Misoprostol For Second-trimester Termination Research Articles

Extra-amniotic saline instillation versus combination of oral mifepristone and vaginal misoprostol for second trimester termination of pregnancy in women with previous one caesarean section: A randomized controlled trial

Background: To study and compare the efficacy and safety of extra-amniotic saline instillation (EASI) and combination of oral mifepristone and vaginal misoprostol for second trimester termination of pregnancy in women with previous one caesarean section.Methods: This randomized controlled trial was conducted in Puducherry, South India. Pregnant women aged 18-45 years with history of previous one caesarean section at 16-27+6 weeks of gestation admitted for pregnancy termination were randomized to receive EASI or combination of oral mifepristone and vaginal misoprostol. Efficacy and safety were compared between the groups in an intention-to-treat analysis.Results: There were 50 patients randomized to the EASI (n=25) and oral mifepristone + vaginal misoprostol (n=25) groups. The median induction to abortion interval was 48 vs 60 hours (p value=0.029), need for another method of termination was 16% vs 44% and side effects were 36% vs 8% with combination of oral mifepristone and vaginal misoprostol in comparison to EASI.Conclusion: Combination of oral mifepristone and vaginal misoprostol appears to be more effective than EASI in reducing the induction-abortion interval, need for another method of termination and duration of hospital stay. The maternal safety profile appears to be comparable but requires further studies.

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).

Mifepristone-Misoprostol for Second Trimester Termination of Pregnancy: Experience at a Teaching Hospital

Abstract Background Combined mifepristone and misoprostol has been used as an effective method of second trimester pregnancy termination in developed countries. But little is known about its use and effectiveness in developing countries. Objectives To assess the effectiveness of mifepristone and Misoprostol in second trimester termination of pregnancy among women admitted to a teaching hospital in Ethiopia. Methods A cross-sectional study was conducted was conducted using a structured questionnaire to collect data clinical profile of patients, the total dose of misoprostol used, the timing of expulsion and complications. The protocol used was: Mifepristone 200 mg oral and 400 mcg misoprostol for gestational age of 13 to 24 weeks and 100 mcg for 24 to 27 + 6 weeks of gestation given intra-vaginally every 3 hours until a maximum of 10 doses in 48 h. Data was entered and analyzed using SPSS. Results In this study 102 patients with 2nd trimester pregnancy between gestational age of 14 to 27 wks + 6 days were given a combined Mifepristone and Misoprostol. About 98 (81.7%) cases have expelled the fetus within 24 hrs. whereas 111 (92.5%) of the cases expelled within 48 hrs of the initiation of medical termination. In 79 cases (77.5%), fetal expulsion has occurred with the first course of misoprostol and about 91 cases (89.2%) have completed the expulsion with the second course of the treatment. There were no cases of uterine rupture and bleeding necessitating blood transfusion. Conclusion Mifepristone and misoprostol combination use for second trimester termination of pregnancy is safe, effective and is not associated with significant complications.

Comparison of Effectiveness of Sublingual and Vaginal Misoprostol for Second-Trimester Abortion.

The aim of this study was to compare the efficacy and safety of sublingual and vaginal misoprostol in second-trimester termination of pregnancy in 24 and 48h. This is a retrospective study of 240 pregnant women seeking termination in second trimester (13-18.5weeks), in which the patients are subdivided into two groups-first group received 400mcg of misoprostol sublingually (n = 120), and second group received 400mcg of misoprostol vaginally (n = 120) every 4h for a maximum of five doses. The course of misoprostol was repeated if the patient did not abort within 24h. The mean induction-to-abortion interval was shorter in sublingual group (10.28 ± 3.1h) versus 14.68 ± 4.2h in vaginal group in 24h (p = 0.0001), and 36.9 ± 4.4h in sublingual versus 29.7 ± 14 in vaginal group in 48h (p = 0.0933). Mean dose requirement for misoprostol by sublingual route was low as compared to vaginal misoprostol (1048 ± 301mg versus 1250 ± 375mg; p = 0.0001 in 24h and 1110 ± 833mg versus 1325 ± 536mg; p = 0.0231 in 48h). No significant difference was found in the success rate (both at 24 and 48h) and in side effects among the two comparison groups. Misoprostol as such by any route has been proven as an effective abortifacient in second trimester. Both sublingual and vaginal routes are effective for medical abortion. But shorter induction-to-abortion interval in sublingual route, less dose requirement and higher acceptability makes sublingual route as a better choice.

