Labor induction with randomized comparison of cervical, oral and intravaginal misoprostol

Background: This study attempts to evaluate the safety and effectiveness of 50μgm intracervical misoprostol in comparison with intravaginal and sublingual for the induction of labor at term pregnant women. Methods: This study is designed as a parallel clinical trial study. Three hundred and fifteen term pregnancies requiring induction of labor were treated with the maximum used misoprostol intracervical, sublingual, and vaginal doses. Participants were randomly allocated into three groups of 105. The dose was repeated every 4 h until adequate uterine contraction and Bishop Score were achieved. The duration of induction to births, time to the active phase, the rate of births, and the need for caesarean section were compared in three groups. Additionally, labor course and side effects were recorded and analyzed. Data were analyzed using SPSS software. A significance level of p < 0.05 was considered for statistical analyses. Findings: Labor was successfully induced in all cases most (63%) of which required a single dose of misoprostol. Ninety-three (93.0%, p < 0.05) cervical participants proceeded to vaginal births. This figure was also the same in the vaginal and sublingual group of 83 cases (83.0%). The other 41 cases received caesarean section with more indications of failure to progress and meconium-stained liquor. The results indicated that 278 (92.7%) births were achieved in less than 10 h. Time from start of medication to the active phase of labor and childbirth was 3.01 پ} 0.86 and 6.1 1.3 h in the Cervical group, 4.2 پ} 0.66 and 8.4 0.92 h in the sublingual group, and 5.06 1.1 and 9.2 1.5 h in the vaginal group respectively (p < 0.001). The Caesarean rate was lower in the cervical group than in the two other groups (p = 0.05). No significant differences were observed between the study groups in terms of Apgar score and meconium- stained amniotic fluid. Furthermore, no maternal and neonatal complications were observed. Conclusion: In addition to the sublingual and intravaginal routes of administration, intracervical misoprostol at a single dose of 50μgm appears to be an effective method for induction of labor in women with an unfavorable cervix. Like all medical interventions, a discussion of the risks, benefits, and alternatives to induction of labor with this medication in each woman should be undertaken before treatment. Trial registration: This clinical study was approved by the Iranian Registry of Clinical Trials with IRCT ID: IRCT2 01904 15043 278N1. Registration date was on May 13, 2019 and May 27, 2019 respectively (http:// www. irct. ir). Keywords: Misoprostol, Labor induced, Term birt

Labor induction with randomized comparison of cervical, oral and intravaginal misoprostol

Background: This study attempts to evaluate the safety and efectiveness of 50μgm intracervical misoprostol in comparison with intravaginal and sublingual for the induction of labor at term pregnant women. Methods: This study is designed as a parallel clinical trial study. Three hundred and ffteen term pregnancies requiring induction of labor were treated with the maximum used misoprostol intracervical, sublingual, and vaginal doses. Participants were randomly allocated into three groups of 105. The dose was repeated every 4h until adequate uterine contraction and Bishop Score were achieved. The duration of induction to births, time to the active phase, the rate of births, and the need for caesarean section were compared in three groups. Additionally, labor course and side efects were recorded and analyzed. Data were analyzed using SPSS software. A signifcance level of p< 0.05 was considered for statistical analyses. Findings: Labor was successfully induced in all cases most (63%) of which required a single dose of misoprostol. Ninety-three (93.0%, p< 0.05) cervical participants proceeded to vaginal births. This fgure was also the same in the vaginal and sublingual group of 83 cases (83.0%). The other 41 cases received caesarean section with more indications of failure to progress and meconium-stained liquor. The results indicated that 278 (92.7%) births were achieved in less than 10h. Time from start of medication to the active phase of labor and childbirth was 3.01±0.86 and 6.1±1.3h in the Cervical group, 4.2±0.66 and 8.4±0.92h in the sublingual group, and 5.06±1.1 and 9.2±1.5h in the vaginal group respectively (p<0.001). The Caesarean rate was lower in the cervical group than in the two other groups (p=0.05). No signifcant diferences were observed between the study groups in terms of Apgar score and meconium-stained amniotic fuid. Furthermore, no maternal and neonatal complications were observed. Conclusion: In addition to the sublingual and intravaginal routes of administration, intracervical misoprostol at a single dose of 50μgm appears to be an efective method for induction of labor in women with an unfavorable cervix. Like all medical interventions, a discussion of the risks, benefts, and alternatives to induction of labor with this medication in each woman should be undertaken before treatment. Trial registration: This clinical study was approved by the Iranian Registry of Clinical Trials with IRCT ID: IRCT201904 15043278N1. Registration date was on May 13, 2019 and May 27, 2019 respectively (http://www.irct.ir). Keywords: Misoprostol, Labor induced, Term birt

