Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens

A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14-28 weeks of gestation

BACKGROUND

Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established.

OBJECTIVES

To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD.

SEARCH STRATEGY

Research databases from January 2006 to October 2018.

SELECTION CRITERIA

Randomized controlled trials with IUFD cases at 14-28 weeks of gestation.

DATA COLLECTION AND ANALYSIS

We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence.

MAIN RESULTS

Sixteen trials from 1695 citations. When misoprostol is used alone, 400 μg is more effective than 200 μg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low.

CONCLUSIONS

Misoprostol 400 μg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.

Gendered trends in early and very early sex and condom use in 20 European countries from 2002 to 2010

BACKGROUND

Sexual activity is often initiated during the adolescent period, and previous research suggests that the age of first sexual intercourse and condom use are crucial determinants of later sexual health. This study examined trends in adolescent sexual behaviours from 2002 to 2010 in 20 countries across four geographical regions of Europe.

METHODS

Data were collected by self-report questionnaires from 15-year-olds in classrooms during 2002, 2006 and 2010. Linear time trends were determined through logistic regression models, stratified for gender.

RESULTS

No linear trend over time was documented for most countries for sexual intercourse at the age of 13 or younger. Increased initiation among girls in Eastern Europe and decreased very early initiation among girls in Northern Europe emerged, along with a general increase in condom use in boys and most notably in girls.

CONCLUSION

Overall prevalence of early and very early sexual intercourse initiation was quite stable in Europe between 2002 and 2010, while condom use increased. More detailed research and policy attention to the antecedents of non-condom use among young people is warranted; and further study of the relationships between age of sexual initiation and condom or pill use would be particularly valuable.

Randomized controlled study comparing misoprostol moistened with normal saline and with acetic acid for second-trimester pregnancy termination. Is it different?

OBJECTIVE

To compare the efficacy and adverse effects of 400 µg intravaginal misoprostol for second-trimester pregnancy termination in live fetuses between two groups: one in which misoprostol was moistened with normal saline solution (NSS) and the other in which misoprostol was moistened with acetic acid.

MATERIALS AND METHODS

A total of 179 pregnant women between 14 and 28 weeks of gestation with live fetuses indicated for pregnancy termination were recruited. They were randomly allocated to receive 400 µg intravaginal misoprostol either moistened with NSS (n = 96) or moistened with acetic acid (n = 83). The same dosage was then repeated every 3 h if adequate uterine contractions were not achieved until 48 h after the initiation of misoprostol. The main outcomes were mean abortion time, success rate, and adverse effects.

RESULTS

The mean abortion time was not significantly different between the groups (24.98 ± 16.42 h vs 25.89 ± 10.34 h, P > 0.05). The rates of abortion within 24 h and 48 h and the adverse effects were also comparable between the groups. Chills and fever were the most common adverse effects in this study.

CONCLUSION

Intravaginal misoprostol either moistened with NSS or acetic acid was comparable in terms of efficacy and adverse effects.