Pak Chung Ho

Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy

Objective To compare the efficacy of vaginal with oral misoprostol in termination of second-trimester pregnancy after pretreatment with mifepristone. Methods Women requesting termination of secondtrimester pregnancy were randomized into two groups. Thirty-six to 48 hours after oral administration of 200 mg of mifepristone, women were given either oral or vaginal misoprostol 200 μg every 3 hours for a maximum of five doses in the first 24 hours. Women receiving oral misoprostol also were given a vaginal placebo (vitamin B6), whereas those receiving vaginal misoprostol were given an oral placebo. If they failed to abort, a second course was given by the same route. Results The median induction-abortion interval in the vaginal group (9 hours) was significantly shorter than that in the oral group (13 hours). The percentage of women aborting within 24 hours in the vaginal group (90%) was significantly higher than that in the oral group (69%). The median amount of misoprostol used in the vaginal group (600 μg) also was significantly less than that in the oral group (1000 μg). There was no significant difference in the incidence of side effects between the two groups except for fatigue and breast tenderness, which were more common in the oral group. Seventy-six percent of the women preferred the oral route, and 24.5% of the women preferred the vaginal route. Conclusion Vaginal misoprostol is more effective than oral misoprostol in termination of second-trimester pregnancy after pretreatment with mifepristone, but more women preferred the oral route.

Misoprostol: Pharmacokinetic profiles, effects on the uterus and side-effects

Misoprostol, a synthetic prostaglandin E1 analogue, is commonly used for medical abortion, cervical priming, the management of miscarriage, induction of labor and the management of postpartum hemorrhage. It can be given orally, vaginally, sublingually, buccally or rectally. Studies of misoprostols pharmacokinetics and effects on uterine activity have demonstrated the properties of the drug after various routes of administration. These studies can help to discover the optimal dose and route of administration of misoprostol for individual clinical applications. Misoprostol is a safe drug but serious complications and teratogenicity can occur with unsupervised use.

A randomised controlled trial of empowerment training for Chinese abused pregnant women in Hong Kong

Objective  To evaluate the effectiveness of an empowerment intervention in reducing intimate partner violence (IPV) and improving health status.

The prevalence of domestic violence against pregnant women in a Chinese community.

Objective: To study the incidence of domestic violence in pregnant women attending the antenatal clinic of a local teaching hospital. Study design: All pregnant women attending their first antenatal clinic in Tsan Yuk Hospital between 11th August and 3rd November, 1998 were interviewed by a designated research nurse (Y.Y.J.L.) using a standard questionnaire (Abuse Assessment Screen) to detect the incidence of domestic violence, the nature of violence, the frequency of violence and the perpetrator of abuse. Demographic factors of the abused group were compared with those of the non‐abused group using students t‐test and chi‐square test. Results: Pregnant women (631) were interviewed; 113 of them (17.9%) had a history of abuse; 99 women (15.7%) had been abused in the last year; 27 of them (4.3%) had been abused during their current pregnancy; 59 women (9.4%) had been sexually abused in the last year. The husband was the perpetrator in the majority of cases. The nature of violence during pregnancy was mainly psychological in the form of threats of abuse without any physical injury. Risk factors included unplanned pregnancy (P=0.002) and women with husbands/partners who were unemployed or manual workers (P<0.05). Unexpectedly, domestic violence occurred more commonly in permanent local residents rather than new immigrants (P<0.05). Conclusion: This is probably the first study on the incidence of domestic violence in pregnant women in a Chinese community. The incidence is comparable to that from American studies. Routine screening with structured questions during the antenatal visits is necessary in order to identify the abused women so as to prevent potential trauma and to interrupt existing abuse.

The impact of psychological abuse by an intimate partner on the mental health of pregnant women

Objective  The objective of this first population‐based study in Hong Kong was to assess the impact of psychological abuse by an intimate partner on the mental health of pregnant women.

A randomized double blind comparison of real and placebo acupuncture in IVF treatment.

BACKGROUND Acupuncture has been used during IVF treatment as it may improve outcome, however, there are concerns about the true efficacy of this approach. This randomized double blind study aimed to compare real acupuncture with placebo acupuncture in patients undergoing IVF treatment. METHODS On the day of embryo transfer (ET), 370 patients were randomly allocated to either real or placebo acupuncture according to a computer-generated randomization list in sealed opaque envelopes. They received 25 min of real or placebo acupuncture before and after ET. The endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were evaluated before and after real and placebo acupuncture. RESULTS The overall pregnancy rate was significantly higher in the placebo acupuncture group than that in the real acupuncture group (55.1 versus 43.8%, respectively, P = 0.038; Common odds ratio 1.578 95% confidence interval 1.047-2.378). No significant differences were found in rates of ongoing pregnancy and live birth between the two groups. Reduction of endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were observed following both real and placebo acupuncture, although there were no significant differences in the changes in all these indices between the two groups. CONCLUSIONS Placebo acupuncture was associated with a significantly higher overall pregnancy rate when compared with real acupuncture. Placebo acupuncture may not be inert. Trial registered with HKClinicalTrials.com: number HKCTR-236.

