first line Oxytocic for the prevention of PPH, the use of misoprostol is increasingly used in gynaecology and obstetrics, not only for the prevention of postpartum haemorrhage, but also for many other obstetric indications. The aim of this study was to assess the knowledge and level of use of misoprostol by healthcare providers in the gynaecology and maternity departments of South Kivu in the practice of gynaecology and obstetrics. Materials and methods We conducted a descriptive study from January 03 up to February 04, 2023. The study of population was made up of healthcare workers in South Kivu. A questionnaire containing questions relating to socio-demographic informations and knowledge of misoprostol was prepared and encoded in the kobo collect software. To access the questionnaire, it was compulsory to read the research protocol and give consent by ticking the “yes” button. All those who ticked “no” were denied access to the questionnaire. The link was sent, with a request to take part in the survey, to groups in the social networks of doctors and midwives in South Kivu. For areas not covered by the internet, a printed format was distributed and then encoded by data entry operators. For the paper format, respondents were also asked to indicate their consent by ticking the “yes” box. All the encoded data was automatically compiled on the server and then analysed and interpreted by the research team. Results: Nearly all (95.8%) healthcare workers in South Kivu knew about Misoprostol, and only 4.2% did not. The majority (90.1%) of healthcare workers had already used Misoprostol. Providers were aware of the obstetrical indications for Misoprostol, but in most cases, they did not know the dosage recommended by FIGO. For the prevention of post-Partum haemorrhage, only 39.9% use the correct dosage, 42.7% for the treatment of incomplete miscarriage and 49.3% for the treatment of post-Partum haemorrhage. 10% to 21% of providers know the indications of misoprostol but have no idea about dosage. Providers were aware of all routes of administration, but in most cases, they prescribed Misoprostol via the sublingual route (84.5%). The side effects observed by the providers were those already observed in other studies.

Misoprostol新用途:人工流产术前应用效果分析

目的;探讨Misoprostol(Miso)在人工流产术(妊娠8～12w)前应用的临床效果。方法:人工流产术前30min～2h口服Miso400～600μg,观察术时宫口大小、出血量、手术时间、子宫收缩和人工流产综合征的发生率。结果:术前口服Miso使宫口松弛、子宫收缩良好、出血量减少,平均手术时间短、人工流产综合征发生率低,术后随访阴道流血时间短,无子宫穿孔和不全流产。结论:口服Miso简便、安全、有效、价廉,可作为人工流产术前常规用药。

口服Misoprostol与Ru486配伍抗早孕临床研究

对50例妊娠≤49天的健康妇女,应用Ru486和Misoprostol(又称米索前列醇)终止妊娠。结果完全流产率98％,6小时内绒毛球完整排出占89.8％,副反应轻微。口服Misoprostol与Ru486配伍抗早孕方法简便、高效、安全、价格低廉,值得推广应用。

米非司酮加Misoprostol终止早孕220例临床分析

妊娠12周末以前称为早孕。近20余年来,世界各国采用最广泛的终止早孕方法是负压吸宫术,但具有一定的危险性与并发症。

Efficacy of Single Dose of Mifepristone Combined with Two Doses of Misoprostol in Early Medical Abortions

Objective To study the efficacy of single dose of mifepristone and two doses of misoprostol in women undergoing early medical abortion （EMA） up to 9 weeks of gestation. Methods An audit was performed on a retrospective data analysis of 162 women who underwent an early medical abortion in Southampton U.K. Relevant data on completeness of abortion and other details were analyzed. Results Majority of the women （67%） aged 20-30 years old, 22% were between 30 and 40 years old and 1% were above 40 years old when they came for abortion. About 94.5% women had complete abortion following the use of single dose mifepristone combined with two doses of misoprostol, 4.9% had an incomplete abortion and 0.6% had failure of the procedure. These figures had significantly improved over the results of similar audit in 2005 with single dose of misoprostol to women below 7 weeks of pregnancy. The results in this audit were 82.1% complete abortion, 7.2% incomplete abortion and O. 7% failed procedure. Conclusion Mifepristone in combination with two doses of misoprostol appears to be more effective in all cases of early medical abortion when compared with single dose of misoprostol for termination below 49 d （7 weeks） and two doses of misoprostol between 49 d and 63 d （7-9 weeks） of pregnancy.

