Misoprostol For Second Trimester Pregnancy Termination Research Articles

Vaginal versus intrauterine extra-amniotic administration of misoprostol for second-trimester pregnancy termination; a randomized clinical trial

Introduction: Misoprostol is a widely used prostaglandin to terminate pregnancy in the second trimester. The route of drug administration has a significant effect on the quality of treatment. Objectives: In this study, we aimed to compare efficacy and adverse effects of vaginal and intrauterine extraamniotic administration of misoprostol in second-trimester termination. Patients and Methods: In a randomized clinical trial, 112 women with an intrauterine fetal death between 13– 24 weeks of gestation attended Akbarabadi hospital were enrolled during 2018-2019. Patients were randomly divided into two groups. In group A, 200 µg misoprostol was diluted in 10ml of normal saline and administered extra-amniotic every 4 hours. Group B received vaginal tablets (200 µg in each) according to FIGO protocol. The primary outcomes were the time needed to expel gestational products and hemoglobin level changes. Results: In group A, conception product expulsion occurred within an average of 7.52 ± 0.29 hours, significantly faster than group B (12.02 ± 0.42 hours; P<0.05). In group A, the Hemoglobin level decreased after intervention (-1.23 ± 1.20 g/dL), and the changes were more prominent than group B (-0.15 ± 0.51 g/dL; P<0.05). Conclusion: For pregnancy termination, intrauterine extra-amniotic administration of misoprostol is a more effective method than the vaginal route in the second trimester. However, regarding further hemoglobin decrease in this method, its safety is still unclear and needs to be approved by further clinical trials with a larger sample size. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trial (identifier: IRCT20190606043830N1; https://en.irct.ir/trial/40184, ethical code: IR.IUMS.FMD.REC1396.941129004).

INTRA-VAGINAL MISOPROSTOL ALONE VS MISOPROSTOL IN COMBINATION WITH INTRA-CERVICAL FOLEY’S CATHETER FOR SECOND TRIMESTER ABORTION: A COMPARATIVE STUDY

Pregnancy termination in the second trimester is riskier than in the first. The primary objective is to create a more effective means of termination while also reducing induction time. To compare the efficacy, safety, and acceptability of intra-cervical foley's catheter with vaginal misoprostol versus vaginal misoprostol for second-trimester pregnancy termination. This clinical study involved 400 pregnant women who were scheduled to have their pregnancy terminated between 13 and 22 weeks of pregnancy for any reason. The enrolled women were divided into two categories: Category I (Misoprostol category): intra-cervical Foley’s catheter inserted with a standard regimen of moistened misoprostol tablets (400 g) 4 hourly inserted vaginally to a maximum of 5 doses; Category II (Combined category): intra-cervical Foley catheter inserted with a standard regimen of moistened misoprostol tablets (400 g) 4 hourly inserted vaginally to a maximum of 5 doses 4 hourly intra-vaginal injections were employed. Misoprostol was retained in the posterior fornix, and the dose was repeated every 4 hours until the catheter was removed, or until a maximum of five doses had been administered. The mean induction to abortion interval in the misoprostol category was 15.38 + 1.25 hours and 8.25 + 2.25 hours in the combination category, which was statistically significant (p= 0.001). The misoprostol category had a 94 percent success rate, while the combined category had a 97 percent success rate. The use of a combined intra-cervical foley's catheter and vaginal misoprostol to end a pregnancy in the second trimester is a novel, safe, effective, and acceptable procedure.

