Uterine Tachysystole Research Articles

Defining uterine tachysystole: how much is too much?

We sought to determine if uterine tachysystole, ≥ 6 contractions per 10 minutes, within the first 4 hours of labor induction, is associated with adverse infant outcomes. This was a prospective cohort study of 584 women ≥ 37 weeks' gestation undergoing induction of labor with 100 μg of oral misoprostol. Fetal heart rate tracings were analyzed for contractions per 10 minutes during the initial 4 hours after misoprostol administration. Patients were analyzed based on the maximum number of contractions per 10 minutes. Infant condition at birth was assessed using the fetal vulnerability composite. Adverse infant outcomes showed no association with increasing number of contractions per 10 minutes. Six or more contractions in 10 minutes were significantly associated with fetal heart rate decelerations (P ≤ .001). Analysis was performed using the maximum number of contractions per 30 minutes with similar results. Uterine tachysystole, as currently defined, when occurring remote from delivery is not associated with adverse infant outcomes.

A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter

We sought to compare the efficacy of a double-balloon transcervical catheter to that of a prostaglandin (PG) vaginal insert among women undergoing labor induction. In all, 210 women with a Bishop score ≤6 were assigned randomly to cervical ripening with either a double-balloon device or a PGE2 sustained-release vaginal insert. Primary outcome was vaginal delivery within 24 hours. The proportion of women who achieved vaginal delivery in 24 hours was higher in the double-balloon group than in the PGE2 group (68.6% vs 49.5%; odds ratio, 2.22; 95% confidence interval, 1.26-3.91). There was no difference in cesarean delivery rates (23.8% vs 26.2%; odds ratio, 0.88; 95% confidence interval, 0.47-1.65). Oxytocin and epidural analgesia were administered more frequently when a double-balloon device was used. Uterine tachysystole or hypertonus occurred more frequently in the PGE2 arm (9.7% vs 0%, P = .0007). The use of a double-balloon catheter for cervical ripening is associated with a higher rate of vaginal birth within 24 hours compared with a PGE2 vaginal insert.

Acute tocolysis for uterine tachysystole or suspected fetal distress

Acute tocolysis for uterine tachysystole or suspected fetal distress

Oral Misoprostol for Labor Augmentation

In addition to artificial rupture of the membranes, intravenous oxytocin is essentially the sole medication for labor augmentation in the United States. Although misoprostol has been shown in numerous trials to be an effective agent for labor induction, there have been concerns with respect to its uterotonic properties and relatively long half-life, when used as a contractile agent for women in spontaneous labor who require augmentation. Limited data are available on the use of oral misoprostol as an augmentation agent. The aim of this randomized controlled trial was to compare the efficacy of oral misoprostol and intravenous oxytocin among women in spontaneous active labor who require augmentation. A total of 350 singleton women with spontaneous labor and cervical dilation between 4 and 8 cm were randomized to either oral misoprostol (n = 376) or intravenous oxytocin (n = 374). The main study outcome was the incidence of uterine tachysystole, hypertonus, or both. Secondary outcomes assessed included mode of delivery, duration of labor, presence of nonreassuring fetal heart rate, and selected maternal and neonatal outcomes. The admission-to-study drug interval was significantly shorter among women in the misoprostol group (330 minutes, range: 252–408) compared with those in the oxytocin group (402 minutes, range: 330–492; P < 0.001). However, no significant difference was found in the interval between initiation of the study drug and delivery (306 minutes in the misoprostol group vs. 276 minutes in the oxytocin group; P = 0.29). The incidence of uterine tachysystole, hypertonus, or both was higher in the misoprostol group (76%) compared with the oxytocin group (64%); P = 0.02. However, this increase appeared to be secondary to uterine hypertonus, as there was no difference between groups in the incidence of tachysystole (P = 0.74). There was no increased likelihood that women in the misoprostol group would experience a nonreassuring fetal heart rate or require a cesarean delivery (P = 0.20 and P = 0.78, respectively). No significant differences were noted between the groups in maternal or neonatal outcomes. The authors conclude that these findings suggest that oral misoprostol may be effective for augmentation of labor.

313: Defining uterine tachysystole: how much is too much?

There is a paucity of data on how much uterine activity is excessive when measured against clinical outcomes. Our purpose was to determine if uterine tachysystole as defined by the American Congress of Obstetricians and Gynecologists, 6 or more contractions per 10 minutes, is associated with adverse fetal outcomes.

