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Fred K. Lotgering - One of the best experts on this subject based on the ideXlab platform.
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Termination of pregnancy in the 2nd trimester: mifepriston/misoprostol preferable to Sulprostone
Nederlands tijdschrift voor geneeskunde, 2009Co-Authors: Sabine Ebbers, Johan W T Creemers, Fred K. LotgeringAbstract:To compare the efficacy of Sulprostone and mifepristone/misoprostol when used for termination of pregnancy (TOP) in the 2nd trimester. Comparative retrospective cohort study. Data were collected on all women whose pregnancies were terminated in the 2nd trimester, in the presence of severe fetal defects, between 1996 and 2007 at the Radboud University Nijmegen Medical Centre, the Netherlands. From the start of 1996 until the end of 2001 TOPs were performed using Sulprostone. In 2001 the treatment was switched to the combination mifepristone/misoprostol. The primary outcome measure was the time interval between the initiation of prostaglandin medication and the birth of the infant. 158 patients met the inclusion criteria: 51 women were treated with Sulprostone, 107 women with mifepriston/misoprostol. The duration of treatment in the mifepristone/misoprostol group (median 8.7 hours, range: 1.1-72.0 hours) was significantly shorter than in the Sulprostone group (median 21.3 hours, range: 7.8-265.0 hours). In the mifepristone/misoprostol group significantly more women (94%) delivered within 24 hours than in the Sulprostone group (55%). In the mifepristone/misoprostol group anti-emetics and pain relief were given significantly less often than in the Sulprostone group 5 versus 12% and 54 versus 90%, respectively). There was no statistically significant difference in the number of women with post partum blood loss (6 versus 6%), (suspected) placental remnants (33 versus 43%) or fever (12 versus 4%). In termination of pregnancy in the 2nd trimester mifepristone/misoprostol was more effective than Sulprostone. Given the disadvantages of Sulprostone in comparison with mifepristone/misoprostol, Sulprostone no longer deserves a place in termination of pregnancy in the 2nd trimester.
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termination of pregnancy in the 2nd trimester mifepriston misoprostol preferable to Sulprostone
Nederlands Tijdschrift voor Geneeskunde, 2009Co-Authors: Sabine Ebbers, Johan W T Creemers, Fred K. LotgeringAbstract:Objective To compare the efficacy of Sulprostone and mifepristone/misoprostol when used for termination of pregnancy (TOP) in the 2nd trimester. Design Comparative retrospective cohort study. Method Data were collected on all women whose pregnancies were terminated in the 2nd trimester, in the presence of severe fetal defects, between 1996 and 2007 at the Radboud University Nijmegen Medical Centre, the Netherlands. From the start of 1996 until the end of 2001 TOPs were performed using Sulprostone. In 2001 the treatment was switched to the combination mifepristone/misoprostol. The primary outcome measure was the time interval between the initiation of prostaglandin medication and the birth of the infant. Results 158 patients met the inclusion criteria: 51 women were treated with Sulprostone, 107 women with mifepriston/misoprostol. The duration of treatment in the mifepristone/misoprostol group (median 8.7 hours, range: 1.1-72.0 hours) was significantly shorter than in the Sulprostone group (median 21.3 hours, range: 7.8-265.0 hours). In the mifepristone/misoprostol group significantly more women (94%) delivered within 24 hours than in the Sulprostone group (55%). In the mifepristone/misoprostol group anti-emetics and pain relief were given significantly less often than in the Sulprostone group 5 versus 12% and 54 versus 90%, respectively). There was no statistically significant difference in the number of women with post partum blood loss (6 versus 6%), (suspected) placental remnants (33 versus 43%) or fever (12 versus 4%). Conclusion In termination of pregnancy in the 2nd trimester mifepristone/misoprostol was more effective than Sulprostone. Given the disadvantages of Sulprostone in comparison with mifepristone/misoprostol, Sulprostone no longer deserves a place in termination of pregnancy in the 2nd trimester.
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Sulprostone reduces the need for the manual removal of the placenta in patients with retained placenta a randomized controlled trial
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Heleen J. Van Beekhuizen, Akosua N.j.a. De Groot, Theo De Boo, David M. Burger, Nicoline E. Jansen, Fred K. LotgeringAbstract:Objective: The purpose of this study was to determine the extent that the administration of Sulprostone reduces the need for manual removal of the placenta in patients with retained placenta. Study design: A double-blinded sequential randomized controlled trial of Sulprostone versus placebo was conducted among 103 patients with retained placenta. Results: In the first phase of this sequential study, Sulprostone was compared with placebo. The null hypothesis of equal effectiveness of both treatments was rejected after 50 patients. In patients with retained placenta, the placenta was expelled after Sulprostone in 13 of 24 cases (51.8%, bias adjusted), whereas expulsion after placebo was achieved in only 4 of 26 cases (17.6%, bias adjusted). The difference was significant (P = .034). In the second phase of the study, in which the placebo arm was stopped, results were confirmed; in 25 of 53 patients (47%), the placenta was expelled. Conclusion: Sulprostone reduces the need for the manual removal of the placenta by 49%.
