Induction-abortion Interval Research Articles

Efficacy and safety of isosorbide mononitrate plus misoprostol compared to misoprostol alone in the management of the first and second trimester abortion: a systematic review and meta-analysis

BackgroundHowever, misoprostol is often used to terminate a pregnancy, but it can also cause side effects. Isosorbide mononitrate (ISMN) can help the cervix mature by increasing the production of prostaglandin E2 and vasodilation. Considering that the results of studies in this field are contradictory, it is the purpose of this study to evaluate the efficacy and safety of vaginal ISMN plus misoprostol compared to misoprostol alone in the management of first- and second-trimester abortions.MethodThe search process was conducted for MEDLINE through the PubMed interface, Scopus, Web-of-Science, Science Direct, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform until November 10, 2023. Our assessment of bias was based on version 2 of the risk-of-bias tool (RoB2) for randomized trials and our level of evidence quality was determined by GRADE. Meta-analysis of all data was carried out using Review Manager (RevMan) version 5.1.ResultSeven randomized clinical trials were included in the systematic review and three in the meta-analysis, with mixed quality. The results of the meta-analysis revealed that in the second-trimester abortion, the inclusion of ISMN in conjunction with vaginal misoprostol results in a noteworthy reduction in the induction abortion interval, specifically by 4.21 h (95% CI: -7.45 to -0.97, P = 0.01). The addition of vaginal ISMN to misoprostol, compared to vaginal misoprostol alone, increased the odds of a completed abortion by 3.76 times. (95% CI: 1.08 to 13.15, P = 0.04).ConclusionThe findings of this study can offer valuable insights aimed at enhancing counseling and support for non-surgical methods of medication abortion within professional settings. Moreover, it improves the effectiveness of clinical treatment and reduces the occurrence of unnecessary surgical interventions in the abortion management protocol.

Critical analysis of misoprostol versus mifepristone with misoprostol in medical termination of pregnancy

Termination of pregnancy by any method before the viable period is called abortion. Medical methods can avoid complications of surgical method of abortion which has many disadvantages like perforation of uterus, hemorrhage, sepsis and increased morbidity. The WHO has approved mifepristone and misoprostol combination for medical abortion. 1. To compare the efficacy of Misoprostol versus combination of mifepristone with Misoprostol. 2. To asses the side effects of Misoprostol and combinationion of Mifepristone and Misoprostol.It is prospective observational study consisting of two groups with each 61 subjects of MTP patients. Group A (Misoprostol alone): Receive tablet misoprostol 600 microgram start placed per vaginally followed by 400 microgram misoprostol tablet placed per vaginally every 4 hourly up to maximum five doses. In case of first trimester cases 800 microgram tablet misoprostol placed per vaginally followed by 400 microgram misoprostol tablet placed per vaginally every 4 hourly up to maximum four doses. Group B (Mifepristone and Misoprostol): Receive tablet mifepristone 200mg orally on empty stomach. After 24 hours will receive tablet misoprostol as mentioned in group A. Misoprostol alone has success rate of 78.69% whereas combination with Mifepristone success was 93.44%. The mean Induction - abortion interval in misoprostol alone group was 11.803 hours and with mifepristone combination it was B5.623 hours. Medical termination of pregnancy by sequential administration of mifepristone with misoprostol has less induction abortion interval compared to using misoprostol alone. This combination has more success rate and also has lesser side effects.

Comparison of Two Different Intervals of Misoprostol Administration in Second Trimester Abortions.

