Induction-abortion Interval Research Articles

Second Trimester Abortion with Vaginal Misoprostol: Is There Any Advantage with Prior Mifepristone Priming? A Comparative Study

ABSTRACT Objective Second trimester medical termination of pregnancy (MTP) can be done by surgical or nonsurgical methods or by various combinations of the two. Every method has its advantages and disadvantages. An ideal method would be one which was safe, quick and 100% effective, inexpensive and without any immediate or late side-effects. However, in the absence of such, various methods in synergistic combinations have been tried to come close to an ideal method. The successes of medical method now appear to be useful in MTP even in second trimester of pregnancy. Our objective is to investigate the effectiveness of only vaginal misoprostol and compare with oral mifepristone plus vaginal misoprostol in second-trimester induction abortions (≥12 and ≤20 weeks). Methods The patients are selected after careful examination and necessary investigations were divided into group A (n = 62) which received 400 μg of vaginal misoprostol followed by 200 μg vaginal misoprostol 4 hourly till expulsion of fetus or a maximum dose of 2000 μg and group B (n = 60) which received 200 mg of oral mifepristone followed 48 hours later by vaginal misoprostol as in group A. Main outcomes measured were efficacy, blood loss, induction-abortion interval and complication. Results The present study showed that the both methods were effective in 2nd trimester MTP. Average blood loss was lesser in group B (131.66 ml) compared to group A (150 ml). Induction abortion interval was shorter in group B (6.62 hours) than in group A (12.19 hours). Ninty percent of group B and 80.7% of group A had no complications. Success rate was higher in group B. Conclusion Therefore, in our study, pretreatment mifepristone followed by misoprostol was found to be a very effective regimen for 2nd trimester abortion with lesser complications and higher efficacy. How to cite this article Mukhopadhyay P, Bag TS, Kyal A, Bhuniya A, Saha TK. Second Trimester Abortion with Vaginal Misoprostol: Is There Any Advantage with Prior Mifepristone Priming? A Comparative Study. J South Asian Feder Obst Gynae 2012;4(1):25-27.

Efficacy and safety of vaginal misoprostol in second trimester medical termination of pregnancy

Search for safe and effective method for second trimester termination of pregnancy continue from the time, when pregnancy termination was legalized through MTP act in India. With the knowledge about the potent uterotonic potential of misoprostol ,a synthetic prostaglandin analog , it is being (off label) used for second trimester termination of pregnancy with satisfactory results .Various dosage schedules and routes have been tried for this purpose .Present study was carried out to know the efficacy and safety of vaginal administration of misoprostol for second trimester of pregnancy .One hundred forty eight women seeking termination of pregnancy in second trimester, for various indications as per MTP act, over three years period at government approved MTP center, attached to Medical college hospital, were included in the study .Initial dose of 400 microgram of misoprostol by per vaginal route ,followed by 200 microgram was used for induction of abortion. Overall success rate was 92 percent and average induction abortion interval was 14 hours .There were no serious side effects or complications related to misoprostol .Average dose required for complete abortion was 1200 micrograms .Misoprostol was found to be safe and effective for second trimester medical termination of pregnancy.

Misoprostol Vs Mifepristone and Misoprostol in Second Trimester Termination of Pregnancy

The present study was conducted with the aim to assess and comparatively evaluate the safety and efficacy of misoprostol alone and mifepristone with misoprostol for second trimester termination of pregnancy. The study was conducted on 200 selected cases, divided in two groups of 100 cases each. In the study group mifepristone was given 200mg 12h before intravaginal insertion of 600μg of misoprostol followed by 400μg every 3h up to a maximum of 5 doses or until the abortion occurs, whichever occurs early. In the control group only misoprostol was inserted in the same dose regime. The results were analyzed. The success rate in both regimens was 100%. Mean induction abortion interval from the insertion of the first misoprostol tablet was significantly shorter in the mifepristone pretreated group 6.72±2.26h as compared to 12.93±3.4h in the misoprostol alone group (P<0.001). The mean blood loss was slightly higher in the control group. The mean dose of the misoprostol required was significantly less in the study group 1,186±291.64μg as against 1,736±320.20μg (P<0.001). The side effects observed in both the groups were similar mainly nausea vomiting, fever, abdominal cramps. Pretreatment with mifepristone 12h before intravaginal misoprostol significantly improves the induction abortion interval.

