Second trimester pregnancy termination including fetal death: comparison of five different methods

Abstract

Objective: To compare the efficacy of methods for second trimester pregnancy termination. Methods: A prospective randomized study of women undergoing pregnancy termination between 14 and 28 weeks gestation. Three hundred and forty patients with poor cervical condition (Bishop score ≤ 4) in whom one of five termination methods were used were assessed: (i) extraamniotic administration of ethacridine lactate (82 patients); (ii) intracervical prostaglandin (PG) E 2 gel (100 patients); (iii) intravenous infusion of concentrated oxytocin (36 patients); (iv) vaginal misoprostol (49 patients); and (v) balloon insertion (73 patients). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine contractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures. Results: The efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% ( 81 82 ) of the patients in ethacridine group; 97.3% ( 35 36 ) of the patients in concentrated oxytocin group; 90.0% ( 90 100 ) of the patients in PGE 2 group; 97.2% ( 71 73 ) of the patients in balloon group; 77.5% ( 38 49 ) of the patients in misoprostol group ( P = 0.000, P < 0.01, Wilcoxon (Gehan) statistic). The overall median induction-abortion interval ± S.D. (in h) in each group were as follows: ethacridine lactate: 15.7 ± 9.6, PGE 2 gel: 20.0 ± 14.5, concentrated oxytocin: 12.2 ± 14.4, misoprostol: 24.0 ± 22.2, balloon: 16.0 ± 15.4 (one way ANOVA, P = 0.003, P < 0.01). Conclusion: In comparison with the five methods, the use of extraamniotic ethacridine, intravenous concentrated oxytocin, and balloon was found to provide more effective treatment than intracervical PGE 2 and misoprostol in terms of achievement of abortion within 24 and 48 h.