米非司酮配伍Misoprostol终止早孕440例临床观察

选择４４０例停经７周以内的健康正常早孕妇女，门诊口服米非司酮配伍Ｍｉｓｏｐｒｏｓｔｏｌ终止早孕．结果显示完全流产率９６．７％，无不全流产致大出血需要清宫者；阴道出血量与孕周、胎囊和胎芽小成正相关（Ｐ＜０．０１）；用药越早、出血越少，效果越好．证实米非司酮配伍Ｍｉｓｏｐｒｏｓｔｏｌ终止早孕是一种安全、方便可靠的好方法．阴道超声检查对指导临床用药和早期诊断早早孕有重要临床价值．

A Simple Procedure for Termination of Pregnancy in the Late First Trimester with Mifeprostone and Misoprostol

Purpose: To assess the efficacy of medical methods for termination of pregnancy at 9 - 12 weeks of gestation. Methods: Between December 2008 and December 2010, the 116 consecutive women received 200 mg oral mifepristone and after 24 - 36 hours they applied 800 μg vaginal misoprostol to medically terminate pregnancy. If the products of conception did not pass, three further doses of 400 μg misoprostol were given vaginally at three hours intervals to medically terminate pregnancy. Results: Of the 116 patients undergoing the procedure 104 (90%) aborted completely. Half of the patients aborted within 6 hours. After medical termination, five per cent of the women were treated because of infection, and five per cent needed a revisit to hospital because of excessive bleeding. Two women received a blood transfusion. Previous live births or previous inducted abortion is presented in the study results. Conclusions: Medical abortion at 9 - 12 weeks’ gestation is a safe alternative to surgery.

Vascular endothelial growth factor mRNA and its protein expression in decidua after terminating early pregnancy by mifepristone plus misoprostol

Objective To investigate the action of mifepristone plus misoprostol on decidua at the level of vascular endothelial growth factor (VEGF) mRNA and its protein expression, as well as the mechanism of prolonged uterine hemorrhage after terminating early pregnancy with these drugs.Methods Forty-five decidua specimens were obtained from 45 pregnant women with amenorrhea of 6 - 7 weeks' duration, in which 15 women were treated with mifepristone and 15 were given mifepristone plus misoprostol. Enzyme-linked immunosorbant assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect VEGF protein and mRNA levels in decidua.Results In all three groups, only the VEGF121 amplification product of 452 bp was visualized. The mRNA and protein levels of VEGF showed no significant differences among the three groups ( P ＞ 0.05).Conclusion In humans, early decidua VEGF121 mRNA is the main isoform. The action of mifepristone plus misoprostol on blood vessels in human decidua may be medicated by some factors other than VEGF.

Tissue-type plasminogen activator and plasminogen activator inhibitor type-1 mRNA and their protein expression levels in human decidua after early pregnancy termination by mifepristone plus misoprostol

Objective To investigate the mechanism of prolonged uterine hemorrhage after terminating early pregnancy by mifepristone plus misoprostol.Methods Forty-five decidua specimens were obtained from 45 pregnant women with amenorrhea of 6-7 week duration. Fifteen women were treated with mifepristone and 15 were treated with mifepristone plus misoprostol. The remaining 15 served as controls. The tPA and PAI-1 mRNA levels were estimated by reverse transcription-polymerase chain reaction. Chromogenic assay and enzyme-linked immunosorbent assay were used to detect tPA activity and PAI-1 protein level in decidua. Results The activities of tPA in the mifepristone plus misoprostol group and in the mifepristone group were 46.91±20.74?IU/mg*protein and 64.25±35.81?IU/mg*protein respectively, lower than those in the normal decidua group (99.76±58.61?IU/mg*protein, P<0.05). tPA mRNA levels in the mifepristone plus misoprostol group were the highest (1.43±0.39) among the groups. In the mifepristone group, tPA mRNA level (0.90±0.16) was not significantly different from that in the normal decidua group (0.94±0.17). The protein and mRNA expression levels of PAI-1 were not significantly different among the three groups (P>0.05).Conclusions Mifepristone plus misoprostol decreased tPA activity in human early decidua by post-transcription pathways, which may influence decidua shedding, endometrial angiogenesis, endometrial remodeling, and cause prolonged uterine hemorrhage after drug abortion.

米非司酮配伍Misoprostol终止早孕临床应用研究

近几年来,由于药物米非司酮的问世,在终止早孕的研究上有了突破性进展,有研究显示：在终止妊娠7周内的早孕上,前列腺素与米非司酮配伍使用可达到90%以上的成功率[1,2],并且用药时间和临床疗效之间存在显著相关性,但同时也发现部分病人存在出血时间较长,出血多,需急诊清宫等亟待解决的问题。因此,为进一步研究药物使用与阴道出血量和妊娠周数之间的关系,本研究通过常规阴道超声检查,在服药前对早孕者进行快速诊断监测,