***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Our purpose was to determine whether intracervical placement of laminaria stalks would improve the effectiveness of inducing termination of pregnancies in the second trimester by intra-amniotic injection of prostagl and in F(2)alpha . STUDY DESIGN This is a prospect i ve r and omized clinical trial conducted at Gynecology Department , Lis Maternity Hospital . Fifty women admitted for indicated second trimester pregnancy termination were r and omly assigned to receive either intracervical placement of laminaria ( n = 25 ) or not ( n = 25 ) , with concurrent use of intra-amniotic injection of prostagl and in F(2)alpha and concentrated oxytocin . The outcome measures were : time from induction to delivery and the side effects and complications of treatment . RESULTS There was no significant difference in the mean interval from induction to delivery in the laminaria and no laminaria groups , being 20 + /- 1.3 ( 8 - 30 ) h versus 19 + /- 1.0 ( 8 - 26 ) h , respectively . In addition , this interval was not different in subgroups of primiparas or multiparas . Other outcome measures such as retained placenta ( 4 % in both groups ) , post-partum hemorrhage ( 4 % in both groups ) gastro-intestinal side effects , fever , and use of analgesia were not significantly different between both groups . CONCLUSION We found no additional value in placing laminaria stalks when using intra-amniotic injection of prostagl and in F(2)alpha followed by concentrated oxytocin infusion for second trimester termination of pregnancy OBJECTIVE To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion . DESIGN A prospect i ve , r and omized , controlled trial . SETTING A university teaching hospital . PATIENT(S ) Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment r and omization . INTERVENTION(S ) Routine surgical evacuation or medical evacuation of the uterus using misoprostol . MAIN OUTCOME MEASURE(S ) Immediate , short-term ( 2 - 3 weeks ) , and medium-term ( 6 months ) medical complications . RESULT ( S ) There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group . There were also fewer major complications in the 6 months after treatment in the medically treated group . Approximately 50 % of the medically treated group subsequently required surgical evacuation , and these subjects required significantly more analgesia . CONCLUSION ( S ) Treatment with misoprostol can reduce the dem and for surgical evacuation in cases of spontaneous abortion , and its use is associated with fewer medical complications Objective The aim of this r and omized prospect i ve study was to compare efficacy and side effects of saline moistened misoprostol with dry misoprostol , administered 800 μg intravaginally every 6 h up to a maximum of 3 doses in 24 h for second trimester pregnancy termination . Material s and methods A total of 81 women seeking termination of second trimester pregnancy ( 55 fetal death , 17 fetal structural anomaly , 5 chromosomal abnormality , 4 other reasons ) were r and omly assigned to one of two treatment groups : ( 1 ) intravaginal non-moistened ( dry ) misoprostol in group A ( n = 40 ) or ( 2 ) misoprostol moistened with 3 ml of saline in group B ( n = 41 ) . Results All of the patients in either group aborted within 48 h ( 100 % success rate ) . Delivery was achieved in a median ( interquartile range ) of 13 ( 40 ) h with the group A protocol and 12 ( 36 ) h with the group B protocol ( P = 0.652 ) . Delivery with first dose , delivery within 12 h and delivery within 24 h were similar ( P > 0.05 ) in group B ( 34.1 , 87.5 and 60 % , respectively ) and group A ( 25 , 82.9 , 46.3 , respectively ) . Both treatment regimens were tolerable and with similar side effects . Conclusion Misoprostol moistened with saline was not more effective  than dry misoprostol for second trimester pregnancy termination BACKGROUND When compared with the conventional surgical evacuation for the treatment of miscarriage , medical evacuation has been largely accepted as an effective and safe management . However , there is a lack of data on the long-term reproductive outcome of these two treatment modalities , which is crucial in patient counselling . The current study evaluates and compares the long-term fertility and pregnancy outcome following these two treatments . METHODS A cohort of 604 women enrolled in a previous r and omized controlled trial comparing medical and surgical evacuation for miscarriage were followed up prospect ively by telephone interview at a median of 6 ( range 4 - 9 ) years using a structured question naire . RESULTS A total of 423 women were contacted and four declined to participate ( response rate 69.4 % ) . Of these , 261 women ( 131 medical and 130 surgical evacuations ) had attempted to become pregnant since the miscarriage . There were no differences in their baseline characteristics including age , reproductive and contraceptive history . The natural conception rates were the same ( 97.7 % , P = 0.99 ) and the cumulative pregnancy rates were similar between groups , being 60 and 80 % at 12 and 24 months respectively . The median time-to-pregnancy was 8 months in both groups ( P = 0.97 ) and the subsequent live birth rates ( 85.2 versus 88.2 % , P = 0.72 ) result ing from the immediate pregnancy following previous treatment were similar . CONCLUSIONS The long-term conception rate and pregnancy outcome are not different following medical or surgical evacuation for miscarriage . Women should be reassured that their long-term fertility potential will not be compromised after medical treatment OBJECTIVE The purpose of this study was to estimate whether the efficacy of treatment with intravaginal misoprostol for first-trimester pregnancy failure is enhanced by the addition of saline solution . STUDY DESIGN Eighty women with embryonic/fetal death or anembryonic pregnancy were assigned r and omly to receive either 800 microg of misoprostol with saline solution ( group I , 41 women ) or without ( group II , 39 women ) . Treatment was repeated on day 3 if the gestational sac remained . Curettage was performed if the gestational sac remained on day 8 or as necessary during at least 30 days of follow-up . Data were analyzed with the Student t test and the chi(2 ) or Fisher exact test . RESULTS By the first follow-up visit , 73 % ( group I ) and 64 % ( group II ) of women passed the gestational sac ( P=.38 ) . By the second follow-up visit , expulsion rates were 83 % and 87 % , respectively ( P=.59 ) . Five subjects in each group underwent curettage . CONCLUSION Misoprostol is effective for the treatment of failed first-trimester pregnancy . The