میزوپروستول

Considering the effect of black cohosh in reducing the symptoms of premenstrual syndrome, breast cancer, migraine and infertility, and due to the lack of studies in this field, the present study was conducted with aim to comparatively investigate the effect of black cohosh plant root with on cervical preparation before hysteroscopy in postmenopausal women.

In this clinical trial study, all postmenopausal women who referred to Mahdieh Hospital for hysteroscopy during 2022-2023 were randomly divided into two groups. The first group received 200 micrograms of misoprostol 6-8 hours before the operation, and the second group in addition to 200 micrograms of misoprostol received 80 mg of black cohosh 6-8 hours before the operation. Complications of hysteroscopy, including pseudocanal, bleeding, and cervical rupture were also investigated and analyzed. After the operation, the patient's pain level was assessed based on the pain, nausea, vomiting, cramping, and shivering scales. Data analysis was performed using SPSS software (version 22).  P<0.05 was considered significant.

The mean dilator size was higher in the intervention group compared to the other group, which was statistically significant (p<0.001). The frequency of severe pain was higher in the control group compared to the intervention group, while the frequency of mild and moderate pain in the intervention group was higher compared to the control group (p=0.01). The mean bleeding was higher in the control group compared to the intervention group, which was statistically significant (p=0.001), while no significant relationship was observed between the two groups in terms of complications such as analgesic use, cervical and uterine rupture, and pseudocanal (p>0.05).

Using black cohosh in patients can lead to a reduction in pain intensity and decrease in bleeding and complications in patients.

Considering the lack of scientific documents published on humans regarding the effect of Stachys lavandulifolia hydroalcoholic extract on abortion in traditional Iranian medicine, the aim of the present study was to determine and investigate the effect of hydroalcoholic extract of mountain tea in combination with misoprostol compared to misoprostol alone in terminating pregnancies less than 12 weeks.

The present randomized clinical trial study was conducted at Imam Sajjad Hospital of Yasuj in 2019-2020 on 40 referring patients divided into two groups. Participants were assigned to two groups of mountain tea extract in combination with misoprostol (group A) or misoprostol alone (group B). In group A, mountain tea in the form of capsules (400 mg every three hours, up to three times, daily) along with 400 micrograms of misoprostol (every three hours, up to three doses, daily) were prescribed. In group B, misoprostol 800 micrograms were taken orally every three hours, up to three doses daily. In case of no abortion, the above dose was repeated on the second day. The intended outcomes included pain intensity, bleeding intensity, patient satisfaction, type of abortion, assessment of side effects (such as vital signs, clinical symptoms, blood parameters, analysis of kidney and liver function indicators). The collected data are analyzed using chi-square and t-test.

There was no statistically significant difference between the two groups in terms of complete abortion (p=0.52) and incomplete abortion (p=52). The duration of intervention in group A (6.10±1.11) was significantly shorter than group B (8.40±0.59) (p>0.001). There was no statistically significant difference between the two groups in terms of pain intensity (p=0.52) and bleeding intensity (p=0.14) at 4-8 hours and 8-12 hours after the intervention. Also, there was no significant difference between the two groups in terms of blood parameters, kidney and liver analysis (p<0.05). In terms of side effects, a statistically significant increase in fever (p=0.008), diarrhea (p<0.001) and nausea (p>0.001) was observed in group B compared to group A. Also, the results of the present study showed that patient satisfaction in group A (6±0) was significantly better than group B (4.60±1.14) (p<0.001).

The findings of this study indicated that S. lavandulifolia hydroalcoholic extract in combination with misoprostol resulted in shorter duration of abortion process, lower adverse outcomes and better patients’ satisfaction compared to the administration of misoprostol alone.

The need to perform an abortion in the first three months of pregnancy with an effective and safe drug therapy is more important than other methods. The purpose of this study is to compare the effects of letrozole and misoprostol versus misoprostol alone on abortion.

