Objectives This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. Methods Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5). Results Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group. Conclusions Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

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Introduction and Objective: The study of the methods of controlling labor pain is very important. One of the methods of pain relief is spinal anesthesia. Due to the different opinions about the effects of spinal anesthesia on the delivery process and maternal and fetal consequences, this study aimed to evaluate the effects of spinal anesthesia and compare it with normal vaginal delivery without spinal anesthesia. Methods: In this retrospective cohort study, 120 mothers, who were admitted to the maternity ward of Firoozabadi Hospital for delivery, were examined. The patients who met the inclusion criteria were divided into two groups of 60 people, one group receiving spinal anesthesia and one without spinal anesthesia, and then, were evaluated in terms of clinical variables and complications of the mother and fetus. Data were analyzed using SPSS statistical software. Results: The mean age of the mothers was 26.6 ± 5.9 years. Five mothers (4.2%) who received spinal anesthesia underwent emergency cesarean section and a significant difference was shown between the two groups ( P = 0.02). The mean duration of the active phase of labor did not show a statistically significant difference between the two groups ( P = 0.2), but the duration of the second phase of labor was significantly longer in the mothers who received spinal anesthesia ( P = 0.008). Conclusion: Spinal anesthesia can be used as a low-complication method in vaginal delivery to reduce pain.

We report a 74-year-old male with a recent history of COVID-19 pneumonia who was admitted with acute periumbilical and left lower quadrant pain and respiratory distress. Laboratory data showed pre-renal azotemia and microscopic hematuria. An abdominopelvic computerized tomography (CT) scan with intravenous contrast was conducted, showing signs of right renal vein thrombosis (RVT) with extension to inferior vena cava (IVC), without any evidence of renal ischemia. The patient did not have any risk factors for thrombosis except for probable hypercoagulopathy due to COVID-19 and diabetes mellitus. He was not an appropriate candidate for surgical or radiologic thrombectomy, thus received heparin infusion accordingly. Unfortunately, he died after the cardiopulmonary arrest on the second day of admission. Considering his respiratory distress, we suspect pulmonary embolism as the most probable cause of death.