Search Results (51)

Background: The standard protocol for early first-trimester termination of pregnancy (TOP) involves administration of mifepristone followed by misoprostol after a 48-h interval. While concurrent administration may improve convenience and access, evidence regarding its effectiveness remains limited. This study aims to compare the efficacy, safety, and acceptability of concurrent oral administration of mifepristone and misoprostol with the 48-h interval regimen for early TOP. Methods: In this randomized controlled trial (ClinicalTrials.gov: NCT03440866), 250 patients with intrauterine pregnancies up to 49 days’ gestation were randomized to receive either concurrent treatment (600 mg mifepristone and 400 mcg misoprostol) or the same medications administered 48 h apart. The primary outcome was complete abortion without additional intervention. Secondary outcomes included adverse events, pain, and patient satisfaction. Follow-up occurred approximately two weeks post-treatment. Data were available for 220 participants. Results: The concurrent group had a significantly lower success rate compared to the control group (68.8% vs. 84.3%, p = 0.007). Continuing pregnancy was more frequent with concurrent administration (13.4% vs. 2.8%, p = 0.004). No significant differences were observed in hemoglobin change, adverse events, or pain scores. Patient satisfaction was higher in the control group (81.1% vs. 63.6%, p = 0.04), though preferences for future abortion methods did not differ between groups. Conclusions: Concurrent administration of mifepristone and misoprostol is less effective and less satisfactory than the standard 48-h regimen, although safety and pain profiles are comparable. It should not replace the interval protocol, and patients choosing concurrent treatment should be counseled about its lower efficacy and higher likelihood of requiring additional intervention. Full article

Background: CP (CP) and HCP (HCP) are rare and high-risk conditions, often historically managed with radical intervention and associated with hemorrhage and fertility loss. Objective: To summarize current evidence on the conservative, fertility-preserving management of cervical and heterotopic cervical pregnancies and to illustrate a stepwise pharmacologic protocol applied in our tertiary center. Methods: A narrative literature review (PubMed, Scopus, Web of Science; inception—July 2025) was conducted using the following key terms: “CP,” “HCP,” “methotrexate,” “mifepristone,” “misoprostol,” “uterine artery embolization,” “hysteroscopy,” and “Doppler ultrasound.” We integrated a personal institutional case that applied stepwise pharmacologic priming, Doppler-guided surveillance, and delayed evacuation. Results: Evidence—primarily from case reports and small series—supports conservative, multi-modal strategies combining systemic or local methotrexate ± mifepristone, timed to Doppler-confirmed vascular regression, before surgical intervention. Adjuncts such as misoprostol, hysteroscopic resection, balloon tamponade, and uterine artery embolization further reduce hemorrhage risk while maintaining fertility. Our case utilized a novel, incremental dosing strategy of mifepristone followed by methotrexate, a week-long interval to confirm vascular involution via Doppler, and delayed suction curettage with minimal blood loss. Conclusions: Conservative, imaging-guided management is promising for reducing hemorrhagic complications and preserving fertility in CP/HCP. Future multicenter registries and standardized Doppler-based protocols are urgently needed to refine decision-making and optimize outcomes. Full article

Medication abortion with mifepristone and misoprostol is a safe and effective method for ending a pregnancy. Pharmacy dispensing of mifepristone was approved by the U.S. Food and Drug Administration in 2023, but educational opportunities for pharmacists were nonexistent. We designed a 1 h continuing education course on medication abortion for pharmacists, which was offered in a live-webinar or recorded-video format over 3 years. It included key medication abortion topics, including medications, patient counseling, relevant policies, and implementing pharmacy dispensing. Using a prepost design, we administered online surveys to participants prior to and after completing the course to assess changes in overall medication abortion knowledge score (six items, Cronbach’s alpha = 0.76) and support for pharmacist dispensing of medication abortion (one Likert-scaled item). During the study period, 279 students and pharmacists took the course, of which 148 completed both the pre- and post-course questionnaires. Adjusted regression analyses demonstrated significant increases in knowledge scores and support for pharmacist dispensing of medication abortion post-course; most thought dispensing mifepristone would be very (21.6%) or somewhat easy (38.5%) to implement, and 75% indicated a willingness to dispense mifepristone if allowed. These findings suggest that video-based education on medication abortion is an effective tool for enhancing pharmacists’ knowledge and support for medication abortion, which could increase access to reproductive health care. Full article