In this clinical trial, 114 candidates for legal abortion in the first trimester of pregnancy were randomly assigned to three groups of 38 people receiving sublingual misoprostol alone with placebo (same amount of letrozole), misoprostol with letrozole 10 mg daily for 3 days and the third group was given misoprostol along with letrozole with a daily dose of 5 mg for 3 days. In addition to the demographic and obstetrical information of the patients, the primary outcome including complete and incomplete abortion, misoprostol dosage and side effects were compared in patients of three groups.

The mean gestational age of the patients was 73.1±9.2 days. A total of 84 (73.7%) patients had complete abortion, including 28 patients (73.7%) in the letrozole 5 mg group, 32 patients (84.2%) in the letrozole 10 mg group, and 24 patients (63.2%) were in the placebo group. In the letrozole 10 mg group, with a statistically significant difference, the rate of complete abortion was higher in them than in the placebo group (84.2 vs. 63.2%, p=0.037). 20 patients in the letrozole 5 mg group, 16 in the letrozole 10 mg group, and all patients in the placebo group received misoprostol, and the difference between the two groups of letrozole 10 mg and placebo was significant in terms of misoprostol intake (p=0.001). The most common side effect in patients of all three groups was nausea and vomiting, which did not have a statistically significant difference between all three groups.

The findings of the present study showed that letrozole 10 mg along with misoprostol is effective in patients who need legal abortion in the first trimester.

The pharmacological approach of abortion is a safe and effective alternative to surgical procedures that is associated with a high level of patient's satisfaction. The present study was performed with aim to evaluate the effect of misoprostol with and without letrozole in the treatment of successful medical abortion and its relationship with BHCG titration level and cervical length.

This two-group randomized clinical trial study was performed in 2021 on 168 pregnant women under 18 weeks of gestation who were candidates for termination of pregnancy. The patients were randomly divided into two groups: A (misoprostol and letrozole) and B (misoprostol and placebo). Initial tests, βHCG titration, ultrasound and cervical length were performed for all patients on the first day of hospitalization. After receiving the drug, all patients underwent ultrasound on the fifth day to evaluate complete abortion and removal of pregnancy residues. Data were analyzed by SPSS software (version 22) and Chi-square, independent t and logistic regression tests. P<0.05 was considered statistically significant.

The results showed that misoprostol + letrozole had a more successful abortion rate than misoprostol + placebo (88.1% vs. 59.5%). Increased cervical length was associated with a higher probability of miscarriage (P <0.001), while BHCG titration did not show a predictive role in induction of abortion (p>0.05).

Adding letrozole to misoprostol for inducing abortion leads to an increase in the percentage of successful abortion and a reduction in the use of curettage.

Cervical ripening is essential for vaginal delivery, therefore, a safe and appropriate method should be considered for cervical ripening. Today, various medical methods are used for cervical ripening, such as estrogen gels, prostaglandins, and nitroglycerine. However, the preference of one to the other is unknown. This study was performed aimed to compare the effects of vaginal misoprostol and vaginal nitroglycerine gelatin capsule on cervical ripening in term and post-term pregnancy.

This trial study was performed in 2019 on 90 pregnant women with term and post-term pregnancies who were candidates for vaginal delivery induced by an unfavorable cervix (bishop score equal or <4) and referred to Fatemieh Hospital in Hamadan. Patients were divided into two groups of vaginal nitroglycerine and vaginal misoprostol. The data of the two groups related to demographics, dilatation, labor progress, newborn Apgar and postpartum bleeding were recorded in the forms through observation. Data were analyzed by SPSS software (version 20) and T-test, Chi-square, and Fisher tests. P<0.05 was considered statistically significant.

The rate of cervical ripening in the nitroglycerine group was significantly higher than the misoprostol group (P<0.05). The incidence of side effects such as headache, hypotension, and postpartum bleeding before and after delivery was 6 cases (13%) in the nitroglycerin group and 12 cases (33.3%) in the misoprostol group, which was statistically significant (p<0.05). Moreover, the active phase of labor was significantly shorter in the misoprostol group than the nitroglycerin group (p<0.05).

vaginal nitroglycerine gelatin capsule with a suitable dose can cause rapid and transient softening of the cervix and can help to vaginal delivery. The side effects of vaginal nitroglycerine gelatin capsule are more limited and controllable than the side effects of vaginal misoprostol.