Cervical ripening with foley balloon plus fixed versus incremental low-dose oxytocin: a randomized controlled trial

Objective: To evaluate cervical ripening with foley balloon combined with a fixed vs. incremental low-dose oxytocin infusion. Methods: Women presenting for term labor induction were randomized to fixed low-dose or standard incremental low-dose oxytocin infusion following foley balloon placement. The primary outcome was time from foley balloon placement to delivery. Results: Among 116 subjects, there was no difference in median time to delivery among subjects receiving fixed low-dose vs. standard incremental low-dose oxytocin during induction of labor with a foley balloon (23.7 vs. 19.2 hours). There were no differences between the two groups in median time to foley bulb extrusion, active labor and second stage of labor or incidence of uterine tachysystole, fetal heart rate abnormalities, mode of delivery or maternal hemorrhage. Conclusions: There is no difference in median time to delivery in women undergoing cervical ripening with a foley balloon combined with a fixed low-dose or standard incremental low-dose oxytocin.

Oral Misoprostol for Labor Augmentation

To estimate the efficacy of oral misoprostol for labor augmentation. We performed a randomized, controlled trial comparing intravenous oxytocin to a 75-microgram dose of oral misoprostol. Women in spontaneous labor were eligible if they had cervical dilation of 4-8 cm and required labor augmentation. Primary outcome was the incidence of uterine tachysystole, hypertonus, or both. Secondary outcomes included labor durations, presence of nonreassuring fetal heart rate, mode of delivery, and select maternal and neonatal outcomes. Three hundred fifty women were randomized, 176 (50%) to oral misoprostol and 174 (50%) to intravenous oxytocin. Whereas the admission to study drug interval was significantly shorter in women randomized to misoprostol (median 330 minutes [252, 408] compared with 402 minutes [330, 492]; P<.001), there was no difference in the time interval between initiation of augmentation and delivery: 306 (150, 534) minutes in the misoprostol group compared with 276 (162, 462) in the oxytocin group (P=.29). Women in the misoprostol group were more likely to experience uterine tachysystole, hypertonus, or tachysystole and hypertonus compared with those in the oxytocin group (76% compared with 64%, respectively; P=.02). This increase was secondary to uterine hypertonus as the incidence of tachysystole did not differ between groups (P=.74). Women in the misoprostol arm were no more likely to experience a nonreassuring fetal heart rate (P=.20) or require a cesarean delivery for this indication (P=.78). There were no significant differences in maternal or neonatal outcomes. Oral misoprostol is an effective agent for augmentation of labor. : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00906347. I.

Intravaginal misoprostol versus Foley catheter for labour induction: a meta-analysis

There are a number of agents used for cervical ripening prior to the induction of labour. Two commonly used agents are intravaginal misoprostol and a transcervical Foley catheter. To review the evidence comparing misoprostol and transcervical Foley catheter placement for induction of labour, and perform a meta-analysis comparing these two induction agents. We conducted database searches of PubMed, Embase, the Cochrane Library Database, and the ClinicalTrials.gov website. Bibliographies of all relevant articles were reviewed. Prospective, randomised trials comparing the use of intravaginal misoprostol and transcervical Foley catheter for the purpose of cervical ripening and induction of labour were included. We excluded studies in which the patients in these two intervention groups also received other induction agents concurrently, such as oral misoprostol, oxytocin, or other prostaglandins. The primary outcomes selected were time to delivery, and the rates of caesarean section, uterine tachysystole, and chorioamnionitis. Random-effects generalised linear models with a poisson distribution and log link function were used to compare the two induction agents across the studies. Nine studies (1603 patients) were identified as eligible to be included in this meta-analysis. There were no significant differences in the mean time to delivery (mean difference 1.08 ± 2.19 hours shorter for misoprostol, P = 0.2348), the rate of caesarean delivery (RR 0.991; 95% CI 0.768, 1.278), or in the rate of chorioamnionitis (RR 1.130; 95% CI 0.611, 2.089) between women who received misoprostol compared with transcervical Foley catheter. Patients who received misoprostol had significantly higher rates of tachysystole compared with women who received a transcervical Foley catheter (RR 2.844; 95% CI 1.392, 5.812). Intravaginal misoprostol and transcervical Foley catheter have similar effectiveness as induction agents. Transcervical Foley catheter is associated with a lower incidence of tachysystole.

