UNASSIGNED: In recent years, the frequency of idiopathic peptic ulcers (IPUs) has increased. However, the clinicopathological characteristics of IPU have not been fully elucidated and treatment methods for recurrent and refractory cases have not yet been established.
UNASSIGNED: A man in his forties complained of epigastric discomfort. Esophagogastroduodenoscopy revealed a gastric ulcer in the lesser curvature of the gastric angle. After Helicobacter pylori was eradicated, the gastric ulcer recurred despite the administration of a potassium competitive acid blocker (PCAB), and a diagnosis of IPU was made. Twenty-four-hour intragastric pH monitoring revealed insufficient gastric acid suppression. Misoprostol was added to the patient\'s treatment. Subsequently, the ulcer healed and recurrence was not observed.
UNASSIGNED: For refractory IPU, the evaluation of pathophysiological function through 24-h gastric pH monitoring may lead to the selection of an appropriate treatment. If a proton pump inhibitor and PCAB do not improve the IPU, combination treatment with misoprostol may be considered as an option.

A 32-year-old multigravida woman, with known familial hypokalaemic periodic paralysis, underwent spinal anaesthesia for an elective lower segment caesarean section. There are several case reports in the literature discussing the optimal anaesthetic technique. In the past there has not been an emphasis on aggressive and early potassium replacement. A target level to commence replacement of potassium at 4.0 mmol/L or less is proposed. Careful preoperative preparation, frequent perioperative monitoring and early potassium replacement resulted in no perioperative episodes of weakness in this case, in contrast with other case reports where potassium was either not monitored or not replaced early enough, resulting in postoperative attacks. Another factor to consider in hypokalaemic periodic paralysis is the avoidance of triggers, including certain medications. Misoprostol was used in this instance to avoid potential electrolyte derangements from other uterotonics.

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality, primarily attributed to uterine atony. Both the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) endorse the use of misoprostol not only for the prevention but also for the treatment of PPH. However, the administration of misoprostol is commonly associated with transient pyrexia, attributed to a shift in the hypothalamic set point observed in certain animal studies. Misoprostol-induced hyperpyrexia can occasionally manifest with a prodrome of shivering, particularly when administered via the sublingual route, which achieves a higher and faster maximum plasma concentration compared to vaginal and rectal routes. General management strategies to reduce fever involve removing clothing and blankets, applying cool compresses, administering oral acetaminophen, and ensuring adequate hydration. While some cases have reported misoprostol-induced convulsions, hyperpyrexia leading to convulsions and subsequent rhabdomyolysis is a rare and potentially lethal side effect. In this case presentation, we emphasize a scenario where misoprostol was employed for the treatment of PPH but led to rhabdomyolysis. Our goal is to highlight the side effects of misoprostol and the significance of considering the initial combination of misoprostol with anti-pyretic management to minimize the risk of hyperthermia-related side effects and prevent additional severe complications.

BACKGROUND: Uterine prolapse is a rare complication of pregnancy, and there is still no consensus on the choice of delivery method.
METHODS: The patient\'s reproductive history included an abortion and eutocic delivery of a girl weighing 3200 g; the current pregnancy was the third pregnancy. Her cervical region was outside the vaginal opening and was red in color, with evident enlargement (6 × 4 cm) and a broken surface. The cervical area also showed white discharge. According to her Transvaginal ultrasonography revealed a fetus in the uterine cavity at approximately 19 weeks of gestation. Gynecological examination revealed prolapse of both the anterior and posterior vaginal walls. Evaluation of the pelvic organ prolapse-Q scores showed that the patient had uterine prolapse at stage IV.
RESULTS: Vaginal delivery was performed smoothly after oral administration mifepristone and misoprostol tablets for a few days, obtaining a dead female fetus in cephalic, 25 cm in length. The cervix of the pregnant woman did not prolapse during the delivery.
CONCLUSIONS: For pregnancy with uterine prolapse and cervical incarceration, transvaginal delivery is a potential treatment option. Maintenance of cervical retraction and oral mifepristone administration with misoprostol tablets is crucial during this delivery. This treatment can minimize the risk of cervical lacerations and uterine rupture, helping surgeons to complete the operation successfully.

