Mean Induction-abortion Interval Research Articles

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.

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, .

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.

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.

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

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.

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.

English

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.

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.

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

English

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.

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.

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.