Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new cytotec research articles will be listed here shortly after becoming available to us.
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Medical research on cytotec
Medical abortion practices: a survey of National Abortion Federation members in the United States.
Contraception. 2008 Dec; 78(6): 486-91
Wiegerinck MM, Jones HE, O'Connell K, Lichtenberg ES, Paul M, Westhoff CL
BACKGROUND: Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation (NAF) members for the year 2001. METHODS: Questionnaires were mailed to 337 active US NAF member facilities. RESULTS: A total of 258 facilities responded (77%); 252 nonhospital facilities were included in the analysis. Most of these facilities (87%) offered medical abortion in 2001, providing an estimated 28,400 medical abortions, approximately 52% of medical abortions in the US that year. Over 75% began offering mifepristone/misoprostol abortions within 5 months of the start of mifepristone distribution. Almost all (99%) reported using mifepristone/misoprostol regimens, with most offering one or more evidence-based alternative regimens (83%); a few (4%) used the FDA-approved regimen. CONCLUSION: After FDA approval of mifepristone, NAF member facilities rapidly adopted evidence-based mifepristone/misoprostol regimens.
Lakartidningen. 2008 Oct 8-14; 105(41): 2855-7
Bendz E, Liljequist VA, Bergström S
Small bowel injury by low-dose enteric-coated aspirin and treatment with misoprostol: a pilot study.
Clin Gastroenterol Hepatol. 2008 Nov; 6(11): 1279-82
Watanabe T, Sugimori S, Kameda N, Machida H, Okazaki H, Tanigawa T, Watanabe K, Tominaga K, Fujiwara Y, Oshitani N, Higuchi K, Arakawa T
BACKGROUND & AIMS: With capsule endoscopy, the ulcerogenic effect of low-dose enteric-coated aspirin on the small bowel and the therapeutic effect of misoprostol on intestinal injury were evaluated. METHODS: Eleven patients who developed gastric ulcers while undergoing low-dose enteric-coated aspirin therapy were enrolled. They continued aspirin therapy while taking proton pump inhibitors (PPIs) for 8 weeks to heal the gastric ulcers. Then misoprostol 200 microg 4 times a day was administered instead of PPIs for 8 weeks. When the patients could not tolerate misoprostol as a result of side effects, they received another 8 weeks of PPI therapy. RESULTS: Capsule endoscopy performed after 8 weeks of PPI treatment identified red spots and mucosal breaks in 100% (11/11) and 90.9% (10/11) of patients, respectively. In 7 patients who completed the study protocol, misoprostol significantly decreased the median number of red spots and mucosal breaks, with complete disappearance of mucosal breaks in 4 patients. Intestinal lesions tended not to heal in 3 patients who discontinued misoprostol. CONCLUSIONS: Low-dose enteric-coated aspirin frequently damages the small intestine, and misoprostol is effective in the treatment of aspirin-induced enteropathy.
J Matern Fetal Neonatal Med. 2008 Oct 31; 1-5
Jansen NE, Pasker-De Jong PC, Zondervan HA
Objective. To compare two methods for second trimester termination of pregnancy: mifepristone and misoprostol versus Dilapan(R) and sulprostone. Methods. This was a randomized study involving 16 patients with a singleton live fetus with congenital malformations or genetic disorders. Eight patients were treated with 200 mg mifepristone orally followed by 200 mug misoprostol vaginally 3 hourly and eight patients received a sulprostone infusion after cervical dilatation with Dilapan. Results. Mifepristone and misoprostol had a mean induction interval of 17.8 hours and sulprostone and Dilapan 20.9 hours. The mean induction interval did not differ significantly. Mean hospital stay was shorter in the patients treated with misoprostol: 2.1 vs. 3.3 days (p = 0.02) with a 95% confidence interval of -2.1 to 0.3. Conclusion. Mifepristone and misoprostol did not reduce the induction interval significantly compared to the sulprostone and Dilapan treatment for second trimester pregnancy termination. Hospital admission was significantly shorter in patients treated with mifepristone and misoprostol.
Cervical Ripening Using Vaginal Misoprostol before Hysteroscopy: A Double-blind Randomized Trial.
