Cassimo Bique

The Effectiveness of Intravaginal Misoprostol (Cytotec) in Inducing Abortion after Eleven Weeks of Pregnancy

At Maputo Central Hospital in Mozambique, intravaginal misoprostol, a PGE2 methyl-analogue, was used by 169 women whose request for interruption of pregnancy had been approved. The drug was used by women who had completed between 12 and 23 weeks of gestation. The initial dose was 800 micrograms, repeated 24 hours later if abortion had not occurred or was not in progress. The treatment was considered a failure when abortion was not advanced by 48 hours after the initial dose, and curettage was performed in all but one of such cases. During the course of the study, the dosage was successively reduced to 600, 400, and 200 micrograms. Abortion was successfully induced in 154 women (91.1 percent); there were 10 failures (5.9 percent), and five women (3.0 percent) dropped out of the study. The mean time from initial dose to abortion was 14.3 hours. No significant association of success rate and time from dosage to expulsion was found with age, parity, previous abortion, or gestational age. Preventive vacuum aspiration of the uterine cavity was carried out on all subjects.

Induction of labor with intravaginal misoprostol in intrauterine fetal death

OBJECTIVE Our purpose was to evaluate the effectiveness and safety of intravaginal misoprostol for the induction of labor in intrauterine fetal death. STUDY DESIGN Seventy-two women at 18 to 40 weeks of pregnancy with intrauterine fetal death, without abdominal scars, were treated with 100 micrograms of intravaginal misoprostol. The dose was repeated every 12 hours until effective uterine contractions and cervical dilatation were obtained, for up to 48 hours. RESULTS The mean time from induction to delivery was 12.6 hours, and only six patients (8%) required between 24 and 48 hours, at the end of which all patients had been delivered. Only the Bishops score was significantly associated with time from first dose to expulsion. No surgical procedure was required. Hypercontractility, sweating, fever, diarrhea, or other gastrointestinal effects were not detected. There was no need for analgesics. CONCLUSIONS Intravaginal misoprostol at the dose of 100 micrograms every 12 hours appears to be a safe, effective, practical, and inexpensive new method for induction of labor in intrauterine fetal death.

Pregnancy Interruption by Vaginal Misoprostol

A total of 132 pregnant women with average gestational age of 14.2 weeks (range 11-22 weeks) undergoing legal abortion volunteered for a trial utilizing vaginal administration of misoprostol. In 106 women a dose of 800 micrograms was utilized, whilst in 26 women 1,200-1,600 micrograms were given. Nonsurgical expulsion of the fetus was successful in 117 cases (88.6%). Four cases had to be excluded for various social reasons. A total of 11 did not achieve fetal expulsion within 56 h after application of misoprostol. These cases (11/132; 8.3%) were considered failures. Previous reports in the literature of toxicity trials on animals reporting no fetotoxic nor teratogenic effects of misoprostol at doses up to 10,000 micrograms/kg body weight seem to be of no validity in the human since we could demonstrate that almost 80% of pregnancies were interrupted at a dose of 10-15 micrograms/kg body weight. The conclusion is that vaginal administration of this prostaglandin analogue, not requiring cool temperature for storage, is remarkably effective in achieving safe interruption of pregnancy without any significant complications.

Vaginal misoprostol as an alternative to oxytocin for induction of labor in women with late fetal death

Background. Induction of labor in women with late fetal death is often difficult in settings with scarce resources. The purpose of this study was to assess the value of vaginal misoprostol for induction of labor in women with such fetal death.

Reducing maternal mortality in Mozambique: challenges, failures, successes and lessons learned

The aim of this paper is to describe different approaches to make emergency obstetric care (EmOC) accessible to women in Mozambique. The definitions of basic (BEmOC) and comprehensive EmOC (CEmOC), proposed by the UN agencies, were adopted by FIGO and by the Mozambican Ministry of Health as a general strategy to reduce maternal mortality. Four projects are presented: (1) José Macamo and (2) Mavalane Hospitals in Maputo city, (3) Manhiça District in Maputo Province and (4) Sofala Province. José Macamo was staffed by physicians 24 h a day; other hospitals by non‐physicians trained in surgical and anesthesiology techniques, as well as nurse‐midwives. José Macamo Hospital provided CEmOC to the city of Maputo and the southern area of Maputo Province. In 2001, this hospital attended 32% of deliveries and 38% of cesarean sections in the city, up from 14 and 2.5%, respectively, in 1998. The Mavalane Hospital failed to provide CEmOC; however, the number of deliveries per year almost doubled. The Manhiça hospital carried out 31% of the Districts C‐sections in 2001, up from 9% in 1998. In Sofala Province, one additional CEmOC and four BEmOCs were installed and case fatality rates decreased. In conclusion, the strategy for ensuring provision of EmOC is feasible even in countries with minimal resources and a scarcity of physicians, such as Mozambique.