Induction of labor is a common procedure that is performed due to medical indications of mother or infant or social and elective causes. There are several methods for induction of labor, including misoprostol and oxytocin. Therefore, the aim of the present study was to determine and compare the effect of oxytocin and oral misoprostol on induction of pregnancy in term and post-term pregnancies.

This is a descriptive study that was conducted in 2019-2021. The statistical population consisted of 160 patients who were candidates for termination of pregnancy and were divided into two groups of 80 people, one group with misoprostol 50 micrograms which was administered as an oral solution up to a maximum dose of 200 micrograms and the other group with oxytocin ampoules with Initial doses of 10 units were induced. The success rate in each group was considered to achieve appropriate contractions (three contractions in ten minutes, each lasting 40 seconds) and finally the rate of successful normal delivery. The collected data were analyzed using Mann-Whitney, Chi-square and t-test.

According to the statistical test, a significant difference was observed between the two groups in the variables of type of delivery and lack of progress of delivery. The percentage of normal delivery in the misoprostol group was higher than the oxytocin group, which was statistically significant (p = 0.005). The mean age of patients in the misoprostol group compared to the oxytocin group was 28.21 7 7.64 and 25.84 99 5.99, respectively, which was not statistically significant (p = 0.005). Also, the lack of progression of labor was higher in the oxytocin group compared to the other group, which was statistically significant (p <0.001).

According to these cases, the present study displayed a better effect on induction of labor by misoprostol and considering that the two drugs were not different in side effects, it could indicate a better and more appropriate efficacy of misoprostol in induction of labor.

One of the important issues in obstetrics is labor induction in the inappropriate conditions of the cervix. Misoprostol improves the condition of the cervix and shortens the duration of the labor and help in delivery sucess. Some studies have been published on the effect of propranolol on labor process in favor of shortening the labor. Therefore, this study was performed with aim to compare the effect of propranolol plus misoprostol with misoprostol alone on labor induction.

This double-blind clinical trial study was performed from November 2017 to September 2019 on 70 pregnant women referred to the maternities of Mashhad University Hospitals. The subjects were randomly divided into two groups. One group received 25 micrograms of sublingual misoprostol every 4-6 hours up to 6 doses plus a placebo capsule, and the other group received misoprostol with the same dose and method of the first group plus two doses of oral 20mg Propranolol tablet with interval of 4 hours. The interval between drug administration with onset of effective contractions, and onset of active phase and delivery were evaluated and compared in the two groups. Data were analyzed by SPSS statistical software (version 16). T-test and chi-square test were used to compare the groups, and equivalent non-parametric methods were used if necessary.

Mean interval of induction onset to effective contractions did not show any significant difference between the two groups (P=0.394). There was no significant difference between the two groups in the mean interval of induction onset to 4cm dilatation (P=0.82) and the mean interval of induction onset to delivery (P=0.108). Delivery complications showed no significant difference between the two groups (P=0.397). There was no significant difference between the two groups in the mean first and fifth minute Apgar score (P=0.715 and P=0.819, respectively).

Propranolol use had no effect on decreasing the induction to delivery interval and reducing cesarean rate. Also, it didn’t cause changes in neonatal outcomes and maternal complications. There were no side effects of propranolol tablets, including bradycardia, hypotension, and drowsiness.

 Post-term pregnancies are pregnancies that last more than 42 full weeks (294 days) from the first day of the last menstrual period. With increasing gestational age, the rate of maternal and fetal morbidity and mortality significantly increases. Among medical methods, misoprostol is widely used to prepare the cervix in post-term pregnancies. But today, due to the high side effects of misoprostol, especially the increasing need for cesarean section, some complementary medicine methods are used to prepare the cervix. The aim of this study was to compare the effect of Misoprostol and Evening primrose oil capsule with Misoprostol on delivery method in post-term pregnancies.

