Home Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
Article Open Access

Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study

  • Gianfranco Sfregola , Pamela Sfregola , Federico Ruta , Federica Zendoli , Alessandra Musicco , Simone Garzon , Stefano Uccella , Andrea Etrusco EMAIL logo , Vito Chiantera , Sanja Terzic , Andrea Giannini and Antonio Simone Laganà
Published/Copyright: July 4, 2023

Abstract

The aim of this study was to evaluate the effect of maternal age and body mass index (BMI) on induction of labor with oral misoprostol for premature rupture of membrane (PROM) at term. We have conducted retrospective cross-sectional study, including only term (37 weeks or more of gestation) PROM in healthy nulliparous women with a negative vaginal-rectal swab for group B streptococcus, a single cephalic fetus with normal birthweight, and uneventful pregnancy that were induced after 24 h from PROM. Ninety-one patients were included. According to the multivariate logistic regression, age and BMI odds ratio (OR) for induction success were 0.795 and 0.857, respectively. The study population was divided into two groups based on age (<35 and ≥35 years) and obesity (BMI <30 and ≥30). Older women reported a higher induction failure rate (p < 0.001); longer time to cervical dilation of 6 cm (p = 0.03) and delivery (p < 0.001). Obese women reported a higher induction failure rate (p = 0.01); number of misoprostol doses (p = 0.03), longer time of induction (p = 0.03) to cervical dilatation of 6 cm (p < 0.001), and delivery (p < 0.001); and higher cesarean section (p = 0.012) and episiotomy rate (p = 0.007). In conclusion, maternal age and BMI are two of the main factors that influence oral misoprostol efficacy and affect the failure of induction rate in term PROM.

1 Introduction

Premature rupture of membrane (PROM) involves the rupture of membranes before the beginning of uterine contractions and labor. This condition occurs in 8–10% of pregnancies, and about 60% of them are at term (37 weeks or more of gestation) [1]. In the majority of term PROM, labor arises spontaneously within 24 h, even when the bishop is unfavorable [2]; however, approximately 40% of the cases will require more than 24 h [3]. In these cases, the labor may be delayed up to 7 days after PROM [2]. Term PROM is associated with immediate risks such as cord prolapse, cord compression, and placental abruption, as well as later complications such as maternal infections (chorioamnionitis and endometritis) and neonatal infections (neonatal sepsis) [4]. The risk of maternal chorioamnionitis and endometritis, which may result in subsequent neonatal infection, lung disease, and cerebral palsy as well as severe morbidity for the mother, increases proportionally with the time between the rupture of membranes and birth [5,6]. This risk factor was further confirmed by evidence that active management of term PROM by induction of labor results in a lower risk of maternal infectious morbidity (chorioamnionitis and/or endometritis) and neonatal sepsis compared with expectant management beyond 24 h, without an increased rate of cesarean section (CS) [3,7]. On that basis, induction of labor is the recommended strategy in these cases [8]. In term PROM, different methods are available to ripen the cervix and/or induce labor: the main important ones are intravenous oxytocin and oral or vaginal prostaglandins, which reported overall comparable effectiveness [7,9,10,11]. Prostaglandins are used for cervical ripening, but at the same time they commonly induce labor, making the distinction between ripening and labor induction almost artificial [9,10,11,12,13,14]. Prostaglandins are derivatives of arachidonic acid and are involved in different physiologic processes. Synthetic analogues of natural prostaglandins are available and utilized for their biological activities, including misoprostol (PGE1) and dinoprostone (PGE2). Although only dinoprostone (PGE2) was approved for cervical ripening/labor induction as cervical gel, intravaginal gel or tablet, misoprostol has been used off label for over 30 years as a labor-induction and cervical-ripening agent for the advantages of significantly lower cost, wide accessibility, and temperature stability compared to dinoprostone [9,13,14,15,16]. Furthermore, according to the latest Cochrane systematic review on the subject, low-dose oral misoprostol was associated with fewer cesarean deliveries, and consequent increase in vaginal deliveries, compared to vaginal dinoprostone, and lower rates of hyperstimulation with changes in the fetal heart rate [17]. Nevertheless, in 2014, generic misoprostol was licensed in Italy by the Italian agency of drug (Agenzia italiana del farmaco, AIFA) for induction of labor in term pregnancies and became available for every day clinical practice consistent with the protocol proposed by the World Health Organization (WHO) [18]. On that basis, the routine management for term PROM was to recommend cervical ripening and induction of labor with oral misoprostol when the bishop score is <7, instead of vaginal prostaglandins.

