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Abortion induced with methotrexate and misoprostol.

https://arctichealth.org/en/permalink/ahliterature212859
Source
CMAJ. 1996 Jan 15;154(2):165-70
Publication Type
Article
Date
Jan-15-1996
Author
E R Wiebe
Author Affiliation
Department of Family Practice, University of British Columbia, Vancouver.
Source
CMAJ. 1996 Jan 15;154(2):165-70
Date
Jan-15-1996
Language
English
Publication Type
Article
Keywords
Abortifacient Agents, Nonsteroidal - administration & dosage - adverse effects
Abortion, Induced - methods
Adolescent
Adult
Canada
Feasibility Studies
Female
Humans
Methotrexate - administration & dosage - adverse effects
Middle Aged
Misoprostol - administration & dosage - adverse effects
Pregnancy
Treatment Outcome
Abstract
To determine the outcome and side effects of a new drug protocol to induce abortion.
Case series.
An urban primary care practice.
One hundred consecutive patients who requested elective termination of pregnancies of less than 8 weeks' gestation.
Subjects received methotrexate (50 mg/m2 body surface area, administered intramuscularly) and, 3 days afterward, misoprostol (800 micrograms, given vaginally).
Number of abortions induced within 24 hours and within 10 days of misoprostol administration, number of surgical aspirations conducted because of incomplete abortion, mean amount of bleeding and pain and the number of women who, if faced with the same situation, said they would again choose a drug-induced abortion over a surgical one.
Abortion occurred within 24 hours of misoprostol administration among 48 women and within 10 days among 69 women. In total, 89 women had an abortion without surgical aspiration. Of these women, 71 said they would choose a drug-induced abortion if faced with the choice again.
Abortion induced with methotrexate and misoprostol appears to be a feasible alternative to surgical abortion and deserves further study.
Notes
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Comment In: CMAJ. 1996 Jul 1;155(1):198673979
Comment In: CMAJ. 1996 Jan 15;154(2):185-78548707
Comment In: CMAJ. 1996 Jul 1;155(1):19-208673980
PubMed ID
8548705 View in PubMed
Less detail

Clostridium sordellii toxic shock syndrome after medical abortion with mifepristone and intravaginal misoprostol--United States and Canada, 2001-2005.

https://arctichealth.org/en/permalink/ahliterature173601
Source
MMWR Morb Mortal Wkly Rep. 2005 Jul 29;54(29):724
Publication Type
Article
Date
Jul-29-2005
Source
MMWR Morb Mortal Wkly Rep. 2005 Jul 29;54(29):724
Date
Jul-29-2005
Language
English
Publication Type
Article
Keywords
Abortifacient Agents - administration & dosage - adverse effects
Abortion, Induced - adverse effects
Canada - epidemiology
Clostridium Infections - epidemiology - etiology
Clostridium sordellii
Female
Humans
Mifepristone - administration & dosage - adverse effects
Misoprostol - administration & dosage - adverse effects
Pregnancy
Shock, Septic - epidemiology - etiology
United States - epidemiology
Abstract
On July 19, 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the deaths of four women in the United States after medical abortions with Mifeprex (mifepristone, formerly RU-486; Danco Laboratories, New York, New York) and intravaginal misoprostol. Two of these deaths occurred in 2003, one in 2004, and one in 2005. Two of these U.S. cases had clinical illness consistent with toxic shock and had evidence of endometrial infection with Clostridium sordellii, a gram-positive, toxin-forming anaerobic bacteria. In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada. All three cases of C. sordellii infection were notable for lack of fever, and all had refractory hypotension, multiple effusions, hemoconcentration, and a profound leukocytosis. C. sordellii previously has been described as a cause of pregnancy-associated toxic shock syndrome.
PubMed ID
16049422 View in PubMed
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Diclofenac/misoprostol during early pregnancy and the risk of miscarriage: a Danish nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature284816
Source
Arch Gynecol Obstet. 2016 Aug;294(2):245-50
Publication Type
Article
Date
Aug-2016
Author
Jon T Andersen
Dimitrios Mastrogiannis
Nadia L Andersen
Morten Petersen
Kasper Broedbaek
Vanja Cejvanovic
Torben K Nielsen
Henrik E Poulsen
Espen Jimenez-Solem
Source
Arch Gynecol Obstet. 2016 Aug;294(2):245-50
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Abortion, Induced - statistics & numerical data
Abortion, Spontaneous - epidemiology - etiology
Adult
Cohort Studies
Denmark
Diclofenac - administration & dosage - adverse effects
Female
Humans
Misoprostol - administration & dosage - adverse effects
Pregnancy
Pregnancy Trimester, First
Proportional Hazards Models
Registries
Retrospective Studies
Risk factors
Young Adult
Abstract
Misoprostol can be used in the prevention of gastric ulcer in treatment with diclofenac and is used in rheumatic diseases. Since misoprostol causes contractions of the uterus, it can also be used to induce abortions when administrated vaginally. The aim of the study was to investigate if early pregnancy exposure to oral diclofenac/misoprostol was associated with miscarriage.
We conducted a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2011. All births were identified using the Medical Birth Registry, and all records of induced abortion and miscarriage were from the National Hospital Register. Data on drug use were from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women exposed to diclofenac/misoprostol in early pregnancy.
We identified 1,338,824 pregnancies (970,491 births, 142,147 miscarriages, 226,145 induced abortions). One hundred sixty-six were exposed to diclofenac/misoprostol in the early pregnancy of which 28.3 % (47) ended up in a miscarriage compared to 10.6 % among unexposed. The adjusted hazard ratio of having a miscarriage after exposure to diclofenac/misoprostol in the first trimester was 3.6 (CI 95 % 2.6-4.9).
We found an increased risk of miscarriage after exposure to diclofenac/misoprostol during the early pregnancy. Women in the fertile age should not be treated with the combination of diclofenac/misoprostol if other options were available.
PubMed ID
26585175 View in PubMed
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First trimester abortion with mifepristone and vaginal misoprostol.