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Sulprostone reduces the need for the manual removal of the placenta in patients with retained placenta: a randomized controlled trial.
American journal of obstetrics and gynecology, 2006Co-Authors: Heleen J. Van Beekhuizen, Akosua N.j.a. De Groot, Theo De Boo, David M. Burger, Nicoline E. Jansen, Fred K. LotgeringAbstract:The purpose of this study was to determine the extent that the administration of Sulprostone reduces the need for manual removal of the placenta in patients with retained placenta. A double-blinded sequential randomized controlled trial of Sulprostone versus placebo was conducted among 103 patients with retained placenta. In the first phase of this sequential study, Sulprostone was compared with placebo. The null hypothesis of equal effectiveness of both treatments was rejected after 50 patients. In patients with retained placenta, the placenta was expelled after Sulprostone in 13 of 24 cases (51.8%, bias adjusted), whereas expulsion after placebo was achieved in only 4 of 26 cases (17.6%, bias adjusted). The difference was significant (P = .034). In the second phase of the study, in which the placebo arm was stopped, results were confirmed; in 25 of 53 patients (47%), the placenta was expelled. Sulprostone reduces the need for the manual removal of the placenta by 49%.
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dinoprostone priming of the cervix prior to termination of midgestation pregnancy with Sulprostone
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1995Co-Authors: Christine C.th. Rietberg, Fred K. Lotgering, Frans J.m. HuikeshovenAbstract:Objective: To determine if cervical ripening with the prostaglandin E2 analogue dinoprostone effectively shortens the induction-to-delivery interval in midpregnancy terminations with Sulprostone. Study design: We retrospectively studied 100 women admitted for pregnancy termination at midgestation because of fetal anomalies between September 1989 and January 1993. Three regimens were used: 27 women received intramuscular Sulprostone only, 29 women received intravenous Sulprostone only, and 44 women received intravenous Sulprostone after cervical priming with dinoprostone. Wilcoxon's rank sum test was used for statistical analysis. Results: Dinoprostone priming did not significantly reduce the induction-to-delivery interval in either parous or nulliparous women. However, when divided into first and subsequent pregnancies, we found that primigravidae, but not multigravidae, had an induction-to-delivery interval that was significantly shorter by approximately 10.5 h when pretreated with dinoprostone. Conclusion: Dinoprostone priming of the cervix prior to termination of midgestation pregnancy with Sulprostone (Nalador) effectively shortens the induction-to-delivery interval in women in their first pregnancy.
Hak Soon Kim - One of the best experts on this subject based on the ideXlab platform.
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preliminary comparison of efficacy of intravaginal misoprostol with intravenous Sulprostone for termination of second trimester pregnancy
Obstetrics & gynecology science, 2006Co-Authors: Sangkyoung Lee, Eun Hwan Jeong, Mangi Kim, Yure Kim, Seunghwa Hong, Yeonjin Park, Hak Soon KimAbstract:Objective: The purpose of this study was to compare the efficacy of intravaginal misoprostol and that of intravenous Sulprostone for termination of second-trimester pregnancy. Methods: Fouty-six patients were randomly assigned to misoprostol and Sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 µg of intravaginal misoprostol every 4 hours until labor pain was established, 200 µg every 6 hours after 20 weeks of gestation. In the Sulprostone group, intravenous Sulprostone was infused at the speed of 100 µg/hr regardless of gestational age. Results: At or before 20 weeks of gestation, the mean time from induction to completion of termination was shorter, and the success rate within 24 hours was higher in the misoprostol group than in the Sulprostone group (9.0 vs. 20.2 hours; 86% vs 50%). After 20 weeks, the mean induction time was longer at misoprostol group than sulprostol group but, there was no significant difference in success rate within 24 hours (14.7 vs. 7.1 hours; 83% vs. 86%). There was no significant difference in the prevalence of complication between two groups. Conclusion: Misoprostol is superior to Sulprostone for termination of pregnancy at or before 20 weeks of gestation, but both have almost equal effectiveness after 20 weeks of gestation. Considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second-trimester pregnancy.
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A comparison of Clinical Efficacy of Intravaginal Misoprostol with Intravenous Sulprostone for Termination of Second-Trimester Pregnancy.
