A comparative study of efficacy of two different regimens of vaginal misoprostol in first trimester termination of pregnancy in a tertiary care hospital

Authors

  • Ramya S. P. Department of Obstetrics and Gynaecology, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India
  • Ushadevi Gopalan Department of Obstetrics and Gynaecology, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230548

Keywords:

Misoprostol, Medical termination of pregnancy, First trimester abortion, Mifepristone, D and C

Abstract

Background: Misoprostol has been authorised as an effective medication for termination of pregnancy at different gestations, cervical ripening, labour inducing in term pregnancy, and possibly therapy of postpartum haemorrhage in the last two decades. Objectives were to compare the efficacy of two different regimens of vaginal misoprostol in first trimester termination of pregnancy.

Methods: This was a randomized controlled trial conducted among 50 women in the reproductive age group with single live intrauterine gestation less than 12 weeks. All patients including both groups received mifepristone 200 mg oral administration as day 1 followed by group A received misoprostol 800 mg stat after 36 hours of mifepristone and group B received misoprostol 400 mg stat after 36 hours of mifepristone followed by 200 mg at 6 hourly 2 doses.

Results: The mean age of the study participants was 26.48±3.77 and 24.72±3.33 in group A and B respectively. The 20% and 16% in group A had repeat dose and dilatation and curettage (D and C) done whereas only 8% had D and C done in group B. There was no significant difference between the prevalence side effects between the groups. Group B showed higher dissatisfaction than group A. The 36% and 8% of the study participants in group A and B respectively had incomplete abortion.

Conclusions: Multidose regimen is found to be more effective in the first trimester termination of pregnancy than the single dose regimen.

References

Sjöström S, Dragoman M, Fønhus MS, Ganatra B, Gemzell‐Danielsson K. Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review. BJOG. 2017;124(13):1928-40.

Kmietowicz Z. Medical abortions more common than surgery for first time in 2014 in England and Wales. BMJ. 2015;350:h3177.

Fink G, Gerber S, Dean G. Misoprostol in abortion care. Review and update. Curr Obstet Gynecol Rep. 2017;6:100-8.

Statistics: Ministry of Health and Family Welfare: GOI. Ministry of Health and Family Welfare GOI. Available at: https://main.mohfw.gov.in/documents/Statistics. Accessed on 17 December, 2022.

Jones RK, Kost K. Underreporting of induced and spontaneous abortion in the United States: an analysis of the 2002 National Survey of Family Growth. Studies Family Planning. 2007;38(3):187-97.

Sedgh G, Henshaw SK. Measuring the incidence of abortion in countries with liberal laws. Methodologies for estimating abortion incidence and abortion-related morbidity: a review. Guttmacher Institute International Union for the Scientific Study of Population. 2010;23.

Rossier C. Estimating induced abortion rates: a review. Studies in family planning. 2003 Jun;34(2):87-102.

MTP act (amendment), 2002-Ministry of Health and Family Welfare. Available at: https://main.mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-act-amendment-2002. Accessed on 17 December, 2022.

MTP regulations. Ministry of Health and Family Welfare, GOI. Available at: https://main.mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-regulations. Accessed on 17 December, 2022.

Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion. (Evidence-based Clinical Guideline No 7). London: RCOG. 2011. Available at: https://www.rcog.org.uk/globalassets/documents/ guidelines/abortion-guideline_web_1.pdf. Accessed on 17 December, 2022.

Jejeebhoy SJ, Zavier AJ, Acharya R, Kalyanwala S. Increasing access to safe abortion in rural Maharashtra: outcomes of a comprehensive abortion care model. Population Council. 2011;1-69.

Petersen SG, Perkins AR, Gibbons KS, Bertolone JI, Mahomed K. The medical management of missed miscarriage: outcomes from a prospective, single‐centre, Australian cohort. Med J Aus. 2013;199(5):341-6.

World Health Organization. The selection and use of essential medicines: report of the WHO Expert Committee, March 2009 (including the 16th WHO model list of essential medicines and the 2nd WHO model list of essential medicines for children). World Health Organization. 2009.