Comparison of two different intervals of misoprostol administration after mifepristone in second trimester abortions. This 12-month prospective study was conducted at a tertiary care facility. Only pregnancies with congenital deformity or sterilisation failure were included in the study's recruitment of 100 women who visited the hospital for a second trimester abortion between 12 and 20 weeks; cases with scarred uteri were omitted. In a systematic random selection of 50 women in each group, the administration of 200 mg of mifepristone orally was followed by two distinct intervals of intravaginal misoprostol administration at 24- and 48-hour intervals. After 24 hours, group A women received intravaginal 400 mcg misoprostol three hourly, up to a maximum of five doses, while group B received the same doses after 48 hours. Induction abortion interval noted on various parameters and paired t test and chi square test applied. The mean IAI following misoprostol administration was 8.14 2±.03 hours in group A and 7.71 ±2.56 hours in group B. This difference was statistically insignificant. Average misoprostol doses for group A were 1.68±0.71 and for the group, B were 1.68±0.84; both doses were found to be statistically insignificant when used to induce abortion. All women aborted successfully in each group. There was no significant difference in side effects in both groups. Based on the results it was observed that shorter interval between mifepristone and misoprostol i.e., 24 hours can be chosen to decrease the hospital stay as there was no significant difference was seen after intravaginal misoprostol in terms of induction abortion interval, number of doses and side effects.

A prospective comparative study of 3 different regimens involving mifepristone and oral/ vaginalmisoprostol combination in medical termination of pregnancy at less than 9 weeks gestation

Background and Objectives: Medical abortion with a combination of mifepristone and a prostaglandin analogue (Misoprostol) is a well-established and adequately studied as an alternative to surgical abortion in early pregnancy for many years now but still no consensus has been reached regarding superiority of one route and dosage. This study is an attempt to compare efficacy in terms of rate of complete abortion, side effects and women’s perceptions of three mifepristone/misoprostol regimens and to study the effect of continued oral misoprostol for one week in medical termination of pregnancies of less than nine weeks gestation. Materials and Methods: Abortion seeking women of less than nine weeks period of gestation were included in this study and were divided into three groups: GROUP I also referred as O+O group, GROUP II the V+O group, and GROUP III referred as V ONLY group. This is an outpatient regimen requiring minimum three visits on day 1, 3 and 15. Initially, tablet mifepristone 200 mg was administered orally in all three groups on day 1. This was followed on day 3 by oral misoprostol 0.8 mg in group I and vaginal 0.8 mg misoprostol in group II & III. It was placebo controlled. Patients were sent home after 4 hour observation period. The oral group and one of the vaginal groups i.e. group I and II continued 0.4 mg of oral misoprostol twice daily for 7 days. Final assessment was done on day 15. Results: All three groups were comparable in terms of rates of complete abortion: Group I 93.06%; II 94.44% and group III 93.06%. Incomplete abortion occurred in 9.72% women in group I, 5.52% in group II and 6.94% women in group III. 73.61 % of women in group I, 76.38% women in group II and 77.76% in group III suffered from lower abdominal pain & cramping. 100% women cited oral route as their preferred route and overall 199 (92%) women were satisfied with treatment, 12(5.6%) were unsure and 5(2.4%) were dissatisfied. For future purposes 100 % women cited medical abortion to be their preferred mode compared to surgical one Conclusion: In light of previous studies establishing superiority of vaginal route over oral, continuation of misoprostol for 7 days possibly improved the efficacy for oral misoprostol group(group I) but it did not seem to further increase the efficacy for vaginal Misoprostol (group II) as all three groups were of comparable efficacy. Additional misoprostol did not shorten the duration of bleeding or induction abortion interval compared to group not continuing additional one week misoprostol. Successful abortion was associated more with lower gestational age,multigravidas and multiparas.Oral group had higher frequency of nausea, vomiting and diarrhea than vaginal administration. Statistically insignificant but still lower number of women were satisfied in the end with the treatment in the oral group compared to vaginal groups despite oral mode being the preferred mode. Additional larger studies are required on initial oral misoprostol administration and its continuation to establish its equivalence to vaginal route.