Background: Missed miscarriage (MM) is a common first-trimester complication. Misoprostol alone achieves moderate success, while combination therapy with mifepristone improves outcomes in spontaneous pregnancies. Evidence in assisted reproductive technology (ART) pregnancies is scarce. We evaluated whether combined mifepristone–misoprostol improves outcomes in ART pregnancies compared with misoprostol alone and compared results with spontaneously conceived (SC) pregnancies. Methods: This retrospective matched cohort study was conducted at a single center (2017–2024). ART pregnancies were matched 1:2 with SC pregnancies by maternal age. Patients received misoprostol alone or 200 mg mifepristone followed 48 h later by misoprostol. The primary outcome was treatment success, defined as complete uterine evacuation without repeat misoprostol or surgery. Secondary outcomes included emergency visits, surgical procedures, and ART-related predictors. Subgroup analyses were performed by ART protocol. Results: Among 307 patients (94 ART, 213 SC), combined therapy yielded higher success than misoprostol alone in SC (84% vs. 71%, p = 0.023) and ART pregnancies (95% vs. 80%, p = 0.035). In hormonally supported frozen embryo transfer (HRT-FET) cycles, success was 100% with combined therapy versus 80% with misoprostol alone. Conclusions: Combined mifepristone–misoprostol is more effective than misoprostol alone, with particularly high success in HRT-FET cycles. Full article

Retained products of conception (RPOC) represent a significant cause of morbidity in the post-abortive and postpartum periods, potentially leading to abnormal uterine bleeding, pelvic pain, infections, and intrauterine adhesions. Accurate diagnosis is crucial to avoid unnecessary surgical interventions and to preserve future fertility. Transvaginal ultrasound constitutes the primary imaging modality for identifying RPOC, but the lack of standardized diagnostic criteria complicates clinical decision-making. This narrative review explores the current literature on sonographic findings associated with RPOC, focusing on the diagnostic value of endometrial thickness (ET), the presence of intrauterine echogenic masses, and the use of Color Doppler imaging. Although an ET ≥15 mm is frequently used to suspect RPOC, the variability in cut-off thresholds and limited specificity reduce its diagnostic reliability. The detection of an echogenic intrauterine mass appears to be the most sensitive and specific sonographic feature. Color Doppler assessment, particularly the presence of enhanced myometrial vascularity (EMV) and classification systems like the Gutenberg score, offers further insight by stratifying hemorrhagic risk and guiding therapeutic choices. However, vascular parameters such as peak systolic velocity (PSV) and resistive index (RI) demonstrate a substantial overlap between benign and pathological conditions, limiting their stand-alone utility. The review also addresses the differential diagnosis of RPOC, including blood clots, arteriovenous malformations, placental polyps, gestational trophoblastic disease, and endometrial osseous metaplasia. The role of three-dimensional ultrasound remains limited in clinical practice, offering no significant advantage over two-dimensional imaging. Finally, the timing of follow-up ultrasound after medical treatment with misoprostol is critical: delayed assessment reduces overtreatment by allowing time for spontaneous resolution. In conclusion, despite advances in ultrasound technology, the diagnosis of RPOC remains challenging due to heterogeneity in imaging findings and inter-observer variability. A multimodal approach integrating grayscale and Doppler ultrasound with clinical evaluation is essential for optimal management. Full article