BACKGROUND: Stock-outs of some life-saving drugs, such as emergency obstetric drugs, are evident in many health facilities and have been reported to be the leading cause of maternal mortality and morbidity for women from low and middle income countries (LMICs). For many cases, this situation is associated with poor inventory management practices. The aim of this study was to investigate the influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: case of the Rwanda Southern Province. Moreover, to gain a better grasp of the problem and to suggest possible areas for improvement.
METHODS: An institutional-based cross-sectional study was carried out in all ten district hospitals (DHs) providing maternal health care and dispensing emergency obstetric drugs namely; Kigeme DH, Munini DH, Kabutare DH, Kibilizi DH, Gakoma DH, Nyanza DH, Ruhango DH, Gitwe DH, Kabgayi DH and Remera Rukoma DH. Both quantitative and qualitative data were collected and analyzed. Oxytocin injection, Misoprostol tablet and Magnesium sulphate injection as recommended emergency obstetric drugs by WHO, UNFPA and Rwanda Essential Medicines list were included in the study.
RESULTS: The study revealed that keeping logistics management tools up to date is the backbone of inventory management practices in the availability of medicines and medical supplies. The results showed that hospitals with up-to-date logistics tools for their pharmaceutical management were 33.25 times more likely to have their emergency obstetric drugs in stock at all times compared to those that do not regularly update their logistics tools. The proper use of bin cards and electronic software (e-LMIS) contributed greatly to reducing the stock-out rate of emergency obstetric drugs by 89.9% and reduction of unusable to usable stock ratio by appropriate use of simple techniques such as the Min-Max inventory control model by 79%. Over an 18-month period, misoprostol tablet had the highest average days (32) of stock-outs (5.9%), followed by magnesium sulphate injection with an average of 31 days (5.7%), and oxytocin injection with an average of 13 days (2.4%).
CONCLUSIONS: Proper use of pharmaceutical management tools within hospitals premises positively influence the availability of life-saving drugs, such as emergency obstetric drugs. Adequate supply chain staffing in health facilities is the most important key to improving inventory management practices and medicine availability.

This study aimed to assess termination of pregnancy (TOP) indications and obstetric outcomes before the 24th gestational week.
This is a retrospective study that includes terminations performed in singleton pregnancies between December 2021 and December 2022 in the Perinatology Clinic of Necmettin Erbakan University Meram Medical Faculty. According to the reasons for TOP, all patients were divided into three groups: maternal, fetal, and obstetric reasons. The termination approach and outcomes were evaluated in all cases.
A total of 210 patients were included in the study. Considering termination indications, 18 (8.5%) patients had maternal causes, 127 (60.5%) had fetal causes, and 65 (31%) had obstetric causes. Maternal causes were significantly higher in the 1st trimester and fetal causes in the 2nd trimester (P = 0.001). In the maternal group, 77.8% dilatation and curettage were used, 70.1% misoprostol and 29.9% misoprostol + Foley catheter in the fetal group, and 66.2% misoprostol in the obstetric group (P = 0.0001). The length of hospital stay and recurrent revision curettage were not statistically different between the fetal, maternal, and obstetric groups (P = 0.099, P = 0.8, respectively).
Termination options should be offered for complicated pregnancies due to fetal, maternal, or obstetric reasons. Pregnancy termination week and indication affect morbidity.

