Use of misoprostol for termination of second and third trimester pregnancy with intrauterine foetal death

Sonal Palod, Trupti Nayak


Background: Prostaglandins (PGs) is an alternative method for induction of labour in women with intrauterine foetal death (IUFD). The vaginal route is advantageous because slow peak levels, sustained for long time and fewer side effects. So this study was aimed to investigate the effectiveness of misoprostol in the induction of labour and abortion in 2nd and 3rd trimester pregnancies associated with IUFD. The objective of the study was to assess the efficacy of misoprostol in fixed dosage schedule for the termination of pregnancy in IUFD and to evaluate induction delivery interval with misoprostol.

Methods: A prospective study was conducted in department of Obstetrics & Gynaecology in tertiary care centre. Inclusion criteria included women of II or III trimester of pregnancy with IUFD. Singleton pregnancy with longitudinal lie in non-scarred uterus with confirmed intrauterine fetal death with bishop score <6. Exclusion criteria included multiple pregnancy, lie other than longitudinal, scarred uterus, hypersensitivity to misoprostol, Bishop score more than 6. Permission from IEC and written informed consent was taken before study participation. Complete examination and investigation of patient was done and induction with misoprostol was done as per dosage schedule mentioned by WHO Bellago, Italy (Feb 2007). Patient was intensively monitored intraoperatively and postoperatively. Follow-up was done till 15 days postpartum.

Results: Out of 107 cases, majority cases were of 22-28 week gestation. Maximum cases (57%) were of age group 21-25years. Induction succeeded in 92 cases with mean induction delivery interval of 13.2 hours. 50% cases had favorable cervix with mean induction delivery interval 9.4 hours and rest had 16.53 hours ID interval with mean ID interval 13.67hours. Complete exclusion was seen in 92 cases (85.98%) and incomplete in 10 cases which required check curettage. Failure of method was seen in 5 cases (4.67%) which were terminated by alternative methods. Most common side effect was abdominal cramp (9.3%) and nausea (5.6%).

Conclusions: Vaginal misoprostol is safe and effective in termination of second and third trimester pregnancy in case of intrauterine fetal death.


IUFD, Misoprostol, Cervical ripening, Induction delivery interval

Full Text:



Centers for Disease Control and Prevention, National Center for Health Statistics Web site; Belkin and Wilder, 2007.

Kochenour NK. Management of fetal demise. Clin. Obstet.Gynecol. 1987;30:322.

Hale RW, Zinberg S. Use of Misoprostol in Pregnancy. New England J. Med. 2001;344:59-60.

Gottschall D, Borgida A, Mihalek J, Sauer F, Rodis I. A randomized clinical trial comparing Misoprostol with prostaglandin E2 gel for pre induction cervical ripening. Am J ObstetGynecol. 1997;177:1067.

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;90(5):735-8.

Ngai SW, Chan YM, Lam SW, Lao TT. Labour charateristics and uterine activity: Misoprostol compared with oxytocin in female at term with pre labour rupture of membranes. Br J Obstet Gynecol. 2002;107:222.

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;109:1290-4.

Bebbington MW, Kent N, Lim K, Gagnon A, Delisle MF, Tessier F. A randomized trial comparing two protocols for the use of Misoprostol in mid trimester pregnancy termination. Am J Obstet Gynecol. 2002;187:853-7.

Jahanfar SH, Ghiyasi P, Haghani H. Risk factors related to intra uterine fetal death in Iran, A case-control study. Shiraz E-Medical Journal. 2005;6(3 & 4).

Elmahaish MO, Asherkaci HM, Elsraiti OA. Epidemiology of ante-partum intra uterine fetal death. Al-satil journal. P: 37-42.

Dutta DC. Text book of obstetrics and gynecology. page no 322.

Abdul MA, Shittu SO, Ameh N. Effectiveness of Misoprostol in the Management of Intra-Uterine Foetal Death. Annals of African Medicine. 2006;5(4):174-7.

Ezechi OC, Ndububa VI, Nwokoro CA. Induction of labour by vaginal misoprostol for Intra Uterine Fetal Death. J Obstet Gynecol Ind. 2004;54(6):561-3.

Gomez ponce de leone R, Wing D, Fiala C. Misoprostol for Intra Uterine Fetal Death. International Journal of Obstretics and Gynecology. 2007;99:S190-3.

EL-Gharib MN, Elebyary MT. Vagiprost in management of second and third trimester intrauterine fetal death. Medical Practice and Review. 2011;2(2):16-22.