Induction-abortion Interval Research Articles

Mifepristone and Misoprostol Vs Misoprostol Alone in Second Trimester Termination of Pregnancy

During the last decade, medical methods for second trimester abortion have considerably improved and become safe and more accessible. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. But where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective. The objective of this study is to compare the efficacy of mifepristone with misoprostol and misoprostol alone for second trimester termination of pregnancy. It is a comparative study conducted on 60 patients from 13 to 18 weeks of gestation admitted for second trimester termination on legal indications. Mean induction abortion interval was comparable in both the groups. Of the 30 cases in each group, nine cases in each Group A and six cases in Group B had incomplete/failed expulsion. Among these 15 cases, only nine required check curettage for complete evacuation while others received oxytocics only for completion. The distribution of these cases was also comparable in both the groups. Only one patient in Group B had complete failure of expulsion and underwent surgical evacuation. However, the difference in dosage of misoprostol required for complete expulsion and incidence of side effects were significantly higher in the group B. Mifepristone and misoprostol combined together is now an established, highly effective and safe method for medical method of second trimester termination. However, when mifepristone is not available or affordable, misoprostol alone can also be used effectively, although a higher total dose is needed and side effects are higher than with the combined regimen.

Prospective Comparative Study of Oral Versus Vaginal Misoprostol for Second-Trimester Termination of Pregnancy.

Various medical methods for second-trimester medical termination of pregnancy (MTP) exist. Misoprostol alone has been used with myriad variations in route and dosage. Comparison between oral and vaginal routes of misoprostol forms the basis of this study. This was a prospective comparative study of misoprostol for second-trimester (14-20weeks) MTP, comparing oral versus vaginal routes. Sixty patients were randomly allotted to two groups; 30 received oral misoprostol 400µg 4h up to a maximum of five doses (2000µg), and 30 received vaginal misoprostol in the same dose and duration. In both groups, oxytocin infusion was started if abortion did not occur. Efficacy of oral versus vaginal misoprostol, induction-abortion interval (AI) and need for surgical intervention were analyzed. Both groups were well matched in terms of age, parity, previous LSCS, mean gestational age and indication for MTP. Overall mean induction-abortion interval was 19.59h (21.66 vs. 18.57h, oral vs. vaginal, respectively), with vaginal group taking lesser time (p 0.09). Sixty percentage in oral group required five doses, while 70% in vaginal group required 3-4 doses of misoprostol (p 0.010). 23.7 versus 6.7% in oral versus vaginal group required check curettage (p 0.038). There were no major complications, and there was only one failure in oral group. Though both oral and vaginal misoprostol are safe, vaginal route appears to be more efficacious for second-trimester MTP.

Comparison of Efficacy and Side Effects of Different Administration Routes of Misoprostol (Oral, Vaginal, and Sublingual) for Second-Trimester Abortion

Background The current study was designed to compare the effectiveness and side effects of oral, vaginal, and sublingual misoprostol in termination of second-trimester pregnancy. Materials and Methods: In this clinical trial (2014 to 2015), 85 pregnant women in the second trimester of pregnancy were included in Imam Reza hospital, Kermanshah, Iran. They were randomly divided into three groups as follows: oral misoprostol (n=28), vaginal misoprostol (n=30), and sublingual misoprostol (n=27). Misoprostol was administered orally (oral misoprostol group), vaginally (vaginal misoprostol group), or sublingually (sublingual misoprostol group). The dosage was similar in three groups (400 micrograms every four hours up to a maximum of five doses). The mothers were followed and induction-abortion interval time, number of dosages required, and misoprostol side effects were documented. The data were analyzed by SPSS version 20.0 software. Results: The mean (standard deviation) age of the sample was 28.27 (±4.97) years. Mean gestational age was 16.58 weeks and mean gravidity was 1.99. Mean number of administered misoprostol doses was 3.89 and most patients responded to three doses of misoprostol. Mean abortion time was 20.08 hours. No side effects were reported in 60% of the subjects. Others experienced side effects such as nausea (16.5%), fever and chills (12.9%), and vaginal bleeding (9.4%). The abortion duration in 35.3% of the subjects was within 18 hours. The most successful method was oral route (82.1%), followed by vaginal route (80%), and sublingual route (70.4%). The abortion duration was statistically different between the three groups (P= 0.001). Conclusion: Finding of the presented study showed that misoprostol is a safe medication to be used for medical abortion in the second trimester of pregnancy. Oral route of administration was superior to vaginal or rectal use of misoprostol.