https://arctichealth.org/en/permalink/ahliterature63809
Source
Contraception. 2001 May;63(5):247-50
Publication Type
Article
Date
May-2001
Author
U B Knudsen
Author Affiliation
Department of Obstetrics and Gynecology, University Hospital of Arrhus, Skejby, Denmark. UBK@dadlnet.dk
Source
Contraception. 2001 May;63(5):247-50
Date
May-2001
Language
English
Publication Type
Article
Keywords
Abortifacient Agents, Nonsteroidal - administration & dosage - adverse effects
Abortifacient Agents, Steroidal - administration & dosage - adverse effects
Abortion, Induced - adverse effects - methods - standards
Administration, Intravaginal
Administration, Oral
Adolescent
Adult
Denmark
Female
Humans
Middle Aged
Mifepristone - administration & dosage - adverse effects
Misoprostol - administration & dosage - adverse effects
Patient satisfaction
Pregnancy
Pregnancy Trimester, First
Abstract
This study assessed the efficacy and side effects of first trimester medical abortion using mifepristone and vaginally administered misoprostol. Medical abortion was first introduced in Denmark in December 1997, and the acceptability of this new approach in a Danish population was evaluated. The study included the first 100 women seeking medical abortion. The gestational age was from 33 to 56 days. All received 600 mg mifepristone (RU 486) orally followed 2 days later by vaginally administered misoprostol 400 microg. Success was defined as achieving complete abortion without the need for surgical evacuation. Ninety-three percent achieved a successful medical termination of pregnancy. Side effects were few, and the acceptability was high. Ninety percent of the women would prefer medical abortion in case of a new unwanted pregnancy. The combination of mifepristone and vaginally administrated misoprostol is effective, safe, has few side effects and is well accepted by Danish women.
PubMed ID
11448463 View in PubMed
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Home use of two doses of misoprostol after mifepristone for medical abortion: a pilot study in Sweden and France.

