Cervical ripening before surgical evacuation of first-trimester pregnancy: a comparison between misoprostol and trinitroglycerin

Introduction: Termination of pregnancy through curettage in the first trimester requires cervical ripening (CR) which can be induced by medicinal or mechanical methods. In the pharmaceutical method, vaginal administration of misoprostol, as well as vaginal trinitroglycerin (TNG), has been shown to induce effective CR. This study was conducted with the aim of comparing vaginal misoprostol and vaginal TNG in the CR of women candidates for the first-trimester curettage. Materials and Methods: This double-blind clinical trial study was conducted on 168 pregnant women with a gestational age of less than 14 weeks who were candidates for curettage. Participants were randomly divided into two groups receiving vaginally either TNG (400 µgr)(n=87) or misoprostol (400 µgr) (n=81). Then, the state of CR and the need for mechanical dilatation were compared between the two groups. Also, the presence of any side effects caused by drug use was determined. Results: The percentage of CR in the misoprostol group (67.9%) was significantly higher than in the TNG group (32.2%) (P0.001). Generally, the rate of complications in the TNG group (35.6%) was significantly higher compared with the misoprostol group (13.6%) (P>0.001). Conclusion: Vaginally Misoprostol is more effective than vaginally TNG on CR of first-trimester curettage as well as it significantly reduces the need for mechanical dilatation of the cervix

Predictive value of serum βHCG level in ectopic pregnancy: A cross sectional study

Abstract Background and Aims Ectopic pregnancy (EP) is a potentially life‐threatening emergency. We investigate the predictive value of serum βHCG level and it's changes from the baseline to the 4th and 7th days after single dose (SD) methotrexate (MTX) treatment in successful treatment of tubal EP. It is important for early diagnosis of EP. Methods In this cross‐sectional study, 690 women with tubal EP and under treatment with SD MTX were evaluated. Successful and failed groups were analyzed on the baseline, 4th and 7th days of MTX treatment. Data were analyzed using SPSS22 software. All p values of less than 0/05 were considered satistically significant. Results SD MTX treatment was successful in 584 (84.7%) patients. The mean baseline ßHCG value was 882.35 ± 430.76 in the successful group and 1083.99 ± 1080.25 in the failed group. There was a 19.53% decrease in ßHCG values between the baseline and 4th days in the successful group and a 12.94% increase in the failed group (p < 0.001). On days baseline, 4 and 7; receiver operating characteristic curve analysis's value was 504.5, 429, 279 for cut off; 58%, 73%, 81% for sensitivity and 51%, 52%, 55% for specificity, respectively. Conclusion A decrease in the ßHCG value and/or a cut‐off decrease of 59.9% on the baseline, 4th day and 81.6% between the baseline and 7th days, can predict the successful treatment of tubal EP with SD MTX