 This study was performed as a single-blind randomized clinical trial on 130 pregnant women with post-term pregnancy referring to the delivery ward of Besat Hospital in Sanandaj, Iran. The samples were selected by available sampling method and assigned to the intervention and control groups by random sampling method. In the intervention group, a 500 mg capsule of evening primrose oil was given vaginally and 25 micrograms of misoprostol were given sublingually, and in the control group, an ineffective capsule was given vaginally with 25 micrograms of misoprostol sublingually. Demographic data, clinical characteristics and delivery method were used for data collection. Data were analyzed by SPSS software version 21 and statistical tests such as Chi-square, t-test and ANOVA. P-value less than 0.05 was considered significant.

 Findings showed that there was no significant difference between the two groups in terms of demographic and midwifery characteristics and the two groups were homogeneous in this respect (P>0.05). But in the evening primrose oil and misoprostol group, the mean bishop score was significantly increased compared to the misoprostol group (P<0.05). Also, in the evening primrose oil and misoprostol group (12.3%), the need for cesarean section was lower than placebo and misoprostol group (41.5%) (P<0.0001).

 The results of the study showed that the use of vaginal capsules of evening primrose oil with misoprostol compared to misoprostol alone while helping to ripening the cervix is associated with a lower rate of cesarean section.

One of the main causes of maternal death in developing countries is postpartum hemorrhage. Cesarean section is one of the most common surgeries all around the world. In comparison with normal vaginal delivery, cesarean section is a greater risk factor for postpartum hemorrhage and need for blood transfusion. The risk of postpartum hemorrhage will increase when other risk factors such as multiple pregnancies, polyhydramnios, severe preeclampsia, peripartum hemorrhage, protracted labor, labor induction, and obesity are present. Oxytocin is conventionally used for the prevention of uterine atony during the cesarean section. The aim of this study was the evaluation of the effect of sublingual misoprostol in combination with oxytocin in reducing blood loss during and after cesarean delivery.

This randomized clinical trial was performed in Ommolbanin hospital; an academic hospital that is affiliated to Mashhad University of medical sciences from September 2016 to January 2018. The subjects were 90 pregnant women with a term pregnancies who were candidates for emergent cesarean delivery under spinal anesthesia and were at high risk for postpartum hemorrhage. All participants received 40 IU oxytocin in 1 liter of normal saline after delivery, and then they were randomly assigned to the intervention group who received 400 μg sublingual misoprostol in combination with oxytocin infusion, and the control group who received only oxytocin infusion without adding misoprostol.

Sublingual misoprostol in combination with oxytocin infusion during cesarean section led to a significant decrease in postoperative blood loss for six hours after the surgery (P<0.001). The decline in the hemoglobin and hematocrit levels and the amount of intraoperative hemorrhage were the same in both groups. Less additional uterotonic agents were needed in the misoprostol group. The frequency of fever and other side effects were similar in the two groups.

It seems that adding sublingual misoprostol to oxytocin infusion among high-risk women for postpartum hemorrhage is more effective for reducing blood loss during and after cesarean section.

Two commonly used methods for inducing labor are vaginal misoprostol and venous oxytocin. The aim of this study was to determine the combined effect of vaginal misoprostol and intravenous oxytocin on induction of labor, Bishop score, and duration of delivery in primipara women. In this randomized controlled clinical trial study, 106 primipara pregnant women with preterm delivery indicating pregnancy termination and Bishop score of less than 4, were divided randomly into two equal groups. The test group first received 25 micrograms of vaginal misoprostol, and after three hours, 10 units of oxytocin for induction of labor. The control group received only one 10-unit oxytocin infusion. The research tool was a researcher-made questionnaire and checklist (information gathering form). Data analysis was performed using Mann-Whitney, chi-square, and independent t tests via SPSS software with a significant level of P < 0.05. Findings: The research units in the two groups were similar in terms of demographic indicators. Independent t test showed that the mean time of the onset of regular uterine contractions, the active phase duration, the duration of the first stage of labor, and the duration of induction to delivery in the experimental group were significantly lower than the control group (P < 0.050). Meanwhile, paired t test showed that after intervention, the mean baseline coefficient of Bishop score in both groups was significantly higher than before intervention (P < 0.001)