Second trimester abortion in women with and without previous uterine scar: Eleven years experience from a developing country

ABSTRACTObjectives To study the safety of second trimester abortion in women with previous uterine scar.Methods We screened the records of 518 women who underwent an abortion between 12 and 20 weeks’ gestation at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, from January 2000 to December 2010. Methods used for abortion were: (i) vaginal misoprostol with or without pre-treatment with mifepristone, and (ii) intracervical dinoprostol gel or vaginal misoprostol ± extra-amniotic saline ± oxytocin infusion. Seventeen women, aborted by means of a hysterotomy, were excluded from further analysis.Results Of the remaining 501 women, 44 had a uterine scar (Group 1) and 457 had none (Group 2). In Group 1, 40/44 (91%) and in Group 2, 452/457 (99%) women aborted successfully. The mean induction-abortion interval (IAI) was similar in the two groups (15.03 ± 10.69 hours and 12.52 ± 9.0 hours in Groups 1 and 2, respectively; p = 0.083). There were three uterine ruptures, 1/44 (2%) in group 1 and 2/457 (0.4%) in group 2 (p = 0.132, NS); all three women had received mifepristone followed by vaginal misoprostol.Conclusion In women with a scarred uterus, midtrimester abortion may be successfully achieved using any of the aforementioned regimens.

A randomized comparative study on vaginal administration of acetic acid-moistened versus dry misoprostol for mid-trimester pregnancy termination

Absorption and effectiveness of vaginally administered misoprostol tablets may vary according to the medium in which it is placed. This study was directed to compare the outcomes of vaginal administrations of acetic acid-moistened misoprostol tablets with those of dry tablets for induction of second-trimester abortion. A randomized comparative trial where 322 women at 13-20 weeks gestation, requiring medical abortion, were randomly assigned to vaginal administration of either acetic acid-moistened or dry misoprostol tablets with a dose schedule of 400 μg three-hourly, up to a maximum five doses over 24 h. The same doses were repeated for another 24 h in nonresponders. Primary outcome measure was complete abortion rate at 24 and 48 h, and the secondary outcome measures were induction-abortion interval, failure rate and side effects. A difference of 15% in success rates at 24 h was used to calculate the sample size required with a power of 0.8 at the 5% significance level. No statistically significant differences in the complete abortion rates were observed at 24 h (70.95 vs. 68.71%, P = 0.675) and at 48 h (86.49 vs. 84.35%, P = 0.604) when both groups were compared. The difference in mean induction-abortion interval was also statistically insignificant between the groups (12.5 ± 1.6 vs. 12.8 ± 1.5 h, P = 0.97). Other outcome measures were also comparable in both groups. Moistening misoprostol tablets with 5% acetic acid before vaginal application creates no difference in outcomes when compared with those after the vaginal application of dry tablets for the termination of second-trimester pregnancy.

Simultaneous administration of mifepristone and misoprostol for early termination of pregnancy: a randomized controlled trial

To compare the efficacy of different intervals of misoprostol administration (simultaneously vis-à-vis 24 h), after mifepristone, in women undergoing medical termination of pregnancy up to gestation of 49 days. Eighty eligible women with single intrauterine pregnancy of ≤ 7 weeks of gestation requesting abortion were randomized to receive either 200 mg of mifepristone orally and 400 μg of misoprostol vaginally simultaneously (Group 1) or at 24-h interval (Group 2).Women who had no bleeding after the drugs were offered a second dose of misoprostol 24 h after the first dose. All patients were followed up on day 14. Primary outcome measure was the complete abortion rate. Secondary outcome measures were the induction-abortion interval, adverse effects, especially bleeding, and treatment acceptability rate. Treatment was considered a failure if surgical intervention was needed for any indication. Complete abortion was achieved in 38 women [95%; 95% confidence interval (CI) 88%, 100%] in Group 1 and 39 women (97.50%; 95% CI 93%,100%) in Group 2 (p = 0.56). A second dose of misoprostol was needed in two patients in Group 1 and in only one patient in Group 2. The induction-abortion interval was 6.50 ± 1.48 h in Group 1 and 5.95 ± 1.81 h in Group 2 (p = 0.13). The difference in frequency of adverse effects in the two groups was statistically insignificant (p = 0.18). The treatment acceptability rate was 97.50% in Group 1 and 95% in Group 2 (p = 0.56). Simultaneous administration of mifepristone and 400 μg vaginal misoprostol is an effective alternative to standard regimens for medical abortion up to 49 days of gestation.

