Prostaglandin-F2 alpha levels in normal saline-induced mid-trimester abortions

Antifertility efficacy of Drynaria quercifolia (L.) J. Smith on female Wister albino rats

ETHNOPHARMACOLOGICAL RELEVANCE

Plant based traditional medicines for birth control has been in practice in rural populations of North-East India, since time immemorial. Fresh rhizome of Drynaria quercifolia (L.) J. Smith is one of the plant parts used traditionally by different ethnic communities in Tripura, India for birth control. The present investigation is aimed to justify the scientific basis in traditional use of Drynaria quercifolia rhizome as anti-fertility agent.

MATERIALS AND METHODS

Ex-vivo uterotonic activity was done on uterine tissue. Acute toxicity test of the plant extract was carried out in rats of both sexes. The abortifacient and anti-implantation activities of the extract were investigated, in-vivo and estimated the level of different hormones release.

RESULTS

The result revealed the effectiveness of methanol (87%) and aqueous (68%) extract of the plant on uterotonic activity. The extracts showed relatively non-toxic effect in acute toxicity study. Methanolic extract has shown higher efficacy for both abortifacient (**p<0.01) and anti-implantation performance (**p<0.01) and also effected hormone release level (**p<0.01).

CONCLUSION

Methanolic extract of Drynaria quercifolia (L.) J. Smith rhizome has been proved to have significant anti-fertility activity.

The use of misoprostol for mid-trimester therapeutic termination of pregnancy

Extra-amniotic prostaglandin F2alpha (PG F2alpha) is probably the most widely used medical method for mid-trimester termination of pregnancy. The method is highly effective but is financially costly, particularly for poor countries faced with restricted health budgets. The aim of this study was to establish whether misoprostol administered vaginally is as effective as PG F2alpha. Sixty-one patients were prospectively randomized to receive either misoprostol (n=30) vaginally, or PG F2alpha (n=31) extra-amniotically. The overall success rate was 83.6%. The success rates in the misoprostol and PG F2alpha groups were 83.3% and 83.8% respectively. There was no statistical difference in the groups in relation to side effects. In this carefully selected group of patients, misoprostol was as safe and effective as PG F2alpha in mid-trimester termination of pregnancy. In these days of financial constraints, misoprostol is the preferred method for mid-trimester termination of pregnancy.

Extra-amniotic saline infusion versus extra-amniotic prostaglandin F2alpha for cervical ripening and induction of labor

OBJECTIVE

To compare the effectiveness of extra-amniotic saline infusion versus extra-amniotic prostaglandin F2alpha for cervical ripening, induction of labor and achievement of vaginal delivery in patients with unfavorable cervices.

METHOD

A randomized trial of extra-amniotic saline infusion versus extra-amniotic prostaglandin F2alpha performed at Harare Central Hospital Maternity Unit, Zimbabwe. One hundred and sixty-four patients were recruited from those referred to Harare Central Hospital Maternity Unit who required induction of labor for either maternal or fetal indications.

RESULTS

162 patients (extra-amniotic PgF2alpha group, N = 81; extra-amniotic saline infusion group, N = 81) had complete information. Two patients (one from each group) were lost to follow up. The demographic characteristics of the patients and the indications for induction were not statistically different. There was a marginally statistically significant difference in the change of Bishop Score in favor of the extra-amniotic saline infusion (4.0, S.D. = 1.4) as compared to (4.5, S.D. = 1.5) for extra-amniotic PgF2alpha (P value = 0.047). All other parameters showed no statistically significant differences. Maternal and fetal complications were minimal and not significantly different. Extra-amniotic saline infusion was however almost six times cheaper than PgF2alpha.

CONCLUSION

Extra-amniotic saline infusion is as effective as PgF2alpha, safe, but much cheaper than PgF2alpha and should be seriously considered as a method of first choice in resource-poor settings.