Although misoprostol has been used for over 30 years and the recent Cochrane review on oral misoprostol included 76 trials demonstrating the effectiveness of this induction method, the pieces of evidence are limited by the variety of different dose and time regimens proposed so far [14]. Moreover, little is known about factors in term PROM that may influence oral misoprostol efficacy and that may be related to induction failure. In this scenario, we conducted a retrospective cross-sectional study, based on prospectively collected data, including term pregnant women with PROM who underwent cervical ripening/induction of labor with oral misoprostol, consistent with the protocol proposed with the WHO [18]. Specifically, the aim of this study was to evaluate the effect of maternal age and body mass index (BMI) on oral misoprostol induction of labor for PROM at term.

2 Methods

This is a retrospective cross-sectional study of prospectively collected data. We used the oral misoprostol regimen proposed by the WHO [18] for induction of labor in term (37 weeks or more of gestation) singleton pregnancies in women who have not had a previous cesarean delivery and a bishop score <7. The regimen was oral misoprostol in an aqueous solution at a low dose of 25 µg every 2 h until a bishop score ≥7, labor, or for a maximum of 8 doses. Cardiotocographic (CTG) evaluation was conducted for at least 30 min before and continued for at least 60 min after each dose of oral misoprostol. Contraindications for the use or the continuation of oral misoprostol were labor (defined as the presence of at least three painful uterine contractions every 10 min), uterine tachysystole (>5 contractions within 10 min for two consecutive 10 min periods), hypertonic uterus, abnormal CTG, and contraindications to vaginal delivery (fetal malpresentation such as a breech presentation or transverse lie, fetal macrosomia, abnormally implanted placenta, active genital herpes infection, cervical cancer). Moreover, patients with parity >4, medical contraindications to misoprostol (asthma, glaucoma), and previous hysterotomies were excluded. In the case of term PROM, oral misoprostol was started at 24 h from PROM if the vaginal-rectal swab was negative for group B streptococcus (GBS), and after 6 h if positive. Moreover, prophylactic antibiotics were administered to prevent neonatal sepsis in cases in which PROM lasted >18 h if the vaginal tampon was negative for GBS and immediately if positive. In order to avoid potential biases, we included in the current analysis only women with vaginal-rectal swab negative for GBS.

Since the introduction of the oral misoprostol regimen in 2015, for all women who underwent labor induction with the new protocol, we prospectively recorded data about general characteristics (age, BMI, gestational age), patients’ history before pregnancy (previous surgeries, disease, therapies), course of pregnancy/recording maternal complications and fetal diseases, mode and characteristics of delivery, and fetal outcomes after birth (weight, Apgar, cord arterial blood pH, and base excess). Moreover, we recorded data about cervical ripening/labor induction such as bishop score (determined by assessing cervical dilation, effacement, station, position, and cervical consistency) at the first misoprostol dose, the number of doses administered, time of induction (time between the first dose and active labor, which was defined as regular uterine contractions and cervical dilation >4 cm), the time between last misoprostol dose and cervical dilation of 6 cm, time between last misoprostol dose and vaginal delivery, induction failure that was defined as an inability to generate regular contractions and cervical changes and/or without the onset of labor after eight doses of oral misoprostol, which required to continue induction with intravenous oxytocin or CS.

For the aim of this study, we retrospectively analyzed the prospectively collected database from January 2015 to June 2018. We included in the analysis pregnant women who underwent cervical ripening/labor induction with oral misoprostol with the following characteristics: nulliparous, single fetus, cephalic presentation, no use of any other cervical ripening methods within 7 days of hospitalization, PROM (diagnosed via vaginal speculum examination in order to determine the amniotic fluid leakage) between 37 and 42 weeks of gestation, and misoprostol started at 24 h from PROM. We considered the following as exclusion criteria: required oxytocin infusion to augment labor, hypertensive disorders, gestational diabetes, preconceptionally maternal diseases, concomitant fetal disease, or fetal birthweight <2,500 g or >4,500 g.