Intravaginal administration of isosorbide mononitrate and misoprostol for cervical ripening and induction of labour: a randomized controlled trial

Labor induction in the presence of unfavorable cervix is a common indication for the use of prostaglandins. However, in the last years, there has been a considerable interest in the use of nitrous oxide donors for cervical ripening and labor induction. To evaluate the efficacy and safety of intravaginal administration of NOD isosorbide mononitrate (IMN) plus misoprostol versus misoprostol alone for cervical ripening and induction of labor. Department of Obstetrics and Gynecology, Woman's Health Center, Assiut University. Two hundred and ninety women scheduled for labor induction were recruited and assigned randomly to IMN or placebo followed by misoprostol 50 μg. The efficacy of the medication was evaluated by predetermined outcome variables for cervical ripening and induction of labor and delivery. The two groups were comparable with respect to age, parity, gestational age, indication for induction, and Bishop's score. Women receiving IMN plus misoprostol showed significant changes in the Bishop score 6 h after administration as compared to misoprostol plus placebo (8.57 ± 1.46 vs. 7.6 ± 1.39 h, P = 0.001), significantly shorter intervals from the beginning of the induction to the beginning of the active phase of labor (10.97 ± 2.87 vs. 13.91 ± 2.16 h, P = 0.0004) and from the beginning of induction to the time of delivery (19.56 ± 3.96 vs. 23 ± 2.62 P ≤ 0.001). No significant differences in the incidence of uterine hypersystole, tachysystole and hyperstimulation. Regarding headache, much more women suffer headache in the IMN group (51) with significant difference to placebo group (11). Using a combination of IMN and misoprostol is more efficient than misoprostol alone in terms of fast cervical ripening and shortening of induction-labour interval.

Castor Oil for Induction of Labor: Not Harmful, Not Helpful

Although published data on the safety and effectiveness of castor oil for the induction of labor are sparse, it is widely used for this purpose outside of medical settings, especially by American nurse-midwives. Its low cost, easy storage, and apparent safety contribute to its popularity. The results of 4 small clinical trials evaluating its safety and effectiveness for labor induction were contradictory. This historical cohort investigated the safety and effectiveness of castor oil for induction of labor in women with an estimated gestation of more than 40 weeks based on ultrasound. Data were obtained from the hospital-based records of pregnant women who had attended antenatal clinics on the Thai-Burmese border between 2005 and 2007. The 612 women (18.1%) who delivered during the study period at a gestational age of more than 40 weeks were divided into 2 groups: those who were prescribed oral doses of castor oil (n = 205) and those who were not (n = 407). A Cox proportional hazards regression model was used to measure the effect of castor oil on the time to delivery. The Fisher exact test was used to compare proportions of women with various identified adverse outcomes. Primary outcomes examined in the safety analysis were maternal deaths and stillbirths. Other analyzed safety measures included fetal distress, meconium-stained amniotic fluid, uterine tachysystole, uterine rupture, abnormal maternal blood pressure during labor, Apgar score, neonatal resuscitation, postpartum hemorrhage, and severe diarrhea. No significant difference was found in the time to birth of women who received castor oil and those who did not; the hazard ratio was 0.99, with a 95% confidence interval of 0.81–1.20. There were no maternal deaths, uterine ruptures, or other harmful effects on the mother or fetus associated with either group. In this study, the use of castor was safe for both mothers and babies but the data provide no evidence that this agent is effective for induction of labor.

Management of Protracted Active Labor With Nipple Stimulation: A Viable Tool for Midwives?

