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Re: Cytotec From: Mats Bergstrom (matsb@sos.sll.se) Wed Jun 5 18:20:26 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: SAVARIS@vortex.ufrgs.br: "Re: Cytotec for induction (was RE: IUD/Abruption)" Previous message: Malcolm Griffiths: "Re: IUD/Abruption" In reply to: DoctorJoe@aol.com: "Re: IUD/Abruption" Next in thread: DoctorJoe@aol.com: "Re: IUD/Abruption" I have read two 'gyn' studies where 200 microg 'oral' tablets were given vaginally. In one study (for inducing early 2nd trimester abortion; some 27% had to be curettaged) they put four tablets in the posterior fornix. In another study (for cervical softening before early primary exeresis; it worked) they put one 200 microg tablet in the posterior fornix together with something called a 'Gyn-Flor' that is supposedly helping to dissolve the misoprostol by lowering pH. A release medium not really developed for vaginal use could possibly come with even more individual differences in biological response than usual, meaning an unpredictable response. For 'obstetric' use, as long as there are established alternatives manufactured for vaginal use, an expectant attitude towards Cytotec(tm) might be wise until further controlled studies are published. Such studies could preferably be conducted in countries where the ridiculous costs of mainstream E2 preparations are downright prohibiting, which already seems to be the case. As a PS I include an old post by Allan James Fisher. There are things to consider in the 'gyn' use of misoprostol if it doesn't work and the woman changes her mind about terminating. -- Mats Bergstrom, MD Ob Gyn South Hospital Stockholm *********************************************************************** Date: Sat, 8 Jul 1995 15:56:33 -0500 From: Allan James Fisher <afish04@emory.edu> Reply to: ob-gyn-l@listserv.bcm.tmc.edu Subject: Misoprostol in the first trimester It interests me to see the information on misoprostol in the literature again since this synthetic analog of PGE has been used in South America as an abortifacient for a number of years. The best documentation of this, where abortion is illegal, is in Brazil. With first trimester exposure to this medication, it has been associated with Mobius sequence with limb abnormalities,agenesis of distal phalanges and hypoplastic nails, cranial nerve palsies of the VI and VII nerves, Down sysndrome, cleft lip/palate, hypotelorism,gastoschisis and cranial anomalies such as hydrocephalus and abnormal cranium development. Most of these studies are case histories with an ascertainment bias. A case-control study in Brazil did not show an attributable increase risk with the two groups (exposed in the first trimester verses not exposed). However, we all know that there is an ascertainment bias with these cases as well-just change your inclusion definitions or increase/decrease the surveillence methods/MDs. Lets not forget intraobserver differences as well. We can all relate this with the data collected for the assessment with CVS verses limb defects-the WHO vs CDC. To my knowledge, there has been no adverse defects associated with third trimester administration of misoprostol. If there is any documentation, I would like to know.the following references are good if you are interested in looking at this subject further. Collins et al Hydrocephalus and abnormal digits after failed first trimester prostaglandin abortion..JPediatr 1983:102:620-23. Fonesca et al . Misoprostol and congenital malformations. Lancet 1991: 338:56. Gonzalez et al. Limb deficiency with or without mobius sequence in seven Brazilian children associated with misoprostol use in the first trimester of pregnancy. Am J Med Genetics 1993;47:59-64. Castilla et al. Teratogenicity of mmisopostol: data from the latin-american collaborattive study of congenital malformation (ECLAMC). Am J Med Genetics 1993;47:161-62. Allan Fisher,MD Emory University, Atl, GA, USA Div of MFM Next message: SAVARIS@vortex.ufrgs.br: "Re: Cytotec for induction (was RE: IUD/Abruption)" Previous message: Malcolm Griffiths: "Re: IUD/Abruption" In reply to: DoctorJoe@aol.com: "Re: IUD/Abruption" Next in thread: DoctorJoe@aol.com: "Re: IUD/Abruption"

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