Evaluation of mid-trimester abortion: A way forward

Background: Need of second trimester abortion has been increasing because of the wide scale introduction of prenatal screening programs detecting women whose pregnancies are complicated by serious fetal abnormalities. Lack of accredited centers and skills required for mid trimester abortion have made this procedure inaccessible to rural population of Nepal.Objectives: This study was conducted to assess correlation of uterine size measured by clinical examination and that assessed by ultrasound, foetal foot length measurement post abortion, dose of misoprostol required and induction delivery interval in medical induction and dilatation and evacuation cases.Methods: This is a hospital based cross-sectional study conducted from April 2011 to July 2012. gestational age was assessed by clinical palpation and ultrasound in women undergoing mid trimester abortion. Standard protocol was followed for medical and surgical abortion. Fetal foot length was measured post abortion. Mean dose of misoprostol and induction abortion interval were noted.Results: Mean age of the patients in dilatation and evacuation group and medical induction group were similar 28 (SD= 6.2) and 27 (SD=7) respectively. The mean dose of misoprostol requiredwas 400 micrograms for dilatation and evacuation and 600 micrograms for medical induction. There was moderate degree of relationship between foot length measurement of the fetus and USG findings, high degree of positive relationship between size of the uterus and fetal foot length measurement.Conclusion: Clinical estimation of period of gestation by size of the uterus correlated well with ultrasonography findings and fetal foot length measurement post abortion. The mid trimester service can thereforebe provided in the centers where sophisticated appliances like ultrasonography is not available.

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Expectant therapy versus curettage for retained products of conception after second trimester termination of pregnancy: analysis of outcomes and complications

To evaluate the prognosis and complications of expectant therapy and curettage for retained product of conception (RPOC) after second trimester termination of pregnancy (TOP). A total of 270 patients with RPOC following second trimester TOP in Nanfang Hospital between January, 2014 and December, 2015 were included in this study. The duration of vaginal bleeding time and menstruation recovery interval were compared between patients receiving expectant therapy and curettage for RPOC, and binary logistic regression was used to assess the risk factors for complications in bivariate and multivariate analyses. The duration of vaginal bleeding time was significantly longer in expectant therapy group than in curettage group (P=0.005), while the menstruation recovery interval did not differ significantly between the two groups. The incidence of vaginal bleeding time for over 42 days was significantly higher in curettage group than in expectant therapy group (P=0.040), and the incidence of a menstruation recovery interval beyond 60 days was comparable between them. The incidence of complications was significantly higher in curettage group than in expectant therapy group either with adjustment of age, gravidity, parity, history of uterine surgery status, gestational age, type of indications, regimens for TOP and induction-abortion interval (OR=18.26 [95% CI: 3.57-93.42], P<0.001) or without adjustment (OR=10.60, [95% CI: 2.36-47.66], P=0.002). Expectant therapy and curettage for RPOC after second trimester TOP have comparable prognosis, but curettage is associated with a significantly higher rate of complications.

Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy

In this prospective randomized parallel group study, subjects with a pregnancy of less than 63 d were randomized to receive either (i) 200 mg oral mifepristone plus 400 μg misoprostol per vaginally concurrently (group A); (ii) or the administration of misoprostol after 48 h (group B). Transvaginal sonography was performed on the 14th day of misoprostol administration to confirm complete abortion. The primary outcome was to compare the rates of complete abortion in two groups. Secondary outcomes were to compare induction abortion interval, side effects and compliance. A total of 200 subjects included in the study were randomized into groups A and B (100 each). Both the groups were comparable for age, parity, gestational age and history of previous abortion. The complete expulsion rate in group A was 96% (95% confidence interval (CI) 95.1–98.2%) and group B was 95% (95% CI 93.0–96.8%) (p > 0.100). A gestational age of more than 56 d was found to predict failure of treatment in both groups. The adverse effect profile in the two groups was the same. Efficacy of concurrent mifepristone and misoprostol in combination is similar to that when misoprostol is given 48 h later (ctri.nic.in CTRI/2010/091/001422).

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BACKGROUND: Abortion is the termination of pregnancy by the removal or expulsion of the foetus or embryo from the uterus before the age of viability. Second trimester pregnancy termination has been reported to be associated with 3-5 times increased morbidity and mortality. Medical methods of induced abortions in the midtrimester has shown development and proven to be safe and accessible. The ideal agent for cervical softening should be clinically effective, it should have a low side effect profile and it should be easy to administer. The cervical ripening effects of nitric oxide donors and of prostaglandin might be additive. So if a small dose of nitric oxide donor is given in combination with a small dose of prostaglandin it will cause effective cervical ripening and reduce the side effects associated with larger doses of either agent used alone. OBJECTIVES: Our aim is to compare the traditional use of vaginal misoprostol versus misoprostol and Isosorbide mononitrate in medical management of second trimester abortions. The comparison involves aspects of efficacy which are evaluated by means of the difference in success rate of inducing abortion, induction to expulsion period, amount of misoprostol used rate of manual/ surgical removal of the placenta and the rate of post abortive haemorrhage and also comparison of safety profile of both drugs. METHODOLOGY: The study was conducted in the labour ward of Institute of Obstetrics and Gynaecology, Egmore (IOG) in the period from October 2014- July 2015. The patients included in the study were 100 pregnant women from 12 to 20 weeks of gestational age undergoing induced abortion. Women were divided into two groups: Group 1 – Combination of 400 mcg of misoprostol and 40 mg of ISMN placed intravaginally. Repeat doses included combination of 400 mcg of misoprostol and 20 mg ISMN every 4 hours for maximum 4 doses..Group 2 - 400 mcg of misoprostol placed intravaginally every 4 hours for maximum 4 doses. RESULTS: It was observed that in Group A. Mean induction abortion interval was significantly less (7 hrs 36 mins ) in Group A, compared with group B(9 hrs 55 min). The mean dose of misoprostol decreased in group A (848 mcg ) when compared with group B (936 mcg) In Group A 76% of the patients aborted with two doses where as in Group B 62 % of the patients aborted with two doses. It is interpreted that on adding ISMN the number of complete abortion rates are higher. There was no failure of abortion.. The side effects such as pain abdomen and fever were less in Group A(38 %) when compared to Group B(78%). Side effects specific to ISMN was very less and reported only in 2 % of study groups. There was no reported evidence of postpartum haemorrhage or increased blood loss. The drug ISMN, was also economical and cost effective. CONCLUSION : Vaginally administered ISMN seems to be safe and well tolerated and provides a merit in some situations, where uterine contractions are unwanted before cervical ripening. Combination therapy of prostaglandins with nitrates might therefore be an ideal method for second trimester termination of pregnancy.

