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Bakhbakhi D, Siassakos D, Davies A, Merriel A, Barnard K, Stead E, Shakespeare C, Duffy JMN, Hinton L, McDowell K, Lyons A, Fraser A, Burden C. Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set. BJOG 2023; 130:560-576. [PMID: 36655361 DOI: 10.1111/1471-0528.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority. OBJECTIVES To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. SEARCH STRATEGY Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. SELECTION CRITERIA Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. DATA COLLECTION AND ANALYSIS Interventions, outcomes reported, definitions and outcome measurement tools were extracted. MAIN RESULTS Forty randomised and 200 non-randomised studies were included. Fifty-eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0-22 tools per outcome. CONCLUSIONS Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.
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Affiliation(s)
| | | | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | | | - Emma Stead
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Anna Lyons
- Northern General Hospital, Sheffield, UK
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Elasy AN, Ibrahem MAM, Elhawy LL, Hamed BM. Vaginal misoprostol versus combined intracervical foley's catheter and oxytocin infusion for second trimester pregnancy termination in women with previous caesarean sections: a randomised control trial. J OBSTET GYNAECOL 2022; 42:2962-2969. [PMID: 36149628 DOI: 10.1080/01443615.2022.2118572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Second trimester pregnancy termination has been reported to be associated with 3-5 times higher maternal morbidity and mortality risks more than first trimester termination. Medical methods had been thoroughly assessed and it is considered the anchor of the safe abortion care. Howevere, there is no global agreement regarding the ideal method for induction of the second trimester abortion in a scarred uterus. The aim of this study was to achieve vaginal expulsion in an expeditious manner with less maternal complications. A total of 158 women having, a history of previous caesarean section undergoing second trimester pregnancy termination, were randomly allocated into group (1) vaginal misoprostol group (n = 79) or group (2) combined intracervical foley's catheter plus intravenous oxytocin infusion group (n = 79). The primary endpoint was complete fetal expulsion. Meanwhile, secondary outcomes were the rates of maternal complications, in terms of the need for surgical evacuation of retained product of conception (ERPOC), severe haemorrhage, uterine rupture, blood transfusion, cervical laceration, diarrhoea, vomiting and fever. The registration number of this trial https://clinicaltrials.gov/ct2/show/NCT04501809. This study showed that the combined use of intracervical foley's catheter and oxytocin is an effective, and safe alternative to vaginal misoprostol for termination of the second trimester pregnancy in women having a previous caesarean delivery.Impact statementWhy was this study conducted? The purpose of this study is to achieve an expeditious delivery for second trimester pregnancy termination in a scarred uterus by combined mechanical and pharmacological methods without significant morbidity. Physicians should balance the benefit of achieving vaginal exlpusion in an expeditious manner versus the risk of uterine rupture or any other maternal complications.What does this add to what is known? This study showed that a combined mechanical and pharmacolohical approach for second trimester termination of pregnancy has comparable efficacy and safety to vaginal misoprostol which is more affordable to the low resources countries where termination of pregnancy in a scarred uterus still has an increased maternal morbidity.What is the implication of this study on clinical practice? The combined use of intracervical foley's catheter with intravenous oxytocin infusion is a safer option than vaginal misoprostol with less serious maternal complications.