https://arctichealth.org/en/permalink/ahliterature63129
Source
Eur J Contracept Reprod Health Care. 2005 Sep;10(3):184-91
Publication Type
Article
Date
Sep-2005
Author
W H Clark
D. Hassoun
K. Gemzell-Danielsson
C. Fiala
B. Winikoff
Author Affiliation
Gynuity Health Projects, New York, USA.
Source
Eur J Contracept Reprod Health Care. 2005 Sep;10(3):184-91
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Abortifacient Agents - administration & dosage - adverse effects
Abortion, Induced - methods
Adult
Female
France
Humans
Middle Aged
Mifepristone - administration & dosage - adverse effects
Misoprostol - administration & dosage - adverse effects
Patient satisfaction
Pilot Projects
Pregnancy
Sweden
Abstract
OBJECTIVE: To test the feasibility, safety, and efficacy of home use of two doses of misoprostol for medical abortion (MA) in European settings. METHODS: One hundred thirty women (100 in Sweden, 30 in France) presenting for first-trimester MA were administered oral mifepristone in the clinic and sent home with two 400 microg doses of misoprostol, along with instructions to take the misoprostol at 24 h intervals. Women were also asked to complete a daily symptom diary. Outcomes of interest included effectiveness, side-effects, and adherence to and acceptability of the home-use regimen. RESULTS: Three women (all in France) were lost to follow-up. Of the remaining 127 women, 124 (98%) had a successful MA. All women adhered successfully to the home-use regimen, and satisfaction with home use was high (98%). Most women experienced noticeable, if transitory, side effects after both the first and second doses of misoprostol (97% and 94%, respectively). CONCLUSIONS: Misoprostol may successfully and satisfactorily be used at home as part of a MA regimen in European settings as it has been for years in the US. Further research to determine if two doses of misoprostol are more effective than a single dose would be useful.
PubMed ID
16318966 View in PubMed
Less detail

[Medical abortion--the first Norwegian experiences]

https://arctichealth.org/en/permalink/ahliterature63463
Source
Tidsskr Nor Laegeforen. 2003 Sep 11;123(17):2422-4
Publication Type
Article
Date
Sep-11-2003
Author
Ole Erik Iversen
Grete Midbøe
Synnøve Lian Johnsen
Grete Augestad
Ingrid Økland
Harald Helland
Sverre Strray-Pedersen
Line Bjørge
Author Affiliation
Haukeland Universitetssykehus oeiv@haukeland.no
Source
Tidsskr Nor Laegeforen. 2003 Sep 11;123(17):2422-4
Date
Sep-11-2003
Language
Norwegian
Publication Type
Article
Keywords
Abortifacient Agents, Nonsteroidal - administration & dosage - adverse effects
Abortifacient Agents, Steroidal - administration & dosage - adverse effects
Abortion, Induced
Adolescent
Adult
English Abstract
Female
Humans
Mifepristone - administration & dosage - adverse effects
Misoprostol - administration & dosage - adverse effects
Pregnancy
Pregnancy Trimester, First
Abstract
BACKGROUND: Medical abortion was first introduced in Norway in April 1998. The aim of this study is to assess the efficacy, side effects and acceptability of medical abortion with mifepristone and vaginally administered misoprostol in a Norwegian population. MATERIALS AND METHODS: The study included the first consecutive 226 women with gestational age of
PubMed ID
14594047 View in PubMed
Less detail

Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy: clinical and economic implications of a single-tablet formulation of diclofenac/misoprostol.

https://arctichealth.org/en/permalink/ahliterature206103
Source
Am J Manag Care. 1998 May;4(5):687-97
Publication Type
Article
Date
May-1998
Author
J L Goldstein
L R Larson
B D Yamashita
Author Affiliation
Department of Medicine, University of Illinois at Chicago, USA.
Source
Am J Manag Care. 1998 May;4(5):687-97
Date
May-1998
Language
English
Publication Type
Article
Keywords
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage - adverse effects - economics
Arthritis - drug therapy
Canada
Cost of Illness
Diclofenac - administration & dosage - adverse effects - economics
Drug Combinations
Humans
Misoprostol - administration & dosage - adverse effects - economics
Models, Econometric
Risk factors
Stomach Diseases - chemically induced - economics - physiopathology - prevention & control
United States
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage arthritis. While controlling symptoms and improving quality of life, NSAID use is associated with gastroduodenal injury and a 2%-4% annual risk for symptomatic gastroduodenal ulceration, hemorrhage, and perforation. This requires clinicians to balance the efficacy of NSAIDs against the potential risk of serious gastrointestinal events. Identification and stratification of risk can help guide the optimal approach for arthritis management of individual patients or large populations such as managed care organizations. NSAID-induced gastroenteropathy carries considerable economic consequences; 46% of arthritis costs are related to managing serious adverse events. It is reasonable to assume that these costs may not be incurred if high-risk patients are recognized and optimally managed. Newer therapies with proven safety margins present an attractive option, especially for patients at higher risk. The single-tablet formulations of diclofenac and misoprostol (Arthrotec) offer an alternative in managing NSAID patients because of their inherent safety profile. Studies with diclofenac/misoprostol indicate its effectiveness in treating signs and symptoms of arthritis and in reducing the incidence of NSAID-induced gastroenteropathy. As such, this agent may provide improved medical and economic outcomes. This review discusses the clinical aspects of NSAID-induced gastroenteropathy, including available preventive therapies. Approaches to assessing patients' risk for developing complications, and the relationship of medical risk and economic outcomes, are also examined. Although not all patients require preventive therapy, patients with heightened risk may benefit clinically and economically from gastroprotective NSAIDs. Additional research or modeling may provide further insight into the economic implications of managing and preventing NSAID-induced gastroenteropathy.
PubMed ID
10179922 View in PubMed
Less detail

