Clinical Use of Misoprostol in Nonpregnant Women: Review Article

Choksuchat, Chainarong

doi:10.1016/j.jmig.2010.03.015

Cited by 30 publications

(11 citation statements)

References 63 publications

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“…60 In vitro studies in human cervical stromal cells clearly demonstrate the potential for the cervix to regulate prostaglandin synthesis, metabolism, and signaling and clinical use of PG as a cervical softening agent demonstrates the ability of the nonpregnant and pregnant cervix to respond to PG at term. [62][63][64][65] The observation that PGs are not elevated in the human cervix in term or with mifepristone treatment along with the identification of prostaglandin-independent and prostaglandin-dependent pathways in the mouse supports the potential for two distinct pathways of remodeling in the human cervix as well. [66][67][68][69] The identification of similarities and differences in term cervical ripening/dilation compared with mifepristone-induced and LPS-induced premature ripening/dilation in the mouse provides important considerations for the development of preventative therapies in women.…”

Section: Cervical Remodeling In Term and Preterm Birthmentioning

confidence: 97%

Distinct Roles of Cervical Epithelia and Stroma in Pregnancy and Parturition

Nallasamy

Mahendroo

2017

Semin Reprod Med

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Through pregnancy the cervix must simultaneously remain competent for pregnancy maintenance and yet become progressively compliant to ensure on time parturition. Cervical changes precede not only term but also preterm birth. Thus, an understanding of the molecular mechanisms by which the cervix maintains the delicate balance between competence and compliance is required to prevent the potential for lifelong health complications that can result from a premature birth. Recent advances and accumulating evidence support distinct roles for the cervical epithelia and stroma in sustaining competence. Concurrently, structural reorganization of the stromal extracellular matrix allows for the gradual decline in tissue compliance. In recent years, advances in our understanding of the cervical remodeling process has resulted from the collective insights derived from biological, genomics, engineering, and mathematical modeling studies on clinical samples and animal models. This review will highlight recent literature that advances understanding of (1) the importance of barrier function in the lower female reproductive tract in protection against ascending infection, (2) cellular and extracellular matrix changes in the cervical stroma that influence the mechanical function of the cervix, (3) the potential translation of biological insights into clinical tools that impact preterm birth, and (4) the distinction between term and specific pathways of preterm birth. Finally, we present a discussion of future areas of investigation that are likely to advance understanding and lead to the development of clinical tools for accurate detection and prevention of premature birth.

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Section: Cervical Remodeling In Term and Preterm Birthmentioning

confidence: 97%

Distinct Roles of Cervical Epithelia and Stroma in Pregnancy and Parturition

Nallasamy

Mahendroo

2017

Semin Reprod Med

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“…The reduction in the incidence of cervical laceration after misoprostol was also confirmed by Preutthipan and Herabutya [20]. Also, some authors believed that the severity of the adverse effect after misoprostol varies considerably and are often not correlated with dosage, interval of use or route of administration [27]. Lee et al [22] reported adverse effects in the form of cramp (10.6%), bleeding (4.3%), nausea (4.3%) and shivering (2.1%) after 400 μg sublingual misoprostol 2-4 h prior to hysteroscopy.…”

Section: Discussionmentioning

confidence: 73%

Prostaglandins prior to hysteroscopy

Moiety¹,

Azzam²

2011

Gynecol Surg

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This prospective randomized controlled study was conducted to assess the role of misoprostol, given sublingually or rectally, on the outcome of hysteroscopic procedures. A total of 212 premenopausal patients undergoing hysteroscopic procedures were randomly allocated into three groups: group 1 (n=71), sublingual misoprostal given 2 h before the procedure; group 2 (n=71) rectal misoprostal 2 h before the procedure; group 3 (n=70), control group, no medications were given. Main outcome measures were ease of cervical dilatation, dilatation time to Hegar 6, complications as cervical laceration and postoperative cramps, bleeding and pyrexia. The cervical canal at the start was significantly wider misoprostol groups (P= 0.038). Cervical dilatation was significantly easier in the rectal misoprostol group over control (P=0.035). Misoprostol groups showed significant reduction in the mean time needed to dilate to Hegar 6 (P=0.021). Postoperative pain and cramps were significantly higher in misoprostol groups (P=0.002). Misoprostol before hysteroscopy demonstrates a benefit in the ease of cervical dilatation, cervical width at the start and time for dilatation with low risk of cervical tears. Rectal misoprostol appears advantageous than sublingual one. However, postoperative adverse effects are more common with misoprostol groups.

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“…The ideal dosage and route of administration need to be clarified. However, it is shown that oral misoprostol reaches its peak concentration in the plasma earlier compared to vaginal route (39,40) .…”

Section: Discussionmentioning

confidence: 99%

Vaginal Misoprostol versus Bilateral Uterine Artery Ligation in Decreasing Blood Loss in Transabdominal Myomectomy : A Randomized Controlled Trial

Abdel-Fattah

Tharwat

Mohammad

et al. 2017

EJHM

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Background: Uterine leimyomas are tumors of the smooth muscles and the connective tissues of the uterus. They are considered to be the most common benign pelvic tumor affecting about 20% of women above the age of 35. The diverse symptomatology of fibroids can be attributed to size, number and location of the tumors. The common symptoms include menorrhagia, infertility, abdominal mass and pressure effects. Aim of the Work: The aim of this study is to compare between the effect of medical (preoperative vaginal misoprostol) and non-medical (bilateral uterine artery ligation) regarding their efficacy to decrease blood loss in trans-abdominal myomectomy. Patients and Methods: Prospective randomized controlled interventional clinical trial. . It included 60 women recruited from those attending the outpatient gynecology clinic, seeking treatment for symptomatic uterine myomas. Results: The current study revealed that there was no statistically significant difference between both groups regarding operative time, blood loss and postoperative hospital stay. Conclusion: A single pre-operative dose of 400 micrograms of vaginal misoprostol is as effective as uterine artery ligation in decreasing blood loss in transabdominal myomectomy. Misoprostol is a simple, cheap, fast, available and applicable tool that can be administered even an hour preoperatively. Recommendations: Preoperative vaginal misoprostol is an effective practical tool in decreasing blood loss in transabdominal myomectomy. Investigation of misoprostol use in larger population groups and with different dosages and administration routes, together with comparison of other methods used to reduce bleeding during myomectomy, is recommended.

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Clinical Use of Misoprostol in Nonpregnant Women: Review Article

Cited by 30 publications

References 63 publications

Distinct Roles of Cervical Epithelia and Stroma in Pregnancy and Parturition

Distinct Roles of Cervical Epithelia and Stroma in Pregnancy and Parturition

Prostaglandins prior to hysteroscopy

Vaginal Misoprostol versus Bilateral Uterine Artery Ligation in Decreasing Blood Loss in Transabdominal Myomectomy : A Randomized Controlled Trial

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