Safety and efficacy of Mifepristone plus Misoprostol in Second Trimester Termination of Pregnancy in Previous CS

Safety and efficacy of Mifepristone plus Misoprostol in Second Trimester Termination of Pregnancy in Previous CS

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.

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.

Effect of cervical length on second trimester pregnancy termination

To evaluate the value of sonographic measurement of cervical length as a predictor of abortion or delivery within 24 h by misoprostol in second trimester termination of pregnancy (TOP). One hundred and sixty-three women underwent TOP between 14 and 26 weeks of pregnancy due to various indications. The primary outcome was abortion within 24 h. Cervical length was measured before transvaginal administration of misoprostol. The effects of cervical length, total misoprostol dose, parity, and gestational age at diagnosis on successful TOP were evaluated. One hundred and sixty-three women were eligible who met the inclusion criteria. TOP occurred in 80.5% of patients within 24 h. Parous women had shorter prolonged induction to expulsion period over 24 h (14.1% vs 28.6%, P = 0.061). Total misoprostol dose and history of abortion were parameters that affected induction to delivery period (P = 0.002 and P = 0.041). Using an optimum cutoff of 36 mm, 58.2% sensitivity and 68.2% specificity were obtained. In addition, positive and negative predictive values were 85.36% and 33.3%, respectively. Pregnant women whose preinduction cervical length was shorter than 36 mm had a shorter induction time and needed a lower total misoprostol dose to achieve TOP than women with a cervical length longer than 36 mm (P = 0.027 and P = 0.011, respectively). Transvaginal measurement of cervical length before administration of prostaglandin analogue was not correlated with successful TOP within 24 h. It cannot be used as a predictor in light of our findings.

Silent Uterine Rupture with the Use of Misoprostol for Second Trimester Termination of Pregnancy : A Case Report

Uterine rupture is an uncommon, but a life-threatening, complication following second trimester medical termination of pregnancy (TOP). The reported cases have been in both the scarred and unscarred uterus (Rajesh et al. 2002, Drey et al. 2006, and Dickinson). A 27-year-old with two previous deliveries, no previous caesarean section, no history of induced abortions, and no gynaecological operations. She presented with amenorrhoea, and according to her last normal menstruation, she was 10 weeks and 5 days. Ultrasound was done, and it reported 16 weeks and 5 days. She asked for TOP. According to the clinic's protocol, misoprostol 800 mcg (4 tabs) were given to be used vaginally as a loading dose and another three to be taken orally after that. In the following day when she attended the clinic for follow up, a manual vacuum aspiration (MVA). A manual vacuum aspiration was indicated as an incomplete abortion. During the procedure, a uterine rupture was found in the uterine lower segment. A laparotomy was done and a lineal uterine rupture was found and sutured. The patient had a good postoperative recovery and was discharged from hospital after four days. The clinician dealing with second trimester terminations should be aware of the possibility of having a uterine rupture, especially in patients with a uterine scar in order to make an early diagnosis.

Role of vaginal misoprostol in second trimester termination of pregnancy

Objective To find out the safety and effectiveness of vaginal misoprostol for second trimester termination of pregnancy.

Villous adenoma after appendiceal uterine transplantation

number of patients (23 [46%] vs 27 [54%] vs 27 [54%]) in the 3 groups. A study by Tang et al. [3] reported a lower success rate when sublingual misoprostol was compared with vaginal misoprostol in second-trimester termination of pregnancy [3]. This could perhaps be explained by the difference in the dose or the frequency of the administration. A further study reported that induction-to-abortion interval was shorter when sublingual misoprostol was compared with oral misoprostol [4].