Corticosteroids and Duration of Medical Induction for Mid-Trimester Abortion

Background: Abortion is defined as the termination of pregnancy (TOP) before fetal viability, regardless of the method used. It has been shown that using misoprostol alone to medically end an abortion in the second trimester is successful. Aim and objectives: The purpose of the research was to assess the impact of intramuscular dexamethasone on the length of induced second trimester abortion in pregnant women between the ages of 16 and 24 weeks of gestation. Patient and methods: From January 2020 to May 2021, this research was conducted in the Obstetrics and Gynecology Department of Qena General Hospital and Qus Central Hospital. A total of 200 pregnant women consented to participate in this research and they were selected from the emergency wards. All women considered for this study were in the second trimester at gestational age from 16 to 24weeks, who were planned for medical induction of abortion. These inclusion and exclusion criteria were used to recruit women. Result: most of cases (94.5%) and (98%) at two groups respectively were Satisfied, there was statistical substantial variation between groups as regard to satisfaction. Conclusion: the administration of dexamethasone intra- muscularly (12 mg every 24h) with the medical induction of abortion by misoprostol (200 mcg intra vaginally every 4hr) appears to be effective as regard shortening the induction-abortion interval (duration between the initiation of induction and expulsion of fetus), reducing the overall misoprostol dosage and the duration of the hospitalization. Its cost effective and availability are apparent benefits

A comparative study of second trimester termination of pregnancy with mifepristone and misoprostol vs misoprostol alone in 50 cases

The aim: To study the efficacy and safety of combined mifepristone and misoprostol used in second-trimester abortion(≥ 12 and ≤ 20 weeks) in comparison with only vaginal misoprostol.
 Materials and methods: This study was a prospective comparative randomised clinical study in women attending hospitals in need of a second-trimester abortion, i.e., 12–20 weeks of pregnancy were taken up and divided as Group A – 50 women with mifeprisptone and misoprostol, Group B – 50 women with misoprostol alone Results were analysed according to age, parity, gestational age, average dose of misoprostol required for complete abortion, Induction abortion interval, completeness of abortion, side effects and mean days of hospital stay.
 Results: Demographic details are comparable and insignificant in the comparison. The average dose of misoprostol (mcg) required for the completeness of abortion in group A is 596±28.28 mcg, and in group B, it is 1148±160.66 mcg (p<0.001) which is statistically significant. In the present study, the induction abortion interval is significantly less in group A compared to group B, with p<0.001. In addition, 10 out of 50 patients in group A aborted within 7 hours, whereas none in group B. Mean duration of hospital stay in group A is 24 hours. In group B, it is 34.82 hours which is statistically significant with a p-value of <0.001. 12 patients in group A and 26 in group B had side effects like nausea, vomiting, fever, headache and diarrhoea. 8 % of group A and 20 % of group B had a fever. These patients were treated with antipyretics. 6 % in group A and 14 % in group B had nausea and vomiting and were treated with antiemetics. 4 % in group A and 8 % in group B had diarrhoea and were treated with antimotility drugs. 6 % in group A and 10 % in group B had a headache; these patients were treated with NSAIDs.
 Conclusions: The combination of mifepristone and misoprostol is a highly effective and safe method for second-trimester termination of pregnancy. The amount of misoprostol needed to accomplish the abortion, and the severity of the adverse effects are lower in the mifepristone-primed group than in the misoprostol-alone group. Since there are fewer difficulties, this approach can be employed in hospitals with high patient density.

Vaginal misoprostol vs intramuscular carboprost in first trimester abortion

Background: A number of conditions demands first trimester abortions including medical and social causes. This study was mainly undertaken in order to compare the oral misoprostol with the intramuscular carboprost for cervical ripening in suction evacuation for medical termination of pregnancy up to 12 weeks of gestation. Material and methods: A randomized controlled trial was undertaken to determine the safety and efficacy of misoprostol over carboprost in first trimester abortions for cervical ripening. A total 120 pregnant women were randomized in to two equal groups where one group received oral misoprostol and another group received intramuscular carboprost. Two groups were studied and compared for the baseline characteristics, induction abortion interval, cervical dilation, blood loss and complications. Results: The mean age of misoprostol group was 26.2 years and carboprost group was 25.8 years. There was no statistically significant difference in marital status, gravidity, parity and gestational age in this study. Incomplete abortion was the common cause of abortion in both the groups. The induction abortion interval was 195.2 minutes in misoprostol group and 89.9 minutes in carboprost group. The mean cervical dilation was 8.35 minutes in misoprostol group and 9.31 minutes in carboprost group.

PROSPECTIVE STUDY ON EFFICACY OF MIFEPRISTONE AND MISOPROSTOL VS MISOPROSTOL ALONE IN 1ST TRIMESTER MTP.