As part of the substantial public discourse surrounding the distribution and use of mifepristone, which is used with misoprostol to facilitate drug-induced abortions, claims comparing the safety of this regimen to that of common pharmaceuticals have emerged and proliferated. Offered in forums ranging from social media to the Supreme Court, these claims have so gained public acceptance that they are now echoed without scrutiny and, at times, reference. Yet the simplistic slogan that “mifepristone is safer than Tylenol”, though easily disseminated, defies both an intuitive understanding of how we evaluate drug safety and our norms and regulations for doing so. Indeed, if such an assertion was attributable to the manufacturer, it would precipitate a reprimand by the FDA given the lack of specific, controlled, and head-to-head evidence rightly required for its support. To the extent that these claims persist, however, including among the outputs of medical societies, abortion centers, clinical researchers, and government officials, and to the extent that they aim to inform both individual and public decision-making, it is critical that the evidence offered for their support be thoroughly explored. Such examination reveals these claims to be wholly unfounded, offering deficient and disingenuous representations of safety for any of the drugs compared. Full article

The prostaglandin E2 receptor EP3 is emerging as a promising therapeutic target in cardiovascular diseases because of its involvement in vascular inflammation, platelet aggregation, and vasoconstriction. However, selective EP3 ligands with validated biological activities are scarce. In this study, we combined computational and experimental strategies to identify and validate novel EP3 receptor ligands with therapeutic potential. We implemented a high-throughput, structure- and ligand-based virtual screening pipeline, enabling efficient exploration of approved drugs and natural compounds from DrugBank and FooDB libraries. Top-scoring candidates were prioritised based on binding energy and pharmacophoric similarity. Selected hits were subjected to in silico ADME/Tox profiling using QikProp to identify molecules with favourable pharmacokinetic and safety parameters. TUCA, masoprocol, and pravastatin sodium have emerged as lead candidates and were validated in vitro using endothelial migration and platelet aggregation assays. TUCA exhibited the most consistent inhibitory effect on endothelial migration, whereas masoprocol and hydrocortisone significantly reduced platelet aggregation. These findings establish a multidimensional workflow for the rational identification of EP3 ligands and support their potential use in cardiovascular therapeutics. Full article

Background and Objectives: Erythromelalgia (EM) is an uncommon condition marked by recurring redness, intense burning sensations, and elevated limb warmth. This syndrome can be significantly debilitating, and finding effective treatment options often proves to be quite difficult. The symptoms can severely impact the quality of life of those affected, resulting in considerable disability. This systematic review aims to compare available medical treatments for EM by evaluating their efficacy and safety. Materials and Methods: Following PRISMA guidelines, the search included the PubMed, Medline, and Web of Science databases, using the keywords (“Erythromelalgia” OR “Mitchell’s Disease”) AND (“Erythromelalgia Treatment” OR “Erythromelalgia Management”). Results: From the 103 papers extracted through the database search, six articles were considered suitable for the systematic review. The included studies investigated various interventions used for a total of 120 patients, including iloprost (n = 8), misoprostol (n = 21), topical amitriptyline-ketamine (n = 36), lidocaine (n = 27), chemical lumbar sympathectomy (CLS, n = 13), and various pharmacological agents (n = 11). The outcomes showed significant improvements in areas like pain reduction, cooling scores, and temperature regulation. Iloprost and misoprostol exhibited notable benefits in cooling scores, sympathetic dysfunction, and EM severity compared to placebos. About 75% of the patients reported pain relief with topical amitriptyline-ketamine, while lidocaine reduced nociceptive feelings in a dose-dependent manner. Conclusions: Comparing interventions demonstrated consistent clinical benefit with varied tolerability. However, adverse events ranged from mild gastrointestinal symptoms to severe complications such as disability and depression, requiring careful monitoring. Given EM’s diverse symptoms and comorbidities, treatment efficacy varies among individuals. A personalized approach incorporating genetic testing, multidisciplinary care, and long-term monitoring is essential to optimize outcomes. Continued research is vital to advance understanding of EM’s pathophysiology and improve patient care. Full article