2.1 Outcomes and statistical analysis

Statistical analysis was performed using SPSS V.21.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics were reported according to data distribution as mean ± SD when they had a Gaussian distribution or median and interquartile range (IQR) when they were not normally distributed; the categorical variables were reported as absolute numbers and percentage (%). Binomial logistic regression was used to evaluate factors related to induction failure. Fisher’s exact test, and parametric (t-test, ANOVA) and non-parametric (Mann–Whitney, Wilcoxon) tests were used to compare baseline characteristics and outcomes as appropriate. Statistical significance was set for p < 0.05.

Based on a previous report (in line with our clinical practice) showing a mean of 5.5 h from the first dose of oral misoprostol to achieve active labor [19] and a potential 25% increase between women with BMI < 30 and BMI > 30, the inclusion of 41 women for each of these two arms would have been calculated to achieve a power of 80% with alpha error 0.05.

2.2 Ethics and methodological standards

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

The design, analysis, interpretation of data, drafting, and revisions conform to the Helsinki Declaration, the Committee on Publication Ethics (COPE) guidelines (http://publicationethics.org/), and the RECORD (reporting of studies conducted using observational routinely collected health data) statement [20], validated by the EQUATOR (enhancing the quality and transparency of health research) network (www.equator-network.org).

Each patient enrolled in this study signed an informed consent for all the procedures to allow data collection and analysis for research purposes. The study was non-advertised, and no remuneration was offered to encourage patients to give consent for the collection and analysis of their data. An independent data safety and monitoring committee evaluated the results.

The retrospective study design and development, with anonymized handling of the data, was approved by the Institutional Review Board of the study centers.

3 Results

Between January 2015 and June 2018, based on inclusion and exclusion criteria, 91 pregnant nulliparous women underwent induction of labor with oral misoprostol for PROM between 37 and 42 weeks of gestation. The mean study population age was 29.9 ± 5.6 years and the mean BMI was 30.1 ± 4.7. PROM occurred in the median at 40 (38–40) weeks of gestation (mean of 278.5 ± 8.1 days of gestation). Cervical ripening and induction of labor failed in 12 out of 91 (13.2%) pregnancies and required further induction with intravenous oxytocin to achieve labor or CS. Seventy-nine (86.8%) women underwent labor after oral misoprostol induction, 69 (87.3%) of them achieved vaginal delivery and 10 (12.7%) underwent CS for dystocia or non-reassuring CTG. The mean time of induction was 304.6 ± 133.6 min with a median of 5 (3–7) doses of oral misoprostol per patient. Cervical dilatation of 6 cm was achieved after a mean of 220.4 ± 241.2 min from the last misoprostol dose, and vaginal delivery was achieved after a mean of 357.2 ± 277.0 min. Episiotomy was performed in nine patients (9.9%), and 61 out of 69 (88.4%) vaginal delivery experienced perineal tears of the first or second degree. The mean fetal birthweight was 3216.3 ± 361.52 g. The median Apgar score was 9 for both the first (8–9) and fifth (9–10) minutes. The mean fetal cord blood pH and base excess were 7.24 ± 0.08 and −5.6 ± 3.02, respectively. No newborn was admitted to the neonatal intensive care unit.

We performed a multivariate logistic regression to evaluate factors that may influence oral misoprostol efficacy and that may be related to the failure of induction in term PROM. We investigated the effect of gestational age (days), maternal age (years), BMI (kg/m2), and fetal weight on induction success, and the results of logistic regression are reported in Table 1. Age and BMI results were associated with the risk of oral misoprostol induction failure. The age reported an odds ratio (OR) of 0.795 (95% confidence interval [CI]: 0.679–0.931) per each year of increased age for induction success; similarly, BMI reported an OR of 0.857 (95% CI: 0.737–0.997) per each unit of BMI for induction success.

