Comparação entre dinoprostone e misoprostol na indução do trabalho de parto em gestações pós-data na presença de cérvix desfavorável

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Tocoginecologia

Labor induction in preeclampsia: Is misoprostol more effective than dinoprostone?

Objective: To compare the efficacy of vaginal misoprostol versus dinoprostone for induction of labor (IOL) in patients with preeclampsia according to the WHO criteria. Study design: Ninety-eight patients were retrospectively analyzed. A total of 47 patients received 3mg dinoprostone suppositories every 6h (max. 6mg/24h) whereas 51 patients in the misoprostol group received either 50μg misoprostol vaginally every 12h, or 25μg every 6h (max. 100μg/24h). Primary outcomes were vaginal delivery within 24 and 48h, respectively. Results: The probability of delivering within 48h was more than three-fold higher in the misoprostol than in the dinoprostone group: odds ratio (OR)=3.48; 95% confidence interval (CI) 1.24, 10.30, whereas no significant difference was observed within 24h (P=0.34). No correlation was seen between a ripe cervix prior to IOL and delivery within 24/48h (P=0.33 and P=1.0, respectively). More cesarean sections were performed in the dinoprostone group due to failed IOL (P=0.0009). No significant differences in adverse maternal outcome were observed between both study groups, whereas more neonates (12 vs. 6) of the dinoprostone group were admitted to the NICU (P=0.068). Conclusion: This study suggests that misoprostol may have some advantages compared to dinoprostone, including improved efficacy and lower cost of the drug, even in cases of preeclampsi

Surprises of off-label drug use - where had all the Prostin gone?

The off-label use of drugs is common, particularly in paediatrics, where many drugs have yet to undergo the rigorous scrutiny demanded by authorities such as the Medicines Control Council (MCC) and the US Food and Drug Administration (FDA) before registration.1,2 Yet some drugs (e.g. paracetamol, salbutamol) are so commonplace in paediatric practice that it may come as a surprise that their use is indeed off-label in many circumstances. Problems may arise when an important drug in everyday (off-label) use is unexpectedly in short supply. An example is dinoprostone, marketed in South Africa as Prostin E2 by Pfizer South Africa (but curiously not listed on their website). Its registered use in South Africa is for induction of labour (as an oral 0.5 mg tablet), yet it is commonly used in South Africa for the emergency maintenance of ductal patency in newborn babies

Early amniotomy after cervical ripening for induction of labor: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE DATA: Timing of artificial rupture of membranes (ie, amniotomy) in induction of labor is controversial, because it has been associated not only with shorter labors, but also with fetal nonreassuring testing, at times necessitating cesarean delivery. The aim of this systematic review and metaanalysis of randomized trials was to evaluate the effectiveness of early amniotomy vs late amniotomy or spontaneous rupture of membranes after cervical ripening. STUDY: The search was conducted with the use of electronic databases from inception of each database through February 2019. Review of articles included the abstracts of all references that were retrieved from the search. STUDY APPRAISAL AND SYNTHESIS METHODS: Selection criteria included randomized clinical trials that compared early amniotomy vs control (ie, late amniotomy or spontaneous rupture of membranes) after cervical ripening with either Foley catheter or prostaglandins at any dose. The primary outcome was the incidence of cesarean delivery. The summary measures were reported as summary relative risk with 95% of confidence interval with the use of the random effects model of DerSimonian and Laird. RESULTS: Four trials that included 1273 women who underwent cervical ripening with either Foley catheter or prostaglandins and then were assigned randomly to either early amniotomy, late amniotomy, or spontaneous rupture of membranes (control subjects) were included in the review. Women who were assigned randomly to early amniotomy had a similar risk of cesarean delivery (31.1% vs 30.9%; relative risk, 1.05; 95% confidence interval, 0.71-1.56) compared with control subjects and had a shorter interval from induction to delivery of approximately 5 hours (mean difference, -4.95 hours; 95% confidence interval, -8.12 to -1.78). Spontaneous vaginal delivery was also reduced in the early amniotomy group, but only 1 of the included trials reported this outcome (67.5% vs 69.1%; relative risk, 0.78; 95% confidence interval, 0.66-0.93). No between-group differences were reported in the other obstetrics or perinatal outcomes. CONCLUSION: After cervical ripening, routine early amniotomy does not increase the risk of cesarean delivery and reduces the interval from induction to delivery

Immunomodulatory properties of mesenchymal stem cells: Cytokines and factors

Mesenchymal stem cells (MSCs) are defined as undifferentiated cells that are capable of self renewal and differentiation into several cell types such as chondrocyte, adipocyte, osteocyte, myocyte, hepatocyte, and neuron-like cells. MSC can be isolated from bone marrow, umbilical cord blood, adipose tissue, placenta, periosteum, trabecular bone, synovium, skeletal muscle, and deciduous teeth. Immunomodulatory of MSCs is one of the important issues nowadays, because this aspect can be clinically applied for graft-versus-host and autoimmune diseases. In this review, we tried to discuss in detail about cytokines and factors such as members of the transforming growth factor superfamily (transforming growth factor-β), hepatic growth factors (HGF), prostaglandin E2 (PGE2), IL-10, indolamine 2,3-dioxygenase (IDO), nitric oxide (NO), heme oxygenase-1 (HO-1), and human leukocyte antigen-G (HLA-G) that are involved in immunomodulatory of MSCs. © 2011 John Wiley & Sons A/S