“Comparative Study of 'Intravaginal Misoprostol Alone' Versus 'Extra Amniotic Ethacridine Lactate Instillation Followed by Intravaginal Misoprostol' for Mid Trimester (13-20 Weeks) Termination of Pregnancy”

Objective(s): To compare the efficacy, safety and induction-abortion interval of alone versus Ethacridine lactate 0.1% followed by intravaginal Misoprostol for mid-trimester (13-20 weeks) abortion. Method(s): 60 women undergoing mid-trimester abortion were recruited for comperative study.They were devided into 2 groups. Group-A (30 cases) received intravaginal tab 600 g followed by 400 g 8 hourly and Group-B (30 cases) received extra-amniotic Ethacridine lactate 0.1% followed 6 hours later by intravaginal 400 g 3 hourly until abortion occurred or upto 48 hours. Result(s): Mean induction-abortion interval in Group-A was 24.9  10.83 hours whereas 18.3  6.1 hours in Group-B. In Group-A complete abortion occurred in 70% cases and in Group-B 83.33%. Failure rate in GroupA was 6.67% while none in Group-B. Efficacy of abortion in Group-A was 93.33% while 100% in Group-B. Side effects and complications were more common in Group-A than Group-B. Conclusion(s) : Ethacridine-lactate followed by is definitely a better and effective method for midtrimester abortion rather than using alone. Keyword(s): Intravaginal Misoprostol, Extra-amniotic Ethacridine lactate, mid-trimester abortion

A Comparative Study of Misoprostol Only and Mifepristone Plus Misoprostol in Second Trimester Termination of Pregnancy.

To compare the effectiveness, success rate and induction to abortion interval between administration of misoprostol only and mifepristone with misoprostol in second trimester abortions (14-20weeks) . The study was conducted by dividing women approaching for second trimester termination, into two groups each consisting of 100 women. Group-I received only misoprostol; 600mcg initial vaginal insertion followed by 400mcg sublingually every 3h until termination. Women in Group-II received mifepristone 200mg and after 24h started with 600mcg misoprostol, per vaginal followed by 400mcg sublingually till abortion was completed, up to a maximum of five doses in both groups. The success rate in Group-I was 89%, whereas in Group-II it was 96%. The mean induction abortion interval in Group-I was 10.67±3.96h compared to Group-II which was significantly less 6.19±2.70h (p value<0.01). The mean dose of misoprostol in Group-I was 1610±511.18mcg and in Group-II, it was lesser 1046±392.71mcg (p value<0.01). There was significant difference in the mean blood loss also, 97.20±36.35ml in Group-I and 52.55±27.96ml in Group-II. Also among the individual groups multigravidae and lower gestational age (<17weeks), women had lesser IAI as well as lesser misoprostol dose was required. Pretreatment with mifepristone significantly reduces the induction abortion interval and the misoprostol dose along with minimal blood loss.

Mifegest and Misoprostol Combination Vs Misoprostol Alone for Termination of Second Trimester of Pregnancy

Objective: Over the last few years, induced abortions have gained more popularity because of safe techniques and medications available. Induced abortion means will ful termination of pregnancy before the period of viability. Medical abortion in the second trimester with misoprostol alone has been shown to be affective, although in comparison with the combination of mifepristone and misoprostol, misoprostol-only protocols have required higher doses, side effects are more common and the time to complete the abortion is longer. Methods: Total of 50 eligible women were enrolled for this study and were divided in two groups of 25 each of the case group and control group. This study was conducted in Obstetrics and gynaecology department of Katihar Medical College and Hospital, Bihar. Women in the case group were given Tablet Mifepristone(200μg) orally followed by Tablet Misoprostol (200μg) vaginally after 24 hours which may be repeated every 3 hrs till 5 doses. Women in control group were given Tablet Misoprostol (200μg) vaginally which may be repeated every 3 hrs till 5 doses. Results: The combination of mifepristone with misoprostol significantly reduces the abortion to induction interval and also have fewer side effects and complications and also reduces the dose of misoprostol. Where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective, although a higher total dose is needed and efficacy is lower than for the combined regimen. Therefore, whenever possible, the combined regimen should be used. Conclusion: Mifepristone followed by misoprostol was more effective and has a shorter Induction abortion interval and fewer side effects.

