Oral versus rectal misoprostol in the treatment of menorrhagia

Introduction: Excessive menstrual loss is a major problem. Effective medical treatments exist and may provide an alternative to surgery. Objective: Evaluation of the effects of oral and rectal misoprostol in the treatment of excessive blood loss in cases of menorrhagia and comparison between both routes. Subjects and methods: Sixty patients with heavy, but however, regular periods (menorrhagia) were included in the study. They were randomly divided into two equal groups. Both groups were evaluated in two consecutive menstrual cycles. First without the treatment (baseline value) and the second cycle by either rectal misoprostol tablets (three times daily for the first 3days of the bleeding) or by oral misoprostol tablets (one tablet three times daily for the first 3days of the bleeding). For both the groups the estimated menstrual blood loss was assessed before and after treatment using subjective and objective assessments. Results: A highly statistical significant reduction in menstrual blood loss occurred by treatments in both groups (p=0.000). Rectal misoprostol produced the highest reduction in the menstrual blood loss with a percent change of 53.45%, while oral misoprostol was less effective in reducing the menstrual blood loss with a percent change of 36.15%. Both routes were effective in improving dysmenorrhea and reducing the number of cycle days with no significant differences between them. Conclusions: Both rectal and oral misoprostol are safe and effective routes for reducing excessive menstrual blood loss (menorrhagia), but the rectal route is more effective

Albumin to creatinine ratio in a random urine sample: Correlation with severity of preeclampsia

Background: Albumin to creatinine ratio (ACR) in random urine samples correlates well with 24-h protein excretion in potential glomerulopathy as in diabetic renal microangiopathy. Using this ratio as an appropriate screening test for proteinuria or for the disease severity in hypertensive disorders with pregnancy needs still to be verified. Objective: To investigate the role of albumin to creatinine ratio in a random urine sample for assessment of severity of preeclampsia. Patients & methods: Two separate groups, fifty women each, were enrolled. All were pregnant at their third trimester with confirmed preeclampsia. Based on their blood pressure levels, Group A, included patients with mild form of preeclampsia, whereas group B included cases with severe form. Albumin to creatinine ratio in random urine samples and the 24-h protein content in urine were assessed. Results: ACR and the 24-h urine protein excretion were significantly correlated, (r = 0.583, p < 0.001). Cut-off value for ACR for this group of patients was calculated to be 14.65 mg/mmol, above which severity of the disease is highly probable. The sensitivity and specificity were 100% and 58.0%, respectively. The positive predictive value was 70.4% and negative predictive value was 100%. Conclusions: Random urine ACR may be a reliable method for prediction and assessment of severity of preeclampsia. Using the estimated cut-off may add to the predictive value of such a simple quick test