Cervical priming with oral misoprostol in pre-labor rupture of membranes at term

Objective To investigate the effectiveness of oral misoprostol as a cervical priming agent for patients presenting with pre-labor rupture of membranes at term Methods Eighty patients presenting with pre-labor rupture of membranes at term were randomized to receive either 200 μg of misoprostol or 50 mg of vitamin B6 orally 1 hour after admission. Labor was induced with intravenous oxytocin infusion 12 hours after oral medication if the patient did not go into labor. We compared the induction rate, duration of labor, mode of delivery, and leaking-to-delivery interval in the two groups. Results The cervical score was significantly improved and the induction rate was also reduced in the misoprostol group when compared with the control group. The interval from recruitment to onset of labor, duration of labor, and the interval from recruitment to delivery were significantly shorter in the misoprostol group. The mode of delivery and the perinatal outcome were similar for the two groups. Conclusion Oral misoprostol is an effective agent for cervical priming and labor induction in patients with pre-labor rupture of membranes at term.

Termination of pregnancy with reduced doses of mifepristone

OBJECTIVES To compare the abortifacient efficacy and side effects of three doses of the antiprogestin mifepristone plus prostaglandin for termination of early pregnancy. DESIGN Randomised, double blind multicentre trial. SETTING 11 departments of obstetrics and gynaecology and of family planning, mostly in university hospitals, in seven countries. SUBJECTS 1182 women with an early pregnancy (menstrual delay of 7-28 days) requesting abortion. INTERVENTIONS Single doses of 200 mg, 400 mg, or 600 mg mifepristone followed, 48 hours later, by vaginal pessary of 1 mg of the prostaglandin E1 analogue gemeprost. MAIN OUTCOME MEASURES Outcome of treatment; duration and subjective amount of menstrual bleeding; side effects and complications; and concentrations of haemoglobin. RESULTS Outcome was similar with the three doses of mifepristone. Of the 1151 women with known outcome, 95.5% had a complete abortion (364 (93.8%) of those given 200 mg mifepristone, 368 (94.1%) of those given 400 mg, and 367 (94.3%) of those given 600 mg), 3.7% had an incomplete abortion (14 (3.6%), 15 (3.8%), and 14 (3.6%)), 0.3% had a missed abortion (three (0.8%), one (0.3%), and none), and 0.4% had a continuing live pregnancy (two (0.5%), two (0.5%), and one (0.3%)). Of the 43 women who had incomplete abortion, 23 underwent emergency uterine curettage (usually for haemostatic purposes) and three of these women were given a blood transfusion. The numbers of reported complaints, bleeding patterns, and changes in blood pressure and haemoglobin concentrations were similar with the three treatments. CONCLUSIONS For termination of early pregnancy a single dose of 200 mg mifepristone is as effective as the currently recommended dose of 600 mg when used in combination with a vaginal pessary of 1 mg gemeprost.

Domestic violence and postnatal depression in a Chinese community

Objectives: To study the relationship between domestic violence and postnatal blues/depression in a Chinese community. Methods: This was a prospective cohort study on 838 women after delivery in a local university teaching hospital. Between October, 2000 and February, 2001, all Chinese speaking women after delivery were invited to be interviewed by a designated research nurse using the Abuse Assessment Screen (AAS) to detect the incidence of domestic violence, the nature of violence and the perpetrator of abuse. Demographic data, pregnancy outcome, Steins Daily Scoring System (SDSS) scores on day 2 or 3 postdelivery, Edinburgh Postnatal Depression Scale (EPDS) scores on day 2 or 3 postdelivery, 1–2 days after discharge from hospital and at 6 weeks postdelivery were compared between the abused and non‐abused groups using Students t‐test, χ2‐test and Fishers exact test as appropriate. Results: A total of 139 women (16.6%) had been abused in the last year (the abused group). Of these, 87 (10.4%) had been abused during the current pregnancy. The nature of abuse was mainly verbal. Fourteen women (1.7%) had been sexually abused in the last year. The husband/boyfriend, mother‐in‐law and employer/colleague were the most common perpetrators of abuse. Socio‐demographic factors did not differ between the two groups except that pregnancy was more likely to be unplanned in the abused group (P=0.002). The pregnancy outcome did not differ. However, the abused group had significantly higher SDSS and EPDS scores at all stages of screening (P=0.003, P=0.000, P=0.010 and P=0.001, respectively). Conclusion: The findings supported our hypothesis that the effect of domestic violence on Chinese pregnant women is mainly on their psychological well‐being.

The role of acupuncture in the management of subfertility

OBJECTIVE To review systematically the use of acupuncture in the management of subfertility. DESIGN A computer search was performed via several English and Chinese databases to identify journals relevant to the subject. RESULT(S) The positive effect of acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and stress reduction. Acupuncture may help restore ovulation in patients with polycystic ovary syndrome, although there are not enough randomized studies to validate this. There is also no sufficient evidence supporting the role of acupuncture in male subfertility, as most of the studies are uncontrolled case reports or case series in which the sample sizes were small. Despite these deficiencies, acupuncture can be considered as an effective alternative for pain relief during oocyte retrieval in patients who cannot tolerate side effects of conscious sedation. The pregnancy rate of IVF treatment is significantly increased, especially when acupuncture is administered on the day of embryo transfer. CONCLUSION(S) Although acupuncture has gained increasing popularity in the management of subfertility, its effectiveness has remained controversial.