Misoprostol versus cervagem for the induction of labour to terminate pregnancy in the second and third trimester: A systematic review

Aims to compare the benefits and harms of misoprostol to induce labour in the second and third trimester of pregnancy with cervagem. Methods MEDLINE was searched using the terms abortion, induced; abortifacient agents; pregnancy, second trimester; pregnancy, third trimester; misoprostol; cervagem; and gemeprost to identify randomised controlled trials in which misoprostol was compared with cervagem, for induction of labour to terminate pregnancy in the second or third trimester. Outcomes included vaginal birth not achieved within 24 h; induction to delivery interval; analgesia requirements; blood loss; blood transfusion; surgical evacuation of the uterus; maternal death or serious maternal morbidity; side effects. Results Six randomised trials were included. Five compared vaginal misoprostol with cervagem [el Refaey H, Hinshaw K, Templeton A. The abortifacient effect of misoprostol in the second trimester: a randomized comparison with gemeprost in patients pre-treated with mifepristone (RU486). Hum Reprod 1993;8(10):1744–6; Ho PC, Chan YF, Lau W. Misoprostol is as effective as gemeprost in termination of second trimester pregnancy when combined with mifepristone: a randomised comparative trial. Contraception 1996;53(5):281–3; Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second trimester abortion. Obstetr Gynecol 1997;90(6):896–900; Wong KS, Ngai CS, Wong AY, Tang LC, Ho PC. Vaginal misoprostol compared with vaginal gemeprost in termination of pregnancy: a randomized controlled trial. Contraception 1998;58(4):207–10; Dickinson JE, Godfrey M, Evans SF. Efficacy of intravaginal misoprostol in second trimester termination of pregnancy: a randomized controlled trial. J Mater Fetal Med 1999;7(3):115–9], and one oral misoprostol with gemeprost [Bartley J, Baird DT. A randomised study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy. Br J Obstetr Gynaecol 2002;109(11):1290–4]. Vaginal misoprostol compared with cervagem was associated with reduced narcotic analgesia (3 studies, 169 women, RR 0.64 95% CI 0.49–0.84), and surgical evacuation of the uterus (5 studies, 319 women, RR 0.71 95% CI 0.53–0.95). No other statistically significant differences were observed for other outcomes with reported data. In the single trial comparing oral misoprostol with gemeprost, reported outcomes were similar. Conclusions Vaginal misoprostol for the termination of second and third trimester of pregnancy appears as effective as cervagem, but information about maternal safety is limited.

Misoprostol (alone) in second trimester terminations of pregnancy: As effective as Gemeprost?

SummaryGemeprost (Cervagem) has been used widely compared with Misoprostol (Cytotec) alone in second trimester pregnancy termination. This prospective randomised trial was to evaluate the efficacy of intravaginal Misoprostol (alone) and Gemeprost in second trimester termination of pregnancy. A total of 54 women with 27 on each arm were involved. A total of 25 patients (92.6%) in the Misoprostol group and 22 patients (81.5%) in the Gemeprost group delivered within 48 h. The Misoprostol group delivered earlier, although average number of tablets required were similar. The side-effects were not significant between the two groups in fact, but there was more pyrexia in the Gemeprost group (p = 0.004). Misoprostol in second trimester termination of pregnancy is clinically as effective and less costly than the standard regimen of Gemeprost.

Two regimens of vaginal misoprostol in second trimester termination of pregnancy – a prospective randomised trial

