Vaginal misoprostol is equally efficacious in labor induction and demonstrates a similar fetal and maternal safety profile to PGE2 gel.

The objective of this study was to compare the efficacy and side-effects of two regimens of vaginal misoprostol for second trimester voluntary medical termination of pregnancy (MTP) according to the MTP Act of India. A randomized trial was conducted in 185 women from January 2007 to September 2008. Women in group 1 were given vaginal misoprostol 400 microg every 6 h for a maximum of four doses. Women in group 2 were given vaginal misoprostol 400 microg every 12 h for a maximum of four doses. Our primary outcome measure was induction abortion interval. Secondary outcome measures were success rate, side-effects and completeness of procedure. Results were calculated applying Fisher's exact test, chi-square test, Z test and calculating the P value using an alpha level of 0.05 for Type I error. The mean induction abortion interval in group 1 (12.59 h) was significantly shorter (P < 0.001) than that in the group 2 (16.41 h). The percentage of women who achieved successful abortion within 12 h in group 1 (56.52%) was also significantly higher (P = 0.00005) than that in group 2 (25.80%). The incidence of side-effects was comparable and not clinically serious. It is concluded that the regimen of vaginal misoprostol 400 microg every 6 h was more effective than the regimen of misoprostol every 12 h in medical termination of second trimester pregnancy.

Background: Ectopic pregnancy (EP) is the single most important cause of maternal morbidity and mortality in the first trimester and its rising trend throws a great challenge to the obstetrician and gynecologist due to its varied presentation. Aim: To study the incidence, clinical trends, risk factors and surgical management of ectopic pregnancy in a tertiary care hospital. Materials and methods: Retrospective study conducted among the diagnosed cases of ectopic pregnancies admitted during a period of 3 years and a total of 474 cases were studied. Data collected from BHT, Labor ward registers, Gynae ward registrars, Operation Theatre registers, Intensive care unit (ICU) and high dependency units (HDU) records. All the parameters were tabulated and analyzed after data entry. Results: Peak age of incidence were among 26-30 years (32.27%), more common in multigravida (74.69%), commonly presented at gestational age between 6-8 weeks (50.42%) risk factors associated with 73.18% of cases. Most commonly presented with lower abdominal pain (75.31%) followed by short h/o amenorrhea (68.35%). Classical triad presents in 37.97% of cases. Clinically extreme pallor and hemodynamically shock stage presented in 26.58% and 33.33% cases respectively. The commonest site of affection was Ampulla of the tube (50.84%) and most common operation done was Salpingectomy (83.54%). There was no mortality. Conclusions: Early diagnosis and proper management becomes the key of success. High degree of suspicion, identification of risk factors, availability of modern investigations and timely intervention will definitely help to reduce the morbidity and mortality associated with EP.

Background: The aim of the study is to compare immediate induction with vaginal misoprostol tablet and immediate induction with vaginal PGE2 gel in women with premature rupture of membranes at term (PROMT).Methods: Nine hundred thirty-two women with PROM at term were assigned randomly to receive intravaginal 25μg misoprostol tablet, 4 hourly with a maximum of 5 doses or 0.5 mg vaginal PGE2 gel 6 hourly with a maximum of 2 doses. The primary outcome measures were cesarean section rate, admission to delivery interval and induction to delivery interval. Secondary outcomes included, mode of delivery, and maternal and neonatal safety outcome. Results were calculated applying Fisher Exact Test, Chi square test, t test and calculating the P-value using an alpha level of 0.05 for Type I error.Results: The mean time from admission to delivery was 13.16 hours in the misoprostol group and 13.56 hours in the PGE2 group (P= 0.3014). Induction to delivery interval was also comparable between the groups (10.23 h versus 10.18 h).Caesarean section rate did not differ significantly between groups (12.13% versus 15.74% ,P=0.135 RR 0.783 95% CI 0.568-1.079).More women in misoprostol group had instrumental delivery (7.57% versus 4.25%, P=0.031, RR 1.089 95% CI 1.04-3.03).The  neonatal outcomes were comparable between the groups . Maternal outcomes were not significantly different except incidence of analgesic use (P=0.009 RR 1.62 95% CI 1.03-1.30), meconium stained liquor (P=.0096 RR 2.03 CI 1.17-3.53) and   number of digital vaginal examinations (P<.0001) in misoprostol group.Conclusions: Vaginal misoprostol is equally efficacious in labor induction and demonstrates a similar fetal and maternal safety profile to PGE2 gel.

INTRODUCTION: Early pregnancy failure (EPF) is an inclusive term that comprises incomplete, complete, or inevitable spontaneous abortion; anembryonic gestation (blighted ovum); and embryonic demise (missed abortion) at less than 14 weeks 1. It is one of the most common complications of pregnancy, accounting for approximately 15% to 20% of clinically recognized pregnancies 1,2. Many EPFs occur before pregnancies have been clinically recognized (that is, women mistake them for “late cycles”). AIMS & OBJECTIVES: To compare the efcacy between mifepristone 200mg orally followed by misoprostol 800µg vaginally 6 hrs later with mifepristone 200mg orally followed by misoprostol 800µg vaginally 24 hrs later in early pregnancy failure for termination up to 9 weeks of gestation. To reduce unusual blood loss. To reduce surgical intervention in case of early pregnancy failure. MATERIALS & METHODS: Hospital based Prospective randomiSe comparative single centre study. Department of Obstetrics and Gynecology Midnapore Medical College and Hospital. One year from January 2019 to February 2020 for data collection and six month for data analysis. Mother attended the Gynae OPD clinic and Obstetrics emergency with features of early pregnancy failure. The sample size was 50, with 25 patients in each group. RESULTS:We found that the table 4 shows the distribution according to gestational age. The main indication for which medical abortion was done in our study is early pregnancy failure (Blighted ovum) and missed abortion. Majority of patients were in the gestational age between 8-9 weeks with 48 % of women who underwent 6 hour interval regimen and 40% of women who underwent 24 hour interval regimen. P value documented is 0.849 which is not signicant. There was no signicant difference between two groups regarding gestational age (p value=0.849). SUMMARY AND CONCLUSION: Vaginal Misoprostol can be safely administered 6 hours following Mifepristone instead of waiting for 24 hours. Efcacy in achieving complete abortion rate is almost equal to 24 hours regimen and most acceptable from patient's side also. Additionally, women are less likely to experience side effects the earlier the misoprostol is used. Women can now have more exibility when using mifepristone and vaginal misoprostol for medical abortion