Obstetrics & gynecology science, 2002Co-Authors: Jeong Kyu Kim, Jong Pil Moon, Yong Beom Kim, Eun Hwan Jeong, Hak Soon KimAbstract:Objective : Our purpose was to compare the clinical efficacy of intravaginal misoprostol and that of intravenous Sulprostone for termination of second-trimester pregnancy. Methods : The patients were assigned to misoprostol and Sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 g of intravaginal misoprostol every 4 hours until labor pain was established, 200 g every 6 hours after 20 weeks of gestation. In the Sulprostone group, intravenous Sulprostone was infused at the speed of 100 g/hr after cervical ripening with 3 mg of intravaginal dinoprostone. Results : At or before 20 weeks of gestation, the median time from induction to completion of termination was longer, but the success rate within 24 hours was less in the misoprostol group than in the Sulprostone group (18.75 vs. 7.15 hours, p=0.015; 50% vs 92%, p=0.014, respectively). After 20 weeks, there was no significant difference in median induction time or success rate within 24 hours (5.54 vs. 8.0 hours, p>0.05; 100% vs. 100%, p>0.05, respectively). There was no significant difference in the prevalence of complication or change of hemoglobin after termination between two groups. Conclusion : Sulprostone may be more effective for termination of pregnancy at or before 20 weeks of gestation and misoprostol may be as effective as Sulprostone after 20 weeks of gestation. But considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second- trimester pregnancy.
Minna Tikkanen - One of the best experts on this subject based on the ideXlab platform.
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intravenous Sulprostone infusion in the treatment of retained placenta
Acta Obstetricia et Gynecologica Scandinavica, 2013Co-Authors: Vedran Stefanovic, Jorma Paavonen, Mikko Loukovaara, Erja Halmesmaki, Jouni Ahonen, Minna TikkanenAbstract:Objective. To analyze the effectiveness of intravenous Sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period. Design. Retrospective observational study. Setting. University teaching hospital. Population. 126 consecutive women with placental retention and intravenous Sulprostone infusion as primary treatment performed from October 2007 up to December 2011. Methods. Hospital records of women who received Sulprostone infusion to attempt placental expulsion were reviewed. Main outcome measures. Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery. Results. The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity. Conclusions. Intravenous Sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta.
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Intravenous Sulprostone infusion in the treatment of retained placenta
Acta obstetricia et gynecologica Scandinavica, 2012Co-Authors: Vedran Stefanovic, Jorma Paavonen, Mikko Loukovaara, Erja Halmesmaki, Jouni Ahonen, Minna TikkanenAbstract:To analyze the effectiveness of intravenous Sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period. Retrospective observational study. University teaching hospital. 126 consecutive women with placental retention and intravenous Sulprostone infusion as primary treatment performed from October 2007 up to December 2011. Hospital records of women who received Sulprostone infusion to attempt placental expulsion were reviewed. Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery. The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity. Intravenous Sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
Nicoline E. Jansen - One of the best experts on this subject based on the ideXlab platform.
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Mifepristone and misoprostol versus Dilapan and Sulprostone for second trimester termination of pregnancy.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine the Federation of Asia and , 2008Co-Authors: Nicoline E. Jansen, Pieternel C. M. Pasker-de Jong, Hans A ZondervanAbstract:Objective. To compare two methods for second trimester termination of pregnancy: mifepristone and misoprostol versus Dilapan® and Sulprostone.Methods. This was a randomized study involving 16 patients with a singleton live fetus with congenital malformations or genetic disorders. Eight patients were treated with 200 mg mifepristone orally followed by 200 μg misoprostol vaginally 3 hourly and eight patients received a Sulprostone infusion after cervical dilatation with Dilapan.Results. Mifepristone and misoprostol had a mean induction interval of 17.8 hours and Sulprostone and Dilapan 20.9 hours. The mean induction interval did not differ significantly. Mean hospital stay was shorter in the patients treated with misoprostol: 2.1 vs. 3.3 days (p = 0.02) with a 95% confidence interval of −2.1 to 0.3.Conclusion. Mifepristone and misoprostol did not reduce the induction interval significantly compared to the Sulprostone and Dilapan treatment for second trimester pregnancy termination. Hospital admission was si...