J Minim Invasive Gynecol. 2008 Nov-Dec; 15(6): 739-44
Waddell G, Desindes S, Takser L, Beauchemin MC, Bessette P
STUDY OBJECTIVE: The aim of this study was to evaluate the use of vaginal misoprostol to decrease both the force required to dilate the cervix and the pain experienced during a hysteroscopy. DESIGN: Randomized clinical trial (RCT) (Canadian Task Force classification I). SETTING: University hospital gynecology clinic. PATIENTS: A total of 101 patients needing a diagnostic hysteroscopy. Fifty patients were randomized to the misoprostol group and 51 to the placebo group. Patient characteristics were similar in the 2 groups. INTERVENTIONS: Self-administration of 400 mug of vaginal misoprostol or vaginal placebo 12 to 24hours before a hysteroscopy. MEASUREMENTS AND MAIN RESULTS: The force needed to dilate the cervix was assessed by a tonometer, and pain was measured by a visual analog scale. The force to dilate the cervix to 6mm was significantly less in the misoprostol group (5.0 vs 7.5N, p=.02). Pain-related measurements after dilatation of the cervix to 6mm were significantly reduced in the misoprostol group (42.1 vs 57.2, p=.004). The main side effect reported with the use of the drug was pelvic cramping. CONCLUSION: The use of 400 mug of vaginal misoprostol 12 to 24hours before hysteroscopy reduces the pain and the force needed to dilate the cervix, with only mild side effects.
Z Geburtshilfe Neonatol. 2008 Oct; 212(5): 183-8
Henrich W, Dudenhausen JW, Hanel C, Chen FC
BACKGROUND: It was the objective of this study to compare the efficacy and safety of oral misoprostol with those of vaginal dinoprostone for the induction of labour at term. PATIENTS AND METHODS: Between 2003 and 2006 224 pregnant women were included in our prospective randomised clinical trial. All of them were admitted for induction of labor at term. Half of the patients received oral misoprostol, initially at a test dose of 25 microg, followed by 50 microg and 100 microg every 4 hours. The control group received 3 mg vaginal dinoprostone every 6 hours. Primary endpoints were time interval until delivery and mode of delivery as well as maternal and neonatal outcome, secondary endpoints were side effects and costs. RESULTS: In the dinoprostone group, the median time interval until delivery was 17.6 hours compared to 24.1 hours in the misoprostol group. Without the test dose, the difference was no longer significant. After dinoprostone induction, more patients had a vaginal delivery within 24 hours (n = 60, 53.6 %, vs. n = 46, 41.1 %). The frequencies of spontaneous deliveries and emergency Caesarean sections did not differ between the groups. The rate of vacuum extractions was higher in the misoprostol group (23 vs. 11, i. e. 20.5 vs. 9.8 %, p < 0.05). With regard to side effects there was no significant difference. No case of hyperstimulation was documented. CONCLUSION: Oral misoprostol is effective and safe for induction of labour at term. In addition, it is much cheaper and independent of storage conditions. At the doses and with the administration intervals used in this study, dinoprostone was slightly more effective than misoprostol.
Int J Gynaecol Obstet. 2008 Dec; 103(3): 276-282
Lovold A, Stanton C, Armbruster D
OBJECTIVE: Increased availability of oxytocin and misoprostol is needed to reduce the risk of postpartum hemorrhage. This review compiles rates and risks of adverse maternal and perinatal outcomes associated with use of these medications for labor induction and augmentation in low-income countries. Recommendations are proposed based on the findings. METHODS: We did a structured literature review using 5 databases followed by analysis of induction and augmentation rates from existing data. RESULTS: Combined induction and augmentation rates were documented in up to 50% of hospital-based deliveries identified in the databases. Data are sparse but suggest associations between induction/augmentation and stillbirth, neonatal resuscitation, and uterine rupture, and inappropriate administration of oxytocin and misoprostol both outside and inside healthcare systems in low-income countries. CONCLUSIONS: Guidelines for labor induction/augmentation are needed specifically for low resourced settings. Rigorous studies should be pursued to quantify the magnitude and effect of inappropriate induction and augmentation on maternal and perinatal morbidity and mortality. Programs are needed to ensure community-wide awareness of the adverse effects of the improper use of these drugs on mothers and babies, especially in out-of-hospital settings.
Safety and efficacy of oral versus vaginal misoprostol use for induction of labour at term.