Labour induction with prostaglandins: a systematic review and network meta-analysis

Abstract OBJECTIVES: To assess the effectiveness and safety of prostaglandins used for labour induction. DESIGN: Systematic review with Bayesian network meta-analysis DATA SOURCES: The Cochrane Pregnancy and Childbirth Group's Database of Trials (which incorporates the results of a broad generic search for all pregnancy and postpartum trials). Sources included are CENTRAL, Medline, Embase, NHS Economic Evaluation Database, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised clinical trials of prostaglandin or prostaglandin analogues used for third trimester cervical ripening or labour induction versus placebo or no treatment, alternative prostaglandin dose or administration, or a different type of prostaglandin. We included studies recruiting women with a viable fetus, but had no other restrictions relating to indication for labour induction or language of publication. Outcomes assessed were serious neonatal morbidity (trialist defined) or perinatal death; serious maternal morbidity (trialist defined) or death; vaginal delivery not achieved within 24 hours, caesarean section, and uterine hyperstimulation with fetal heart rate changes. RESULTS: 280 randomised clinical trials were included (48 068 women) in the review. Maternal and neonatal mortality and serious morbidity were rarely reported and are summarized narratively. Unresolved inconsistency was observed for the hyperstimulation outcome. Relative to placebo, the odds of failing to achieve a vaginal delivery were lowest for vaginal misoprostol (≥50 µg) (odds ratio 0.06 (95% credible interval 0.02 to 0.12)), with a 39% absolute probability of event (95% credible interval 1% to 94%). Compared with placebo, odds of caesarean section were lowest for titrated oral misoprostol solution

Complicaciones materno – fetales asociados al uso de Misoprostol para la inducción de trabajo de parto en embarazos a término, en el servicio de alto riesgo obstétrico del Hospital Bertha Calderón Roque, en el I trimestre del año 2015

Con el objetivo de identificar las Complicaciones materno– fetales asociados al uso de misoprostol para la inducción de trabajo de parto en embarazos a término se realizó un estudio retrospectivo en el Servicio de Alto Riesgo Obstétrico del Hospital Bertha Calderón Roque en el periodo de enero a marzo de 2015, mediante la revisión de 140 expedientes de pacientes que se administró misoprostol 25 mcg por vía vaginal cada 4 – 6 horas hasta un total de 6 dosis como inductor de trabajo de parto en embarazos a término, los resultados reportan: de acuerdo a los datos socio-demográficos se encontró que el 73 % pertenece al grupo de edad entre 20 a 35 años, el 93 % pertenecen al área urbana y el 69 % cursaron la secundaria. Con respecto a los antecedentes gineco-obstétricos encontramos que el 41% de las pacientes eran primigestas y el 54% de éstas estaban entre las 39 a 40 semanas de gestación. La patología más común por la cual se indicó el uso de misoprostol se relacionó a oligoamnios en un 33 %. Dentro del score de Bishop en las pacientes ingresadas se encontró un 72% con un puntaje de 3 a 4, para lo cual se utilizaron 3 a 4 dosis en un 44%. En relación a la vía de finalización del parto el 90 % está representado por la vía vaginal. Dentro de las complicaciones maternas predominó la hemorragia posparto con 16 % y de las complicaciones fetales el líquido meconial predominó con un 29%. De acuerdo a las reacciones adversas asociadas al misoprostol que se presentó en mayor porcentaje fue las náuseas en un 19 %. Se concluye que el misoprostol es una prostaglandina para la inducción del parto en embarazos a término, fármaco que debe estar bajo estricta vigilancia por el equipo de salud para disminuir complicaciones materno–fetale

Cytotec til framköllunar fæðinga

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCytotec eða misoprostol er prostaglandín E1 analog þ.e.a.s virkar eins og náttúrulegt prostaglandín. Samdráttareiginleikar prostaglandína á leg voru uppgvötvaðir um 1969 þegar það var fyrst notað til gangsetninga á 10 konum (1). Náttúruleg prostaglandín hafa mjög stuttan helmingunartíma og þarf að gefa mjög háa skammta með stuttu millibili ef áhrifa á að gæta. Einnig voru algengar aukaverkanir frá meltingarvegi og lélegt geymsluþol var til vandræða. Þannig var fljótlega hætt að nota hin náttúrulegu prostaglandín og í staðinn farið að þróa lyf með sömu virkni, en með lengri helmingunartíma og færri aukaverkanir. Þannig hafa prostaglandín analogar eins og Prostin (Dinoproston) og Cytotec tekið yfir og eru notuð í dag í stað hinna náttúrulegu prostaglandína