The patient is a 36‐year‐old G3 P0020 at 39 gestational weeks who presented in labor to the hospital where she planned to give birth. She attended prenatal care visits regularly, had a healthy pregnancy, and desired a natural birth without intervention. On admission, her initial cervical examination was 2 to 3 cm, 100% effacement, — 1 station, and membranes intact. She reported regular contractions for 2 hours prior to coming to the hospital. An abdominal examination indicated a longitudinal lie, cephalic presentation, and right occiput posterior position of the fetus. The fetal heart rate pattern was reassuring. Contractions occurred every 3 to 5 minutes via external tocometer. The patient coped well with her husband's support and was encouraged to return home to labor through latent phase. Feeling uncomfortable about the possibility of staying home too long, the patient chose to be admitted and placed on intermittent monitoring. The patient was examined 4 hours later and her cervix was 5 cm, 100% effaced, — 1 station. Her contraction pattern was unchanged. The fetal heart rate pattern was consistently reassuring. Four hours later, 8 hours after her admission, the patient reported increased discomfort and wanted to know how much progress she had made. Her cervix was 7 cm, 100% effaced, — 1 station; her infant remained in occiput posterior position. At this time, the midwife diagnosed a protracted active labor pattern.The midwife encouraged the patient to use positions such as hands and knees and side lunge to encourage rotation of the fetal head, yet her cervical examination remained unchanged over the next 4 hours. At 12 hours after admission, the midwife suggested nipple stimulation in an effort to enhance uterine forces and promote progressive cervical change. The patient's husband stimulated her nipples bilaterally for 15 minutes, followed by a 15‐minute rest period. The midwife remained in the room during nipple stimulation to ensure consistent use of the technique. She noted no uterine tachysystole, which she defined as five contractions in 10 minutes, and the fetal heart rate pattern remained reassuring.The cycle was repeated four times over the next 2 hours, at which point the patient's cervix was 8 cm, 100% effaced, 0 station, with contractions every 5 to 10 minutes. Despite cervical change, the contraction strength and frequency pattern were thought to be insufficient for active progress expected at this point in first‐stage labor. Fourteen hours after hospital admission, the collaborative decision was made to simultaneously perform amniotomy and initiate oxytocin augmentation at a rate of 1 mU/min. Nipple stimulation was discontinued at this time. Continuous external fetal monitoring was initiated.Oxytocin was progressively increased by 2 mU/min every 30 minutes for the next 6 hours. After more than 20 hours of laboring in the hospital, the patient felt the urge to push and her cervix was completely dilated. She pushed for a full hour and gave birth to a healthy infant girl in direct OP position, with Apgar scores 9 and 9 at 1 and 5 minutes, respectively.

A Randomized Clinical Trial Comparing Vaginal Misoprostol versus Cervical Foley Plus Oral Misoprostol for Cervical Ripening and Labor Induction

We compared labor induced by vaginal misoprostol versus a supracervical Foley catheter and oral misoprostol. Singleton pregnancies at > or = 24 weeks' gestation were randomized to either an initial 25-microg dose of intravaginal misoprostol, followed by 50-microg intravaginal doses at 3- to 6-hour intervals, or a supracervical Foley balloon and 100 microg of oral misoprostol at 4- to 6-hour intervals. Primary outcome was time from induction to delivery. One hundred twenty-six women were randomized to vaginal misoprostol alone (group I) and 106 women to Foley and oral misoprostol (group II). The groups were similar in age, weight, gestational age, parity, indication for induction of labor, and oxytocin use. Cesarean delivery rates at 37% and cesarean indications were similar ( P = 0.25). The time from induction to delivery in group II (12.9 hours) was significantly shorter than that in group I (17.8 hours, P < 0.001). Uterine tachysystole occurred less often in the vaginal misoprostol group (21% versus 39%, P = 0.015). Compared with vaginal misoprostol, delivery within 24 hours was significantly more likely with a Foley balloon and oral misoprostol. The use of terbutaline and peripartum outcomes were similar in the two groups.

Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review

The induction of full-term labour in women with a live fetus remains a major challenge in modern obstetrics. To determine, using the best level of evidence available, the efficacy and safety of sublingual administration of misoprostol compared with vaginal misoprostol in the third trimester of pregnancy for the induction of labour, according to initial doses, in women with a live, full-term fetus and an unripe cervix. Pubmed/Medline, Lilacs and Scielo databases were consulted, as well as clinical trials registered in the Cochrane Register from January 1996 to February 2008, using the keywords 'misoprostol', 'labour, obstetric', 'delivery, obstetric', 'induced labour' and 'parturition' with the search limits of 'clinical trials' and 'randomised clinical trials'. This review contains randomised clinical trials in which the sublingual and vaginal routes of administration of misoprostol were compared. Participants were pregnant women with an indication for induction of labour and a live fetus more than 37 weeks of gestational age. The primary analysis compared sublingual and vaginal routes of administration of misoprostol. Secondary analyses compared different routes and initial doses of misoprostol. Statistical analysis included odds ratios and their respective 95% CI. To evaluate the heterogeneity of the studies, the I-squared test was used, studies being considered heterogeneous when I 2 was greater than 50%. Five good quality clinical trials involving a total of 740 women were eligible, and all were included. No statistically significant difference was found between the sublingual and the vaginal misoprostol groups with respect to the rate of vaginal delivery not achieved within 24 hours (OR 1.27, 95% CI 0.87-1.84), uterine hyperstimulation syndrome (OR 1.20, 95% CI 0.61-2.33) or caesarean section (OR 1.33, 95% CI 0.96-1.85). An increased risk of uterine tachysystole was found in the sublingual misoprostol group (OR 1.70, 95% CI 1.02-2.83). When the studies were grouped according to the initial dose of misoprostol, no significant difference was found between sublingual or vaginal groups. The sublingual route of administration is as effective as the vaginal route in inducing labour in full-term pregnancies with live fetuses. However, the safety, adverse effects, optimal dose and perinatal outcome related to this route of administration remain to be established, and it cannot be recommended for routine use in obstetric practice.