Globally,second-trimester abortion accounts for 10-15% of all abortions and is responsible for two-thirds of abortion-related complications. Misoprostol is known as a powerful and effective medication for the termination of pregnancy in the second trimester. Several studies with different results were carried out into the proper dosage of misoprostol; however, there is no consensus about its proper dosage. This study was performed to compare the efficacy of two doses of vaginal misoprostol for second-trimester abortion.
This randomized clinical trial was conducted among 100 pregnant women, who were hospitalized for second-trimester abortion. They were randomly assigned into two groups in the Department of Obstetrics and Gynecology, Ali ibn Abi Talib Hospital, Zahedan, Iran, 2013. The subjects in the first and second groups received vaginal misoprostol in the doses of 400 µg given every 3 hours and 600 µg given every 6 hours up to five doses, respectively. Data were collected using a form containing the received dose, abortion interval, and complications. Data analysis performed using Chi-squared and t-test. P The mean age of participants was 58.5±5.5 years old; and all the abortions were successful. In the first group, total administered dose was significantly lower than the other group (P Both studied doses of misoprostol had similar effects and the rate of complication was the same. Nonetheless, the dose of 400 µg was preferred due to need to lower total dose and shorter abortion interval.

Labor induction is one of the most public ways carried out global for delivering mothers. The aim of labor induction is to encourage uterine contractions before the spontaneous onset of labor, resultant in vaginal delivery misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Regarding the importance and lack of similar researches in Iran, this research was done to compare the efficacy of buccal and sublingual misoprostol for labor induction in pregnant women.
This study was conducted as a randomized double-blind clinical trial from March 2017 to February 2018. In this survey, 200 women were randomly assigned to receive 50 µg buccal misoprostol and sublingual (100 buccal and 100 sublingual) in Kosar Hospital, Qazvin University of Medical Sciences, Iran. The maternal and fetal complications, Bishop score, and time of pain onset and its interval with labor were monitored in two groups and the findings were analyzed.
Research variables were age, gestational age, BMI, number of previous pregnancy, neonatal weight, total dose, Bishop score 1, Bishop score 6, oxytocin, and delivery type. The results showed that there were no differences between Bishop score 6 (P=0.07), and 1 (P=0.36), total dose (P=0.58), neonatal weight (P=0.43), number of pregnancy (P=0.67), BMI (P=0.67), and pregnancy weak (P=0.108) of sublingual group and buccal group. About 43 patients (43%) in buccal and 64 (64%) in sublingual group had vaginal delivery (P=0.05). The frequencies of maternal and fetal complications were similar between two groups.
It can be concluded that there is no difference between efficacy of sublingual and buccal misoprostol in pregnancy results, maternal, and fetal complications, however, it seems that the sublingual group is more effective than buccal group due to the significant amount of vaginal delivery, achieving vaginal delivery in less than 24 hours, and less need for oxytocin.