UNASSIGNED: Most of abortions occur before the 13th week of pregnancy. Nowadays, non-surgical approaches for evacuation of uterine have been replaced with surgical ones due to the reduction in bleeding, fewer complications, ease of management, and cost-effectiveness. Misoprostol is a prostaglandin E1 analog that is used for labor induction. It is known as a safe drug with very few side effects.
UNASSIGNED: A 29-year-old woman with the gestational age of 11 weeks and 6 days with a diagnosis of cystic hygroma introduced herself to the labor ward. At the time of hospitalization, the patient was conscious. The heart sounds were normal. A vaginal exam indicated no pathological findings. Totally, she received 1000 mg of Misoprostol. Approximately, 2 hours after the last placement of Misoprostol, the patient developed bending and mild cyanosis of fingers and showed tachycardia with a pulse rate of 140 beats/min. Her O2 saturation decreased to 78%. At this time, the patient had a successful miscarriage. Echocardiography showed an ejection fraction of 55% and normal right ventricular size. The electrocardiogram showed sinus tachycardia. Therefore, she was sent to CCU with a possible diagnosis of embolism. The cardiologist administered a heparin drip of 5000-unit IV stat, and 1000 unit/h heparin and asked for a D-Dimer test. However, the laboratory reported that the patient\'s blood sample was hemolyzed and they could only check her hemoglobin which was 4 g/dl. Immediately, the heparin drip was held and the patient received 3 packed cells. Her Hb was 6.5 g/dl. 12 hours later she showed tachycardia, and her O2 saturation reduced to 70%. She lost her consciousness. Nearly 40 minutes later, she had cardiorespiratory arrest and CPR wasn\'t successful and she died.
UNASSIGNED: In Conclusion, even a frequently used drug such as Misoprostol can cause life-threatening side effects, leading to emergent situations.

We present the case of a primigravida with disseminated intravascular coagulation at 21 weeks\' gestation. Furthermore, we performed a short review of the evidence-based management of the condition. The patient presented with pain and vaginal bleeding. Clinical examination, laboratory studies, and an abdominal ultrasound produced inconclusive results about the origin of her disseminated intravascular coagulation. She was transferred to a tertiary facility where blood and plasma product transfusions were performed, and further investigations revealed fetal demise caused by placental abruption as the underlying cause of her disseminated intravascular coagulation. Cervical preparation was conducted with a balloon catheter and misoprostol. Surgical evacuation of her uterus was performed and she made a full recovery.

Misoprostol, a synthetic prostaglandin E1 analog, is currently used for medical termination of pregnancy. In the summary of the product characteristics of different market authorization holders of misoprostol tablets, approved by major regulators, serious mucocutaneous reactions, including toxic epidermal necrolysis are not documented as adverse effects. We are now reporting an unusual case of toxic epidermal necrolysis following the use of misoprostol 200 mcg tablets prescribed for termination of a pregnancy. A 25-year-old grand multipara woman from the Gash-Barka region of Eritrea visited Tesseney hospital with a history of amenorrhea that lasted for four months. She was admitted as a case of missed abortion for medical termination of pregnancy. Following three doses of misoprostol 200 mcg tablet the patient developed toxic epidermal necrolysis. Except misoprostol, no other possible alternatives that could explain the condition were identified. Accordingly, the adverse effect was judged to be possibly related to misoprostol. The patient recovered after four weeks of treatment without sequelae. Toxic epidermal necrolysis could, therefore, be a possible adverse effect of misoprostol that needs to be further investigated with better epidemiological studies.

Rupture of the uterus is a deadly obstetric complication. Its occurrence is uncommon and much less common in the second trimester. Given that the mother and fetus are in danger, it is a catastrophe for both. The incidence has increased in recent years as the cesarean section rate has increased, but in developing nations, multiparity and the inappropriate use of uterotonics are more common. This potentially disastrous event may have a vague initial presentation. Here forth, we present a case with solitary right lateral wall uterine rupture covering the entire length of the uterus, the fetus and placenta enclosed in between the broad ligament leaves, most likely due to injudicious misoprostol use at a private health care center superimposed on multiparity, and a literature review. As far as we know, this is the first instance of an isolated right lateral uterine wall rupture sparing the lower segment and, with the fetus trapped between the broad ligaments simulating abdominal pregnancy.