Second Trimester Medical Termination of Pregnancy with Combined Intracervical and Intravaginal Misoprostol: Comparative Analysis with Intravaginal Misoprostol—A Pilot Study

Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. In this IRB approved prospective study, twenty-two women (mean age 25.4±3.2 years, range 23-32 years; mean BMI 22.3±3.4kg/m(2); mean parity 2.1±1.4, average gestational age 17.9±2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. Mean induction-abortion interval for intravaginal group and combination group was comparable (t=7.9±1.8 and 6.5±3.5h, respectively). Three patients required surgical evacuation for incomplete abortion (n=2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6h was more in the intracervical-intravaginal group (36.3%). Patients with intracervical misoprostol complained of abdominal pain more often than those in other groups. Excessive bleeding and uterine rupture was not seen in any patient. Intracervical misoprostol is an effective method of medical treatment of second trimester pregnancy failure. Its short induction to abortion interval and acceptable safety profile makes induction via the cervical route acceptable for second trimester abortion.

Comparison of different regimes of misoprostol for the termination of early pregnancy failure

BackgroundNearly 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. The aim of this study was to compare the efficacy and the side effects of different regimes of misoprostol in causing expulsion of products of conception in early pregnancy failure. MethodWomen patients with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were divided into two, Group-A: tab. Misoprostol 800 mcg 6 hourly vaginally, upto 3 doses. Group-B tablet misoprostol 600 mcg 6 hourly, sublingually for 3 doses. All observations were noted and statistical analyzed. ResultsMean gestational age was 7.93 weeks. Mean induction abortion interval 18.183 h. Women patients with less than six weeks gestational age had least mean induction-abortion interval time, 15.75 ± 2.82 h in vaginal group but was highest in sublingual group 22 ± 2 h and 18.43 h in overall (P = 0.02). Though after 8 weeks, both routes were equally effective. Mean dose required in group-A was 20044 mcg and in group-B was 1564 mcg (P < 0.001). Efficacy of protocol was 88.89% in group-A and 92.85% in group-B. ConclusionBoth regimes had comparable efficacy, acceptability (90%) and side effects. In women patients less than six weeks period of gestation, the vaginal (800 mcg) route was distinctly superior, in women patients with 6–8 weeks the sublingual (600 mcg) route was more advantageous. The correct dose must be used for the route chosen. The route of administration should be decided in accordance with the preference of the patient and the clinical situation.

Comparative Study of Misoprostol in First and Second Trimester Abortions by Oral, Sublingual, and Vaginal Routes.

To identify an effective misoprostol-only regimen for termination of pregnancy between 12 and 20weeks of gestation, a prospective randomized study comparing sublingual, vaginal, and oral routes of administration of misoprostol was done. One hundred and fifty women (12-20weeks gestation) were randomly divided into three groups and given 400mcg misoprostol sublingually, vaginally, and orally every 4h up to a maximum of four doses. Primary outcome was the success rate at 24h. Secondary outcomes were failure rate, induction-abortion interval, and need for surgical intervention. Various side effects and patients' subjective assessment of comfort with the route of administration were also studied. Success rate at 24 h of sublingual (86%) group was higher compared to oral (64%) group (P=0.011). Complete abortion rate of sublingual (76%) group was higher than that of oral (48%) group (P=0.004). There was no significant difference in the failure rate and need for surgical intervention in the three groups. Induction-abortion interval in sublingual (9.8±3.6h) and vaginal (10.6±2.9h) groups was shorter than that in oral group (14.3±3.3). Diarrhea occurred significantly more in the oral group (28%) and sublingual (22%) compared to vaginal group (6%). Fever was significantly higher in vaginal (36%) than that in the oral group (12%). Oral route of administration was most comfortable. Sublingual route results in significantly higher abortion rate compared to oral route. Vaginal route has efficacy similar to sublingual route.

