Development of medical termination of pregnancy: a review

Ho, Pak Chung

doi:10.1111/1471-0528.14905

Cited by 10 publications

(8 citation statements)

References 44 publications

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“…It achieves cervical softening through disintegration and dissolution of extracellular collagen [41]. There are multiple routes of administration for misoprostol, including oral, buccal, sublingual, vaginal, and rectal [41][42][43][44][45][46][47]. Compared to an oral or sublingual route, which creates a rapid spike in misoprostol plasma concentrations more beneficial in postpartum hemorrhage (PPH) management, intravaginal administration has a more gradual onset and greater bioavailability [45].…”

Section: Introductionmentioning

confidence: 99%

“…Compared to an oral or sublingual route, which creates a rapid spike in misoprostol plasma concentrations more beneficial in postpartum hemorrhage (PPH) management, intravaginal administration has a more gradual onset and greater bioavailability [45]. It has also been shown to be more effective in other obstetric treatments, such as abortion [43].…”

Section: Introductionmentioning

confidence: 99%

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Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Lee

Huang

Chen

et al. 2020

IJERPH

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Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy without identifying risk factors. Therefore, the purpose of this study is to conduct a systematic review and meta-analysis of randomized control trials (RCTs) comparing concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening. We systematically searched Embase, Pubmed, and Cochrane Collaboration databases for randomized controlled trials (RCTs) comparing intracervical Foley catheter plus intravaginal misoprostol and intravaginal misoprostol alone using the search terms “Foley”, “misoprostol”, “cervical ripening”, and “induction” up to 29 January 2019. Data were extracted and analyzed by two independent reviewers including study characteristics, induction time, cesarean section (C/S), clinical suspicion of chorioamnionitis, uterine tachysystole, meconium stain, and neonatal intensive care unit (NICU) admissions. Data was pooled using random effects modeling and calculated with risk ratio (RR) and 95% confidence interval (CI). Pooled analysis from eight studies, including 1110 women, showed that labor induction using a combination of intracervical Foley catheter and intravaginal misoprostol decreased induction time by 2.71 h (95% CI −4.33 to −1.08, p = 0.001), as well as the risk of uterine tachysystole and meconium staining (RR 0.54, 95% CI 0.30–0.99 and RR 0.48, 95% CI 0.32–0.73, respectively) significantly compared to those using intravaginal misoprostol alone. However, there was no difference in C/S rate (RR 0.93, 95% CI 0.78–1.11) or clinical suspicion of chorioamnionitis rate (RR 1.22, CI 0.58–2.57) between the two groups. Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Lee

Huang

Chen

et al. 2020

IJERPH

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“…Unlike most mammals in which parturition is initiated by declining maternal plasma P4 levels, during higher primate and guinea pig parturition, elevated P4 levels are sustained until after delivery of the placenta (12)(13)(14), indicating that a physiologic block of P4 signaling in target cells elicits "functional P4 withdrawal" (12,14). Consistent with this hypothesis, treatment of women with PR antagonists (e.g., RU486) and prostanoids induces labor at any stage of pregnancy (15). Potential mechanisms contributing to functional P4 withdrawal include decreased PR levels (16)(17)(18), changes in PR coregulators, and/or indirect antagonism by other transcription factors (19).…”

mentioning

confidence: 86%

Decidual cell FKBP51–progesterone receptor binding mediates maternal stress–induced preterm birth

Guzeloglu‐Kayisli

Semerci

Guo

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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Depression and posttraumatic stress disorder increase the risk of idiopathic preterm birth (iPTB); however, the exact molecular mechanism is unknown. Depression and stress-related disorders are linked to increased FK506-binding protein 51 (FKBP51) expression levels in the brain and/or FKBP5 gene polymorphisms. Fkbp5-deficient (Fkbp5−/−) mice resist stress-induced depressive and anxiety-like behaviors. FKBP51 binding to progesterone (P4) receptors (PRs) inhibits PR function. Moreover, reduced PR activity and/or expression stimulates human labor. We report enhanced in situ FKBP51 expression and increased nuclear FKBP51-PR binding in decidual cells of women with iPTB versus gestational age-matched controls. In Fkbp5+/+ mice, maternal restraint stress did not accelerate systemic P4 withdrawal but increased Fkbp5, decreased PR, and elevated AKR1C18 expression in uteri at E17.25 followed by reduced P4 levels and increased oxytocin receptor (Oxtr) expression at 18.25 in uteri resulting in PTB. These changes correlate with inhibition of uterine PR function by maternal stress–induced FKBP51. In contrast, Fkbp5−/− mice exhibit prolonged gestation and are completely resistant to maternal stress–induced PTB and labor-inducing uterine changes detected in stressed Fkbp5+/+ mice. Collectively, these results uncover a functional P4 withdrawal mechanism mediated by maternal stress–induced enhanced uterine FKBP51 expression and FKPB51-PR binding, resulting in iPTB.

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“…It is an anti-progesterone which blocks the action of progesterone, a hormone necessary to maintain pregnancy and thus inhibiting the action of progesterone. Mifepristone alters the endometrium, causes softening, and dilatation of the cervix [2,3]. Prostaglandins have been used widely for peptic ulcer prevention from Non-steroidal anti-inflammatory drugs use and also from ulcer bleeding.…”

Section: Introductionmentioning

confidence: 99%

First Trimester Medical Abortion Practice in North East India

Vanremmawii¹,

LALROMAWII

Vanlalhruaii

2021

Asian J Pharm Clin Res

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Objectives: This study is to compare the efficacy of Mifepristone combined with Misoprostol (Prostaglandin) administered through vaginal and sublingual route in termination of pregnancy of ≤63 days. Methods: Randomized comparative study comprised of 140 pregnant women of ≤63 days gestational age was conducted at Zoram Medical College, Mizoram. Women in group A received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol sublingually 36–48 h later, whereas women in group B received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol vaginally 36–48 h later. A 2nd dose of 400 μg Misoprostol was given through the same route if abortion process does not start within 4 h. All women who aborted were seen at follow-up and ultrasound pelvis done to confirm complete expulsion of products of conceptions. Results: The total number of primigravida was 34 (24.3%) and multigravida was 106 (75.7%). Complete abortion was seen in 91.4% and 94.28% of per sublingual and per vaginal route group, respectively (p = 0.51). Failure of abortion was 8.57% and 5.71%, respectively, in per oral and per vaginal route (p = 0.51). Conclusion: Sublingual and per vaginal misoprostol after pre-treatment with mifepristone are both an effective method for termination of pregnancy for gestational age of 63 days or less, but the tolerance for sublingual misoprostol was poorer.

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Development of medical termination of pregnancy: a review

Abstract: This article reviews the events and challenges in the development of medical termination of pregnancy.

Cited by 10 publications

References 44 publications

Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Decidual cell FKBP51–progesterone receptor binding mediates maternal stress–induced preterm birth

First Trimester Medical Abortion Practice in North East India

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