Comparison of sublingual versus vaginal misoprostol for second-trimester pregnancy termination: A meta-analysis

The development of safe and effective techniques for second-trimester abortion (associated or not with fetal death) has become a major clinical challenge. To compare the efficacy and safety of sublingual versus vaginal misoprostol for mid-trimester pregnancy termination. We conducted a meta-analysis of published randomised controlled trials that compared sublingual and vaginal routes. Primary outcome measures were complete abortion rate at 24 and 48 h and induction-abortion interval, and the secondary outcome measures were side effects and patients' preference for the route. Pooled risk ratios were calculated for categorical variables, and continuous variables were compared by means of weighted mean differences. Both routes' efficacy was similar following 24 h of treatment (pooled RR 1.04, 95% CI 0.93-1.7). Successful induction percentage after 24 h was significantly higher in nulliparous women with vaginal misoprostol (pooled RR 0.78; 95% CI 0.71-0.87). The efficacy after 48 h was significantly greater with vaginal misoprostol in the general population (pooled RR 0.96; 95% CI 0.93-0.99) and in nulliparous women (pooled RR 0.89; 95% CI 0.86-0.95). The sublingual route shortened the induction-fetal expulsion interval (WMD -4.54, 95% CI -8.03 to -1.05) and was the route preferred among women. No statistically significant differences between treatment groups were observed for placental retention or for any side effect except for fever, which was more common in the vaginal group. Sublingual and vaginal misoprostol are safe and effective for mid-trimester pregnancy termination. The differences obtained between both routes probably do not have clinical consequences.

Is mifepristone 100mg an effective alternative to standard dose for medical abortion

To study the efficacy of a low dose of mifepristone (100 mg) in combination with misoprostol, in women undergoing medical termination of pregnancy up to gestation of 49 days. A prospective study was performed in 50 women (mean age 26.54±3.68 years) with single intrauterine pregnancy of up to 49 days of gestation, presenting to our institution between November 2007 and October 2009. 100 mg mifepristone was given orally, followed 24 hours later by 400 micrograms misoprostol vaginally. Misoprostol 400 micrograms was repeated vaginally on the third day if indicated. The primary outcome of complete abortion rate and secondary outcomes of induction-abortion interval and adverse effects, especially bleeding, were assessed. Mean period of gestation was 38.74±3.90 days. None of the women expelled the products of conception before misoprostol insertion. A second dose of misoprostol was needed in four patients. Complete abortion was achieved in 94.00% of patients, incomplete abortion in 4% and missed abortion in 2%. Approximately all the women reported one or more adverse effects but none of them had any serious ones, the most common being pain in 42 (84%) women followed by nausea, vomiting, fever and diarrhoea in 12 (24%), 6 (12%), 4 (8%) and 3 (6%) women respectively. The overall acceptability rate of the dosing regimen in our study was 94%. A regimen of low dose mifepristone (100 mg) followed 24 hours later by vaginal misoprostol can be safely and effectively used for early abortion.

“Comparative study of medical abortion by mifepristone with vaginal misoprostol in women &lt; 49 days versus 50–63 days of amenorrhoea”

To compare the outcome with Mifepristone and vaginal Misoprostol combination in women having amenorrhea <-49 days (group-A) verses 50–63 days. (Group-B) We administered 200 mg of mifepristone to 200 women willing for medical abortion within 63 days of amenorrhea. After 48 hours they were assigned to receive 400 microgram of misoprostol vaginally. At the end of 4 hours, if required, reinstillation of 400 microgram misoprostol vaginally was done. Complete abortion rate in women with amenorrhea <-49 days verses 50–63 days were 99.16% and 98.75% respectively. Average duration of bleeding was 6.26 (S, D. 2.43 days ) and 6.98 days (2.26 days)respectively and the difference is statistically significant (p<0.05). The proportion of women with induction abortion interval <-4 hours in the two groups as 83.33% and 72.25% respectively. This difference is statistically not significant (Chi-square=3.47, P>0.05). The success rate at the end of 14 days in group A and B was 99.16% and 98.75% respectively and this difference is statistically not significant. (Chi-square = 0.19, P>0.05) The combination of oral mifepristone and vaginal misoprostol is currently approved for medical abortion in women with amenorrhoea up to 49 days (7 weeks gestation ). Our study has demonstrated that the use of this combination can be effectively and safely extended for inducing abortions in women with amenorrhoea up to 63 days (9 weeks gestation).