A Comparative Study of Vaginal Misoprostol Moistened with Acetic Acid and Normal Saline in Second-trimester Pregnancy Termination: A Randomized Clinical Trial

Introduction: Second-trimester pregnancy termination with live fetuses is an important issue in obstetric practice since it is more challenging than first- and third-trimester pregnancy termination. The present study aimed to compare the effectiveness of vaginal misoprostol moistened with normal saline and acetic acid in second-trimester pregnancy termination.Methods: This clinical trial was conducted on 95 pregnant women with the gestational age of 14-26 weeks admitted for medical induced abortion. The subjects were randomly divided into two groups. The first group was administered with vaginal misoprostol moistened with acetic acid (n=47), and the second group received vaginal misoprostol moistened with normal saline (n=48). The abortion rate within the first 24 hours, induced abortion interval, length of hospital stay, and curettage and its complications were assessed in the study groups using statistical methods, and the P-value of less than 0.05 was considered significant.Results: Abortion within the first 24 hours occurred in 100% of the patients in the acetic acid group and 75% of the subjects in the normal saline group, and the difference was considered statistically significant (P<0.001). The mean time for fetal delivery was significantly lower in the acetic acid group (12.3±4.8) compared to the normal saline group (17.5±6.6) (P<0.001). In addition, the length of hospital stay was significantly lower in the acetic acid group compared to the normal saline group (P=0.008). The rate of abortion following the second dose of misoprostol was 46.8% in the acetic acid group and 20.8% in the normal saline group. However, no significant differences were observed in curettage and its complications between the groups.Conclusion: According to the results, high vaginal acidity was associated with the increased effectiveness of misoprostol in second-trimester pregnancy termination.

Análisis comparativo de dos protocolos de misoprostol en abortos de segundo trimestre de la gestación

Objective To compare the mean induction-expulsion times in two regimens of vaginal misoprostol for second-trimester pregnancy termination. Material and methods We performed a retrospective study of 281 pregnancies between January 2000 and December 2005 (regimen A: 800 μg /24 h) and between June 2007 and December 2008 (regimen B: 400 μg /4 h). Induction-expulsion time was taken as the main outcome. Results The mean expulsion time was similar in both regimens (19.7 h for A and 17.7 h for B). No significant differences were found in the expulsion rate at 12, 24 and 48 h. The most commonly observed adverse effect was fever, which was more frequent in regimen B. No major adverse effects such as uterine rupture or severe hemorrhage were observed. Conclusions No significant differences were found between regimens A and B in the mean fetal expulsion time, although fever was more common in regimen B.

Randomized controlled study comparing misoprostol moistened with normal saline and with acetic acid for second‐trimester pregnancy termination. Is it different?

To compare the efficacy and adverse effects of 400 µg intravaginal misoprostol for second-trimester pregnancy termination in live fetuses between two groups: one in which misoprostol was moistened with normal saline solution (NSS) and the other in which misoprostol was moistened with acetic acid. A total of 179 pregnant women between 14 and 28 weeks of gestation with live fetuses indicated for pregnancy termination were recruited. They were randomly allocated to receive 400 µg intravaginal misoprostol either moistened with NSS (n = 96) or moistened with acetic acid (n = 83). The same dosage was then repeated every 3 h if adequate uterine contractions were not achieved until 48 h after the initiation of misoprostol. The main outcomes were mean abortion time, success rate, and adverse effects. The mean abortion time was not significantly different between the groups (24.98 ± 16.42 h vs 25.89 ± 10.34 h, P > 0.05). The rates of abortion within 24 h and 48 h and the adverse effects were also comparable between the groups. Chills and fever were the most common adverse effects in this study. Intravaginal misoprostol either moistened with NSS or acetic acid was comparable in terms of efficacy and adverse effects.

Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination

Objective The study was conducted to compare the efficacy of two different dose regimens of misoprostol administered vaginally in combination with mifepristone for second trimester termination of viable and non-viable pregnancies. Design Double-blind randomized controlled trial conducted at the University hospital in the Netherlands. One hundred seventy-six women between 14 and 24 weeks gestation with an intrauterine fetal death ( n=31), congenital or genetic abnormalities of the fetus ( n=116) or requesting a termination of pregnancy for psychosocial reasons ( n=29) were studied. Randomization was into one of two groups. Both groups ingested mifepristone 200 mg. Depending on the randomization group, this was followed by either 200 or 400 mcg misoprostol given vaginally beginning 36–48 h later at 4-h intervals (with a maximum of 10 administrations in 48 h) until the fetus was delivered. Randomization, administration of the medication and assessment of the outcome was performed independently from the investigators. Main outcome measures were expulsion rate and the number of incomplete abortions warranting surgical evacuation of retained products of conception. Secondary outcome measures consisted of the time between the first administration of misoprostol to the delivery of the fetus, side-effects, blood loss, live births and changes in hemoglobin level. Results In the 200-mcg misoprostol group, 66% (57/86) had a complete expulsion of fetus and placenta compared to 73% (66/90) in the 400-mcg group (p=NS). The time between the first administration of misoprostol and delivery of the fetus was significantly longer in the misoprostol 200-mcg group: mean 11.6 h (range: 9.7–13.5 h) versus 9.3 h (range: 8.1–10.5 h) in the 400-mcg group (p=.042). No significant differences between the groups were found for frequency of side-effects like nausea, retching, vomiting, fever, headaches and diarrhea. Blood loss was similar in both groups with a mean of 337 mL in the 200 mcg misoprostol and 296 mL in the 400-mcg misoprostol group (p=NS). Of the women with a viable pregnancy at the beginning of the trial, 18.6% (13/70) in the 200 mcg misoprostol group delivered a live fetus compared to 22.8% (17/75) in the 400 mcg misoprostol group (p=NS). Conclusions Both regimens used in this trial proved to be equally effective for termination of both viable and non-viable pregnancies during the second trimester. The time between the first administration of misoprostol and delivery of the fetus was significantly longer in the 200-mcg group than in the 400-mcg group. This outcome may be used as the rationale for choosing a 400 mcg misoprostol regimen for termination of pregnancy during the second trimester.

Vaginal misoprostol for second-trimester pregnancy termination after one previous cesarean delivery

Objective To determine the safety and efficacy of using misoprostol vaginally for second-trimester abortion in women with a single previous cesarean delivery. Method This prospective observational study was carried out at a university hospital in Egypt with 50 pregnant women with 1 previous cesarean delivery; a gestation of at least 16 weeks but less than 20 weeks (group 1) or 20 or more weeks (group 2); and a need to terminate the pregnancy. The regimen was 4 doses of 200 μg of misoprostol applied vaginally every 4 hours daily, with a 12-hour nightly rest from misoprostol applications, until contractions appeared but not for more than 72 hours. The primary outcome was the induction-to-abortion interval. Results There were no cases of uterine rupture. Abortion within the study protocol occurred in 45 of the 50 women, for a 90% success rate. There was no significant difference in the induction-to-abortion interval between the 2 groups. Conclusion Inducing abortion with lower misoprostol doses appear to be safe and effective throughout the second trimester in women with a single previous cesarean delivery. Larger randomized trials are needed to validate these results.

Vaginal versus sublingual misoprostol for second-trimester pregnancy termination and effect on Doppler measurements

Objective To compare the efficacy of vaginal versus sublingual misoprostol for second-trimester pregnancy termination, and to evaluate the effect on the blood flow of the uterine and umbilical arteries. Methods Forty-nine patients were randomized to receive either 200 μg of vaginal misoprostol every 6 hours or 200 μg of misoprostol sublingually every 6 hours. Doppler velocimetry studies were assessed immediately before and 60 minutes after the administration of the first dose. Standard descriptive calculations, Mann–Whitney U, Wilcoxon, and χ 2 tests were performed. Results The mean interval between induction and onset of active labor, induction and delivery, and the duration of oxytocin administration were significantly shorter in the sublingual misoprostol group. Both routes of administration increased the Doppler indices for the uterine arteries; however, misoprostol via the sublingual route did not affect the umbilical arteries. Conclusion Sublingual administration of misoprostol for second-trimester medical abortion results in a higher success rate and does not affect umbilical blood flow.