A comparison of misoprostol and ricnus oil meal for cervical ripening and labor induction

Objective To compare the safety and efficacy of intravaginal prostaglandin E1, misoprostol with ricinus oil meal for labor induction. Methods 120 patients with an indication for induction of labor were randomly assigned to two groups (60 cases each) induction with misoprotol, 50μg intravaginally every 3 hours until active labor, or with that ricinus oil meal was taken. Results The time from start of intuction to vaginal deliery was significantly shorter than in the misoprostol group [(12.2±3.5)h vs (18.1±3.2)h] (P<0.05), and fewer patients in the misoprostol group required oxytocin augmentation (10% vs 40%, P<0.05). The mean change in the Bishop score was significantly higher than in those receiving misoprotol (5.5 vs 3.1, P<0.05). Uterine tachysystole occurred more frequently in patients in the misoprostol group (16.7%) than in the ricinus oil meal group (3.0%). No significant difference was noted in the mode of delivery and patients of successful labor induction. Conclusion Vaginally administered misoprostol is an effective agent for the cervical ripening and induction of labor. Key words: Misoprotol; Labor induced

Outpatient cervical ripening with nitric oxide donor isosorbide mononitrate prior to induction of labor

Objective: To examine the effectiveness and safety of outpatient vaginal administration of isosorbide mononitrate (IMN) to induce cervical ripening. Methods: A prospective, double-blind, placebo-controlled, randomized clinical trial was conducted on 102 singleton term pregnant women with unfavorable cervices who were randomly assigned to receive outpatient intravaginal IMN or placebo before admission for induction of labor. The main outcome variable was time from hospital admission to delivery. Secondary outcomes included fetal and maternal morbidity, labor characteristics, and incidence of cesarean delivery. Results: The admission–delivery interval was 13.45±6.63 and 20.12±8.19 h (P=0.0001) for the IMN and placebo groups, respectively. Of the IMN patients 62.75% needed prostaglandins for cervical ripening versus 90.2% with placebo (P=0.002). The incidence of tachysystole was significantly lower in the IMN group (P<0.05) but there were no significant differences in cesarean delivery rate, neonatal outcomes, and incidence of hyperstimulation. Conclusions: Outpatient use of IMN resulted in shorter admission to delivery interval, and was associated with less prostaglandin use and lower incidence of uterine tachysystole.

Pilot Study of Labor Induction with Titrated oral Misoprostol

To evaluate the safety and efficacy of titrated oral misoprostol for labor induction at term. Seventy-seven pregnant women (37 nullipara and 40 multipara), with medical or obstetric indications for labor induction after 37 weeks of gestation and unfavorable cervices (Bishop's score < 7), were induced according to the principles of titrated oral doses of misoprostol against uterine response. Our primary outcome measurements were the percentage of patients who had a vaginal delivery within 24 hours of induction and the interval from induction to vaginal delivery. Secondary measurements included oxytocin requirement, total misoprostol dosage, number of cesarean deliveries, induction failure, uterine hyperstimulation rates and neonatal outcomes. Seventy-five women (97.4%) experienced active labor within 24 hours, with 72 (93.5%) completing vaginal delivery within 24 hours. The mean interval from induction to vaginal delivery for all the women was 9.7 hours, with a 2.3-hour active phase. The mean misoprostol dosage was 206 microg, with eight women (10.4%) requiring oxytocin augmentation. There was no uterine hyperstimulation or induction failure, except for seven cases of uterine tachysystole (9.1%). Titrated oral misoprostol is a safe and effective method of labor induction because the dosage can be adjusted according to individual response.