Petrou S, Trinder J, Brocklehurst P, Smith L. Economic evaluation of alternative management methods of first‐trimester miscarriage based on results from the MIST trial. BJOG. 2006;113(8):879-89.

Borgatta L, Kapp N. Labor induction abortion in the second trimester. Contraception. 2011;84(1):4-18.

Ashok PW, Flett GM, Templeton A. Termination of pregnancy at 9-13 weeks' amenorrhoea with mifepristone and misoprostol. Lancet. 1998;352(9127):542-3.

Carbonell JL, Varela L, Velazco A, Fernandez C, Sanchez C. The use of misoprostol for abortion at≤ 9 weeks' gestation. Euro J Contracep Reprod Heal Care. 1997;2(3):181-5.

Tang OS, Schweer H, Seyberth HW, Lee SW, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Human Reprod. 2002;17(2):332-6.

Tang OS, Xu J, Cheng L, Lee SW, Ho PC. Pilot study on the use of sublingual misoprostol with mifepristone in termination of first trimester pregnancy up to 9 weeks gestation. Human Reprod. 2002;17(7):1738-40.

Tang OS, Miao BY, Lee SW, Ho PC. Pilot study on the use of repeated doses of sublingual misoprostol in termination of pregnancy up to 12 weeks gestation: efficacy and acceptability. Human Reprod. 2002;17(3):654-8.

Tang OS, Ho PC. Pilot study on the use of sublingual misoprostol for medical abortion. Contraception. 2001;64(5):315-7.

Dickinson JE, Evans SF. The optimization of intravaginal misoprostol dosing schedules in second-trimester pregnancy termination. Am J Obstetr Gynecol. 2002;186(3):470-4.

Stanulov G, Anthoulaki X, Deuteraiou D, Chalkidou A, Trypsianis G, Rath W et al. Comparative study for efficacy of termination in first trimester pregnancy using Misoprostol and Mifepristone. Arch Community Med Publ Heal. 2018;4(2):038-46.

Chen QJ, Zhang J, Huang ZR, Fan XF, Wang HY, Hong ZH et al. Mifepristone in combination with misoprostol for the termination of pregnancy at 8-16 weeks' gestational age: a multicentre randomized controlled trial. J Reprod Contracep. 2013;24(2):101-13.

Ngai SW, Tang OS, Chan YM, Ho PC. Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation: efficacy and acceptability. Human Reprod. 2000;15(5):1159-62.

Van Bogaert LJ, Sedibe TM. Efficacy of a single misoprostol regimen in the first and second trimester termination of pregnancy. J Obstetr Gynaecol. 2007;27(5):510-2.

Brouns JF, van Wely M, Burger MP, van Wijngaarden WJ. Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination. Contraception. 2010 ;82(3):266-75.

Dalenda C, Ines N, Fathia B, Malika A, Bechir Z, Ezzeddine S et al. Two medical abortion regimens for late first-trimester termination of pregnancy: a prospective randomized trial. Contraception. 2010;81(4):323-7.

Hamoda H, Ashok PW, Flett GM, Templeton A. A randomised controlled trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion up to 13 weeks of gestation. BJOG. 2005;112(8):1102-8.

Bugalho A, Faundes A, Jamisse L, Usfa M, Maria E, Bique C. Evaluation of the effectiveness of vaginal misoprostol to induce first trimester abortion. Contraception. 1996;53(4):243-6.

Creinin MD, Vittinghoff E. Methotrexate and misoprostol vs misoprostol alone for early abortion: a randomized controlled trial. JAMA. 1994;272(15):1190-5.

Koopersmith TB, Mishell Jr DR. The use of misoprostol for termination of early pregnancy. Contraception. 1996;53(4):237-42.

Singh K, Fong YF, Prasad RN, Dong F. Does an acidic medium enhance the efficacy of vaginal misoprostol for pre-abortion cervical priming? Human Reprod. 1999;14(6):1635-7.

Downloads

Published

2023-02-27

Issue

Section

Original Research Articles