J Coll Physicians Surg Pak. 2008 Oct; 18(10): 625-9
Abbassi RM, Sirichand P, Rizvi S
Objective: To compare the safety and efficacy of Misoprostol through oral and vaginal routes for induction of labour at term. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Gynaecology and Obstetrics (Unit-IV), Liaquat University Hospital, Jamshoro, Pakistan, from January to December 2004. Methodology: Eighty term patients who met the inclusion criteria were selected for induction of labour with (50 mug) Misoprostol, either by oral or vaginal route. The patients were allocated in two groups-A and B, using non-probability convenient sampling technique. The dose was repeated at an interval of 6 hours upto maximum dose of 150 mug. Improvement in Bishop's score, analgesic requirements, route of delivery, maternal complications, neonatal outcomes were noted. Results: The commonest indication in group-A was premature rupture of membranes in 16 patients (40%) and in 8 (20%) patients of group-B. Mean improvement in Bishop's score after 6 hours was greater in group-A (3.6 + 3.09) than group-B (3.3 + 3.45, p=0.70). Induction to delivery interval was less in group-A (6.7 + 4.4 hours) than group-B (7.5 + 4.3 hours, p=0.41). Oxytocin augmentation was required more in group-B as compared to group-A. Normal vaginal deliveries were achieved in 95% of group-A and in 80% of group-B. The dose of 50 mug was effective in 31(77.5%) patients of group-A as compared to 24 (60.0%) patients of group-B, while 100 mug was needed in 6 (15.0%) patients of group-A as compared to 13 (32.5%) patients in group-B. There was no significant difference between both the groups with regard to analgesic requirement, instrumental delivery, maternal complications and neonatal outcome. Conclusion: Safety and efficacy was comparable between low-dose vaginal and oral Misoprostol uses for induction of labour. However, oral route was better with respect to treatment interval, number of doses required and route of delivery. Both routes of administration can alternatively be used for induction of labour in developing countries where cost of drug does matter.
Am J Gastroenterol. 2008 Oct 1;
Chan FK, Abraham NS, Scheiman JM, Laine L,
BACKGROUND: Prescribing nonsteroidal antiinflammatory drugs (NSAIDs) is challenging because physicians have to consider gastrointestinal (GI) and cardiovascular (CV) safety issues. OBJECTIVE: The purpose of the study was to determine appropriate NSAID treatment strategies based on different combinations of GI and CV risks. METHODS: The working party comprised a multidisciplinary international panel of 19 experts. Two hundred eighty-eight vignettes were evaluated for the appropriateness of each of six options: naproxen, non-naproxen nonselective NSAIDs, naproxen plus proton pump inhibitor (PPI)/misoprostol, non-naproxen nonselective NSAID plus PPI/misoprostol, cyclooxygenase-2 selective NSAID (coxib), or coxib plus PPI/misoprostol. Using a two-stage modified Delphi process, the panel anonymously ranked the appropriateness of each option from 1 (extremely inappropriate) to 9 (extremely appropriate). Vignettes were considered appropriate if >/=80% of all panelists' scores were 7-9 and inappropriate if >/=80% of all panelists' scores were 1-3. RESULTS: The panel rated nonselective NSAIDs as appropriate when the patient had average GI risk (
Am J Perinatol. 2008 Oct 10;
Hill JB, Thigpen BD, Bofill JA, Magann E, Moore LE, Martin JN
We compared labor induced by vaginal misoprostol versus a supracervical Foley catheter and oral misoprostol. Singleton pregnancies at >/= 24 weeks' gestation were randomized to either an initial 25-mug dose of intravaginal misoprostol, followed by 50-mug intravaginal doses at 3- to 6-hour intervals, or a supracervical Foley balloon and 100 mug of oral misoprostol at 4- to 6-hour intervals. Primary outcome was time from induction to delivery. One hundred twenty-six women were randomized to vaginal misoprostol alone (group I) and 106 women to Foley and oral misoprostol (group II). The groups were similar in age, weight, gestational age, parity, indication for induction of labor, and oxytocin use. Cesarean delivery rates at 37% and cesarean indications were similar ( P = 0.25). The time from induction to delivery in group II (12.9 hours) was significantly shorter than that in group I (17.8 hours, P < 0.001). Uterine tachysystole occurred less often in the vaginal misoprostol group (21% versus 39%, P = 0.015). Compared with vaginal misoprostol, delivery within 24 hours was significantly more likely with a Foley balloon and oral misoprostol. The use of terbutaline and peripartum outcomes were similar in the two groups.