Higher rates of tachysystole among patients with clinically apparent uterine leiomyomas

This study was undertaken to determine uterine and fetal heart rate (FHR) tracing patterns associated with clinically apparent uterine leiomyomas. Uterine and FHR patterns of 44 women with diagnosed uterine leiomyomas were compared with 601 tracings of controls. Tracings were interpreted during the first stage of labor, using the National Institute of Child Health and Human Development Research Planning Workshop guidelines. Stratified analysis that used the Mantel-Haenszel technique was performed to control for confounders. Patients with leiomyomas had higher rates of uterine tachysystole as compared with those without leiomyomas (22.7% vs 1.3%; odds ratio [OR] = 21.8, 95% CI 7.4-65.6; P < .001). No significant differences were noted between the groups regarding FHR patterns. Higher rates'of prostaglandin induction and oxytocin augmentation were noted in the uterine leiomyomas group (6.8% vs 0.8%; P = .005 and 52.3% vs 10.5%; P < .001, respectively). However, controlling for prostaglandin induction and oxytocin augmentation, with the use of the Mantel-Haenszel procedure, did not change the significant association between uterine leiomyomas and tachysystole (weighted OR 12.5, 95% CI 6.2-75.1, and weighted OR 8.7, 95% CI 3.6-43.1, respectively). Clinically apparent uterine leiomyomas, although not coupled with abnormal FHR patterns, are associated with higher rates of tachysystole.

Uterine tachysystole and hyperstimulation during induction of labor

Uterine tachysystole and hyperstimulation during induction of labor

Intracervical misoprostol and prostaglandin E 2 for labor induction

Objectives: To compare the safety and efficacy of misoprostol with PGE 2 for induction of labor by intracervical administration. Methods: Eighty-six women with indications for labor induction at term were randomly assigned to two groups. Each woman received either 50 μg of misoprostol or 0.5 mg of prostaglandin E 2 intracervically. If labor was not initiated after 4 h, the same dose was repeated every 4 h to a maximum of 200 μg of misoprostol or 1.5 mg of PGE 2 until adequate labor was achieved. Results: Forty-three women were allocated to the misoprostol group and 43 to the prostaglandin E 2 group. Misoprostol was more effective than PGE 2 in producing cervical changes ( P<0.025). Delivery within 12 h after the first administration occurred more often in the misoprostol group than in the PGE 2 one (85% vs. 56%, P<0.05). Less patients in the misoprostol group required oxytocin augmentation than in the PGE 2 one (16.3% vs. 39.5%, P<0.05). Uterine tachysystole and hyperstimulation occurred more frequently in the misoprostol group (44.1%) than in the PGE 2 group (18.7%) ( P<0.05). Nevertheless, no statistically significant differences were noted between the two groups including mode of delivery and neonatal or maternal adverse outcome. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (480±172 min vs. 657±436 min, P<0.01). Conclusions: Compared with prostaglandin E 2, intracervical misoprostol is more effective in cervical ripening and labor induction at term. The higher frequency of uterine hypercontractility associated with the use of misoprostol did not increase the risk of adverse intrapartum and neonatal outcomes.

Misoprostol in second and early third trimester for termination of pregnancies with fetal anomalies

Objectives: To assess the effectiveness of a prostaglandin E1 analog, misoprostol, using different regimens compared with dinoprostone in termination of pregnancies in second and early third trimester complicated by either congenital fetal anomalies or intrauterine fetal demise. Methods: A retrospective review of 59 pregnancies between 15 and 30 weeks was performed which were terminated due to congenital fetal anomalies or intrauterine fetal demise. In group 1 ( n=29) 400 μg oral and 600 μg vaginal misoprostol, in group 2 ( n=12) 600 μg vaginal misoprostol and in group 3 ( n=18) 0.5 mg dinoprostone gel were given for the termination of the pregnancies. All these groups were evaluated for demographic characteristics and delivery findings. Statistical analysis were performed by one-way ANOVA, Kruskal–Wallis and χ 2-test. Results: No significant statistical difference was observed in terms of age, gravidity, parity, previous abortion, gestational week, frequency of prostaglandin usage, and birth weights among the three groups. The time intervals between the first administration and delivery were 20.3 h for oral vaginal misoprostol, 17.3 h for vaginal misoprostol and 22.5 h for the dinoprostone group ( P=0.594). Evacuation rates after single doses were similar in all groups (83%, 73% and 72%, respectively). Uterine tachysystole was the only major side effect encountered in the oral-vaginal misoprostol group. Conclusions: All three regimens yielded similar results for termination of pregnancies in second and third trimester. The major advantage of misoprostol was the cost.