Table 1

Binomial logistic regression for factors influencing the success of labor induction with oral misoprostol in women with term PROM

P OR 90% CI – inferior OR 90% CI – superior OR
Gestational age (days) 0.873 0.993 0.905 1.088
Maternal age (years) 0.004 0.795 0.679 0.931
BMI (kg/m2) 0.045 0.857 0.737 0.997
Fetal birthweight 0.672 1.000 0.998 1.001
Constant 0.240 43569382.670

Values shown in bold are those that reached statistical significance.

Based on these results, the study population was investigated by dividing patients based on age and BMI. Table 2 reports data on the study population analyzed after dividing it into two groups based on the cutoff of 35 years old. This analysis confirms the higher induction failure rate in women older than 35 years (OR = 13.9; p < 0.001); moreover, the results reported a longer time to achieve a cervical dilation of 6 cm (p = 0.03) and delivery (p < 0.001) after the last oral misoprostol dose. Based on BMI (Table 3), the study population was divided into two groups based on the diagnosis of obesity (BMI ≥ 30) or non-obesity (BMI < 30): obese women reported a higher induction failure rate (OR = 7.3; p = 0.01), number of oral misoprostol doses (p = 0.03), time of induction (p = 0.03), cervical dilatation of 6 cm (p < 0.001) and delivery (p < 0.001); moreover they reported a higher CS rate (p = 0.012) and episiotomy rate (p = 0.007) compared with non-obese women.

Table 2

Comparison between women aged <35 or ≥35 years with PROM who underwent labor induction with oral misoprostol

PROM <35 years (n = 68) PROM ≥35 years (n = 23) p
Maternal age (years) 27.48 ± 4.05 37.13 ± 2.33 <0.001
Gestational age (days) 278.53 ± 8.17 278.61 ± 7.61 0.97
BMI (kg/m2) 29.57 ± 4.44 31.78 ± 5.62 0.06
Misoprostol doses 5 (3–7) 7 (4–7) 0.092
Time of induction (min) 291.18 ± 133.73 344.35 ± 130.12 0.10
Time between the last misoprostol dose and cervical dilation of 6 cm (min) 189.74 ± 191.04 381.82 ± 398.32 0.003
Time between the last misoprostol dose and delivery (min) 316.12 ± 229.41 573.64 ± 398.51 <0.001
Induction failure 3/68 (4.4%) 9/23 (39.1%) <0.001
CS 7/65 (10.8%) 3/14 (21.4%) 0.37
Episiotomy 7/58 (12.1%) 2/11 (18.2%) 0.63
II-degree vaginal laceration 24/58 (41.4%) 7/11 (63.6%) 0.20
Neonatal weight (g) 3,196.98 ± 367.12 3,273.47 ± 360.09 0.39
Cord arterial blood pH 7.23 ± 0.09 7.26 ± 0.07 0.15
Cord arterial blood base excess −5.95 ± 3.20 −4.57 ± 2.19 0.16
Apgar at 1 min 9 (8–9) 9 (8–9) 0.67
Apgar at 5 min 9 (9–10) 9 (9–10) 0.27

Values shown in bold are those that reached statistical significance.

Table 3

Comparison between non-obese (BMI <30) and obese (BMI ≥30) women with PROM who underwent labor induction with oral misoprostol

PROM <30 BMI (n = 49) PROM ≥30 BMI (n = 42) p
Maternal age (years) 29.10 ± 5.44 30.88 ± 5.83 0.13
Gestational age (days) 280.35 ± 7.46 278.45 ± 8.30 0.25
BMI (kg/m2) 26.37 ± 1.60 34.52 ± 2.99 <0.001
Misoprostol doses 5 (3–6.5) 6 (4.75–7) 0.03
Time of induction (min) 276.73 ± 132.05 337.14 ± 131.97 0.03
Time between the last misoprostol dose and cervical dilation of 6 cm (min) 117.89 ± 105.24 412.5 ± 307.79 <0.001
Time between the last misoprostol dose and delivery (min) 251.89 ± 164.43 554.58 ± 344.40 <0.001
Induction failure 2/49 (4.1%) 10/42 (23.8%) 0.01
CS 2/47 (4.3%) 8/32 (25%) 0.012
Episiotomy 2/45 (4.4%) 7/24 (29.2%) 0.007
II-degree vaginal laceration 17/45 (37.8%) 14/24 (58.3%) 0.13
Neonatal weight 3,227.86 ± 361.47 3,202.86 ± 368.02 0.74
Cord arterial blood pH 7.24 ± 0.09 7.24 ± 0.08 1
Cord arterial blood base excess −5.68 ± 2.31 −5.51 ± 3.56 0.78
Apgar at 1 min 9 (8–9) 9 (8–9) 0.48
Apgar at 5 min 9 (9–10) 9 (9–10) 0.46

