Randomised comparison of oral and vaginal misoprostol when combined with mifepristone for termination of second trimester pregnancy

Authors

  • Madhuri N. Department of Obstetrics and Gynaecology, J.S.S Medical College, Mysore, Karnataka, India
  • Veena G. R. Department of Obstetrics and Gynaecology, J.J.M medical college, Davangere, Karnataka, India
  • Manjunath G. H. Department of Obstetrics and Gynaecology, J.J.M medical college, Davangere, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20160400

Keywords:

Mifepristone, Second trimester medical abortion, Misoprostol

Abstract

Background: Objective of the study was to compare the effectiveness of vaginal (200µg) and oral (400µg) misoprostol when combined with mifepristone (200 mg) in termination of second trimester pregnancy.

Methods: 60 women who were pregnant between 13 and 20 weeks were included in the study. They were divided into two groups by random sampling method and they all received 200 mg of mifepristone orally on day 1. 36 hours later they received 200 µg of misoprostol vaginally or 400 µg of misoprostol orally every 3 hours as determined by the random sampling method. Main outcome measures were induction abortion interval, complete abortion rate and side effects.

Results: There was a statistical difference in the amount of misoprostol required in the oral and the vaginal group, the total dose being higher in the oral group. The mean induction-abortion interval in the vaginal group was 6.2 hrs  and oral group was 11.6 hrs and this difference was statistically significant. There was no statistical difference in the complete abortion rate of the two groups. There was no difference in the side effects caused by both routes of misoprostol administration.

Conclusion: 200 µg misoprostol inserted vaginally is better than 400 µg of oral misoprostol, 36 hours after administration of tab. Mifepristone 200 mg for termination of second trimester pregnancy.

References

Nagaria T, Sirmor N. Misoprostol Vs Mifepristone and Misoprostol in Second Trimester Termination of Pregnancy. J Obstet Gynaecol India. 2011;61(6):659-62.

Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, Campana A. Medical methods for first trimester abortion. Cochrane Database Syst Rev. 201;11.

Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. N Eng J Med. 2001;344:38-60.

Lalitkumar S, Bygdeman M. Gemzell – Danielsson K. Mid trimester induced abortion: a review. Hum Reprod Update. 2007;13:37-52.

Webster D, Penney GC, Templeton AA. A comparison of 600 and 200mg mifepristone prior to second trimester abortion with the prostaglandin misoprostol. Br J Obstet & Gynecol. 1996;103:706-9.

EL-Rafey, Rajasekhar D, Abdatta M. Colder L. Induction of abortion with mifepristone and oral and vaginal misoprostol. N-Eng J Med. 1995;332:983-7.

Nigam A, Singh VK, Prakash A. Vaginal Vs oral misoprostol for mid trimester abortion. Int J Gynaecol Obstet. 2006;92:270-1.

El-Rafaey H, Templeton A. Induction of abortion in the second trimester by a combination of misoprostol and mifepristone : a randomized comparison between two misoprostol regimens. Hum Reprod. 1995;10:475-8.

Guix C, Palacio M, Figueras F, Bennasar M, Zamora L, Coll O. Efficacy of two regimens of misoprostol for early second trimester pregnancy termination. Fetal Diagn Ther. 2005;20(6):544-8.

Tang OS, Schweer H, Seyberth HW, Lee SW, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Human Reprod. 2002;7(2):332-6.

Ashok PW, Templeton A, Wagaarachchi PT, Flett GMM. Mid trimester medical termination of pregnancy: A review of 1002 consecutive cases. Contraception. 2004;69:51-8.

Bebbington MW, Kent N, Lim K., Gagnon A, Delisle MF. A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination . Am J Obstet Gynecol. 2002;187(4):853-7.

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

Kapp N, Borgatta L, Stubblefield PG, Vragovic O, Moreno N. Mifepristone in mid trimester medical abortion: A randomized controlled trial. Obstet & Gynecol. 2007;110:1304-10.

Downloads

Published

2016-12-17

Issue

Section

Original Research Articles