Vaginal Versus Oral Misoprostol for Second-Trimester Pregnancy Termination: A Randomized Trial

The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for second-trimester pregnancy termination. Sixty women in second trimester of gestation with indications for pregnancy termination were randomly assigned in two equal groups to receive either vaginal or oral misoprostol. The dosing regimen was 400 microg as the initial dose followed by 400 microg up to 3 doses (1200 microg) if needed in each group. Efficacy and side effects were compared. The percentage of women who delivered was significantly higher in vaginal group than the oral group (86.7 vs. 43.3 p = 0.0006). No significant differences in complication rates and induction to delivery interval were noted between the two groups. Vaginal administration of misoprostol resulted in a higher success rate for second trimester pregnancy termination, whereas, no significant differences in induction to delivery time and complication rates were noted between vaginal and oral groups.

The use of vaginal misoprostol for second-trimester pregnancy termination in women with previous single cesarean section

Introduction This retrospective study reports of 85 women in the second trimester with one prior cesarean section undergoing medical abortion of a viable unwanted pregnancy using vaginal misoprostol. Two regimens that were selected in a nonrandomized manner were used. Materials and Methods Eighty-five women treated with vaginal misoprostol in a 3-year period were retrospectively analyzed. All received 400 μg of misoprostol initially and 22 (25.8%) aborted. Then Group A ( n=43) received subsequent administration of 200 μg every 6 h, whereas Group B ( n=20) received 400 μg/6 h. Results All patients aborted. The groups had no statistical difference in mean age, gravidity, parity, gestational age, and time from previous cesarean section, and there was no difference in occurrence of side effects and mean induction to abortion time interval. The lower dosage group received a median of 600 μg of vaginal misoprostol (min 600 μg to max 1000 μg). There were no uterine ruptures, need for hysterotomy, or excess bleeding in any patient. Conclusions This is the largest series reported to date of second-trimester pregnancy termination in cases with one previous cesarean section using only vaginal misoprostol. The study shows that both used regimens are safe and equally effective. All 85 women aborted.

Misoprostol for Second-Trimester Pregnancy Termination in Women With a Prior Cesarean Delivery

To evaluate the use of misoprostol in second-trimester abortion in women with prior cesarean deliveries. A review of women with prior cesarean deliveries undergoing abortion at 14-28 weeks of gestation for a fetal anomaly over a 7.5-year period. Outcome data were compared with a contemporaneous cohort of women with unscarred uteri undergoing the same procedure. Misoprostol was used to induce abortion in all cases, and a variety of dosage regimens were used, the most frequent being 400 mug vaginally every 6 hours (71.3%). During the study period, 720 consecutive women underwent a second-trimester abortion for a fetal anomaly using misoprostol. One hundred one women (14%) had at least 1 prior cesarean delivery: 78 women had 1, 19 women had 2, and 4 women had 3 prior cesarean deliveries. Women with a prior cesarean birth were significantly older (30 years [interquartile range 26-35] versus 33 years [29-37], no cesarean delivery versus cesarean delivery, P = < .001) and of increased parity. The median gestational age at delivery was 19.4 weeks (interquartile range 18-20.7) versus 19.3 weeks (17.7-21), no cesarean delivery versus cesarean delivery, P = .48. The presence of a prior uterine scar did not impact upon abortion duration (16.6 hours [12.1-23.8] versus 14.5 hours [11.4-21.4], no cesarean delivery versus cesarean delivery, P = .07). No differences in blood loss, major hemorrhage, or blood transfusion occurred. There was no case of uterine rupture or hysterectomy. In second-trimester abortion, the use of misoprostol in women with prior cesarean delivery was not associated with an excess of complications compared with women with unscarred uteri. II-2.

Safety and efficacy of misoprostol for second-trimester pregnancy termination: Effect of prior cesarean section

TERMINATION: EFFECT OF PRIOR CESAREAN SECTION LARA FRIEL, MEREDITH ROCHON, CYNTHIA GYAMFI, ADAM JACOBS, Mount Sinai School of Medicine, Obstetrics, Gynecology, and Reproductive Science, New York, New York OBJECTIVE: To assess the safety and efficacy of misoprostol for secondtrimester pregnancy termination in patients with a prior cesarean section using a meta-analysis of published studies. STUDY DESIGN: Studies were identified using a medline search from 19662004, limited to english language and human subjects.