A comparison of two regimens of misoprostol for second trimester medical termination of pregnancy: a randomized trial

The objective of this study was to compare the efficacy and side-effects of two regimens of vaginal misoprostol for second trimester voluntary medical termination of pregnancy (MTP) according to the MTP Act of India. A randomized trial was conducted in 185 women from January 2007 to September 2008. Women in group 1 were given vaginal misoprostol 400 microg every 6 h for a maximum of four doses. Women in group 2 were given vaginal misoprostol 400 microg every 12 h for a maximum of four doses. Our primary outcome measure was induction abortion interval. Secondary outcome measures were success rate, side-effects and completeness of procedure. Results were calculated applying Fisher's exact test, chi-square test, Z test and calculating the P value using an alpha level of 0.05 for Type I error. The mean induction abortion interval in group 1 (12.59 h) was significantly shorter (P < 0.001) than that in the group 2 (16.41 h). The percentage of women who achieved successful abortion within 12 h in group 1 (56.52%) was also significantly higher (P = 0.00005) than that in group 2 (25.80%). The incidence of side-effects was comparable and not clinically serious. It is concluded that the regimen of vaginal misoprostol 400 microg every 6 h was more effective than the regimen of misoprostol every 12 h in medical termination of second trimester pregnancy.

Evaluation of intravaginal misoprostol for medical management of pregnancies less than 20 weeks of gestation with absent cardiac activity

To assess the efficacy and side-effects of misoprostol (800 microg used intravaginally) for terminating non-viable pregnancies up to 20 weeks of gestation. Sixty five patients with non-viable pregnancies up to 20 weeks of gestation were given 800 microg misoprostol intravaginally on day 1. A second dose of 800 microg was repeated after 24 h if complete abortion was not attained with one dose. Primary outcome measure was success (defined as complete abortion in 48 h without surgical intervention). Duration and amount of blood loss, fall in hemoglobin, and other side-effects (pain, vomiting, diarrhea, fever and chills) were studied as secondary outcome measures. 73.8% of our patients had a gestational age <or=12 weeks (group A) and 26.2% had a gestational age between 12 and 20 weeks (group B). Success rate after one dose was 66.1% and rose to 84.6% after the second dose. Success rate was higher with increasing gestation (81.2% in group A vs 94.1% in group B). Mean induction abortion interval was 18.8 +/- 11.6 h in group A and 10.8 +/- 6.2 h in group B. Mean duration of bleeding was 9.4 +/- 2.3 days. Average blood loss was 134.9 +/- 113.2 mL. No patient required blood transfusion. Mean fall in hemoglobin was 0.56 +/- 0.48 g/dL. Most patients had mild pain. Only 6.2% had severe pain requiring injectable narcotic analgesics. Other side-effects were minimal. Patients who failed to abort completely with misoprostol underwent surgical evacuation. 800 microg vaginal misoprostol is an effective regimen for termination of non-viable pregnancies <20 weeks of gestation. It has minimal side-effects and avoids surgical intervention.

Management of missed abortion by intramuscular administration of 15(S) 15 methyl prostaglandin F2 alpha.

22 subjects with a diagnosis of missed abortion were induced with 15(S) 15 methyl prostaglandin F2alpha (PGF2alpha) by the intramuscular route. The induction succeeded in all cases. The mean induction-abortion interval was 16 hours with a range of 2 hours 30 minutes to 32 hours 10 minutes. The average dose of 15 methyl PGF2alpha required was 1675 mcg. 9 subjects (42%) had complete abortions. 7 (31.8%) had no gastrointestinal side effects. The mean number of episodes of vomiting and diarrhea was 1.3 and 0.8 respectively. 15(S) 15 methyl PGF2alpha has a high degree of efficacy in the management of missed abortion.

To Assess The Efficacy Of Two Regimens Of Misoprostol For Second Trimester Pregnancy Termination-A Randomized Comparison

:We performed a randomized clinical trial in patients who were at 19-23 weeks gestation who were admitted for medical termination of pregnancy. All patients received 800 m gm of vaginal misoprostol and were assigned randomly to 400 m gm of oral misoprostol or 400 m gm of vaginal misoprostol every 8 hourly up to a maximum of 4 doses. Efficacy and side effects were compared. The mean induction abortion interval was compared in both groups.