A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage.

https://arctichealth.org/en/permalink/ahliterature63183
Source
BJOG. 2005 Aug;112(8):1090-5
Publication Type
Article
Date
Aug-2005
Author
F. Blohm
B E Fridén
I. Milsom
J J Platz-Christensen
S. Nielsen
Author Affiliation
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden.
Source
BJOG. 2005 Aug;112(8):1090-5
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Abortifacient Agents, Nonsteroidal - administration & dosage - adverse effects
Abortion, Incomplete - drug therapy
Administration, Intravaginal
Adult
Analgesics - therapeutic use
Anti-Bacterial Agents - therapeutic use
Bacterial Infections - etiology - prevention & control
Double-Blind Method
Female
Humans
Misoprostol - administration & dosage - adverse effects
Pain - etiology - prevention & control
Pregnancy
Pregnancy Trimester, First
Research Support, Non-U.S. Gov't
Treatment Outcome
Abstract
OBJECTIVES: To study if misoprostol 400 microg, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. DESIGN: Randomised, double blind placebo controlled study. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden. SAMPLE: One hundred and twenty-six women seeking medical attention for early miscarriage. METHOD: Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 microg or placebo. MAIN OUTCOME MEASURES: Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. RESULTS: Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20-2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P
PubMed ID
16045523 View in PubMed
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Safe induction of labour with low-dose misoprostol, but less effective than the conventional dinoprostone regimen.

https://arctichealth.org/en/permalink/ahliterature266795
Source
Dan Med J. 2013 Sep;60(9):A4706
Publication Type
Article
Date
Sep-2013
Author
Jesper Friis Petersen
Thomas Bergholt
Ellen Christine L Løkkegaard
Source
Dan Med J. 2013 Sep;60(9):A4706
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adult
Amniotic Fluid
Apgar score
Cesarean Section - statistics & numerical data
Denmark
Dinoprostone - administration & dosage - adverse effects
Female
Humans
Intensive Care, Neonatal - utilization
Labor, Induced - adverse effects - methods
Meconium
Misoprostol - administration & dosage - adverse effects
Oxytocics - administration & dosage - adverse effects
Pregnancy
Retrospective Studies
Time Factors
Young Adult
Abstract
Off-label use of the prostaglandin-E1 analogue misoprostol has become standard practice when inducing labour. In Denmark, a low-dosage misoprostol regimen is common. The regimen consists of one 25 µg application on the first day of induction. The registered prostaglandin-E2 analogue dinoprostone is used in 3 and 6 mg doses. This study compared induction procedures with dinoprostone and misoprostol in terms of induction time, foetal outcome and maternal outcome.
This retrospective study included 1,645 induced deliveries from two periods: 2003-2005, when dinoprostone was standard treatment (n = 635), and 2008-2010, when misoprostol was standard treatment (n = 633). We evaluated the induction method, outcomes and confounders using Kaplan-Meier, Cox and logistic regression analyses.
In the first 24 h, 38% and 59% of women delivered in the misoprostol and dinoprostone groups, respectively. Compared with dinoprostone, misoprostol was associated with a longer induction time (hazard ratio = 0.79, 95% confidence interval (CI): 0.69-0.90). Both regimens showed similar risks of caesarean section (odds ratio (OR) = 0.88, 95% CI: 0.64-1.12), rates of meconium-stained amniotic fluid (OR = 0.85, 95% CI: 0.63-1.15), 5-min Apgar scores
PubMed ID
24001467 View in PubMed
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9 records – page 1 of 1.