Randomized controlled trial of misoprostol for second-trimester pregnancy termination associated with fetal malformation

Objective Our purpose was to compare the effectiveness, women's views of the termination procedure, and success of umbilical cord culture for vaginal and oral misoprostol versus intra-amniotic prostaglandin PGF 2α for second-trimester pregnancy termination (STPT). Study design We randomized 217 women, 15 to 24 weeks' gestation, into 3 groups. Oral (OM) and vaginal (VM) misoprostol groups received 400 μg of misoprostol every 4 hours for 24 hours. The intra-amniotic PGF 2α (IAPG) group received 40 mg of PGF 2α followed by oxytocin infusion. Women completed self-administered questionnaires 3 weeks after the termination procedure. Umbilical cord samples were collected at delivery for karyotype analysis. The primary outcome was the time from start of the procedure to placental delivery. Secondary outcomes were maternal complications, women's acceptance of the termination procedure, and success rates of umbilical cord culture. Results The time was longer for the OM group (30.5±14.4 hours) compared with the VM group (18.3±8.2 hours) and the IAPG group (21.1±10.2 hours), P<.001 for both comparisons. Women in the VM group reported being more willing to repeat the termination method in the future and reported fewer side effects than those in the other groups, P<.001. Failure rates for umbilical cord cultures were 9.6%, 17.0%, and 45.6% for the VM, OM, and IAPG groups, respectively. Conclusion Oral misoprostol is less effective than intra-amniotic PGF 2α or vaginal misoprostol for STPT. Women report vaginal misoprostol more acceptable than other methods. Umbilical cord culture failure rate is highest in the IAPG group.

A randomized comparison of two regimens of misoprostol for second-trimester pregnancy termination

Objective The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for second-trimester pregnancy termination. Study design We performed a randomized clinical trial in patients who were at 14 to 23 weeks of gestation and who were admitted for medical termination of pregnancy. All patients received 800 μg of vaginal misoprostol and were assigned randomly to 400 μg of oral misoprostol or 400 μg of vaginal misoprostol every 8 hours. Efficacy and side effects were compared. The mean induction time of the study group was compared with that of an historic control group that had received 400 μg vaginally every 12 hours. Results Forty-three women were assigned randomly, 22 women to vaginal misoprostol and 21 women to oral misoprostol. Induction time and hospital stay were slightly shorter for the oral group; however, the differences were not significant. Side effects were similar for both groups. Conclusion After an initial 800 μg dose of vaginal misoprostol, a regimen of 400 μg of oral misoprostol every 8 hours is as effective as the same dose of vaginal misoprostol with no additional side effects, which provides a convenient alternative for midtrimester pregnancy termination.

A Comparison of Oral Misoprostol With Vaginal Misoprostol Administration in Second-Trimester Pregnancy Termination for Fetal Abnormality

In Brief OBJECTIVE To compare the clinical efficacy and side effects of oral misoprostol with vaginal misoprostol for second-trimester pregnancy termination. METHODS A randomized clinical trial of medical pregnancy termination between 14 and 26 weeks' gestation was conducted. Three misoprostol regimens were compared: 400 μg vaginally at 6-hour intervals (group 1), 400 μg orally at 3-hour intervals (group 2), and a loading dose of 600 μg vaginally followed by 200 μg orally at 3-hour intervals (group 3). A sample size of 225 women was required for equivalence of the three regimens, with an interim safety analysis planned at 80 women. RESULTS A significant difference between the groups was evident at the interim safety analysis and the study ceased. The subset of 84 women recruited before the study closure is described. There was a significant difference in the median time to achieve delivery among the three groups: group 1, 14.5 hours (95% confidence interval 12.0, 16.9), versus group 2, 25.5 hours (13.5, 23.8), versus group 3, 16.4 hours (interquartile range 14.2–37.3) (P = .042). Within 24 hours of commencement 85.7% of women in group 1, 44.8% in group 2, and 74.1% in group 3 delivered (P = .003). At 48 hours 0% in group 1, 20.7% in group 2, and 3.7% in group 3 were undelivered (P = .011). There was no difference in women's perceptions of the termination process. CONCLUSION In second-trimester pregnancy termination, a vaginal misoprostol regimen of 400 μg every 6 hours was 1.9 times more likely to result in delivery within 24 hours from commencement than an oral regimen of 400 μg every 3 hours. In second-trimester pregnancy termination for fetal abnormality, avaginal misoprostol regimen was 1.9 times more likely to result indelivery within 24 hours from commencement than an oral regimen.