Background: Unsafe abortions are the third leading cause of maternal mortality in India, close to 8 women die from unsafe abortion each day.(1) MMR in India is 103/100,000 live births (2017-2019),unsafe abortion account for 8% of the MMR. Both MTP act of 1971 and MTP amendment act 2021,which expanded the scope of the act and provides impetus for safer abortions, are progressive and encouraging. Each year 4.7-13.2%of maternal death attributed due to unsafe abortions (2). Unsafe abortion accounts for 13% of maternal deaths worldwide of which 19% occurs in South East Asia (3, 4).Medical methods of abortion has become preferable method with availability of prostaglandin analogue misoprostol and antiprogesterone mifepristone. There are many studies for both drugs and each study claims its schedule to be superior and safer than others.(5,6,7) AIM:This study mainly aims to compare efficacy of Mifepristone and Misoprostol combination versus Misoprostol alone in procuring complete abortions in first trimester by comparing their Need for Manual /electric vacuum aspiration. OBJECTIVES: Ÿ To compare efficacy in relation to gestational period. Ÿ To compare the Success rate of combination drugs with misoprostol alone. Ÿ To compare Induction to abortion time intervals. Ÿ To evaluate the Safety. This is a prospective observational study conducted at Government Victoria hospital, Department of Obstetrics & Gynaecology,Andhra Medical College,Visakhapatnam,and Andhra Pradesh Total no.of patients – 100 No.of women who were given Mifepristone & Misoprostol combination 50 No.of women received Misoprostol alone -50 Observations of this study 1.Maternal age was compared in both the groups.Majority of patients belongs to 21 to 25 years age group. 2.Majority are multigravida in both groups 3.Majority (64%) have opted for termination before 45days in mifepristone +misoprostol group,where as in misoprostol group 60% between 45-63 days 4.In both major indication for termination is unwanted pregnancy. 5. In mifepristone and misoprostol group 46 cases had complete abortion whereas 4 cases required electric vacuum aspiration 6.when comparing induction and abortion interval mifepristone and misoprostol group mean interval is 4.31 hours whereas misoprostol group is 16.18 hours and p value is <0.0001 showing induction abortion interval is less in mifepristone and misoprostol group 7.Unwanted symptoms were noted in both groups but significantly more with misoprostol only group but the p value was not significant. 8.There were no statistically significant major complications in both groups,none required blood transfusion 9. Although Mifepristone and Misoprostol combination is costly but more effective with higher rate of complete expulsion,should be preferred over Misoprostol alone where cost is not a restraining factor. CONCLUSION Based on findings from this study it can be concluded that 1. Mifepristone plus vaginal misoprostol combination group is associated with shorter induction abortion interval and 96% success rate when compared to misoprostol group alone. 2. Mifepristone plus vaginal misoprostol combination group is associated with complete abortion rate compared to misoprostol alone group.Vaginal misoprostol alone group is cost effective. 3. Routine use of Mifepristone-Misoprostol combination is an effective option for early MTP where cost is not a consideration and is ideal for home management. 4.Complication are less in Mifepristone-Misoprostol combination The only confounding factor is the cost involved which is about 20 times that of Misoprostol alone

COMPARATIVE STUDY OF SUBLINGUAL AND VAGINAL MISOPROSTOL TABLET IN MISSED ABORTION

Introduction: Management of missed abortion is matter of concern for obstetrician in terms of its methods and complications. Objectives: To compare efficacy, side effects and complications of sublingual and vaginal misoprostol tablet in missed abortion case of less than 20 weeks of gestation. Methods: Total 300 cases were taken, and out of those 300 cases, group A (150cases) included cases who were given sublingual misoprostol tablet, and group B (150 cases) included cases who were given vaginally misoprostol tablet. Observation: Mean gestational age is 7.9 and 8 weeks in Group A and Group B respectively. P value is 0.94. (Not significant). Mean induction abortion interval is 11.6 hours and 12.9 hours in Group A and Group B respectively i.e., the induction abortion interval is slightly short in the Group A. P value is 0.9, means the difference is not statistically significant. Mean dose of misoprostol was 1004.6 microgm and 1080 microgm for group A and group B respectively. P value is 0.029 is significant. Incidence of side effects (nausea, vomiting, unpleasant taste) was higher in group A than group B. P value is <0.05 is significant. Success rate was 86% in group A and 80% in group B. Conclusion: Sublingual and vaginal misoprostol tablet are both equally effective for medical management of missed abortion. Mean dose required for abortion is more in vaginal misoprostol but side-effects are more associated with sublingual misoprostol tablets.