Background and aim: Labor induction is increasing in obstetric practice. In women with an unfavorable cervix, cervical ripening is required for successful induction. We conducted this review to compare the effectiveness and tolerance of two interventions used for cervical ripening, topical prostaglandin E2 (dinoprostone) and transcervical Foley’s catheter. Methods: We systematically searched four biomedical databases on 15 November 2024, for relevant studies. The studies’ eligibility was determined after screening their titles, abstracts, and full texts. We extracted relevant data from the studies included. RevMan software V5.4 was used to conduct the random-effect meta-analysis. Misoprostol was excluded from this review due to variability in dosing protocols and inconsistent reporting across studies. A review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD420251026183. Results: This review included 41 studies that in total enrolled 12,877 women (6722 for Foley’s catheter and 6155 for dinoprostone). The efficacy of the two interventions was comparable as evidenced by the similarity in the induction to delivery time, Bishop score change, the rate of vaginal delivery within 24 h, and the risk of induction failure. Foley’s catheter was linked with lower risks of caesarian delivery (RR = 0.84, p = 0.006), uterine hyperstimulation (RR = 0.39, p < 0.001), postpartum hemorrhage (RR = 0.76, p = 0.03), and a 1-min Apgar score < 7 (RR = 0.75, p = 0.02). However, it was associated with an extra need for oxytocin augmentation (RR = 1.18, p < 0.001). The risks of instrumental delivery, intrapartum pyrexia, postpartum infection, meconium passage, umbilical cord arterial pH < 7.1, a 5-min Apgar score < 7, and neonatal intensive care requirement were comparable for the two interventions. Conclusions: In comparison with dinoprostone, Foley’s catheter is equally effective and well tolerated. We recommend Foley’s catheter use for women with a previous caesarian delivery and in low-resource settings. Full article

Background/Objectives: Women’s experience plays an important role in the evaluation of different methods in obstetric practice with a patient-centered approach, especially for induction of labor (IOL). For IOL, cervical ripening seemed to be associated with a less positive experience of childbirth. More specific data regarding the different cervical ripening methods might help the obstetrician to better counsel and support women requiring cervical ripening to improve their experience of IOL. The aim of this study was therefore to assess whether the method is associated with altered experiences of cervical ripening and childbirth among nulliparous women. Methods: A prospective observational study included 340 nulliparous women with a singleton fetus in cephalic presentation and cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a cervical ripening balloon (CRB, 33.8%), dinoprostone vaginal insert (PG, 32.7%), oral misoprostol (M, 3.8%), or repeated methods (R, 29.7%). The cervical ripening method was left to the free discretion of the obstetrician responsible for the women. A self-developed questionnaire assessed women’s feelings and experience of cervical ripening and childbirth using Likert scales from 0 to 10 (very satisfied) according to the method in the immediate postpartum period. We compared the women’s experiences and feelings according to the cervical ripening method (CRB, PG, M, or R) and specifically studied the association (assessed by multivariate logistic regression analyses) between women’s experience in the immediate postpartum period and the cervical ripening method. Results: The overall vaginal rate was 79.1% and was similar between groups (CRB 77.4%, PG 87.4%, M 69.2%, and R 73.3%; p = 0.15). The experience of ripening was significantly better with CRB, M, or PG compared to R (CRB: 6.7 ± 2.5, PG: 7.2 ± 2.6, M: 6.8 ± 3.6, and R: 5.2 ± 2.8; p < 0.001). The maximum pain during ripening was significantly higher in PG (7.9 ± 2.5 vs. CRB 7.2 ± 2.4, M 7.0 ± 3.9, and R 7.8 ± 2.4; p = 0.02). The experience of childbirth was more negative in the R group (6.1 ± 2.7 vs. CRB 6.9 ± 2.6, PG 7.2 ± 2.4, and M 7.4 ± 3.1; p = 0.02). After multivariate analysis with adjustment for confounders (method for cervical ripening, pain during IOL, mode of birth, maternal morbidity, and neonatal morbidity), repeated methods were significantly associated with worse overall experiences of cervical ripening (aOR = −1.4, 95%CI −2.1–−0.67; p < 0.001) and childbirth (aOR = −0.75, 95% CI −1.6–−0.05; p = 0.03), compared to PG, CRB, or M used alone. After adjustment, maternal experience and childbirth were similar between methods used alone for cervical ripening. Conclusions: Nulliparous women who required repeated methods for cervical ripening at term had significantly worse experiences of ripening and childbirth in the immediate postpartum period compared to PG, CRB, or M used alone, regardless of the mode of delivery and maternal and neonatal morbidity. Full article