The use of misoprostol and transcervical Foley catheter is an effective method in cervical ripening. According to the literature, there is a controversy surrounding the results of the comparison of these two methods and the combined method. This study was conducted to compare the individual and combined administration of misoprostol and transcervical Foley catheter in Ayatollah Mousavi Hospital, Zanjan, Iran, during 2013-14.
This randomized clinical trial was carried out among 85 nulliparous women with the gestational age of 40 weeks or more and the Bishop score of equal to or less than 4 with less than two contractions every 10 min. The subjects were randomly assigned into three groups of misoprostol (n=30), transcervical catheter (n=30), and combined (n=25). The misoprostol group received the maximum dose of 100 µg of misoprostol in equally divided doses every 4 h. A transcervical Foley catheter 18 F, inflated with 50 cc of normal saline was inserted into the cervices of the participants in the transcervical catheter group. Additionally, the combined group were simultaneously treated with both methods. The time interval between the intervention and the onset of labor, duration of the latent and active phases, and method of delivery (cesarean section or natural vaginal delivery), and the rates of neonatal and maternal complications were compared in these three groups. Data analysis was performed using the Chi-squared test and one-way analysis of variance in the SPSS software, version 22. The P-value less than 0.05 was considered statistically significant.
No significant difference was observed between the groups in terms of the method of delivery, duration of the active phase, meconium, fetal distress, chorioamnionitis, and uterine tachysystole (P>0.05). However, the duration of latent phase was significantly shorter in the combined group compared to the misoprostol group (P=0.002, P=0.001). The duration of the first phase of labor was significantly shorter in the combined group in comparison to the transcervical Foley catheter group (P=0.009).
Given the results, both methods were effective in cervical ripening; nevertheless, the combined method was more effective than using transcervical Foley catheter in shortening the duration of the first phase of labor.

Cervical ripening is essential in vaginal delivery; so, a safe and suitable method should be considered for cervical ripening. Nowadays, different methods are used for cervical ripening, including estrogen gels, prostaglandins and TNGs that their preference is unclear. This study was performed with aim to compare vaginal misoprostol and trinitroglycerin (TNG) on cervical ripening at term pregnancy.
This randomized clinical trial was performed in 2011 on 148 primigravida patients with term pregnancy and unfavorable cervix (Bishop score ≤ 4) who were candidate for induced vaginal delivery and referred to Zahedan Ali Ebne Abi Talib hospital. The patients were divided into two groups: group A (400 µg vaginal TNG) and group B (25 µg vaginal misoprostol). The outcomes in two groups were recorded in the forms by observation. Data was analyzed by SPSS software (version 11.5) and Chi-square and T-test. P After administration of the drugs, cervical ripening (P Misoprostol compared to TNG causes more effective and rapid cervical ripening and also has less side-effect.

Therapeutic abortion in the second trimester of pregnancy can be done by a number of medical or mechanical methods. The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria in preoperative cervical ripening among women with under second-trimester abortion.
In this interventional study, 120 pregnant women with the gestational age of 20 weeks, who were candidates for therapeutic abortion, were selected and randomly divided into three groups (n=40). Proper counseling was done and a written informed consent was obtained before starting the treatment regimen. The first group received vaginal misoprostol alone and the second group received misoprostol in combination with laminaria and oral placebo. In the third group, in addition to cervical placebo on the first and second days, letrozole was prescribed, and on the third day, the patients were hospitalized and received vaginal misoprostol and third dose of letrozole. The patients were regularly examined every 4 hours, and in the absence of abortion, vaginal misoprostol was repeated after 4 hours.
The results showed that termination of pregnancy was caused by embryo anomaly in 23 cases and fetal death in 97 cases. In this study, response to treatment was 90% in the group receiving laminaria and misoprostol 85% in the group receiving letrozole and misoprostol and 67% in the group receiving misoprostol. Regarding the duration and amount of bleeding, the groups receiving laminaria and misoprostol had the lowest duration and severity of bleeding, but this difference was not statistically significant. Combination of misoprostol and laminaria caused a significantly shorter time interval from the initiation of intervention to abortion, and pain relief was also higher than the other two groups.
Based on the obtained results, a combination of misoprostol and laminaria is recommended for induction of second-trimester therapeutic abortion.