Misoprostol alone is effective for mid-trimester abortion

Background: The use of prostaglandins has substantially reduced the risk related with mid- trimester abortions. Misoprostol is available in many countries worldwide and is advantageous from the rest of prostaglandin as it is inexpensive, thermo and light stable. It is easy to use and is cheap. It can be used by different routes. Misoprostol has route dependent pharmaco-kinetic profile with best absorption following vaginal administration. Objective: To find efficacy and safety of intra-vaginal Misoprostol for mid- trimester abortion. Methods: A hospital based prospective study was carried out at Kathmandu Medical College Teaching Hospital from 1st Jan 2009 to 31st Dec 2010. A total of 50 cases of mid- trimester termination of pregnancy were analyzed in that period using intra-vaginal Misoprostol 400 microgram every 12 hours till a maximum of 48 hours. Results: The most common indication for undergoing mid trimester abortion was missed abortion (56%) followed by congenital abnormalities (22%). Most of the women were married (98%). The mean age of the women was 26.21± 5.8 years (Mean± SD). The mean gravidity was 2.63 ±1.76. Mean gestational was 19.60±3.937 weeks. The success was defined if Misoprostol was able to induce abortion. Complete abortion was defined if fetus and placenta was expelled completely and was not resorted further to either medical or surgical means. The success rate was 96%. The complete abortion rate was 86%. The mean induction abortion interval was 13.067±6.21 hours. Mean dose of misoprostol was 616.667±285.34 microgram. The most common side effect was fever with chills and rigor. Conclusion: Intra-vaginal misoprostol is safe, effective, cheap and easily available method for second trimester termination of pregnancy.DOI: http://dx.doi.org/10.3126/jkmc.v2i2.10627Journal of Kathmandu Medical College, Vol. 2, No. 2, Issue 4, Apr.-Jun., 2013, page: 59-62

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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. Mean dose required was 1564mcg.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.

Efficacy of a single dose vaginal misoprostol 800 microgram in termination of pregnancy in first trimester.

Background and objectives The use of single dose of Misoprostol vaginally at the primary care level where mifepristone is not available and Misoprostol being cost-effective has the potential to significantly increase the rural womens access to safe abortion. The aim of our study was to 1 to evaluate the efficacy of single dose 800 micrograms of vaginal Misoprostol in first trimester pregnancy termination 2 to critically evaluate the percentage of patients needing multiple doses and 3 to study and evaluate the failure rate complications and side effects with Misoprostol usage.Methods This study was carried out in the Department of Obstetrics and Gynaecology Government Rajaji Hospital Madurai during the period of February 2007 to July 2007. Fifty patients with intrauterine pregnancy up to 12 weeks were selected for the study. Under strict aseptic precautions 800 microgram of Misoprostol was kept in posterior fornix. Time of application of tablet was noted. Analysis was done in the following aspects 1 induction abortion interval. 2 efficacy of single dose percentage of patients requiring second dose and curettage.3to note side effects. Analysis was done with the help of computer using epidemiological information package EPI 2002.Results 74 of the patients had a complete expulsion with single dose and the mean induction abortion interval was 11.38 hours.Conclusion Single high dose of vaginal misoprostol was found to be effective in first trimester pregnancy termination with minimal side effects and shorter induction abortion interval and hospital stay.nbsp

Comparative Study of Sublingual and Vaginal Misoprostol in Second Trimester Induced Abortion