THE STUDY OF EFFICACY OF SUBLINGUAL MISOPROSTOL IN TERMINATION OF EARLY PREGNANCY

Introduction: Nearly 20% of all confirmed pregnancies end in spontaneous abortion. Misoprostol’s use in early pregnancy failure is varied and dose and route are not well established. AIM: To study the efficacy of sublingual misoprostol in causing expulsion of products of conception in early pregnancy failure.
 Methods: Women with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were included in the study. Tablet Misoprostol 600 mcg was given six hourly sublingually for 3 doses. All observations were noted and analyzed. Results: Mean gestational age was 7.946+1.2 weeks. Mean induction abortion interval was 18.241+1.2 hours. Women with gestational age six to eight weeks had least mean induction-abortion interval time of 17.38+2.86. Mean dose required was 1560mcg. Efficacy of protocol was 92.85% in achieving complete abortion.
 Conclusion: The regime had 92.85% efficacy, acceptability (90%) and few side effects. Thus by using a lower dose and appropriate interval between two doses (six hours), the side effects were lessened with high efficacy.
 Keywords: Efficacy, Missed Abortion, Misoprostol.

Misoprostol only or in combination with intra cervical Foley’s catheter for termination of the second trimester demise pregnancy in patient with previous caesarean sections

Objective: Termination of second trimester pregnancy is unique obstetric contest due to its difficulty and risky especially if the condition is associated with prior Caesarean deliveries. Aim of the work: To compare the safety and efficacy of two regimens for termination of the second trimester pregnancy in ladies with scarred uterus by prior Caesarean deliveries either by using sublingual and vaginal misoprostol or sublingual misoprostol in a combination with intra cervical Foley’s catheter. Patients and methods: 163 pregnant ladies with second trimester demise pregnancy at14-24 gestational weeks in scarred uterus (≥ one cesarean sections) participated in this prospective randomized comparative study which was performed in obstetric emergency unit in Zagazig University Hospitals, Egypt from June 2019 to May 2020. 140 patients only far-reached the trial through termination of the pregnancy via induction of abortion by sublingual and vaginal misoprostol Group 1 (GI) or Foley’s catheter with vaginal misoprostol Group 2 G (II). Whichever of those methods sustained for 48 hours else the fetus expulsed formerly .Outcomes was determined by comprehensive expulsion of fetus and placenta, Induction Abortion interval, Incidence of side effects, requirement for surgical intervention and complications" rate. Results: The demographic criteria of both groups revealed no significant difference (P-value>0.05). The mean (SD) of Induction to abortion interval (hours) in GI was significant longer than in G II (51.07±23.84, 45.20±31.28) respectively with (P- value 0.021). Total dose (μg) of misoprostol used in GI (1100.72±23.54) was higher than G II (645.35± 322) with p value 0.001. Admission-termination hospitalization (days) was significant longer in G I (4.11±1.02) than in G II (2.371±1.98) with P value 0.004. No significant difference as regard occurrence of adverse effects between both groups except the incidence of fever (17.1%) in G I and (5.7%) in G II with P value 0.01. Success rate in GI and G II were (80%, 95%) respectively with P-value 0.01. Incomplete expulsion was higher in GI (14.3%) in comparison with G II (4.2%) with P value 0.04. Incidence of haemorrhage was significant higher in G II than in GI P value 0.03. No significant differences between both groups as regard incidence of rupture uterus or occurrence of infection. Conclusion: Practice of inserting Foley’s catheter through cervix with misoprostol sublingually for termination of mid-trimester pregnancy in preceding uterine scar(s) is efficient, inexpensive and safe procedure.

