Abstract
To compare two medical methods for second-trimester abortion, mifepristone followed by misoprostol versus mifepristone followed by ethacridine lactate and oxytocin for success rate, induction to abortion time and acceptability. This is a randomized trial conducted from July 2014 to May 2016 and enrolled 120 women undergoing second trimester abortion (13-20 weeks). All patients received 200mg mifepristone orally and were randomized to receive further treatment after 36 hrs. Patients in Group M (n=60) received 400 microgram of misoprostol vaginally every 3 hours (maximum - 5 doses) and Group E (n=60) had extra-amniotic ethacridine lactate instillation followed by oxytocin infusion (max-100miu). Baseline demographic characteristics were comparable in both the groups. Success rate was 100% in group M and 98.3% in group E (p=0.31). Mean induction to abortion time was significantly shorter in group M than group E (8.2+2.3hours & 10.9+2.6 hours respectively; p=0.001). Majority of women reported side effects, 96.7% women in group M and 75% women in group E (p=0.001). Fall in hemoglobin after procedure was significantly higher in group M (0.70+0.33gram %) than group E (0.52+0.23 gram %) (p=0.001). Perception of intensity of pain was significantly more in group M but patient satisfaction in both groups was similar. Both methods are comparable for success rate, induction interval was more for ethacridine lactate compared to misoprostol.
Highlights
Abortion is a major social and health issue, in the developing countries
Perception of intensity of pain was significantly more in group M but patient satisfaction in both groups was similar. Both methods are comparable for success rate, induction interval was more for ethacridine lactate compared to misoprostol
This study compares two second-trimester abortion methods of mifepristone followed by ethacridine lactate (EL) and oxytocin with the commonly used protocol of mifepristone followed by misoprostol
Summary
Abortion is a major social and health issue, in the developing countries. Mifepristone followed by misoprostol is a safe and effective regimen in the second-trimester abortion. A systematic review of 40 randomized controlled trials addressing various regimens for the abortion between 12 and 28 weeks of gestation concluded that the combination of mifepristone and misoprostol appeared to have the highest efficacy and shortest induction time [2]. The World Health Organization (WHO) [3] and Royal College of Obstetrics & Gynecology (RCOG) [4] strongly recommend the use of the anti-progestin and mifepristone, followed by misoprostol, as the medical method for second-trimester abortion. One of the drawbacks of this regimen are misoprostol side effects, which can occur in up to 30% of cases [5], and the possibility of uterine rupture in women with a previous uterine scar [6, 7]
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