Improved maternal and fetal outcome in women with SLE has occurred following integrated multidisciplinary approach. This emphasizes the importance of postponing pregnancy when predictors of poor outcome are encountered.
Objectives: To assess the effectiveness, safety and acceptability of intracervical foley catheter and vaginal misoprostol versus vaginal misoprostol for termination of second trimester pregnancy.
Methods:This clinical study was conducted on 200 pregnant patients intended for termination of pregnancy between 13-24 gestational weeks for any indication. Enrolled women were equally allocated into two groups:Group I (Misoprostol group): a standard regimen of moistened misoprostol tablets (400 μg) 4 hourly inserted vaginally.
Group II (Combined group):intracervical Foley catheter inserted with a standard regimen of moistened misoprostol tablets (400 μg) 4 hourly intravaginally was used.Procedure efficacy (defined as complete abortion performed on site), safety and acceptability were assessed.
Results:The induction to abortion interval was 8.16 ± 1.52 hours in the combined group compared to 12.76 ± 1.63 hours in the misoprostol group (P value<0.001) with success rate of 96% in the combined group and no major complications reported.
Conclusions:Combined use of intracervical foley catheter and vaginal misoprostol is a novel safe, effective and acceptable method for termination of second trimester pregnancy. Synopsis: Combined use of intracervical foley catheter and vaginal misoprostol is a novel safe, effective and acceptable method for termination of second trimester pregnancy.
Objective: to test the hypothesis whether uterine artery pulsatility index (PI) and resistance index (RI) at 6 weeks postpartum could predict amenorrhea in women wishing to use the lactational amenorrhea method (LAM) for contraception.Methods: This prospective observational study included 840 lactating women with exclusive breastfeeding who were underwent uterine artery Doppler study at 6 weeks postpartum and followed for 6 months for the return of menstruation with women divided into two groups; the amenorrhea group (n=384) and the menstruating group (n=456). The primary outcome measure was the value of uterine artery PI and RI in the prediction of amenorrhea. Data was collected and tabulated.Results: There was a highly significant difference between the two groups regarding the uterine artery PI and RI at 6 weeks postpartum (p<0.001). Uterine artery PI at a cut off value of ≥3.5 (area under the curve; AUC .846, sensitivity 92% and specificity 84.4%) and uterine artery RI at a cut off value ≥0.8 (AUC .806, sensitivity 80% and specificity 82.2%) are predictors of amenorrhea among women desiring to use the LAM by multiple logistic regression analysis.
Conclusion:Uterine artery Doppler studies is simple, non-invasive and could be a valuable tool to predict amenorrhea among women desiring postpartum contraception who are interested in the LAM. Larger studies are warranted to confirm our findings.
LNG-IUS and DMPA induce hemodynamic changes in the uterine arteries denoting positive correlation with menstrual irregularities. Larger multicentre studies are warranted to potentiate our findings.
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