Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens

Yılmaz, Bülent; Ertaş, İbrahim Egemen; Kelekçi, Sefa; Süt, Necdet; Mollamahmutoğlu, Leyla; Danışman, Nuri

doi:10.3109/13625180903417486

Cited by 9 publications

(8 citation statements)

References 23 publications

(47 reference statements)

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“…Young people typically engage in experimental behaviours, including sexual behaviours, which help them to establish their individual identity as they make the transition into adulthood [ 4 ]. The onset of sexual intercourse is a time of social and personal significance which also has major health implications [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study

2018

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BackgroundThe need to tackle sexual health problems and promote positive sexual health has been acknowledged in Irish health policy. Young people’s sexual behaviour however remains under-researched with limited national data available.MethodsThis study presents the first nationally representative and internationally comparable data on young people’s sexual health behaviours in Ireland. Self-complete questionnaire data were collected from 4494 schoolchildren aged 15–18 years as part of a broader examination of health behaviour and their context. The prevalence of sexual initiation, very early sexual initiation (< 14 years) and non-condom use at last intercourse are reported and used as outcomes in separate multilevel logistic regression models examining associations between sociodemographic characteristics, lifestyle characteristics and young people’s sexual behaviours.ResultsOverall, 25.7% of boys and 21.2% of girls were sexually initiated. Older age was consistently predictive of initiation for both boys and girls, as were alcohol, tobacco and cannabis involvement, living in poorer neighbourhoods and having good communication with friends. Involvement in music and drama was protective. Very early sexual initiation (< 14 years) was reported by 22.8% of sexually initiated boys and 13.4% of sexually initiated girls, and was consistently associated with rural living, cannabis involvement and bullying others for both. Boys’ very early initiation was predicted by alcohol involvement, receiving unhealthy food from parents and taking medication for psychological symptoms, whereas better communication with friends and more experience of negative health symptoms were protective. Girls’ very early initiation was predicted by being bullied and belonging to a non-Traveller community, whereas taking medication for physical symptoms and attending regular health checks was protective. Condom use was reported by 80% of sexually initiated students at last intercourse. Boys’ condom use was associated with older age, higher family affluence, bullying others, more frequent physical activity and health protective behaviours. For girls, condom use was predicted by belonging to a non-Traveller community, healthy food consumption, higher quality of life and being bullied, whereas taking medication for physical and psychological symptoms was associated with non-condom use.ConclusionsThese nationally representative research findings highlight the importance of focusing on young people as a distinct population subgroup with unique influences on their sexual health requiring targeted interventions and policy.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5217-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study

2018

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“…Trials in first‐trimester pregnancy termination in which misoprostol was either moistened with NSS or acetic acid compared to dry tablet form show different results 2–6 . To our best knowledge, only three studies involving misoprostol moistened with acetic acid for second‐trimester pregnancy termination have been reported 7–9 . First, bd‐El‐Maeboud 7 showed that vaginal pH influences on the efficacy of misoprostol administered vaginally for induction of mid‐trimester abortion and an acidifying agent, like acetic acid, can facilitate the absorption of misoprostol, resulting in a better outcome in terms of shorter abortion time and lower incidence of fever and abdominal pain.…”

Section: Introductionmentioning

confidence: 99%

“…However, that report suffers from a small sample size and further study is needed. Third, Yilmaz et al 9 . showed that misoprostol moistened with acetic acid was effective for second‐trimester pregnancy termination but not compared with other types of moistening solution.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6] To our best knowledge, only three studies involving misoprostol moistened with acetic acid for second-trimester pregnancy termination have been reported. [7][8][9] First, bd-El-Maeboud 7 showed that vaginal pH influences on the efficacy of misoprostol administered vaginally for induction of mid-trimester abortion and an acidifying agent, like acetic acid, can facilitate the absorption of misoprostol, resulting in a better outcome in terms of shorter abortion time and lower incidence of fever and abdominal pain. Second, Yilmaz et al 8 demonstrated that misoprostol moistened with acetic acid was significantly more effective than misoprostol moistened with saline.…”

Section: Introductionmentioning

confidence: 99%

“…However, that report suffers from a small sample size and further study is needed. Third, Yilmaz et al 9 showed that misoprostol moistened with acetic acid was effective for second-trimester pregnancy termination but not compared with other types of moistening solution. There is only limited data on the effectiveness of misoprostol moistened with acetic acid compared to that moistened with NSS or other types of moistening solutions.…”

Section: Introductionmentioning

confidence: 99%

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Randomized controlled study comparing misoprostol moistened with normal saline and with acetic acid for second‐trimester pregnancy termination. Is it different?

Pongsatha

Tongsong

2011

J of Obstet and Gynaecol

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A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14–28 weeks of gestation

Cleeve

Fønhus

Lavelanet

2019

Intl J Gynecology & Obste

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Background Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established. Objectives To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. Search strategy Research databases from January 2006 to October 2018. Selection criteria Randomized controlled trials with IUFD cases at 14–28 weeks of gestation. Data collection and analysis We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. Main results Sixteen trials from 1695 citations. When misoprostol is used alone, 400 μg is more effective than 200 μg (RR 0.78; 95% CI, 0.66–0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70–1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85–1.03, low certainty evidence). Certainty of evidence related to mifepristone–misoprostol regimens and safety and acceptability is very low. Conclusions Misoprostol 400 μg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.

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Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens

Abstract: Misoprostol moistened with acetic acid is effective for second-trimester pregnancy termination when given vaginally 3-hourly, 6-hourly or 12-hourly. The former two regimens are significantly more effective than the latter.

Cited by 9 publications

References 23 publications

Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study

Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study

Randomized controlled study comparing misoprostol moistened with normal saline and with acetic acid for second‐trimester pregnancy termination. Is it different?

A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14–28 weeks of gestation

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