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Affiliation(s)
- Amina Nagy Elasy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Lamiaa Lotfy Elhawy
- Department of Community, Environmental and Occupational medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Basem Mohamed Hamed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Analysis on Medication Rules of Chinese Medicinal Herb Formulae in Uterine Subinvolution Treatment Based on Data Mining. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1752352. [PMID: 35399626 PMCID: PMC8991393 DOI: 10.1155/2022/1752352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022]
Abstract
Introduction Uterine subinvolution, especially the subinvolution of the placental site, can be a life-threatening disease that induces secondary postpartum hemorrhage (PPH). Chinese Herbal Medicine has been widely used to improve postpartum recovery and treat uterine subinvolution for thousands of years. Yet, there are many potential laws hidden that are worth exploring. Methods Prescriptions treating uterine subinvolution were searched and collected to form datasets. Data mining methods including frequency analysis, cluster analysis, and association rule learning were performed to uncover the potent prescription laws of uterine subinvolution treatment. Results A total of 803 formulae involving 249 herbs were obtained. The top 6 most frequently used herbs were Angelicae Sinensis Radix (Danggui), Chuanxiong Rhizoma (Chuanxiong), Leonuri Herba (Yimucao), Persicae Semen (Taoren), Zingiberis Rhizoma Preparatum (Paojiang), and Radix Glycyrrhizae Preparata (Zhigancao). Most of the 249 herbs were being warm in properties, sweet in tastes, and mainly distributed to liver and spleen meridian tropisms. Deficiency-tonifying herbs accounted for the most proportion and heat-clearing herbs ranked the second, followed by blood-activating and stasis-eliminating herbs. 6 clusters were generated by hierarchical clustering, and 5 of them were of clinical significance. 78 rules with support values over 0.25, confidence values over 0.8, and lift values greater than 1 were generated by association rule learning. Conclusion The basic principles for uterine subinvolution treatment were deficiency-tonifying, heat-clearing, blood-activating, and stasis-eliminating. Herbs with warm properties, sweet tastes, and liver and spleen meridian tropisms are generally suitable. In addition, Sheng-Hua-Tang was the most frequently used formula for the treatment of uterine subinvolution, yet the dialectical prescriptions were diversified with different patterns/symptoms.
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Asadi N, Vafaei H, Hessami K, Darabi MH, Kasraeian M, Faraji A, Alavi A, Abdi N, Gissuei A, Roozmeh S, Bazrafshan K, Gharibpour F. Vaginal misoprostol and intravenous oxytocin for success of termination in the second-trimester intrauterine fetal demise: A randomized controlled clinical trial. J Obstet Gynaecol Res 2022; 48:966-972. [PMID: 35261120 DOI: 10.1111/jog.15180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/29/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
AIM To compare the success rate of vaginal misoprostol versus intravenous (IV) oxytocin in termination of pregnancy in the second trimester intrauterine fetal death (IUFD). METHODS This was an open-label randomized controlled study for 106 women with second trimester IUFD. Patients were randomly divided into two groups: women given vaginal misoprostol (400 mcg every 6 h up to 48 h) versus those given IV oxytocin (starting with 50 units up to a maximum of 300 units). When the first-line treatment (as mentioned above) failed, treatment methods were replaced with each other. When the second-line treatment failed, the patients underwent dilation and evacuation. RESULTS The first-line treatment yielded the successful rate of 88.7% versus 73.7% for misoprostol versus oxytocin, respectively (p = 0.047). Among those with first-line treatment failure, the second-line treatment yielded success rate of 85.7% versus 83.3% for misoprostol versus oxytocin (p = 0.891). The mean duration of induction to delivery in women with successful response to first-line treatment was 28.72 and 20.55 h after initially receiving misoprostol versus oxytocin, respectively (p < 0.001). While during second-line treatment, this mean interval was not significantly different among those with misoprostol versus oxytocin (p = 0.128). No severe adverse events were observed. CONCLUSION Vaginal misoprostol was associated with higher termination rate than oxytocin without adverse events when used as the first-line treatment. Both methods yielded the same success rate when used as the second-line treatment.
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Affiliation(s)
| | - Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamaran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohammad Hasan Darabi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Kasraeian
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Faraji
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azin Alavi
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nazanin Abdi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Atena Gissuei
- Department of Obstetrics and Gynecology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shohre Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Gharibpour
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhang Y, Zhu H, Chang HM, Leung PCK. ALK3-SMAD1/5 Signaling Mediates the BMP2-Induced Decrease in PGE2 Production in Human Endometrial Stromal Cells and Decidual Stromal Cells. Front Cell Dev Biol 2020; 8:573028. [PMID: 33043005 PMCID: PMC7523465 DOI: 10.3389/fcell.2020.573028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/13/2020] [Indexed: 12/30/2022] Open
Abstract
BMP2 is a critical factor that is involved in the processes of embryo implantation and uterine decidualization. The expression of cyclooxygenase (COX) and subsequent prostaglandin E2 (PGE2) production are critical for successful pregnancy. However, it is not clear whether BMP2 can regulate the production of PG during endometrial decidualization. The aim of this study was to investigate the effects of BMP2 on COX-1 expression and PGE2 production as well as the underlying molecular mechanisms in the human endometrium. Immortalized human endometrial stromal cells (HESCs) and human decidual stromal cells (HDSCs) were used as the study model to investigate the effects of BMP2-induced cellular activities. Our results showed that BMP2 treatment significantly decreased PGE2 production by downregulating COX-1 expression in both human endometrial stromal and decidual stromal cells. Additionally, BMP2 induced an increase in the levels of phosphorylated SMAD1/5/8, and this effect was completely abolished by the addition of the inhibitors DMH-1 and dorsomorphin, but not by SB431542. Knocking down ALK3 completely reversed the BMP2-induced downregulation of COX-1. Moreover, concomitantly knocking down SMAD1 and SMAD5 completely reversed the BMP2-induced downregulation of COX-1. Our results indicated that BMP2 decreased PGE2 production by downregulating COX-1 expression, most likely through the ALK3/SMAD1-SMAD5 signaling pathway in human endometrial stromal and human decidual stromal cells. These findings deepen our understanding of the functional role of BMP2 in the regulation of endometrial decidualization in humans.