expulsion rate is not improved by adding saline solution BACKGROUND We aim ed to compare patients ' health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management . METHODS A multicentre r and omized clinical trial was performed in The Netherl and s. In all , 154 women with early pregnancy failure confirmed at ultrasonography who had been managed expectantly unsuccessfully for > or = 1 week were r and omly assigned to undergo either treatment with misoprostol ( n=79 ) or curettage ( n=75 ) . The main outcome measures were health-related quality of life and satisfaction with treatment . RESULTS In the misoprostol strategy 47 % of the women needed additional curettage  , as compared to 4 % after curettage . In both groups , health-related quality of life was impaired most severely 2 days after treatment . In the misoprostol group , health-related quality of life was more severely impaired ; after 2 days this was due to more pain and after 2 and 6 weeks this was due to a worse general health perception . Health-related quality of life was temporarily significantly more impaired in women in whom misoprostol failed as compared to women in whom misoprostol treatment was successful . In both treatment groups , an equal percentage of women ( 58 % ) would choose the same treatment in the future . In women treated with misoprostol , however , this choice depended on the initial success of misoprostol : in cases where misoprostol had caused complete evacuation , 76 % of the women would opt for the same treatment , whereas only 38 % of women who needed curettage after unsuccessful misoprostol would do so ( P<0.01 ) . CONCLUSION Our study shows that , although both the misoprostol strategy and the curettage strategy result ed in complete evacuation in the end , women are willing to accept some disadvantages of misoprostol to avoid curettage . A treatment inconvenience using misoprostol is accepted as long as initial evacuation rate is high . This finding should be an integral part of counselling women when deciding upon management of early pregnancy failure A total of 85 women with antepartum fetal death between 14 and 42 weeks gestation was r and omly assigned to one of two regimens of intravenous infusion of the prostagl and in analogue 16‐phenoxy‐17 , 18 , 19 , 20‐tetranor‐PGE2‐methylsulphonamide ( sulprostone ) for inducing labour . Women received either 1 μg/min until delivery or the commonly recommended treatment of 1500 μg in 8 h followed by another , identical course of treatment if delivery did not occur within 24 h. The 1 μg/min dose schedule used half the amount of prostagl and in and result ed in statistically significantly fewer gastrointestinal side‐effects compared with the conventional treatment . All women were delivered vaginally and there were no differences in induction‐to‐delivery intervals between the two treatments  . Sulprostone infused at a rate of 1 μg/min result ed in a 50 % chance of being delivered within 12 h and a 90 % chance of being delivered within 24 h , with an overall frequency of side‐effects of 20 % OBJECTIVE To compare the efficacy of intramuscular methotrexate plus vaginal misoprostol to vaginal misoprostol alone in completing  abortion in women with non-viable early first trimester pregnancy . METHOD Twenty-one women with non-viable pregnancy up to 49 days gestation were r and omized to receive intramuscular methotrexate , followed 2 days later by vaginal misoprostol or misoprostol alone . We also collected patient satisfaction information . RESULT Complete abortion occurred in all 12 ( 100 % ) women in the combined group and eight of nine ( 89 % , RR = 1.13 , CI 0.89 - 1.42 ) women in the misoprostol only group . Of the women , 75 % rated their experience as good and would choose medical management again . CONCLUSION Either methotrexate plus misoprostol or misoprostol alone effectively completed abortion in women with non-viable early pregnancy and represent acceptable medical alternatives to surgery or expectant management BACKGROUND Responses to miscarriage range from relief to devastation , yet there have been no r and omized controlled studies that demonstrate significant effects of counseling with women who miscarry . OBJECTIVE To test the effects of caring-based counseling , measurement , and time on the integration of loss ( miscarriage impact ) and women 's emotional well-being ( moods and self-esteem ) in the first year after miscarrying . METHOD ANCOVA was used in this r and omized , longitudinal Solomon four-group experimental investigation . Enrolled were 242 ; 185 completed . Outcomes included : self-esteem , overall emotional disturbance , anger , depression , anxiety , confusion , overall miscarriage impact , personal significance , devastating event , lost baby , and isolated . RESULTS During the first year after loss ( a ) caring was effective in reducing overall emotional disturbance , anger , and depression ; and ( b ) time passing led to increased self-esteem and decreased anxiety , depression , anger , confusion , and personal significance of loss . CONCLUSION Caring , measurement , and time had some positive and significant effects on the integration of loss and enhancement of well-being in the first year subsequent to miscarrying AIM To evaluate and compare effectiveness , side effects and patient acceptability between oral and sublingual 600 µg misoprostol for the treatment of incomplete abortion . METHODS A r and omized controlled trial was conducted . Pregnant women of less than 14 weeks gestation , diagnosed with incomplete abortion , were r and omly assigned to receive 600 µg misoprostol orally or sublingually . The patients were evaluated at 48 h after drug administration for complete abortion . RESULTS A total of 64 women were recruited to the study ( 32 in the oral group and 32 in the sublingual group ) .  The complete abortion rate was not statistically different between oral and sublingual groups ( 87.5 % versus 84.4 % , P > 0.05 ) . There was no statistical difference in side effects and satisfaction rate . Fever/chills were the most common side effects . CONCLUSION Both sublingual and oral 600 µg misoprostol are useful for the management of incomplete abortion . Side effects and satisfaction rates are not different . Thus , these methods may be used as alternative treatments 
    Output:
    
Limited evidence suggests that women generally seem satisfied with their care .
The available evidence suggests that medical treatment , with misoprostol , and expectant care are both acceptable alternatives to routine surgical evacuation  given the availability of health service re sources to support all three approaches .