Introduction: Pharmacies are important points of access and information for women seeking medication abortion. In the context of the Democratic Republic of Congo [DRC], where the legal conditions for abortion have expanded in recent years and now allow pharmacies to dispense medication abortion with a prescription, little is known about medication abortion counseling and care offered by pharmacy staff. The aim of this study was to explore the quality of information provided by pharmacy staff to customers seeking medication abortion in Kinshasa. Methodology: A cross-sectional study using the mystery client (MC) approach was conducted in 480 pharmacies between April and May 2023. Trained female (n = 9) and male (n = 3) investigators played the role of mystery clients seeking abortion medication for themselves (or their partner or relative), and they asked questions to assess the performance of pharmacy staff and the quality of the provided information. The MCs recorded the results of their visits immediately after they left the pharmacy. Data were analyzed using Stata 17.0 and QGIS. The research protocol received ethical approval from the Kinshasa School of Public Health, and the need for informed consent was waived as pharmacy providers were being observed acting in their professional capacity. Results: Misoprostol was available at 40% of pharmacies visited, while mifepristone–misoprostol was available at less than 2%. Correct dosage information for misoprostol was provided by only 23% of the providers, with the lowest proportion observed in interactions involving male partners (2.4%). During discussions, only 10.6% of the providers explained what to expect during the abortion process. The quality of information differed according to the client profile, the district, and whether the client had a prescription. Conclusions: While medication abortion can provide a safe option for women seeking to manage their own abortion, the lack of adequate information on the correct dosage and administration can hinder the effectiveness of this regimen. To fully realize the potential of this medication for reducing unsafe abortion, it is essential that pharmacy staff are trained and supported to provide high-quality information and services, and that inequities in access to medications are addressed. Full article

Background and Objectives: First trimester medical abortion with the combination of mifepristone and misoprostol is highly effective. The aim of this study was to assess the efficacy and safety of a modified medical abortion protocol, offering a structured outpatient approach up to 9 weeks (63 days) of gestation. This study may contribute to existing evidence by evaluating a slightly altered regimen and its real-world effectiveness in clinical practice. Material and Methods: This was a retrospective cohort study conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, during a two-year period (2022–2024). Women aged 18 years or older with an intrauterine pregnancy ≤63 days confirmed by transvaginal ultrasound were included. Exclusion criteria included ectopic pregnancy, contraindications to study medications, or loss to follow-up. Mifepristone (200 mg) was administered orally on Day 1, and misoprostol (800 mcg) was administered vaginally on Day 3. Serial follow-up visits on Days 8, 15, and 21 were scheduled according to the success of each cycle. Results: In total, 130 women were included in the study. A high success rate of 96.9% (95% CI: 92.3–99.2%) was observed. Success was most frequently observed on Day 8 (60.8%). Success rates were 100% for the age group of 18 to 25 years, approximately 96% for both the groups of 26–35 and 36–45 years, and around 50% for those aged >45 years. With regards to gestational age, success rates were 97.5% for ≤7 weeks (49 days) and 95.9% for >7 weeks (p = 0.63). Side effects were reported by 13.2% of participants (95% CI: 7.8–20.1%) and mainly involved the gastrointestinal system. Pain intensity was reported as moderate; analgesics were used by 75.4% of patients. The satisfaction rate for the medical abortion process was 95.4% (95% CI: 90.2–98.3%). Conclusions: Early-first-trimester medical abortion on an outpatient basis is a feasible, patient-friendly method with high efficacy, exhibiting limited side effects and a high satisfaction rate. Full article