Background: To identify an effective misoprostol-only regime for the termination of second trimester pregnancy. Objectives: To compare the efficacy, safety and acceptability of sublingual and vaginal misoprostol for second trimester pregnancy termination. Methods: In a prospective randomized comparative study, over 138 pregnant women at 13 - 20 weeks (91 - 140 days) of gestation requiring medical abortion were randomly assigned to the sublingual or vaginal route for misoprostol administration with dose schedule of 400 mcg every 3 hours up to 5 doses within 24 hours. The course of misoprostol was repeated if the woman did not abort within 24 hours. Primary outcome was the efficacy of the treatment to terminate pregnancy completely at 24 and 48 hours. Secondary outcomes measured were induction-abortion interval, side effects, failure rate, and women’s perception to these treatments. Results: At 24 h, the complete abortion rate was 87.88% in the vaginal administration group and 79.41% in sublingual group (difference 8.5%, 95% CI: 3.8 to 13.2). No significant difference in the complete abortion rates was observed at 48 h(90.91% versus 88.24% difference: 2.7%, 95% CI: ?0.04 to 5.4) when vaginal and sublingual groups were compared. Mean induction-abortion interval in sublingual and vaginal groups was 12.28 h (95% CI of mean 11.019 - 13.541 h) and 13.11 h (95% CI of mean 12.0301 - 14.1899 h) respectively; p = 0.485. The rates of side effects were similar in both groups except for fever, which was more common in vaginal group. Significantly more women in the sublingual group preferred the route as compared to vaginal administration (RR 1.618. 95% CI: 1.277 - 2.050; p < 0.0001). Conclusion: Both sublingual and vaginal routes of misoprostol are equally effective in medical termination of pregnancy in second trimester but sublingual route was preferred by the women.

Pre-induction with Mifepristone for Second Trimester Termination of Pregnancy

To study the efficacy and safety of combining mifepristone before misoprostol use in second trimester to considerably reduce the induction-abortion interval with the lowest possible dose and adverse reaction. A prospective study was conducted which included 60 patients visiting the antenatal OPD for elective abortions between 13 and 20weeks of gestation as per the MTP act. They were randomly divided into two groups of 30 each-the study group received mifepristone 200mg orally before misoprostol, whereas the control group was induced with misoprostol alone. The results were analyzed. Statistical analysis of the study was done using χ(2) test. The induction-abortion interval was significantly shorter in the study group, thereby decreasing the side-effects of the drug as well as duration of hospital stay. This study, like many others, offers a reliable, safe, and cost-effective option by combining mifepristone before misoprostol to decrease the induction-abortion interval.

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OBJECTIVES : To know the efficacy and outcome of single dose of vaginal Misoprostol 800Ug in first trimester abortion. MATERIAL AND METHODS : This study was conducted over a period of 3 yrs at Adichunchanagiri institute of medical sciences. A total of 200 pregnant women upto 12 wks of gestation wanting termination of pregnancy was recruited in this study. The efficacy, outcome, and induction abortion interval was studied in these cases. RESULTS: In our case study 76% of the patients had complete abortion with single dose of 800ug Misoprostol and 4 % underwent check curettage due to profuse bleeding and retained products in uterus on USG. 20% of the cases needed second dose of 200ug of Misoprostol. The mean induction to abortion interval was 11.38hrs. 96% of the patients had complete abortion with medical method and only 4% underwent surgical curettage due to profuse bleeding after the single dose. The mean haemoglobin prior to induction was 9.76gm% and post expulsion was 9.59gm % respectively. No statistical difference was noted .The incidence of side effects like nausea, vomiting and diarrhoea was minimal and transitory. No major complications noted. CONCLUSION: Vaginal PGE 1 analogue is very safe and effective method of termination of first trimester pregnancy. Single high dose of vaginal Misoprostol 800ug is found to be cost -effective with minimal side effects, shorter Induction Abortion interval and a day care procedure with good success rate and can be adopted at community and primary health care units to reduce the maternal morbidity and mortality in developing countries like India due to unwanted pregnancies and unsafe abortions INTRODUCTION: The incidence of illegal abortion is twice as high as that of legal MTP'S.Many incidences have not been reported. Unwanted pregnancies due to failure to obtain appropriate contraceptive services and also unwillingness of the women result in both legal and illegal abortions. The complications of unsafe abortions can vary from chronic infection and infertility to septic shock syndrome ,multiorgan failure and death. Medical abortion is a safe,effective means of terminating pregnancy provided the