Rectal misoprostol for myomectomy: A randomised placebo-controlled study
Mohamed Abdel-Hafeez,
Ahmed Elnaggar,
Mohamed Ali,
Abdel Mgeed Ismail and
Mina Yacoub
Article first published online: 14 JUL 2015
DOI: 10.1111/ajo.12359
Background
Uterine leiomyomas are the most common benign tumours in women.
Misoprostol, which is widely used in the treatment and prevention of
postpartum haemorrhage in obstetrics, may decrease intra-operative
bleeding in abdominal myomectomies when haemorrhage constitutes a
challenging problem.
Aims
To
assess the effect on intra-operative blood loss of using a single
pre-operative dose of rectal misoprostol in abdominal myomectomy
surgeries.
Materials and Methods
In
a randomised double-blind placebo-controlled trial, 50 women undergoing
abdominal myomectomy for symptomatic uterine leiomyomas were randomly
assigned to receive a single dose of pre-operative of rectal 400 μg
misoprostol (n = 25) or placebo (n = 25) 1 h before
the operation. The primary outcome was intra-operative blood loss. This
clinical trial was registered in clinicaltrial.gov registry with number:
NCT02061657.
Results
Intra-operative
blood loss was significantly lower in those women randomised to receive
rectal misoprostol versus the placebo group (574 ± 194.8 mL vs
874 ± 171.5 mL). Additionally, the drop in postoperative haemoglobin was
significantly less in the misoprostol group (1.7 ± 0.4 g/dL) compared
with the placebo group (2.1 ± 0.5 g/dL).
Conclusion
A
single pre-operative dose of rectal misoprostol (400 μg) is a simple
applicable method for reducing intra-operative blood loss and operative
time in abdominal myomectomy.
Jellyfish-shapped object caught in HollandScreenshot from Groninganus Blog
In a new development that could expose evidences of extra terrestrial
life, Welsh Government has been asked to provide details of UFO
(unidentified flying objects) sightings at Cardiff Airport.
Darren Millar, Shadow Minister for Health and Social Services, and
Conservative Assembly Member for Clwyd, North Wales, has asked economy,
science and transport minister Edwina Hart for details of alien
spaceships sightings at Cardiff Airport since its acquisition by the
Welsh Government, according to BBC.
Interestingly, the Welsh Government replied to the query in Star Trek language Klingon instead of the usual English and Welsh.
"Jang vIDa je due luq," Welsh government spokesman replied, according
to BBC. "'Ach ghotvam'e' QI'yaH devolve qaS" which means "The minister
will reply in due course. However this is a non-devolved matter."
"I've always suspected that Labour ministers came from another
planet. This response confirms it," Millar was quoted as saying
following the use of fictional language by Welsh government.
The report went on to say that Millar had asked three questions on
"how many reports of unidentified flying objects there have been at
Cardiff Airport since its acquisition by the Welsh government,"
discussions of the government with the Ministry of Defence on UFO
sightings in Welsh in the last five years, and if the government is
funding "research into sightings of unidentified flying objects in
Wales."
In a similar development, the United Kingdom's Ministry of
Defence (MoD) might release the country's top secret on Unidentified
Flying Object (UFO) sightings dubbed as the "British X-Files" in the
next eight months, according to Express.
It added that government has assured on the eve of World UFO Day that
the MoD would release the secret files to the National Archives by March
2016 when Lord Black of Brentwood asked for an update through a
Parliamentary question.
The same website has
also reported that the German Supreme Administrative Court in Leipzig
has ordered the German Bundestag to release files containing UFO
sightings record
The Food and Drug Administration (FDA) is strengthening an existing
label warning that non-aspirin non steroidal anti-inflammatory drugs
(NSAIDs) increase the risk of a heart attack or stroke.Based on the comprehensive review of new safety information, the FDA
is requiring updates to the drug labels of all prescription NSAIDs. As
is the case with current prescription NSAID labels, the Drug Facts
labels of over-the-counter (OTC) non-aspirin NSAIDs already contain
information on heart attack and stroke risk. The FDA will also request
updates to the OTC non-aspirin NSAID Drug Facts labels.
Based on the FDA review and the advisory committees' recommendations,
the prescription NSAID labels will be revised to reflect the following
information:
The risk of heart attack or stroke can occur as early as the
first weeks of using an NSAID. The risk may increase with longer use of
the NSAID.
The risk appears greater at higher doses.
It was previously thought that all NSAIDs may have a similar
risk. Newer information makes it less clear that the risk for heart
attack or stroke is similar for all NSAIDs; however, this newer
information is not sufficient for the FDA to determine that the risk of
any particular NSAID is definitely higher or lower than that of any
other particular NSAID.