Labor induction despite unfavorable cervix leads to a prolonged phase. Several methods are provided for preparing the cervix before induction of labor to improve the probability of success labor. This study aimed to compare the effect of double-balloon catheter and misoprostol for cervical ripening and labor induction in postterm pregnancy with unfavorable cervix in Shahid Beheshti hospital, Isfahan, Iran, during 2015-16.
In a clinical trial study, 110 postterm women were randomly divided into two groups of 55. For labor induction in the first group, 100 µg misoprostol tablets and in the second group, double-balloon catheter were placed in the posterior cul-de-sac. Progress of labor was measured using Bishop score and compared between the two groups.
Findings: During the intervention, Bishop score improved from 1.69 ± 1.05 to 8.62 ± 1.52 in misoprostol group and from 1.78 ± 0.98 to 7.93 ± 1.96 in double-balloon catheter group. Mean difference of Bishop score in the first and second groups was 6.92 ± 1.74 and 6.15 ± 1.87, respectively, and the difference between the two groups was statistically significant (P = 0.025).
Using double-balloon catheter is effective at least as misoprostol to induce labor in postterm pregnant women with unfavorable cervix. As misoprostol is associated with the risk of some side effects, using double-balloon catheter is more suitable for induction of labor.

More than 25% of pregnant women have bleeding at first trimester and first of second trimester that half of them will experience miscarriage. There are different causes and methods for diagnosis and treatment of bleeding during pregnancy. Regarding to relatively high prevalence of first trimester bleeding and recommended diagnostic and treatment methods, this study was performed with aim to evaluate the causes, diagnostic and treatment methods and pregnancy outcomes in patients admitted in the department of obstetrics, Semnan Amiralmomenin hospital.
This cross-sectional and prospective study was performed on 200 patients with first trimester bleeding admitted in the department of obstetrics, Semnan Amiralmomenin hospital during 2013-2014. Information of patients with approved pregnancy including the causes of bleeding, diagnostic and treatment methods and pregnancy outcome were studied and recorded in researcher-made questionnaire. Data was analyzed by SPSS software (version 16) and descriptive statistical methods. P Causes of abnormal bleeding were blighted ovum in 2 cases (1%), incomplete abortion in 52 (26%), missed abortion in 62 (31%), complete abortion in 24 (12%), threatened abortion in 54 (27%), ectopic pregnancy in 2 (1%), molar pregnancy in 1 (0.5%) and cervical polyps in 1 (0.5%). Treatment method was medical and surgery in 56 cases (48.27%), medical in 40 (34.48%) and surgical in 20 (17.24%). Among 54 (31%) of threatened abortion, 20 (37.05%) had abortion, 10 (18.5%) preterm delivery, and 22 (47.4%) term delivery. All cases had gestational age The causes of abnormal uterine bleeding which led to admission at first trimester of pregnancy were inevitable abortion, threatened abortion, ectopic pregnancy, molar pregnancy and cervical polyp, respectively. The most common causes of admission were inevitable abortion and the most common treatment methods were medical surgery. About half of the threatened abortion cases resulted in term delivery, 37 % abortion and 18% preterm delivery. Gestational age

our purpose is to report the experience of uterine rupture in a primigravida patient with uterine anomaly for whom misoprostol is used for induced abortion in the second trimester. Misoprostol is a synthetic analogue of E1 prostaglandin which is used to prevent the ulcer peptic causing NSAID. Misoprostol is prescribed for oral, sublingual, vaginal and rectal consumptions to force induced labor and termination in mid-pregnancy and it is also used for dilation and suction in the first trimester. Food and Drug Administration presents the side effects of Misoprostol usage as follow: Uterine hyper stimulation, uterine tetany, uterine ruptures, shocks maternal death, fetus bradycardia and death as well as Meconium amnion fluid.
Uterine rupture in women with uterine anomalies is one of the rare yet serious complications in the second trimester of induced labor and the anomaly rate is between 0.5 to 1.8. Pregnancy in rudimentary horn is rare but it is followed with lethal side effects such as uterine rupture, abortion, ectopic pregnancy and etc. The review of this study indicates that not enough data is available in order to support the usage of Misoprostol for women with uterine anomaly.
although uterine rupture is rarely followed by the usage of Misoprostol, it is of great importance to take in to consideration the irrecoverable complications which compel us undertaking vital cautions and also make sure of the normality of uterine before prescribing Misoprostol.