Acute Severe Pancreatitis in Pregnancy Masquerading as Partial Hemolysis Elevated Liver enzymes Low Platelet (HELLP) Syndrome

Introduction: Acute severe pancreatitis may result in biochemical abnormalities resembling those seen in Hemolysis Elevated Liver enzymes Low Platelet (HELLP) Syndrome. Case Presentation: A 17-year-old female with 27 weeks of gestation presented mild acute pancreatitis. Based on the criteria of persistent Systemic Inflammatory Response Syndrome (SIRS) she subsequently developed severe pancreatitis. Bilirubin 2.2 mg/dL, lactate dehydrogenase 2171 IU/L and platelet of 53000 mm3 after 48 hours of the onset of pain, also indicated the possibility of partial HELLP syndrome. However, the results of the differential diagnosis ruled out the presence of Disseminated Intravascular Coagulation (DIC), Thrombotic Thrombocytopenic Purpura (TTP), Systemic Lupus Erythematosus (SLE) and Anti phospholipids syndrome. We terminated her pregnancy due to the above-mentioned diagnoses and postponed the cholecystectomy. Conclusions: Termination of pregnancy was performed as it would save the patient’s life in either deteriorated acute severe pancreatitis or HELLP. Keywords: Pancreatitis; Syndrome; Pregnanc

Acute Severe Pancreatitis in Pregnancy Masquerading as Partial Hemolysis Elevated Liver enzymes Low Platelet (HELLP) Syndrome

Introduction: Acute severe pancreatitis may result in biochemical abnormalities resembling those seen in Hemolysis Elevated Liver enzymes Low Platelet (HELLP) Syndrome. Case Presentation: A 17-year-old female with 27 weeks of gestation presented mild acute pancreatitis. Based on the criteria of persistent Systemic Inflammatory Response Syndrome (SIRS) she subsequently developed severe pancreatitis. Bilirubin 2.2 mg/dL, lactate dehydrogenase 2171 IU/L and platelet of 53000 mm3 after 48 hours of the onset of pain, also indicated the possibility of partial HELLP syndrome. However, the results of the differential diagnosis ruled out the presence of Disseminated Intravascular Coagulation (DIC), Thrombotic Thrombocytopenic Purpura (TTP), Systemic Lupus Erythematosus (SLE) and Anti phospholipids syndrome. We terminated her pregnancy due to the above-mentioned diagnoses and postponed the cholecystectomy. Conclusions: Termination of pregnancy was performed as it would save the patient’s life in either deteriorated acute severe pancreatitis or HELLP. Keywords: Pancreatitis; Syndrome; Pregnanc

Effect of Metformin on Diabetes Mellitus Prevention in Pregnant Women with Risk Factors

Objective: This study evaluated the efficacy and safety of metformin on prevention of gestational diabetes mellitus in women with high risk of GDM. Materials and methods: Total number of 189 pregnant women aged between 25 to 35, and 10 to 14 weeks pregnancy,admitted to  Mirza Koochakkhan Hospital, Tehran in January 2008 - January 2009 entered to this randomized controlled clinical trial. The women had one of the three risk factors; history of GDM, family history of diabetes, or BMI ≥ 30 kg/m2, with normal results in the glucose challenge test (GCT) or the glucose tolerance test (GTT). Subjects were randomly split to two groups; 63 women (group A) who received metformin (500 mg, twice a day) and 126 women (group B) did not use metformin. Incidence  of gestational diabetes was compared between two groups. Results: The incidence  of gestational diabetes was significantly different between two groups (%1.4 in group A, %15.4 in group B) (p<0.001). The study also showed that the insulin requirement was significantly different between two groups after developing GDM (group A %3.6, group B %9.5, p=0.001). Conclusion: Using Metformin can effectively reduce the incidence of GDM in pregnant women at risk