Comparison of effectiveness of mifepristone misoprostol combination versus mifepristone Foley EAS (Extra-amniotic instillation of saline) combination in second trimester pregnancy termination

Second trimester medical abortion with mifepristone followed by misoprostol is effective and is associated with considerably shorter induction abortion interval. This study is a comparison of the effectiveness, safety profile and side effects of mifepristone- misoprostol and mifepristone-Foley’s EAS combinations in second trimester termination. The patients were grouped into two, first group received oral mifepristone 200 mg followed by vaginal misoprostol 800 mcg after 48 hours and then 400 mcg misoprostol vaginally 3 hourly up to a maximum of 4 further doses. Second group were induced with oral mifepristone 200 mg followed by extra amniotic saline instillation through a Foley’s catheter after 48 hours. The success rates were comparable between the two groups. But the 6 hour expulsion rates (36.4% Vs 0%) as well as 12 hour expulsion rates (56.36% Vs 3.6%)(p value=0.001) were significantly high in mifepristone – misoprostol group compared to mifepristone-Foley EAS group. Mean induction abortion interval was shorter in the first group (14.64hrs vs 18.4hrs)(p=0.026).But the incidence of complaints after administration of misoprostol was significantly high. 7 patients from Group 1 and 5 patients from Group 2 required surgical evacuation for retained placenta. The study revealed that mifepristone-Foley’s EAS induction can be used as an effective alternative to mifepristone-misoprostol combination with similar success rates and significantly reduced side effects but with significantly increased induction abortion interval. The results of this study can be extrapolated to cases where prostaglandins are contraindicated like in previous cesarean section cases. Keywords: Foley EAS, Misoprostol, Abortion, .

Therapeutic goals of terminaton and their efficacy in patients

: The purpose of this study is to provide the most safest, effective and cost-effective method with least or no complications in both first and second trimester.Induction abortion can be done either by medical or surgical methods. Medical method of abortion has advantages over surgical methods. The morbidity of the second trimester abortion continues to be more than the morbidity of first trimester termination. Causes for termination in Telangana region include oral contraceptive failure, Fetal anomalies, Lack of knowledge on termination procedure.: A Prospective observational study was conducted for 6 months, a total of 120 women in the first and second trimester of pregnancy who are eligible for termination following inclusion and exclusion criteria were included, the women attending at, Govt. maternity Hospital, Hanamkonda, Warangal. The main outcome in studied were, induction abortion interval, incidence of side-effects, success rates, pain pattern and bleeding pattern. For first trimester abortion mifepristone followed by misoprostol is found to be more effective, has shorter induction abortion interval and lesser side effects compared to misoprostol alone, D&C regimen. For second trimester abortion misoprostol is found to be more effective, has shorter induction abortion interval and lesser side effects compared to D&C, Foley’s catheter, Hysterotomy regimens. All methods used in the department showed efficacy and it does not effect on conceiving rate of women.

Comparison of successful abortion rate of mifepristone –Misoprostol combination with exrtaamniotic ethacridine lactate – misoprostol for termination of second trimester pregnancy

Abortion procedure is one of the commonly practiced procedure in practice thereby demanding a safe and effective method of abortion. Objective: Objective of study was to compare successful abortion rate and to compare the mean induction-abortion interval. Materials and Methods: The present was undertaken among the patients admitted to hospitals attached to J.J.M. Medical College; Bapuji hospital, women and children hospital and Chigateri general hospital Davangere during the study period from November 2016 - October 2017. Patients are randomized in two groups. Patients coming for second trimester abortion to above mentioned hospitals were assigned serial number from one to eighty and all patients with even number will be allocated to group 1 and all patients with odd number will be allocated in group 2, each group comprising 40 women each. Results: In the present study the mean induction abortion interval for group 1 was 19.56±1.82 hours and group 2 was 14.13±2.72 hours. This was statistically significant. Of the 40 cases in each group, 37 had complete abortion i.e. 92.5% 3 cases (7.5%) from both the groups had incomplete abortion and was supplemented with check curettage in both groups. Conclusion: Ethacridine lactate instilled extra­amniotically then by vaginal misoprostol is safer and acceptable, has short I-A interval than mifepristone – misoprostol for 2nd trimester termination of pregnancy. Keywords: Abortion rate, Induction-abortion interval Extraamniotic; Ethacridine lactate, Mifepristone, Second trimester abortion, Misoprostol.

