Comparative study of combination of misoprostol with Foley’s bulb compared with misoprostol alone for termination of second trimester pregnancy

Authors

  • Priya Agarwal Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India
  • Sudha Gandhi Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India
  • Prachika Indora Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20222090

Keywords:

Foley’s catheter, Misoprostol, Second trimester, Mifepristone, Cerviprime gel

Abstract

Background: Second trimester abortion is termination of pregnancy in a period from 13 to 28 weeks of gestation. Second trimester losses may be due to maternal factors such as uterine malformation, growths in the uterus (fibroids), or cervical problems. These conditions also may contribute to premature birth.  Aims and objectives were to compare the efficacy, safety and suitability of combination of misoprostol with intracervical Foley’s catheter v/s misoprostol alone for termination of second trimester pregnancy.

Methods: This randomized controlled trial study was conducted on 100 study subjects who passed our inclusion and exclusion criteria. Group A: received misoprostol with intracervical Foley’s catheter. Group B: received misoprostol alone. The groups were compared with respect to the patients’ characteristics, gestational age, indication for termination of pregnancy, rate of complications, etc.

Results: Mean value of age (years) of study subjects was 27.12±4.5. Mean induction to delivery time (hours) in P0 was 17.73±6.46 and in P1-P2 was 14.78±4.9 which was significantly higher as compared to ≥P3 (11.46±3.82). (p=0.0004). Mean induction to delivery time (hours) in 14 to 18 weeks was 15.25±5.4 and >18 weeks was 15.02±5.84. (p=0.854). Distribution of side effect between group A and B. (6% vs 20% respectively) (p=0.041).

Conclusions: We conclude that intracervical Foley catheter and vaginal misoprostol is a safe and effective method for second trimester abortion as compared to misoprostol alone group with no additional risks.

 

Author Biographies

Priya Agarwal, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India

Resident

Department of Obstetrics and Gynaecology,

RNT Medical College, Udaipur

Sudha Gandhi, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India

Sr. Professor and Unit Head

Department of Obstetrics and Gynaecology,

RNT Medical College, Udaipur

Prachika Indora, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India

Resident,

Department of Obstetrics & Gynaecology

RNT Medical College, Udaipur

References

ACOG Practice Bulletin No. 135: Second-trimester abortion. Obstet Gynecol. 2013;121:1394.

Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH. Induced abortion: estimated rates and trends worldwide. Lancet. 2007;370(9595):1338-45.

Shabana A, Salah H, Kandil M, Solimon E, Morsi D. Termination of mid trimester pregnancies: misoprostol versus concurrent weight d Foley catheter and misoprostol. F1000 Res. 2012;1:36-40.

Lalit kumar S, Bygdeman M, Gemzell-Danielsson K. Mid-trimester induced abortion: a review. Hum Reprod Update. 2007;13(1):37-52.

Henshaw SK, Finer LB. The accessibility of abortion services in the United States, 2001. Perspect Sex Reprod Health. 2003;35:16.

Ipas. Comprehensive Abortion Care. 2018.

Hamoda H, Ashok PW, Flett GM, Templeton A. A randomized trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion at 13-20 weeks gestation. Hum Reprod. 2005;20:2348-54.

Dixit TB, Manandhar T, Sitaula S, Basnet T. Sequential Foley catheter and misoprostol versus misoprostol alone for induction of labor in postdated pregnancy: a randomized controlled trial. JBPKIHS. 2020;3(1):105-12.

Ngai SW, Tang OS, Ho PC. Randomized comparison of vaginal (200 microg every 3 h) and oral (400 microg every 3 h) misoprostol when combined with mifepristone in termination of second trimester pregnancy. Human Reprod. 2000;15:2205-8.

Bhatiyani B, Parul S, Kansaria JJ, Parulekar SV. Induction of labor, Foley's catheter. Bombay Hospital J. 2003;45 (2):297-300.

Murmu S, Dwivedi C. A comparative study of intracervical Foley’s catheter and intracervical PGE2 gel for pre-induction cervical ripening. IJRCOG. 2018;7(8):3122.

Prabhu S, Krishnaswamy KP, Shetty A. A study of different doses of sublingual misoprostol after oral mifepristone in medical termination of pregnancy. J Evol Med Dental Sci. 2015;4(91):15673-8.

Rezk M, Abo-Elnasr M, Al-Halaby A. Combined use of intracervical Foley catheter and vaginal misoprostol for termination of second trimester pregnancy: a three-year observational study. Clin Obstet Gynecol Reprod Med. 2015;1(3):79-83.

Mahajan P, Sharma N, Sharma P. Study to compare the effectiveness of intravaginal misoprostol alone with combined use of intravaginal misoprostol and intracervical Foley’s catheter for termination of mid trimester pregnancy. Int J Reprod Contracept Obstet Gynecol. 2020;9:2560-5.

Dickinson JE, Evans SF. The optimization of intravaginal misoprostol dosing schedules in second-trimester pregnancy termination. Am J Obstet Gynecol. 2002;186:470.

Carbonell JL, Torres MA, Reyes R, Ortega L, García-Gallego F, Sánchez C. Second-trimester pregnancy termination with 600-microg vs. 400-microg vaginal misoprostol and systematic curettage post expulsion: a randomized trial. Contraception. 2008;77:50-5.

Jamali M, Bakhtiyari M, Areb F and Mirzamoradi M. Misoprostol complications in second-trimester termination of pregnancy among women with a history of more than one cesarean section. Obstet Gynecol Sci. 2020;63(3):323-9.

Manninen HJ, Kuvaja P, Mattila AT. Clinical efficacy of mifepristone and misoprostol in second trimester pregnancy termination. Acta Obstetr Gynecol. 2010;89:1552-6.

Odeh M, Tendler R, Sosnovsky V, Kais M, Ophir E, Bornstein J. The effect of parity and gravidity on the outcome of medical termination of pregnancy. Isr Med Assoc J. 2010;12(10): 606-8

Rettenmaier MA, Hanson FW. Rettenmaier MA. A comparative study of two types of prostaglandins for abortion during the second trimester. Surg Gynecol Obstet. 1983;156(5):585

Allen R, O’Brein B M. Uses of Misoprostol in Obstetrics and Gynecology. Rev Obstet Gynecol. 2009;2(3):159-68.

Samantaray S, Sarojini A, Mohapatra, Vivekanand A, Ranjan S. Comparison of intravaginal misoprostol alone and in combination with intracervical Foley's catheter for termination of second trimester pregnancy-3 years study at a tertiary care hospital. ResearchGate. 2016;4(1):1-5.

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Published

2022-08-29

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Section

Original Research Articles