Role and efficacy of vaginal dinoprostone gel (PGE2) plus vaginal misoprostol (PGE1) in second trimester termination of pregnancy


  • Abhijeet Kumar Department of Obstetrics and Gynecology, Military Hospital Ramgarh Cantt, Ramgarh, Jharkhand, India
  • Raju Agarwal Department of Obstetrics and Gynecology, Command Hospital Lucknow, Lucknow, Uttar Pradesh, India



Dinoprostone gel, Misoprostol, PGE1, PGE2, Prostaglandin, Second trimester termination of pregnancy


Background: The addition of dinoprostone gel (PGE2) to standard regimen of second trimester abortion using vaginal misoprostol (PGE1) reduces failure rate and decrease induction abortion time interval. We evaluated the role and efficacy of vaginal dinoprostone gel with vaginal misoprostol in women undergoing second trimester abortion. Objective of present study was to assess the safety and effectiveness of vaginal dinoprostone gel plus vaginal misoprostol for second trimester termination of pregnancy.

Methods: This study was a prospective cohort involving 100 women with 12-20 weeks gestation requesting termination of pregnancy. In study group 0.5mg dinoprostone gel applied vaginally followed by 400µg misoprostol every four hourly (max 3 doses) after six hours of dinoprostone gel application. The mean age of the women study was 27.2 years and mean gestational age was 18.9 weeks. The primary effectiveness of the study was the efficacy of the treatment to terminate pregnancy at 20 hrs. Secondary outcomes were induction abortion interval, failure rate, side effects. statistical analysis of study was carried out using chi square test.

Results: At 20 hours, the complete abortion rate was 100%. Within 16 hours 98% women aborted without any significant side effects. Mean induction abortion interval was 14.56 hours.

Conclusions: Combination of vaginal dinoprostone gel (PGE2) plus misoprostol (PGE1) is effective, safe and alternate method for second trimester pregnancy termination with. In this protocol induction to abortion interval time is less as compared to other methods of second trimester pregnancy termination.


World Health Organization. Medical methods for termination of pregnancy: report of a WHO Scientific Group. World Health Organization. Geneva; 1997.

Tietza, C. Second-Trimester Abortion: A Global View. In: Berger GS, Berger WE, Keith LG, Eds., John Wright, Boston;1981:1-11.

Gómez PD, Wing DA. Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy-a systematic review. Contraception. 2009 Apr;79(4):259-271.

El-Refaey H, Templeton A. Pregnancy: Induction of abortion in the second trimester by a combination of misoprostol and mifepristone: a randomized comparison between two misoprostol regimens. Human Reprod. 1995 Feb;10(2):475-8.

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 May 1;53(5):281-3.

Wong KS, Ngai CS, Yeo EL, Tang LC, Ho PC. A comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy: a randomized comparative trial. Human Reprod. 2000 Mar;15(3):709-12.

Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997 Jul;90(1):88-92.

Tang OS, Schweer H, Seyberth HW, Lee SW, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Human Reprod. 2002 Feb 1;17(2):332-6.

Meckstroth KR, Whitaker AK, Bertisch S, Goldberg AB, Darney PD. Misoprostol administered by epithelial routes: drug absorption and uterine response. Obstet Gynecol. 2006 Sep;108(3, Part 1):582-90.

Ho PC, Ngai SW, Liu KL, Wong GC, Lee SW. Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy. Obstet Gynecol. 1997 Nov;90(5):735-8.

Ngai SW, Tang OS, Ho PC. Prostaglandins for induction of second-trimester termination and intrauterine death. Best Pract Res Clin Obstet Gynecol. 2003 Oct;17(5):765-75.

Tang OS, Lau WN, Chan CC, Ho PC. A prospective randomised comparison of sublingual and vaginal misoprostol in second trimester termination of pregnancy. BJOG. 2004 Sep 1;111(9):1001-5.

Bhattacharjee N, Saha SP, Ghoshroy SC, Bhowmik S, Barui G. A randomised comparative study on sublingual versus vaginal administration of misoprostol for termination of pregnancy between 13 to 20 weeks. Australian New Zealand J Obstet Gynaecol. 2008 Apr;48(2):165-71.

von Hertzen H, Piaggio G, Wojdyla D, Huong NT, Marions L, Okoev G et al. Comparison of vaginal and sublingual misoprostol for second trimester abortion: randomized controlled equivalence trial. Human Reprod. 2008 Sep;24(1):106-12.

Ganguly RP, Saha SP, Mukhopadhyay S, Bhattacharjee N, Bhattacharyya SK, Patra KK. A comparative study on sublingual versus oral and vaginal administration of misoprostol for late first and early second trimester abortion. J Indian Med Assoc. 2010 May;108(5):283-4.






Original Research Articles