Sublingual v/s vaginal misoprostol for second trimester termination of pregnancy: A comparative study

Misoprostol is a recommended drug for medical termination of pregnancy in both first and second trimester of pregnancy. Considering the various routes and different doses of administration of the drug available, the aim of the study was to compare the efficacy of misoprostol by sublingual and vaginal route for second trimester MTP.This prospective comparative study was conducted on seventy women who were randomly assigned into two groups. Thirty-five women received 400mcg of misoprostol at every 4 hours interval for a maximum of 5 doses by sublingual route and 35 women received the same dose by vaginal route. The efficacy of misoprostol (expulsion of products of conception) and induction-abortion interval were studied in the two groups. Instrumental evacuation was done for incomplete abortion. Oxytocin augmentation was given for cases who failed to abort after the last dose of misoprostol.Majority of women (71%) in both the groups required 3 to 4 doses of misoprostol for abortion. Misoprostol was effective in 74% women in the sublingual group and in 71% women in the vaginal group. The mean induction-abortion interval was 18.69 h and 18.43 h in sublingual and vaginal group respectively. No statistically significant difference was found between the two groups in terms of efficacy of misoprostol in achieving complete abortion.Both sublingual and vaginal routes of administration of misoprostol appear to be safe and equally effective for second trimester MTP.

Effect of Intravenous Dexamethasone on Induction of Mid-Trimesteric Abortion Randomized Controlled Trial

Background: Medical abortion, the termination of pregnancy through the use of a drug or a combination of drugs, has the potential to reduce complications and to expand access to abortion provided not only by specially trained clinicians but also by other health care providers who may or may not have training in surgical methods of abortion.Aim: This study aimed to elicit the safety and efficacy of intravenous injection of dexamethasone with vaginal misoprostol for shortening the induction abortion interval in the second trimester of pregnancy.Materials and Methods: This study was conducted in Ain-Shams Maternity University Hospital where 140 pregnant females were included for induction of second trimester abortion from June 2018 till December 2019.Results: There was significant statistical difference between the two groups as regard induction-expulsion interval (P >0.001) and length of hospital stay (P > 0.001), mean induction-expulsion interval in dexamethasone group was 10.5 hours; while in the control group was 17.5 hours, the mean length hospital stay was 16 hours in the dexamethasone group while it was 23 hours in the control group. There was significant statistical difference between the two groups as regard dose of misoprostol used (P>0.001), mean dose of misoprostol in the dexamethasone group was 800 mcg while it was 1600 mcg in the control group.Conclusion: It was suggested that use of intravenous injection of dexamethasone with misoprostol was effective in shortening the induction- abortion interval, the length of hospital stay and reducing the misoprostol doses

Safety and efficacy of misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks

Aims: To compare the safety and efficacy of Misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks.
 Methods: This is comparative study where Misoprostol 800 μg was administered sublingually four hourly till expulsion of products or maximum of three doses in one group and 400 μg misoprostol followed by manual vacuum aspiration 4 hours later was done under local anaesthesia in another group from October 2019 to March 2020 at Government Medical College and Hospital, Aurangabad, Maharashtra. Unpaired t-test and Chi squared test were performed with alpha-error set at 0.05.
 Results: The success rate in Misoprostol group was 88 % and in the MVA group, it was 98%. Mean duration of hospital stay in Misoprostol group was 2.46±1.18 days and in MVA group was 1.55 ± 1.52 days (p= 0.3). Mean induction abortion interval in Misoprostol group was 8.125±3.29 and 4.46±0.44 hours in MVA group (p=0.000). One woman from MVA group had perforation of uterus which could be attributed to previous LSCS with tight os.
 Conclusion: Single dose of Misoprostol followed by manual vacuum aspiration is better than the multiple dosage of Misoprostol for the treatment of first trimester missed abortion in terms of duration of treatment but not for the individual success rate. Hospital stay is similar.
 Keywords: manual vaccum aspiration, misoprostol, missed abortion

