L. Tang

Vaginal Misoprostol Compared With Vaginal Gemeprost in Termination of Second Trimester Pregnancy A Randomized Trial

A prospective randomized trial was conducted in 140 women to compare the efficacy of vaginal gemeprost with vaginal misoprostol for termination of second trimester pregnancy. Women requesting termination of second trimester pregnancy were randomized into two groups. Group A women were given 1 mg vaginal gemeprost every 3 h for a maximum of five doses in the first 24 h, whereas group B women were given 400 micrograms vaginal misoprostol every 3 h for a maximum of five doses in 24 h. The median induction-abortion interval in the vaginal misoprostol group (14.1 h) was significantly shorter than that in the gemeprost group (19.5 h). The percentage of women who achieved successful abortion within 24 h in the misoprostol group (80.0%) was significantly higher than that in the gemeprost group (58.6%). There was no significant difference in the incidence of side effects between the two groups except for diarrhea, which was more common in the gemeprost group. The incidence of fever was more common in the misoprostol group. It is concluded that vaginal misoprostol is more effective than gemeprost in termination of second trimester pregnancy.

The Accuracy of Intraoperative Frozen Section in the Diagnosis of Ovarian Tumors

A retrospective study of 316 ovarian neoplasms which had frozen section evalutation between January 1, 1990 to December 31, 1995 was conducted to determine the accuracy of frozen section diagnosis of ovarian neoplasms. The frozen section results were compared with final diagnoses from paraffin sections. The frozen section diagnosis was accurate in 95.2% of all cases and inaccurate in 4.8%. The positive predictive value of a positive (or malignant) frozen section was 100%, the negative predictive value of a negative (or benign) frozen section was 98.2%. The sensitivity for malignant tumors was 87%. For tumors of borderline malignancy, the sensitivity and specificity were 60% and 98.6% respectively. Of the false negative frozen section diagnoses, 73% (8 cases) occurred in tumors of borderline malignancy. We concluded that with the exception of the sensitivity for the diagnosis of tumors of borderline malignancy, the sensitivity and specificity of frozen section diagnosis for benign and overtly malignant ovarian neoplasms are high.

Pilot study on the use of repeated doses of misoprostol in termination of pregnancy at less than 9 weeks of gestation

Pregnancy was terminated by repeated doses of vaginal misoprostol in 20 women at a gestational age of less than 9 weeks. The women were given 800 μg of vaginal misoprostol as an initial dose followed by 400 μg of vaginal misoprostol every 3 h for 4 doses. Fourteen women (70%, 95% confidence interval: 48–85%) had a complete abortion. Two women (10%) had a missed abortion, and two (10%) had an ongoing pregnancy. Two women (10%) had an incomplete abortion. The interval between the first dose of misoprostol and the passage of tissue mass was 25.3±34.4 h (median: 15 h).The duration of vaginal bleeding was 23.6±20.4 days (median: 14 days). Side-effects were mild and there was no significant drop in hemoglobin level. Repeated doses of vaginal misoprostol may be an alternative for women who do not want surgical abortion and who live in an area where mifepristone is not available.

Use of fetal-pelvic index in the prediction of vaginal birth following previous cesarean section.

Aim:  To clarify the usefulness of the fetal‐pelvic index as a predictor of vaginal birth after previous lower segment cesarean section.

Oral misoprostol for induction of labor in prelabor rupture of membranes (PROM) at term: a randomized control trial

Objective. To compare the efficacy of two different dosages of oral misoprostol (50 and 100 μg) with control, in medical induction of labor for patients with prelabor rupture of membranes (PROM) at term. Methods. One hundred women with PROM at term were randomized to receive placebo (vitamin B6 50 mg, control), 50 μg (treatment group 1), or 100 μg (treatment group 2) of oral misoprostol every 4 h to a maximum of six doses. The main outcome measures included time interval from onset of PROM to delivery, duration of first stage of labor, and occurrence of vaginal delivery within 24 h from PROM. Results. The time intervals from PROM to delivery were significantly reduced in both treatment groups compared to control (control, 25.1±10.5 h; treatment group 1, 14.5±6.2 h; and treatment group 2, 13.0±6.1 h, p<0.0001 for both). The duration of the first stage of labor was significantly shortened only in treatment group 2 compared to control (3.3±2.5 versus 6.2±3.4 h, p=0.01). Of those who delivered vaginally (93% in treatment group 1 and 97% in treatment group 2), significantly more women delivered within 24 h of PROM in the treatment group compared to the control group (50%, p<0.05). Conclusions. Oral misoprostol 50 μg every 4 h is safe, cheap, and as effective as 100 μg in reducing the PROM to delivery time interval and labor duration in primiparous women. The same effect is not observed in a multiparous group.

Massive secondary postpartum haemorrhage from rupture of thrombosed uterine artery following lower segment caesarean section

(1997). Massive secondary postpartum haemorrhage from rupture of thrombosed uterine artery following lower segment caesarean section. Journal of Obstetrics and Gynaecology: Vol. 17, No. 1, pp. 57-58.