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Affiliation(s)
- Yu Zhang
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.,Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Hua Zhu
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Hsun-Ming Chang
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Peter C K Leung
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Şık A, Bilecan S, Kumbasar S, Akpak YK, Aba YA. Does feticide shorten termination duration in second trimester pregnancy terminations? Afr Health Sci 2019; 19:1544-1553. [PMID: 31148982 PMCID: PMC6531983 DOI: 10.4314/ahs.v19i1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Backround A retrospective (case-controlled) study was conducted with the aim of identifying the effect of the use of misoprostol on termination time in patients who did and did not undergo feticide procedures in second trimester pregnancy terminations. Methods The sampling of the study consisted of 144 pregnant women who were diagnosed as having major fetal anomalies incompatible with life, and were recommended for termination of pregnancy. The investigation showed that feticide procedures were performed for 99 women, and feticide procedures were not performed for 45 women. Misoprostol protocol was administered for 48 hours in the termination period; whether the feticide procedure directly affected the termination duration in patients who did and did not undergo feticide was evaluated. Results Abortion/birth was achieved in 103 (71.5%) women during the first 48 hours. There was no significant difference between the termination duration of the misoprostol protocol among the women who did and did not undergo feticide. There was no significant difference between the termination durations and fetal biometric measurements (BPD, HC) except head diameters (p=0.020 and p=0.015). Conclusions The misoprostol protocol is shown to be effective and safe for the termination of pregnancies during the second trimester. Feticide has no affect on the duration of termination.
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Affiliation(s)
- Aytek Şık
- Istanbul Aydın University, Department of Obstetrics and Gynaecology, Istanbul, Turkey
| | - Sedat Bilecan
- Süleymaniye Research and Education Hospital, Department of Obstetrics and Gynaecology, Istanbul, Turkey
| | - Serkan Kumbasar
- Sakarya University School of Medicine, Sakarya Research and Education Hospital, Department of Obstetrics and Gynaecology, Sakarya, Turkey
| | - Yaşam Kemal Akpak
- Ankara Mevki Military Hospital, Department of Obstetrics and Gynaecology, Ankara, Turkey
| | - Yilda Arzu Aba
- Bandırma Onyedi Eylül Üniversitesi, Health Science Faculty, Balikesir, Turkey
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Ye Y, Vattai A, Ditsch N, Kuhn C, Rahmeh M, Mahner S, Ripphahn M, Immler R, Sperandio M, Jeschke U, von Schönfeldt V. Prostaglandin E 2 receptor 3 signaling is induced in placentas with unexplained recurrent pregnancy losses. Endocr Connect 2018; 7:749-761. [PMID: 29700097 PMCID: PMC5958745 DOI: 10.1530/ec-18-0106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
Abstract
Although an inflammatory microenvironment is required for successful implantation, an inflammatory overreaction is one of the causes of unexplained recurrent pregnancy losses (uRPL). Prostaglandin E2 (PGE2) plays a pivotal role in regulating immune balance during early pregnancy, and it can stimulate inflammatory reactions via prostaglandin E2 receptor 3 (EP3). However, the role of PGE2 receptor signaling in the uRPL remains unknown. We aimed to investigate whether EP3 signaling is involved in the mechanism of uRPL. Via immunohistochemistry we could show that the expression of cyclooxygenase-2, EP3 and G protein alpha inhibitor 1 (Gi1) was enhanced in the decidua of the uRPL group in comparison to the control group in first-trimester placentas. In vitro, we demonstrated that sulprostone (an EP1/EP3 agonist) inhibited the secretion of beta-hCG and progesterone in JEG-3 cells and the secretion of beta-hCG in HTR-8/SVneo cells while it induced the expression of plasminogen activator inhibitor type 1 in JEG-3 cells. In addition, PGE2/sulprostone was able to stimulate the expression of Gi1, phosphorylated-extracellular signal-regulated kinases 1/2 (p-ERK1/2) and p53. L-798,106 (an EP3-specific antagonist) suppressed the expression of EP3 and p-ERK1/2 without affecting the secretion of beta-hCG. Elevated activation of EP3 signaling in first-trimester placentas plays an important role in regulating the inflammatory microenvironment, the hormone secretion of extravillous trophoblasts and the remodeling of extracellular matrix in the fetal-maternal interface. L-798,106 might be a 'potential therapeutic candidate' for the treatment of uRPL.