4 Discussion

Our results show that maternal age and BMI are two of the main factors that influence oral misoprostol efficacy and that are related to the failure of labor induction in term PROM. Both logistic regression and subsequent analysis confirm a higher risk of induction failure and a longer time to achieve cervical dilatation and delivery after induction for term PROM with oral misoprostol in older women. At the same time, obese women required a higher number of oral misoprostol doses, with subsequent longer time of induction, reporting a higher failure rate; moreover, obese women had longer labor and a higher rate of CS and episiotomy.

A higher risk of induction failure and CS after induction were previously reported in older women [21,22]. Similarly, obesity was already associated with a higher risk of induction failure, a higher risk of CS, and prolonged labor [23,24] due to impaired uterine contractility, potentially caused by altered cholesterol levels, increased leptin concentration, and hormonal imbalance [25].

We acknowledged that available pieces of evidence about the induction of labor using oral misoprostol report different and sometimes conflicting results. This variability can be explained, at least in part, by the different doses (from 20 to 200 µg) used for the induction of labor in the different studies published so far [26].

To the best of our knowledge, this is the first study demonstrating that both age and BMI play a key role in influencing oral misoprostol efficacy and failure rate of labor induction in term PROM.

This evidence may solicit to investigate the effectiveness of different available methods in older and obese women, considering that different pharmacokinetics and pharmacodynamics could support the use of a method instead of another one in these subpopulations. For example, misoprostol is available to be administered in oral, sublingual, and vaginal routes; nevertheless, pharmacokinetic studies suggest that vaginal misoprostol leads to a lower peak serum concentration but delayed time to peak concentration compared with oral administration, with greater exposure to the drug when it is vaginally administered [27]. Moreover, considering the heterogeneity of different dose and time regimens of oral misoprostol available in the literature [14,28], our study may suggest investigating a higher dosage and/or different time of oral misoprostol in obese and older patients instead of other induction methods. Finally, in everyday clinical practice, our results may help clinicians in counseling patients about the failure rate and time of induction and delivery.

Although this study gives new insight into the cervical ripening/labor induction in term PROM with oral misoprostol, our results are limited by the retrospective study design, which is intrinsically the carrier of bias compared to the prospective approach and by the limited number of patients included in the study population. Nevertheless, the prospectively collected database, the standard applied protocol, and the strict inclusion and exclusion criteria provide robust results and limit this bias. Despite the relatively low number of women enrolled, this is fully within the sample size analysis, so the study can be considered sufficiently powered to detect significant differences between the groups.

In particular, we included only term PROM in healthy nulliparous women with single cephalic fetuses with normal birthweight and uneventful pregnancy that were induced 24 h after PROM; moreover, the exclusion of women further induced with oxytocin or with oxytocin-augmented labor was mandatory to avoid the bias of oxytocin action.

In our opinion, however, it would be appropriate to perform further clinical analyses aimed to evaluate women further induced with oxytocin or oxytocin-augmented labor after primary induction with oral misoprostol in an aqueous solution, in order to address future research priorities.

In conclusion, our study shows that maternal age and BMI are two of the main factors that influence oral misoprostol efficacy for labor induction in term PROM. Older and obese women have a higher risk of induction failure and have poorer responses to oral misoprostol. These data may help to perform detailed counseling and may guide further research on different dose and time regimens of oral misoprostol or different induction methods in these subpopulations. Based on these preliminary data, we take the opportunity to solicit further studies to investigate the possible factors influencing the effectiveness of cervical ripening/induction of labor in term PROM.

Acknowledgements

Not applicable.