The optimization of intravaginal misoprostol dosing schedules in second-trimester pregnancy termination

OBJECTIVE: The purpose of this study was to compare the clinical efficacy and side effects of 3 doses of intravaginal misoprostol for second-trimester pregnancy termination. STUDY DESIGN: This was a prospective randomized, double-blind controlled clinical trial of 150 women who underwent pregnancy termination between 14 and 30 weeks of gestation. Three intravaginal misoprostol regimens were compared: 200 μg misoprostol at 6-hour intervals (group 1), 400 μg misoprostol at 6-hour intervals (group 2), and a loading dose of 600 μg misoprostol followed by 200 μg at 6-hour intervals (group 3). RESULTS: There was a significant difference in the median time to achieve delivery among the 3 groups: group 1 (18.2 hours [IQ, 13.3-32.5 hours]) vs group 2 (15.1 hours [IQ, 10.9-23.7 hours]) vs group 3 (13.2 hours [IQ, 11.2-21.7 hours]; P =.035). Fifty-nine percent of the women in group 1, 76% of the women in group 2, and 80% of the women in group 3 delivered within 24 hours (P =.013). There were 7.8% of the women in group 1, 0% of the women in group 2, and 2% of the women in group 3 who were undelivered at 48 hours (P =.02). There was an increase in the incidence of fever in the first 12 hours (P =.038) and in the incidence of vomiting within 3 hours of the initial dose (P =.048) in group 3 compared with the other groups. CONCLUSION: Intravaginal misoprostol 400 μg at 6-hour intervals appears to be the preferred regimen for second-trimester pregnancy termination, with a shorter commencement to delivery interval than the 200 μg regimen and fewer maternal side-effects than the 600 μg loading dose regimen. (Am J Obstet Gynecol 2002;186:470-4.)

A Comparison of Two Dosing Regimens of Intravaginal Misoprostol for Second-Trimester Pregnancy Termination

A Comparison of Two Dosing Regimens of Intravaginal Misoprostol for Second-Trimester Pregnancy Termination

A comparison of prostaglandin E 2 and misoprostol for second-trimester pregnancy termination

A comparison of prostaglandin E 2 and misoprostol for second-trimester pregnancy termination

A comparison of two dosing regimens of intravaginal misoprostol for second-trimester pregnancy termination

Objective: To compare the effectiveness of misoprostol administered intravaginally every 6 versus every 12 hours for termination of second-trimester pregnancies. Methods: One hundred pregnant women at 12–22 weeks’ gestation were randomized to receive 200 μg of misoprostol intravaginally either every 6 or every 12 hours for up to 48 hours. Results: The incidences of abortion within 48 hours after initial drug administration were 87.2 and 89.2%, the complete abortion rates 43.9 and 33.3%, and the mean abortion intervals 13.8 and 14.0 hours in the 6- and 12-hour groups, respectively. Side effects were similar between groups. Conclusion: Misoprostol administered vaginally is effective for terminating second-trimester pregnancies. Shortening the dosing interval from 12 to 6 hours produced no significant benefit.

Efficacy of intravaginal misoprostol in second-trimester pregnancy termination: A randomized controlled trial

Efficacy of intravaginal misoprostol in second-trimester pregnancy termination: A randomized controlled trial