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Affiliation(s)
- Yao Ye
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Aurelia Vattai
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Nina Ditsch
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Christina Kuhn
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Martina Rahmeh
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
| | - Myriam Ripphahn
- Walter Brendel Centre of Experimental MedicineDepartment of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Roland Immler
- Walter Brendel Centre of Experimental MedicineDepartment of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Markus Sperandio
- Walter Brendel Centre of Experimental MedicineDepartment of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Udo Jeschke
- Department of Obstetrics and GynecologyUniversity Hospital, LMU Munich, Munich, Germany
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Hua Y, Zhang W, Hu X, Yang A, Zhu X. The use of misoprostol for cervical priming prior to hysteroscopy: a systematic review and analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2789-2801. [PMID: 27660411 PMCID: PMC5019271 DOI: 10.2147/dddt.s111625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effects of misoprostol use on cervical priming prior to hysteroscopy have been controversial. Therefore, a systematic literature review and meta-analysis of studies were conducted to assess the effect of misoprostol on cervical priming prior to hysteroscopy. All studies published before July 2014 with data related to the use of misoprostol for cervical priming compared with placebo or no medication prior to hysteroscopy, were identified. Twenty-five randomized controlled trials involving 2,203 females were systematically analyzed. The results showed that, compared with placebo or no medication, the use of misoprostol prior to hysteroscopy led to a significant relief of the need for cervical dilatation, resulted in a significantly greater cervical width, had fewer hysteroscopy complications, and mild and insignificant side effects. Subgroup analyses revealed that the regimen of 200 or 400 μg vaginal misoprostol may be a simple and effective method for cervical priming, especially prior to operative hysteroscopy.
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Affiliation(s)
- Ying Hua
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenwen Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaoli Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ansu Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Yang CF, Che HL, Hsieh HW, Wu SM. Concealing emotions: nurses' experiences with induced abortion care. J Clin Nurs 2016; 25:1444-54. [DOI: 10.1111/jocn.13157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Cheng-Fang Yang
- Graduate Institute of Nursing; National Taiwan University; Taipei Taiwan
- Department of Nursing; Cardinal Tien College of Healthcare & Management; New Taipei City Taiwan
| | - Hui-Lian Che
- Department of Gerontological Care and Management; Chang Gung University of Science and Technology; Taoyuan City Taiwan
| | - Hsin-Wan Hsieh
- Department of Nursing; Chang Gung University of Science and Technology; Puzi City Chiayi County Taiwan
| | - Shu-Mei Wu
- Department of Nursing; Chang Gung University of Science and Technology; Taoyuan City Taiwan
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Chen YP, Wang PH, Tsui KH. Comment on the combination of mifepristone and misoprostol for the termination of second-trimester pregnancy. Taiwan J Obstet Gynecol 2015; 54:469-70. [PMID: 26384078 DOI: 10.1016/j.tjog.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Yen-Po Chen
- Department of Obstetrics and Gynecology, Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung County, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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Ting WH, Peng FH, Lin HH, Lu HF, Hsiao SM. Factors influencing the abortion interval of second trimester pregnancy termination using misoprostol. Taiwan J Obstet Gynecol 2015; 54:408-11. [DOI: 10.1016/j.tjog.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 10/23/2022] Open
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Nkwabong E, Mbu RE, Fomulu JN. How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study. BMC WOMENS HEALTH 2014; 14:108. [PMID: 25199407 PMCID: PMC4166018 DOI: 10.1186/1472-6874-14-108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 09/04/2014] [Indexed: 12/01/2022]
Abstract
Background Complications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA). Methods This retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant. Results Women with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death. Conclusions Clandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.
