The use of misoprostol in medical termination of first and second term pregnancies and cervical priming in surgically induced termination of pregnancies has been studied extensively. A survey is given on the available literature (MEDLINE to May 1998) on the usage as a single medication or in combination with mifepristone or methotrexate. A review is given on literature concerning side effects and complications. Misoprostol is a most promising, cheap, and effective agent, which does not need cool storage like other prostaglandins. The use of misoprostol as an abortifacient has, however, not been supported by the manufacturer. This leads to the situation (similar to mifepristone/RU 486) that it is used and researched, but probably will not be officially approved for this specific indication.

SummaryA double-blind, randomised study was conducted to compare the efficacy and safety of a combination of pefloxacin and metronidazole versus doxycycline and metronidazole in patients with pelvic inflamma tory disease (PID). The clinical diagnosis had to be confirmed by laparoscopy before patients were includ ed. Of the 74 patients who fulfilled the clinical criteria for PID, laparoscopy confirmed the diagnosis in only 40 patients (54%). The microorganism most frequently found as causative pathogen was Chlamydia trachomatis. Both treatment groups showed a good response to the study-medication. At discharge 9 patients in the pefloxacin group (45%) were cured and 10 patients (50%) had improved. In the doxycycline group 7 patients (35%) were cured and 10 patients (50%) had improved. Obviously pefloxacin/metroni dazole and doxycycline/metronidazole are equally effective in the treatment of PID.

The nationwide screening program for cervical carcinoma in The Netherlands was unique in that all women between the age of 35 and 55 years were individually invited to undergo a cervical spatula smear. The total rate of positive histologic findings in six regions of the country was 3.9 per thousand, and decreased in the second screening after 3 years with 48% of patients. Further analysis of the change in rates of the separate histologic subgroups in six regions revealed: Severe dysplasia showed no change in rates. The rates of carcinoma in situ and invasive squamous cell carcinoma were influenced clearly by the screening. The preinvasive stages of adenocarcinoma of the cervix were underdiagnosed in the first screening, and there was no decrease in the score of invasive adenocarcinoma. The rates in the six regions differed significantly and were dependent on the degree of urbanization. Cervical screening using the Ayre spatula is not effective for detecting cervical adenocarcinomas.

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