A prospective randomized comparison of mifepristone with misoprostol and prostaglandin E2 gel with misoprostol for medical termination of pregnancy between 13-20 week of gestation
Keywords:Mid trimester abortion, Mifepristone, Misoprostol, Prostaglandin E2 gel
Background: Worldwide mid-trimester abortion constitutes 10-15% of all induced abortions. Similar trend is seen in India where mid-trimester abortion accounts for 12.9% of all abortions. Prostaglandins have been used for therapeutic termination of pregnancy from 9-22 weeks of gestation since 1970s. The ideal method for mid-trimester abortion with best efficacy and acceptability and least side effects are still to be found. Objective of this study was to compare two drug regimens for mid trimester abortion using mifepristone with intra-vaginal misoprostol and prostaglandin E2 (PGE2) gel with intra-vaginal misoprostol for efficacy and side effects.
Methods: This prospective randomized comparative clinical study was conducted on 50 women seeking mid trimester abortion, in two groups. One group received PGE2 gel and misoprostol, second group received mifepristone and misoprostol. Induction abortion interval, side effects were compared between two groups.
Results: The mean induction-abortion interval in Group 1 was 6.50±3.54 hours and in Group 2 was 7.33±2.5 hours. In Group 1, success rate at 15 hours was 88%. In Group 2, success rate was 92% both at 15 and 24 hours. Surgical evacuation was required in 8% women in both groups.
Conclusions: Both regimens are safe and has a few minor side effects. There was no major side effect and blood loss was within acceptable limits in both groups. The cost of abortifacients and hospital stay was lessor in group1 (prostaglandin gel and misoprostol) making it more economical.
Ian Donald practical obstetric problems, 6th edition, chapter 2, page 17, B.I. Publications Pvt Ltd; 2006.
Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH. Induced abortion: estimated rates and trends worldwide. Lancet. 2007;370:1338-45.
The Medical Termination of Pregnancy Act of 1971, Act No. 34 (Aug 10,1971). Available at: https://main.mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-act-1971. Accessed on 20th February 2019.
Lalit Kumar S, Bygdeman M, Gemzell-Danielsson K. Mid-trimester induced abortion: a review. Hum Reprod. 2006;13(1):37-52.
Family welfare programme in India. Year Book, 2001. Available at: https://nrhm-mis.nic.in/Family%20Welfare%20Programme%20in%20India%201971%20to%202001/YEAR%20BOOK-%201988-89/1C-YEAR%20BOOK-1988-89.pdf. Accessed on 25th February 2019.
Stubblefield PG, Ellis SC, Borgatta L. Methods for induced abortion. Obstet Gynecol. 2004;104(1):174-85.
Bhathena RK, Sheriar NK, Walvekar VR, Guillebaud J. Second trimester pregnancy termination using extra-amniotic ethacridine lactate. Br J Obstet Gynaecol. 1990;97(11):1026-9.
Karim SMM, Filshie GM. Therapeutic abortion using prostaglandin F2α. Lancet. 1970;1:157-9.
Jain JK, Mishell DR. A comparison of intravaginal misoprostol with prostaglandin E2 for termination of second-trimester pregnancy. N Engl J Med. 1994;331(5):290-3.
Rodger MW, Baird DT. Pre-treatment with mifepristone (RU486) reduces interval between prostaglandin administration and expulsion in second trimester abortion. Br J Obstet Gynaecol. 1990;9a7(1):41-5.
Tang OS, Schweer H, Seyberth HW, Lee SWH, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002;17(2):332-6.
Goyal BK, Singh G. Mid-trimester MTP using endocervical PGE2 gel and serial intramuscular carboprost. Med J Armed Forces India. 2000;56(1):37-9.
Bal H, Singh SK. A study of midtrimester abortion using cerviprime gel and extra-amniotic prostodin. MJAFI. 2006;62:129-30.
Khooshideh M. The comparison of misoprostol and dinoprostone gel for termination of second trimester pregnancy. J Med Sci. 2007;7(2):289-93.
Ashok PW, Templeton A, Wagaarachchi PT, Flett GM. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contracept. 2004;69(1):51-8.
Gupta N, Mittal S. Is mifepristone needed for second trimester termination of pregnancy? J Turkish-German Gynecol Assoc. 2007;8(1):58-62.
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(8):2348-54.
Bartley J, Baird DT. A randomized study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy. Br J Obstet Gynaecol. 2002;109(11):1290-4.