EFFICACY OF VAGINAL MISOPROSTOL IN FIRST AND SECOND TRIMESTER MISSED ABORTIONS

Objectives : Missed abortion is a common problem in obstetrics and gynecology. This study aims to study the efficacy of vaginal misoprostol in termination of first and second trimester missed abortions. Materials and Methods: Fifty women with missed abortions were included in the study, out of which 30 patients were in first trimester comprised of group I, other 20 patients in second trimester were designated as group II. After getting informed consent, 200 mcg misoprostol was kept in posterior fornix, every 4 hours 200 mcg was repeated until the patient expelled. Parameters analyzed were induction abortion interval, change in PCV, success rate. Results : In the present study out of the 70% (21/30) cases belonging to group I – the mean induction abortion interval was between 12-16 hrs. In group II category in (19/20) 95% of women , the mean induction abortion interval was less than 8 hrs. One patient failed to expel even after maximum of 4 dose and hence underwent surgical termination giving a failure rate of 5%, ‘P’ value is also significant. Conclusion : Vaginal Prostoglandin E analogue (misoprostol) is a very safe and effective method to be used in missed abortion. It was more effective and successful in II trimester compared to I trimester. The failure rate was very minimum and complications were almost nil with very few side effects

Role of adding Isosorbide-5-Mononitrate to misoprostol in Induction of the second trimesteric abortion, a randomized controlled trial

Objective: To compare the therapeutic efficacy of prostaglandins when they used alone versus a combination therapy of prostaglandins and a nitric oxide (NO) donor as isosorbide-5-mononitrate to induce cervical ripening and effacement for induction of the second trimester missed abortion and occurrence of complete abortion. Methods: A Randomized clinical trial study in which 160 Second trimester (13-26weeks) missed abortion pregnant women admitted for medical induction of abortion, were randomly divided into two group (80 patients in each). One group received only vaginal Misoprostol and the other group received combined vaginal Misoprostol with Isosorbide-5-mononitrate. To determine the efficacy in form of " induction abortion interval ": the duration interval between the beginning of the induction and the complete expulsion of the abortus and also the number of the doses of misoprostol needed to complete expulsion and also the adverse events that increased or newly discovered when prostaglandins and a nitric oxide donor used together such as severe bleeding, headache, abdominal pain, pelvic pain, sever hypotension, backache, fever, nausea and vomiting. Results: It is proved in the study that combination between misoprostol and isosorbide mononitrate gives better results regarding cervical consistency improvement, cervical dilatation, effacement, the whole induction time and the number of misoprostol doses needed to complete expulsion when compared to misoprostol alone and also fewer side effects as abdominal pain. Conclusion: Misoprostol is a good cervical ripening agent when used alone but we can get a benefit from combining both misoprostol and NO donor (isosorbide-5- mononitrate) making a synergistic action with fewer side effects.

Study of the Efficacy and Success Rate of Single Dose Oral Mifepristone and Vaginal Misoprostol v/s Vaginal Misoprostol alone for Second Trimester Termination of Pregnancy

Background: Second trimester abortions constitute 10-15% of all induced abortions and are considered to be less safe than first trimester abortions. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Aim: To compare the efficacy and the success rate of single dose oral mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second trimester termination of pregnancy. Materials and Methods: A comparative study and was conducted in the Department of Obstetrics and Gynecology in a Tertiary Health Care Hospital. The study was carried out by dividing women into two groups (72 each). Group A received 200mg of oral Tablet Mifepristone and 400 of vaginal misoprostol (48 hours later) which was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Group B received 400 of vaginal misoprostol directly and the dose was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Results: The success rate in Group A was 98.6%, whereas in Group B was 84.7%. The mean induction abortion interval in Group A was lesser (6.2 hours) as compared to Group B (10.8 hours) (p value <0.00001). The mean dose of misoprostol in Group A was 613.88mcg compared to the Group B 1591.66mcg (p value <0.00001). Conclusion: Pretreatment with mifepristone significantly reduces the induction abortion interval (I-A-I) and the misoprostol dose.