Sublingual misoprostol 100 microgram versus 200 microgram for second trimester abortion: a randomised trial

Objectives To compare the efficacy of repeated doses of 100 μg vs. 200 μg misoprostol given sublingually for induction of second trimester abortion.Methods One hundred and sixty-two women at 15–22 weeks' gestation were randomized to receive every 2 h either 100 μg (group 1; n = 81) or 200 μg (group 2; n = 81) misoprostol sublingually. The primary outcome measure was the abortion rate within 24 h. The secondary outcome measures were the induction-abortion interval, the total misoprostol dose required, and side effects of the regimen.Results There was no significant difference between the two groups with regard to the abortion rates within 12 h (43.2% in group 1 vs. 48.1% in group 2; p = 0.52; relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.4–1.5) and 24 h (92.6% in group 1 vs. 91.4% in group 2; p = 0.77; RR: 1.11; 95% CI: 0.37–3.6). The induction-abortion intervals in the two groups were of similar length (885 minutes in group 1 vs. 912 minutes in group 2; p = 0.72). When the total dose of misoprostol was compared between the two groups, women belonging to group 2 on average had received significantly more misoprostol than those in group 1 (1274 ± 592 μg [7 ± 3 doses] vs. 614 ± 432 μg [6 ± 4 doses], respectively; p = 0.000).Conclusions Sublingual administration of repeated doses of 100 μg misoprostol for abortion induction appears to be equally effective to that of repeated doses of 200 μg.

Randomized comparison of dry tablet insertion versus gel form of vaginal misoprostol for second trimester pregnancy termination

To compare the effectiveness of vaginal misoprostol between dry tablet insertion and gel form for second trimester pregnancy termination. A non-blinded block randomized controlled trial was conducted on 148 pregnant women with live fetuses in the second trimester undergoing pregnancy termination. They were randomly allocated to receive vaginal misoprostol (400 microg) either dry tablet insertion (n=72) or gel form (n=76). The same dose was then repeated every 3 h if adequate uterine contraction was not achieved until 48 h after the initiation of misoprostol. If abortion did not occur within this period, the treatment was considered a failure and other technique of termination was then given based on the decision of the attending physicians and the cervical status. The mean induction-abortion interval in group 1 (20.9+/-12.3 h) was not significantly different from that in group 2 (17.7+/-10.2 h). The mean total dose of misoprostol was also not significantly different between the two groups (group 1, 1556.9 microg; group 2, 1350.9 microg), but the adverse effects of misoprostol (chill and diarrhoea) were more common in the gel group. Tablet insertion or gel form of vaginal misoprostol have similar effectiveness but the gel form was associated with more common adverse effects.

A randomised comparative study on sublingual versus vaginal administration of misoprostol for termination of pregnancy between 13 to 20 weeks

Misoprostol is the drug of choice for medical abortion worldwide but consensus is yet to be reached regarding its preferred route of administration. To compare the outcome of sublingual with vaginal administrations of misoprostol for induction of second trimester abortion. A randomised comparative trial where 300 women at 13-20 weeks gestation, requiring medical abortion, were randomly assigned to sublingual or vaginal route for misoprostol administration with a dose schedule of 400 microg three-hourly, up to a maximum five doses over 24 h. The same doses were repeated for another 24 h in non-responders. Primary outcome measure was complete abortion rate at 24 and 48 h, and the secondary outcome measures were induction-abortion interval, failure rate, side-effects and patients' preference to the route. No statistically significant differences in the complete abortion rates were observed at 24 h (64.03% vs 61.59%, P = 0.767) and at 48 h (79.14% vs 82.01%, P = 0.651) when sublingual and vaginal groups were compared. Mean induction-abortion intervals in sublingual and vaginal groups were 14.1 and 14.5 h, respectively (P = 0.066). Other outcome measures were also more or less similar in both groups. Differences in the incidence of side-effects were also statistically insignificant when both groups were compared. Sublingual administration of the drug was preferred by most of the women as compared to vaginal administration (P < 0.0001). Both sublingual and vaginal administrations of misoprostol are equally effective in inducing medical abortion during second trimester but sublingual route was preferred by the patients.