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Affiliation(s)
- Elie Nkwabong
- Department of Obstetrics & Gynecology, University Teaching Hospital & Faculty of Medicine and Biomedical Sciences, PO Box 1364, Yaoundé, Cameroon.
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Lin CH, Yu MH, Chang FW. Cervical priming with misoprostol for the termination of cesarean scar pregnancy. Taiwan J Obstet Gynecol 2014; 53:109-11. [PMID: 24767660 DOI: 10.1016/j.tjog.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- Chen-Hsien Lin
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fung-Wei Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Agaoglu A, Aslan S, Emre B, Korkmaz Ö, Özdemir Salci E, Kocamuftuoglu M, Seyrek-Intas K, Schäfer-Somi S. Clinical evaluation of different applications of misoprostol and aglepristone for induction of abortion in bitches. Theriogenology 2014; 81:947-51. [DOI: 10.1016/j.theriogenology.2014.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/27/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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Alavi A, Rajaei M, Amirian M, Ghazvini LN. Misoprostol versus High Dose Oxytocin and Laminaria in Termination of Pregnancy in Second Trimester Pregnancies. Electron Physician 2013; 5:713-8. [PMID: 26120407 PMCID: PMC4477781 DOI: 10.14661/2013.713-718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In 2 recent decades, found drug regimen to induce abortion that are more effective than surgery. Prostaglandins especially misoprostol, oxytocin and osmotic dilators such as laminaria use for termination but the best method is unknown. Therefore we aimed to assess the comparison between the Misoprostol regimen and the highly concentrated oxytocin with laminaria regimen in second trimester of pregnancy termination. METHODS In this randomized clinical trial, 100 women with gestational age 14 to 24 week coming to hospital due to termination of pregnancy in the absence of uterine contractions and items of exclusion criteria enrolled to study and randomly assign to 2 groups and received misoprostol (group 1) or oxytocin (group 2). Data collected with use of observation, examination and demographic checklist. In group 1, in admission time and then every 6 hour patients received 200 µgr misoprostol until start the pain or vaginal bleeding or abortion in 48 hr. in group 2, patients first received laminaria in cervix with duration of 6 hr and then oxytocin 50 unit in 500 cc normal saline in 3 hr. after 1 hr rest, oxytocin dosage elevated as multiple into 2 and continue until termination or maximum dose of 300 u in 500 cc normal saline. Data entered to SPSS software version 16 and analyzed with use of descriptive methods and also Chi-square and T-test. RESULTS In each group enrolled 50 women that approximately no different in baseline characteristic. Number of abortion in misoprostol group was more than oxytocin group (P<0.001) and duration of abortion also was shorter than oxytocin in misoprostol group (P<0.001). Side effects in 23 (46%) women in misoprostol group were seen but no side effect seen in oxytocin group. Complementally interventions was seen in 31 women (60%) in misoprostol group versus 32 women (62%) in oxytocin group but this difference was not significant (P>0.05). CONCLUSION This study demonstrated that misoprostol is effective than oxytocin in termination of pregnancy but with attention to limitation of this study include of limited abortion causes due to legal laws, additional studies on different doses of misoprostol and oxytocin due to achieve to suitable regimen with lower side effects recommended.
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Affiliation(s)
- Azin Alavi
- Assistant Professor, Hormozgan Fertility & Infertility Research Center, Bandar Abbas, Iran
| | - Minoo Rajaei
- Associate Professor, Hormozgan Fertility & Infertility Research Center, Bandar Abbas, Iran
| | - Malihe Amirian
- Assistant Professor, Hormozgan Fertility & Infertility Research Center, Bandar Abbas, Iran
| | - Lili Nikuee Ghazvini
- Obstetrics & Gynecology Resident, Hormozgan Fertility & Infertility Research Center, Bandar Abbas, Iran
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Tsui KH, Lin LT, Yu KJ, Chen SF, Chang WH, Yu S, Cheng JT, Wang PH. Double-balloon cervical ripening catheter works well as an intrauterine balloon tamponade in post-abortion massive hemorrhage. Taiwan J Obstet Gynecol 2012; 51:426-9. [DOI: 10.1016/j.tjog.2012.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 10/27/2022] Open
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