NSAIDs can increase the risk of heart attack or stroke in
patients with or without heart disease or risk factors for heart
disease. A large number of studies support this finding, with varying
estimates of how much the risk is increased, depending on the drugs and
the doses studied.
In general, patients with heart disease or risk factors for it
have a greater likelihood of heart attack or stroke following NSAID use
than patients without these risk factors because they have a higher risk
at baseline.
Patients treated with NSAIDs following a first heart attack were
more likely to die in the first year after the heart attack compared to
patients who were not treated with NSAIDs after their first heart
attack.
There is an increased risk of heart failure with NSAID use. The FDA will request similar updates to the existing heart attack and
stroke risk information in the Drug Facts labels of OTC non-aspirin
NSAIDs. In addition, the format and language contained throughout the
labels of prescription NSAIDs will be updated to reflect the newest
information available about the NSAID class.
Patients and health care professionals should remain alert for
heart-related side effects the entire time that NSAIDs are being taken.
For more information visit FDA.gov.
THIRUVANANTHAPURAM: There is a revolutionary invention to prevent the
death of mothers due to uncontrollable bleeding during delivery
The
number of women and girls who died each year from complications of
pregnancy and childbirth declined from 523,000 in 1990 to 289,000 in
2013. These improvements are particularly remarkable in the light of
rapid population growth in many of the countries where maternal deaths
are the highest.
Still, about 800 women are dying each day from
complications in pregnancy and childbirth. And for every woman who dies,
approximately 20 others suffer serious injuries, infections or
disabilities.
Almost all maternal deaths (99 per cent) occur in
developing countries. Two regions, sub-Saharan Africa and South Asia,
account for 86 per cent of maternal deaths worldwide. Sub-Saharan
Africans suffer from the highest maternal mortality ratio - 510 maternal
deaths per 100,000 live births, or 179,000 maternal deaths a year. This
is nearly two thirds (62 per cent) of all maternal deaths per year
worldwide.
South Asia follows, with a maternal mortality ratio of
190, or 68,000 maternal deaths a year, accounting for 24 per cent of
the global total. That said, regional and global averages tend to mask
large disparities both within and among countries.
In India the
death due to bleeding is predominantly recorded in the northern and
northeastern parts of India due to the non-proximity of hospitals during
the delivery. The delivery is attended by the local midwife who has
only crude and non-professional practical knowledge of the process.
Death
due to bleeding (PPH) is the single major cause. There are many reasons
for this dangerous bleeding. The most important and difficult form of
bleeding after delivery is due to atonic PPH.
During atonic PPH,
the uterus will not contract and remains soft. There are many treatment
strategies for this. In spite of all these treatments some women will
die helplessly in front of the doctor due to massive bleeding.
Thanks
to my experience and exposure to thousands of deliveries during my
career, I have been able to invent a new treatment to prevent and stop
bleeding from the uterus after delivery or abortion. I have also
designed a quick surgical technique to stop the bleeding from the uterus
in emergency situations when other methods fail.
The method is to use a specially-made suction cannula that is introduced
into the uterine cavity. A negative suction pressure of 600mm of
mercury is applied for 30 minutes. This will stop all the bleeding
mechanically pressing the bleeding vessels and closing them due to the
force of suction. Because of the strong suction inside the uterine
cavity the uterus cannot expand and will not become atonic. This
principle is the same as medical practitioners do routinely whenever
there is an injury and bleeding. They press the area of injury to stop
the bleeding. The pressure is maintained for 10 to 15 minutes so that
clotting occurs in the bleeding vessels and bleeding is stopped
permanently.
The same principle is used here, as we cannot apply
pressure inside the uterine cavity. But we can produce a negative
pressure to get a strong pressing effect on the inner wall of the
uterus.
The main attraction of the technique is that all the
equipment used are locally designed and manufactured at a very nominal
cost; any local midwife can be given training in using the equipment at
any place within a short time. These can be used in the remotest
villages as electricity is not required for its functioning.
I
have also invented another medical and surgical treatment to stop PPH.
This is by injecting dilute vasopressin into the uterine muscle. This
will contract all the vessels of the uterus and stop bleeding. The
surgical technique is by a special stitch that can stop all the blood
supply to the uterus and save the mother. All these treatment methods
can prevent the death of the mother due to bleeding by 100%, if the
mother is brought to the hospital with a beating heart.
I will be
presenting this treatment technique at the World Congress of Obstetrics
& Gynecology 2015 at Canada on 5th October, 2015. The author is Dr Vasudeva Panicker, who runs a maternity hospital at West Nada, Kodungaloor