Effect of vaginal pH on the efficacy of vaginal misoprostol for induction of midtrimester abortion

To evaluate the effect of vaginal pH on the efficacy of misoprostol for induction of midtrimester abortion. The study comprised 110 women, with a gestational age of 14-26 weeks, with a missed abortion as an indication for the induction of abortion. On admission, the vaginal pH was measured and two groups were generated: (A) those with pH<5 (n=63); and (B) those with pH >or= 5 (n=47). All of the women received intravaginal misoprostol tablets moistened with 3 mL of 5% acetic acid, 200 microg every 4 h for a maximum of 5 doses within 24 h. If the patient did not have adequate uterine contractions, the same regimen was repeated over the following 24 h and if no response was achieved, this was considered a failure of therapy. All patients aborted within 48 h. A significant positive correlation between vaginal pH and the misoprostol application-abortion interval was found. The mean induction-abortion interval was significantly shorter in group A compared to group B (12.1 vs 23.6 h, P<0.001), with abortion rates at 24 h being 100% and 63.8%, respectively. Moreover, a significantly lower dose of misoprostol was used in group A with a lower incidence of fever and abdominal pain. Vaginal pH influences the efficacy of misoprostol administered vaginally for the induction of midtrimester abortion. The presence of this relationship, despite premoistening misoprostol with an acidifying agent, suggests that the effect of vaginal pH might extend beyond affecting the pharmacokinetics of the drug.

Misoprostol for termination of mid‐trimester post‐Caesarean pregnancy

To evaluate the efficacy and safety of PGE1 analogue, misoprostol, for inducing abortion or labour during mid-trimester in women who have had a prior Caesarean section (one or more). Women who had to undergo termination of pregnancy between 13 and 26 weeks of gestation for various indications and who had at least one previous Caesarean section were studied over a period of two and a half years. The standard regimen for misoprostol in all the cases was 400 microg up to 20 weeks of gestation and 200 microg for pregnancies longer than 20 weeks, either vaginally or sublingually every six hours (up to maximum 24 h). A contemporaneous cohort of women undergoing the same procedure for similar indications but without scarred uteri served as control. Eighty women in the study group underwent termination procedures for unwanted pregnancy, missed abortion, fetal anomaly or fetal death. The median induction-abortion interval was 16.4 h (10-21 h) and did not differ much from that in women without previous Caesarean delivery (median: 15.6 h; range 9.6-20 h), P > 0.05. Misoprostol was found to be safe in our cohort of post-Caesarean women and there was no case of scar rupture or dehiscence. No significant differences in rates of incomplete abortions, blood loss or sepsis were detected in the study group compared to the control group. The use of misoprostol for mid-trimester pregnancy termination is not contraindicated in women with Caesarean scar and is effective and comparable with those in women without scarred uteri.

THERAPEUTIC ABORTIONS

Objectives: The study was conducted to compare intravaginal misoprostolwith extra amniotic prostaglandin F2 alpha (PGF2") for labour induction in therapeutic abortions from 10-28 weeksgestation. Design: A prospective study experimental. Setting At Military Hospital, Rawalpindi. Period: FromMarch–December 2002. Materials &amp; Methods: 68 patients with indications for therapeutic termination. Groups wereassigned through non-probability convenient sampling procedure. In one group 200:g of misoprostol in the form ofTab Arthrotec 50 was administered every two hours up to three doses. Other group of patients had received extraamnioticPGF2" solution. Main outcome measures were induction-abortion interval, cost-effectiveness and thefrequency of side effects. Induction was considered successful where abortion was achieved within 24 hours. Results:The average induction-abortion interval in the misoprostol group was 16.09±9.38hours.Successful abortions wereachieved in 79.41 percent(27/34).Total failures were seven of 34 cases. In the PGF2" group, all women aborted within20.24±11.57 hours, 76.47 percent (26/34) of which aborted within 24 hours. Conclusion: The acceptable expulsiontime, clinically insignificant side effects and the abortion rate obtained, showed that misoprostol by vaginaladministration may be an alternative method for interrupting gestation of 10-28 weeks.

A study of midtrimester abortion using cerviprime gel and extra-amniotic prostodin

Background: A study was carried out to evaluate the efficacy of intra cervical dinoprostone gel and extra-amniotic prostodin in midtrimester abortions. Material and Method: A total of 25 cases were included in this study. Dinoprotone gel was inserted intracervically in the evening and next morning Inj Prostodin diluted in saline was injected extra amniotically. The efficacy and side effects of the method were studied. Results: The mean induction abortion interval was found to be 17.32 hrs and there were no failures. 04 cases required assistance for removal of placenta. There were no other complications. Conclusion: Intra-cervical dinoprostone gel combined with extraamniotic prostodin is an effective and safe method of mid trimester abortion.