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Sulprostone reduces the need for the manual removal of the placenta in patients with retained placenta a randomized controlled trial
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Heleen J. Van Beekhuizen, Akosua N.j.a. De Groot, Theo De Boo, David M. Burger, Nicoline E. Jansen, Fred K. LotgeringAbstract:Objective: The purpose of this study was to determine the extent that the administration of Sulprostone reduces the need for manual removal of the placenta in patients with retained placenta. Study design: A double-blinded sequential randomized controlled trial of Sulprostone versus placebo was conducted among 103 patients with retained placenta. Results: In the first phase of this sequential study, Sulprostone was compared with placebo. The null hypothesis of equal effectiveness of both treatments was rejected after 50 patients. In patients with retained placenta, the placenta was expelled after Sulprostone in 13 of 24 cases (51.8%, bias adjusted), whereas expulsion after placebo was achieved in only 4 of 26 cases (17.6%, bias adjusted). The difference was significant (P = .034). In the second phase of the study, in which the placebo arm was stopped, results were confirmed; in 25 of 53 patients (47%), the placenta was expelled. Conclusion: Sulprostone reduces the need for the manual removal of the placenta by 49%.
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Sulprostone reduces the need for the manual removal of the placenta in patients with retained placenta: a randomized controlled trial.
American journal of obstetrics and gynecology, 2006Co-Authors: Heleen J. Van Beekhuizen, Akosua N.j.a. De Groot, Theo De Boo, David M. Burger, Nicoline E. Jansen, Fred K. LotgeringAbstract:The purpose of this study was to determine the extent that the administration of Sulprostone reduces the need for manual removal of the placenta in patients with retained placenta. A double-blinded sequential randomized controlled trial of Sulprostone versus placebo was conducted among 103 patients with retained placenta. In the first phase of this sequential study, Sulprostone was compared with placebo. The null hypothesis of equal effectiveness of both treatments was rejected after 50 patients. In patients with retained placenta, the placenta was expelled after Sulprostone in 13 of 24 cases (51.8%, bias adjusted), whereas expulsion after placebo was achieved in only 4 of 26 cases (17.6%, bias adjusted). The difference was significant (P = .034). In the second phase of the study, in which the placebo arm was stopped, results were confirmed; in 25 of 53 patients (47%), the placenta was expelled. Sulprostone reduces the need for the manual removal of the placenta by 49%.
René Frydman - One of the best experts on this subject based on the ideXlab platform.
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conservative management of ectopic pregnancy prospective randomized clinical trial of methotrexate versus prostaglandin Sulprostone by combined transvaginal and systemic administration
Fertility and Sterility, 1991Co-Authors: Hervé Fernandez, Catherine Baton, Christophe Lelaidier, René FrydmanAbstract:In a prospective randomized study, 21 patients with an unruptured tubal pregnancy were treated with local and systemic injection. On the day of diagnosis, methotrexate (MTX) (1 mg/kg) or Sulprostone (500 μ g) were injected into the gestational sac under transvaginal sonographic control. The systemic component consisted of an intramuscular injection of MTX (1 mg/kg) 3, 5, and 7 days after local injection or of Sulprostone (500 μ g) on the 1st 2 postlocal injection days. Methotrexate therapy was successful in 8 of 12 patients and Sulprostone therapy in 6 of 9. Laparoscopy was then performed on the 7 unsuccessful patients: 3 of them had pain and hemoperitoneum and 4 of them had rising human choriogonadotropin (hCG) levels. One stomatitis after MTX and one cramping abdominal pain were observed. Thirteen of 14 successfully treated patients had initial hCG levels
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Conservative management of ectopic pregnancy: prospective randomized clinical trial of methotrexate versus prostaglandin Sulprostone by combined transvaginal and systemic administration.
Fertility and sterility, 1991Co-Authors: Hervé Fernandez, Catherine Baton, Christophe Lelaidier, René FrydmanAbstract:In a prospective randomized study, 21 patients with an unruptured tubal pregnancy were treated with local and systemic injection. On the day of diagnosis, methotrexate (MTX) (1 mg/kg) or Sulprostone (500 micrograms) were injected into the gestational sac under transvaginal sonographic control. The systemic component consisted of an intramuscular injection of MTX (1 mg/kg) 3, 5, and 7 days after local injection or of Sulprostone (500 micrograms) on the 1st 2 postlocal injection days. Methotrexate therapy was successful in 8 of 12 patients and Sulprostone therapy in 6 of 9. Laparoscopy was then performed on the 7 unsuccessful patients: 3 of them had pain and hemoperitoneum and 4 of them had rising human choriogonadotropin (hCG) levels. One stomatitis after MTX and one cramping abdominal pain were observed. Thirteen of 14 successfully treated patients had initial hCG levels less than 5,000 mIU/mL. At subsequent hysterosalpinography, 13 of 14 patients had normal tubal configuration and patency. Three of 10 patients who desired another pregnancy had already achieved a normal intrauterine pregnancy. These results suggest that MTX and Sulprostone were equally effective, and medical approach for the unruptured ectopic pregnancy may be restricted to patients with hCG less than 5,000 mIU/mL.