Low-dose vaginal misoprostol for induction of labor with a live fetus

Objective: To test the effectiveness and safety of low‐dose vaginal misoprostol for induction of labor with a live fetus. Methods: Labor was induced in 666 pregnant women with a live fetus in the cephalic position, who had no medical complications and no history of uterine surgery. One‐fourth of a 200‐μg tablet of misoprostol (50 μg) was placed in the posterior vaginal fornix every 12 h for a maximum of four doses or until active labor commenced. Time from induction to delivery, side effects and neonatal outcome were evaluated. Results: Labor was successfully induced in all cases. The mean time from induction to delivery was 10.4 h. The cesarean section rate was 7.8%. There were eight perinatal deaths, six of which occurred in low birth weight fetuses. There was one case of abruptio placenta, which was less than that expected in the study population. Conclusion: Vaginal misoprostol, in very low doses, was a remarkably efficient and safe method for induction of labor with a live fetus.

Labor induction by vaginal misoprostol in grand multiparous women

BACKGROUND Grand multiparous women in poor and under-privileged settings run a high risk of uterine rupture at labor induction. The purpose was to elucidate whether vaginal misoprostol medication is a safe and cost-effective alternative induction method in grand multiparous women, in whom, under prevailing circumstances, induction by oxytocin is associated with high risk of adverse maternal outcome of pregnancy. METHOD One hundred and sixty-five grand multiparous parturient women with five or more previous deliveries were divided into two groups. The first group (n=134) had the fetus alive and the second (n=31) had late intrauterine fetal death. Both groups were subject to induction of labor by use of vaginal misoprostol in a dose of 50 microg (live fetus) and 100 microg (intrauterine fetal death). No additional oxytocin was utilised. RESULTS Labor induction by vaginal misoprostol was successful in grand multiparous women. The proportion of women requiring a Cesarean section was 6.0%, which is less than one third of the average Cesarean section rate in the setting studied. Women with fetus alive had significantly shorter application-to-expulsion interval (AEI) than women with fetal death (10.1 versus 15.4 hours; p=0.039). Significantly shorter AEI was recorded in women with prelabor rupture of membranes (9.1 hours) than in women with intact membranes (12.9 hours) (p=0.01). With Bishops score > or = 5 and < 5 AEI was 8.7 hours and 14.4 hours, respectively (p=0.001). No significantly adverse neonatal or maternal outcomes of pregnancy were registered and it was specifically noted that no uterine rupture occurred among the 165 grand multiparous women induced. CONCLUSIONS Induction of under-privileged grand multiparous women with live fetus or with fetal death can be performed safely and cost-effectively by vaginal misoprostol.

Uterine evacuation by vaginal misoprostol after second trimester pregnancy interruption.

Background The purpose was to study the capacity of vaginal misoprostol in combination with methylergometrine to achieve complete evacuation of the uterus without ensuing surgical evacuation of the uterine cavity.

A Comparative Study of Vaginal Misoprostol and Intravenous Oxytocin for Induction of Labour

Fifty-two women who had labour induced by intravenous oxytocin were compared with 404 women in whom labour was induced by vaginal misoprostol (50-150 micrograms). The induction-to-delivery intervals in the oxytocin and misoprostol groups, respectively, had the following durations. With Bishops score < 6, 24.3 vs. 14.4 h (p = 0.002), with Bishops score > or = 6, 10.5 vs. 7.6 h (p = 0.02), with ruptured membranes, 8.8 vs. 8.5 h (p = 0.83), and with intact membranes, 19.6 vs. 13.1 h (p = 0.005). The Caesarean delivery rate was 17.3% in the oxytocin group and 8.7% in the misoprostol group (p = 0.09). Maternal complications were few and drug side effects rare. It is concluded that vaginal misoprostol is a valuable and cost-effective alternative to intravenous oxytocin infusion for induction of labour.

Comparison of women having clandestine and hospital abortions: Maputo, Mozambique

Abstract In Mozambique a Ministry of Health decree since 1981 allows public hospitals to carry out abortions if pregnancy results from contraceptive failure or places a womans health or life at risk. As a result the number of hospital abortions has increased and the number of women attending hospital for complications of clandestine abortion has decreased. Nevertheless, clandestine abortions continue to cause maternal deaths and morbidity. This study compared women attending the main hospital in Maputo for complications of clandestine abortion and those having an induced abortion in the hospital. Most of those in the first group were young and primigravida, had experienced fewer abortions and lived in poorer socio-economic conditions. Fewer had a steady partner, were more frequently recent migrants to Maputo, and had lower knowledge and use of contraceptives. To reduce the number of illegal abortions and their consequences, governmental programmes should aim to make contraceptive and abortion services more available and accessible, particularly to young, unmarried women of low socio-economic status.