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Abstract

To the Editors: We congratulate Hidar et al1Hidar S. Fekih M. Chaieb A. Bibi M. Mellouli R. Khairi H. Oxytocin and misoprostol administered intravaginally for termination of pregnancy at 13 to 29 weeks of amenorrhea: a prospective randomized trial.J Gynecol Obstet Biol Reprod. 2001; 30: 439-443PubMed Google Scholar on their publication of, what appears to be, the first description of a combined misoprostol and oxytocin regimen for mid trimester pregnancy termination. We suspect that our failure to identify this publication was a result of including only English language articles in our query. The regimen used by these investigators (misoprostol 800 μg in 48 hours with constant oxytocin infusion at 15 mIU/min) uses a relatively low dose of both agents and is quite different from that used in our investigation (misoprostol 900 μg in 24 hours with escalating-dose concentrated oxytocin). Whereas Hidar et al1Hidar S. Fekih M. Chaieb A. Bibi M. Mellouli R. Khairi H. Oxytocin and misoprostol administered intravaginally for termination of pregnancy at 13 to 29 weeks of amenorrhea: a prospective randomized trial.J Gynecol Obstet Biol Reprod. 2001; 30: 439-443PubMed Google Scholar observed a mean induction to delivery interval of 22 hours with their combined misoprostol/oxytocin regimen, we observed an interval of 18 hours for our higher dose combination regimen. It is impossible to discern to what degree either the increased misoprostol dose or the increased oxytocin dose may have contributed to this apparent difference. Although the use of a combination misoprostol/oxytocin regimen as evaluated in the study of Hidar et al1Hidar S. Fekih M. Chaieb A. Bibi M. Mellouli R. Khairi H. Oxytocin and misoprostol administered intravaginally for termination of pregnancy at 13 to 29 weeks of amenorrhea: a prospective randomized trial.J Gynecol Obstet Biol Reprod. 2001; 30: 439-443PubMed Google Scholar and in our investigation2Nuthalapaty F.S. Ramsey P.S. Biggio J.R. Owen J. High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for mid trimester labor induction: a randomized trial.Am J Obstet Gynecol. 2005; 193: S1065-S1070Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar appears to be safe, we have demonstrated through our recent investigation2Nuthalapaty F.S. Ramsey P.S. Biggio J.R. Owen J. High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for mid trimester labor induction: a randomized trial.Am J Obstet Gynecol. 2005; 193: S1065-S1070Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar and a previous one3Ramsey P.S. Savage K. Lincoln T. Owen J. Vaginal misoprostol versus concentrated oxytocin and vaginal PGE2 for second-trimester labor induction.Obstet Gynecol. 2004; 104: 138-145Crossref PubMed Scopus (34) Google Scholar that the use of a high-dose misoprostol regimen alone (2600 μg in 24 hrs) results in a significant shortening of the induction-to-delivery interval (median time, 12 hours) when compared with both of these alternative combination misoprostol/oxytocin regimens, with comparable side effect profiles. In our investigation, the concurrent use of oxytocin with misoprostol did not improve the efficacy of the treatment regimen. With these observations in mind, we believe that most practitioners would be unlikely to choose a regimen that was associated with a significantly longer induction time and was more complicated to administer, even if it was associated with a low live birth rate.