  1. Funding information: This study was not funded.

  2. Author contributions: GS and ASL: study design and project development; GS, FR, PS, and FZ: data collection; AM, ST, and SG: data analysis; SG, SU: manuscript writing; AE, AG, and VC manuscript editing and final approval. All the authors conform to the International Committee of Medical Journal Editors (ICMJE) criteria for authorship, contributed to the intellectual content of the study, and gave approval for the final version of the article. The authors alone are responsible for the content and writing of the paper.

  3. Conflict of interest: Dr Antonio Simone Laganà and Dr Simone Garzon serve as Editors in Open Medicine but it did not affect the peer-review process. The authors have no proprietary, financial, professional, or other personal interest of any nature in any product, service, or company.

  4. Data availability statement: All data generated or analyzed during this study are included in this published article.

References

[1] Duff P. Premature rupture of the membranes in term patients: induction of labor versus expectant management. Clin Obstet Gynecol. 1998;41(4):883–91. 10.1097/00003081-199812000-00012.Search in Google Scholar PubMed

[2] Hannah ME, Seaward GR. Prelabour rupture of membranes at term: the role of induction of labour. Fetal Matern Med Rev. 1998;10(2):61–8. 10.1017/S0965539597000211.Search in Google Scholar

[3] Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, Myhr TL, et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. N Engl J Med. 1996;334(16):1005–10. 10.1056/NEJM199604183341601.Search in Google Scholar PubMed

[4] Saccone G, Berghella V. Antibiotic prophylaxis for term or near-term premature rupture of membranes: metaanalysis of randomized trials. Am J Obstet Gynecol. 2015;212(5):627.e1–9. 10.1016/j.ajog.2014.12.034.Search in Google Scholar PubMed

[5] Tran SH, Cheng YW, Kaimal AJ, Caughey AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol. 2008;198(6):700.e1–5. 10.1016/j.ajog.2008.03.031.Search in Google Scholar PubMed

[6] Herbst A, Källén K. Time between membrane rupture and delivery and septicemia in term neonates. Obstet Gynecol. 2007;110(3):612–8. 10.1097/01.AOG.0000277632.36186.84.Search in Google Scholar PubMed

[7] Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev. 2017;1(1):CD005302. 10.1002/14651858.CD005302.pub3.Search in Google Scholar PubMed PubMed Central

[8] Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol. 2013;122(4):918–30. 10.1097/01.AOG.0000435415.21944.8f.Search in Google Scholar PubMed

[9] Lin MG, Nuthalapaty FS, Carver AR, Case AS, Ramsey PS. Misoprostol for labor induction in women with term premature rupture of membranes: a meta-analysis. Obstet Gynecol. 2005;106(3):593–601. 10.1097/01.AOG.0000172425.56840.57.Search in Google Scholar PubMed

[10] Hofmeyr GJ, Alfirevic Z, Kelly AJ, Kavanagh J, Thomas J, Neilson JP, et al. Methods for cervical ripening and labour induction in late pregnancy: generic protocol. Cochrane Database Syst Rev. 2009;3:CD002074. 10.1002/14651858.CD002074.pub2.Search in Google Scholar

[11] Tan BP, Hannah ME. Prostaglandins versus oxytocin for prelabour rupture of membranes at term. Cochrane Database Syst Rev. 2000;(2):CD000159. 10.1002/14651858.CD000159.Search in Google Scholar PubMed

[12] Thomas J, Fairclough A, Kavanagh J, Kelly AJ. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database Syst Rev. 2014;2014(6):CD003101. 10.1002/14651858.CD003101.pub3.Search in Google Scholar PubMed PubMed Central

[13] Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010;2010(10):CD000941. 10.1002/14651858.CD000941.pub2.Search in Google Scholar PubMed PubMed Central

[14] Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labour. Cochrane Database Syst Rev. 2014;2014(6):CD001338. 10.1002/14651858.CD001338.pub3.Search in Google Scholar PubMed PubMed Central

[15] Liu A, Lv J, Hu Y, Lang J, Ma L, Chen W. Efficacy and safety of intravaginal misoprostol versus intracervical dinoprostone for labor induction at term: a systematic review and meta-analysis. J Obstet Gynaecol Res. 2014;40(4):897–906. 10.1111/jog.12333.Search in Google Scholar PubMed

