***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 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 Two doses , 200 and 400 micrograms , of misoprostol , administered vaginally every 12 hours , up to four times , were tested in 101 and 133 healthy women , respectively , for interruption of pregnancies with 35 through 77 days of amenorrhea . The proportion of women who aborted increased with longer duration of treatment and was significantly higher with 400 than with 200 micrograms ( 66 versus 46 percent at 48 hours ) . Significance was maintained after controlling by age , body weight , parity , previous abortion and gestational age . Abortions were classified as incomplete or complete , according to the presence or not of embryonic tissue in the uterine cavity , diagnosed by vaginal sonography . Vacuum aspiration was carried out in all cases not classified as complete abortion 48 hours after the initiation of treatment , or earlier in case of persistent bleeding or woman 's request . The possibility of increasing effectiveness by using higher dose , shorter intervals or longer duration of treatment is discussed 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 Dilatation and curettage ( D&C ) has been the usual treatment for early pregnancy failure ( EPF ) . Medical management with misoprostol may be an effective alternative . Bleeding patterns during and after medical management of EPF are unknown . METHODS A prospect i ve cohort study was conducted at University-based clinics and physician offices . Eighty women < 11 weeks estimated gestational age with a diagnosis of missed abortion or fetal demise were enrolled . Treatment consisted of either 800 micro g of moistened ( 2 ml of saline ) or dry vaginal misoprostol . Self-reported bleeding and sanitary product usage were recorded in a daily 2 week diary . Haemoglobin was assessed at enrollment and 2 weeks later . RESULTS After misoprostol treatment , patients reported bleeding or spotting every day for the 14 days observed . Self-assessed heavy bleeding days were few ( median 3 ) and usually occurred immediately after treatment . Sanitary pad use was highly variable ( mean 30.5 , range 2 - 125 pads over the 2 week period ) and not related to changes in haemoglobin . The mean decrease in haemoglobin was 0.5 g/dl ( SD 1.2 ) . Complete expulsion without D&C occurred in 85 % of subjects . CONCLUSIONS Bleeding for at least 2 weeks after vaginal misoprostol for EPF is common . Heavy bleeding is usually limited to a few days after treatment . Clinical ly important changes in haemoglobin are rare OBJECTIVE The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for second-trimester pregnancy termination . STUDY DESIGN We performed a r and omized clinical trial in patients who were at 14 to 23 weeks of gestation and who were admitted for medical termination of pregnancy . All patients received 800 microg of vaginal misoprostol and were assigned r and omly to 400 microg of oral misoprostol or 400 microg of vaginal misoprostol every 8 hours . Efficacy and side effects were compared . The mean induction time of the study group was compared with that of an historic control group that had received 400 microg vaginally every 12 hours . RESULTS Forty-three women were assigned r and omly , 22 women to vaginal misoprostol and 21 women to oral misoprostol .  Induction time and hospital stay were slightly 
    Output:
    
Available evidence from r and omised trials suggests that medical treatment with vaginal misoprostol may be an acceptable alternative to surgical evacuation or expectant management .
In general , side effects of medical treatment were minor , consisting mainly of nausea and diarrhoea .
There were no major differences in effectiveness between different routes of administration .