The search continues for a safe, effective, and cheap method for mid-trimester termination of pregnancy. Misoprostol is a strong contender in this respect. The dose schedule of misoprostol is still not fixed. The objective of our present study was to compare the efficacy and adverse events of 2 dose regimens of vaginal misoprostol for second trimester termination. A prospective, randomised, controlled trial was undertaken in 138 women at 14-20 weeks gestation, in a teaching hospital. Subjects were randomised to receive either regime A: 400 microg of intravaginal misoprostol every 3 h, or regime B: loading dose of 600 microg, followed by 200 microg every 3 h. The main outcome measure was the success rate at 48 h, total dose required, induction-abortion interval, and adverse events. Data was analysed by Student's t-test, Mann-Whitney U-test, the chi-squared test or Fisher's exact test, using Statistica 6.0 software. There was no significant difference in the success rates at 24 and 48 h (Regime A: 97.18 and 98.59%; Regime B: 95.45 and 95.45%), and in mean induction-abortion interval (12.97 versus 12.13 h). However, mean misoprostol requirement was significantly higher for Regime A (1701.4 versus 1269.7 microg). The incidence of fever was significantly less in Regime B (32.4 versus 14.9%). Use of vaginal misoprostol for second trimester abortion had comparable efficacy with less drug requirement for the 600 microg loading dose followed by 200 microg 3-hourly regime compared to the 400 microg 3-hourly regime.

Induction of labor with vaginal misoprostol for second trimester termination of pregnancy in the scarred uterus

Objectives: To assess the safety of vaginal misoprostol for second trimester pregnancy termination in patients with a history of cesarean section. Methods: A consecutive series of 593 women with pregnancies of 14–26 weeks were studied. A cohort of 56 cases had undergone previous cesarean section delivery. The 528 cases who had no history of prior uterine surgery served as the controls. The termination was carried out according to the regimen used at the time of enrolment, either 600 μg applied at every 6 or every 12 h, or 800 μg applied at every 12 h using the vaginal route. Results: The median induction to abortion time in the previous cesarean section group (15.1 h) was not significantly different from that of the controls (15.8 h). The median total dosage of misoprostol used was the same for both groups (1200 μg). The rates of incomplete abortion and analgesia usage were significantly higher in the previous cesarean section group as compared with the controls. Conclusions: Vaginal misoprostol was effective for the second trimester pregnancy termination but the safety of misoprostol in the scarred uterus cannot be assumed from this study. A large series is needed to reach the power to see the difference.

Misoprostol for second trimester termination of pregnancies with prior low transverse cesarean section

Misoprostol for second trimester termination of pregnancies with prior low transverse cesarean section

Misoprostol in second trimester termination of pregnancy

Objective: The purpose of this study is to compare misoprostol to oxytocin and prostaglandin E 2 (PGE 2) in second trimester termination of pregnancy. Methods: Patients between 14 and 24 weeks gestation scheduled for induction were asked to enroll in the study using misoprostol. Comparison was made with historical controls delivered over the last 3 years who received medical induction with (PGE 2) suppositories or received high dose oxytocin. After pretreatment with acetaminophen, lomotil, and promethazine, a PGE 2 suppository (20 mg) was placed every 4 hours until passage of fetus or treatment failure. Oxytocin was given in dosages that were sequentially infused in 500 mL of D-5 LR over 3 hours each beginning at 50 units/500 mL and increasing an additional 50 units with each subsequent infusion until a maximum of 300 units. Each infusion was followed by 60 mL NS over 1 hour. Treatment failure was defined as undelivered after completion of the 24-hour infusion regimen. Misoprostol was placed into the posterior vaginal fornix every 8 hours until passage of fetus or treatment failure, which was defined as failure to pass fetus within 48 hours. Development of maternal signs or symptoms severe enough to preclude further treatment was also considered treatment failure. Data were collected on use of analgesia, induction to delivery interval, and adverse symptoms. Results: A total of 54 subjects were analyzed. Sixteen were given misoprostol, 21 high dose oxytocin, and 18 PGE 2. Mean induction to delivery times were 1374.2 ± 1009.5 minutes, 609.2 ± 515.6 minutes, and 933.6 ± 1363.7 minutes, respectively. ANOVA with least square analysis showed no difference between groups. There were 3 misoprostol failures, 7 high dose oxytocin failures, and 1 prostin failure. χ 2 analysis of failure rates showed a difference between the 3 groups ( P < .05), attributable to the difference between PGE 2 and oxytocin. Conclusions: Induction to delivery interval was not different between the three agents using intravaginal misoprostol of 200 μg every 8 hours. More treatment failures, however, occurred with oxytocin than prostaglandin. In view of lower cost and ease of storage and administration, misoprostol may be a more useful agent.