[16] ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009;114(2 Pt 1):386–97. 10.1097/AOG.0b013e3181b48ef5.Search in Google Scholar PubMed

[17] Kerr RS, Kumar N, Williams MJ, Cuthbert A, Aflaifel N, Haas DM, et al. Low-dose oral misoprostol for induction of labour. Cochrane Database Syst Rev. 2021;6(6):CD014484. 10.1002/14651858.CD014484.Search in Google Scholar PubMed PubMed Central

[18] Tang J, Kapp N, Dragoman M, de Souza JP. WHO recommendations for misoprostol use for obstetric and gynecologic indications. Int J Gynaecol Obstet. 2013;121(2):186–9. 10.1016/j.ijgo.2012.12.009.Search in Google Scholar PubMed

[19] Eriksson A, Jeppesen S, Krebs L. Induction of labour in nulliparous women- quick or slow: a cohort study comparing slow-release vaginal insert with low-dose misoprostol oral tablets. BMC Pregnancy Childbirth. 2020;20(1):79. 10.1186/s12884-020-2770-0.Search in Google Scholar PubMed PubMed Central

[20] Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015;12(10):e1001885. 10.1371/journal.pmed.1001885.Search in Google Scholar PubMed PubMed Central

[21] Tolcher MC, Holbert MR, Weaver AL, McGree ME, Olson JE, El-Nashar SA, et al. Predicting cesarean delivery after induction of labor among nulliparous women at term. Obstet Gynecol. 2015;126(5):1059–68. 10.1097/AOG.0000000000001083.Search in Google Scholar PubMed PubMed Central

[22] Ciancimino L, Laganà AS, Chiofalo B, Granese R, Grasso R, Triolo O. Would it be too late? A retrospective case-control analysis to evaluate maternal-fetal outcomes in advanced maternal age. Arch Gynecol Obstet. 2014;290(6):1109–14. 10.1007/s00404-014-3367-5.Search in Google Scholar PubMed

[23] Maged AM, El-Semary AM, Marie HM, Belal DS, Hany A, Taymour MA, et al. Effect of maternal obesity on labor induction in postdate pregnancy. Arch Gynecol Obstet. 2018;298(1):45–50. 10.1007/s00404-018-4767-8.Search in Google Scholar PubMed

[24] Stefely E, Warshak CR. Contraction frequency after administration of misoprostol in obese versus nonobese women. J Matern Fetal Neonatal Med. 2019;32(21):3526–30. 10.1080/14767058.2018.1465919.Search in Google Scholar PubMed

[25] Carlson NS, Hernandez TL, Hurt KJ. Parturition dysfunction in obesity: time to target the pathobiology. Reprod Biol Endocrinol. 2015;13:135. 10.1186/s12958-015-0129-6.Search in Google Scholar PubMed PubMed Central

[26] Padayachee L, Kale M, Mannerfeldt J, Metcalfe A. Oral misoprostol for induction of labour in term PROM: A systematic review. J Obstet Gynaecol Can. 2020;42(12):1525–31.e1. 10.1016/j.jogc.2020.02.111.Search in Google Scholar PubMed

[27] Khan RU, El-Refaey H, Sharma S, Sooranna D, Stafford M. Oral, rectal, and vaginal pharmacokinetics of misoprostol. Obstet Gynecol. 2004;103(5 Pt 1):866–70. 10.1097/01.AOG.0000124783.38974.53.Search in Google Scholar PubMed

[28] Stephenson ML, Wing DA. Misoprostol for induction of labor. Semin Perinatol. 2015;39(6):459–62. 10.1053/j.semperi.2015.07.008.Search in Google Scholar PubMed

Received: 2023-03-28
Revised: 2023-06-01
Accepted: 2023-06-13
Published Online: 2023-07-04

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
  33. A novel autophagy-related long non-coding RNAs signature predicting progression-free interval and I-131 therapy benefits in papillary thyroid carcinoma
  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
  46. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study
  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
  51. TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia
  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
  62. Inhibition of glycolysis represses the growth and alleviates the endoplasmic reticulum stress of breast cancer cells by regulating TMTC3
  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
Downloaded on 8.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0747/html
Scroll to top button