Intrauterine devices (IUDs) are highly effective long-acting contraceptives. However, pain associated with insertion deters some women and impacts satisfaction. This systematic review critically evaluates the effectiveness of local anesthetics, misoprostol, nonsteroidal anti-inflammatory drugs (NSAIDs), and conscious sedation for managing pain associated with IUD insertion. A comprehensive database search including PubMed, Web of Science, Google Scholar, ClinicalTrials.gov, and ProQuest was conducted from inception to July 2023 for randomized controlled trials (RCTs). RCTs assessing interventions for IUD insertion pain were included. Case reports, non-randomized studies, and non-English papers were excluded. Two independent reviewers extracted data on pain outcomes and adverse effects. The risk of bias was assessed using Cochrane tools. Thirty-nine RCTs (n = 12,345 women) met the inclusion criteria. Topical lidocaine effectively reduced pain on consistent findings across multiple high-quality RCTs. Misoprostol pretreatment facilitated easier insertions through cervical ripening. However, evidence for NSAIDs was inconclusive, with some RCTs finding no additional benefits versus placebo. Results also remained unclear for nitrous oxide conscious sedation due to variability in protocols. Nulliparity predicted higher reported pain consistently. Lidocaine and misoprostol show promise for minimizing IUD insertion pain and difficulty. Further optimization is required to standardize conscious sedation and fully evaluate NSAIDs. Improving pain management may increase favorable experiences and uptake of this reliable method. Full article

Limited information is available concerning the termination of pregnancy in non-human primates. Thus, a comprehensive review of this topic will be beneficial for veterinary staff in laboratories, zoos, and wildlife rehabilitation centers. The most relevant studies concerning the termination of viable and non-viable pregnancy in non-human primates were analyzed, and dosages, administration routes, adverse effects, and the efficacy of the drugs used are reported. The literature revealed that termination of pregnancy is most commonly performed in marmosets and macaques. The combination of mifepristone and misoprostol was reported to be effective and fast-acting in terminating first-trimester pregnancy in macaques, while cloprostenol was identified as the best agent for use in marmosets. This review also provides insights about the limitations of previously described methods of pregnancy termination and discusses potential alternatives and areas for future investigation. Full article

Objective: This study offered an updated meta-analysis of randomized controlled trials (RCTs) that assessed preoperative misoprostol compared to control (matched placebos or no treatment) during abdominal myomectomies. Methods: Six databases underwent screening until 7 April 2024. The risk of bias was assessed using the Cochrane Collaboration tool. The results were presented as mean differences (MDs) or risk ratios (RRs) along with 95% confidence intervals (CIs) using the random-effects model. Results: Sixteen RCTs were analyzed, involving 975 women. The overall quality of the studies was rated as “low” or had “some concerns” of bias in seven and eight RCTs, respectively; one RCT had an overall “high” risk of bias. For primary endpoints, the misoprostol intervention had significantly lower mean intraoperative blood loss (n = 15, MD = −180.2 mL, 95% CI [−224.04, −136.35], p < 0.001), mean hemoglobin drop (n = 13, MD = −0.58 g/dl, 95% CI [−0.82, −0.35], p < 0.001), and rate of perioperative blood transfusion (n = 13, RR = 0.43, 95% CI [0.29, 0.63], p < 0.001) compared to the control intervention. For secondary endpoints, the misoprostol intervention had significantly lower mean hematocrit drop (MD = 2.15, 95% CI −3.34, −0.96], p < 0.001), mean operative time (MD = −12.95 min, 95% CI [−19.89, −6.01], p < 0.001), and mean hospital stay (MD = −0.14 days, 95% CI [−0.25, −0.02], p = 0.02) compared to the control intervention. Nonetheless, no significant change was indicated between both interventions regarding the rate of postoperative fever. Conclusions: During abdominal myomectomy, the administration of preoperative misoprostol was generally safe and yielded statistically significant reductions in intraoperative blood loss, hemoglobin drop, and perioperative blood transfusion. Full article