Vaginal misoprostol for early second-trimester abortion

Abstract Background Abortion is the termination of pregnancy by any means (surgical or medical) before the age of viability. The definition varies in duration of gestational age according to the countries and available facilities. Estrogen is important in the maintenance of pregnancy. Aromatase inhibitors such as letrozole, suppress the peripheral conversion of androgen to estrogen, the use of letrozole combined with vaginal misoprostol was more effective than misoprostol alone in termination of pregnancy. Objective Assessing the efficacy of addition of letrozole to Misoprostol in medically induced abortion in the second trimester of pregnancy in the Maternity hospital of Ain Shams University. Methods This clinical trial was conducted at Ain Shams University Maternity hospital in the period between December 2018 and May 2019. Patients that seem to be fulfilling the inclusion criteria were recruited, then informed written consent was taken from every patient before starting the examination That was followed by detailed history and examination of all patients to confirm fulfilling the inclusion and exclusion criteria. Results This study demonstrated that 10 mg letrozole for three days followed by 800 mcg of vaginal misoprostol is more effective than misoprostol alone for second trimester abortion. In the total of 72 women were recruited the complete abortion rate of the letrozole group was significantly higher than that of the control group (61,1% in the letrozole group compared with 33,3% in the control group). Conclusion s: The use of letrozole in addition to misoprostol was associated with a higher complete abortion rate, shorter induction to abortion interval and shorter curettage rates compared to a placebo followed by misoprostol in patients undergoing induction of abortion between 12 & 24 weeks gestation.

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Comparative effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen of mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182367 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2449

Author(s):

Arunima Saini ◽

Preet Kamal Bedi ◽

Nisha Bhagat

Keyword(s):

Gestational Age ◽

Outcome Measure ◽

Secondary Outcome ◽

Simultaneous Administration ◽

Second Trimester ◽

Trimester Abortion ◽

Group A ◽

Second Trimester Abortion ◽

Vaginal Misoprostol ◽

Group B

Background: In second trimester abortion, medical methods are preferred. Prostaglandins are the most widely used. Amongst them, misoprostol is the most commonly used. Thus, the study was conducted to delineate the effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion.Methods: It was a prospective, single centered, comparative study conducted on 50 patients in Department of Obstetrics and Gynaecology, GMC, Amritsar coming for second trimester abortion, either elective or emergency, with gestational age between 12-20 weeks. Initially, 53 patients were enrolled in the study, 3 patients dropped out at different stages of study. Finally, 50 patients were enrolled and divided into two groups of 25 patients each by 1:1 randomization. In Group-A, mifepristone 200 mg orally along with misoprostol 600µg vaginally were given simultaneously, followed by 400 µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Group-B initially received mifepristone 200 mg per oral followed by 12 hours later misoprostol 400µg vaginally and then 400µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Primary outcome measure was effectiveness of regimen in complete abortion, which was confirmed on pelvic ultrasound 1-week after the last dose. Secondary outcome measure was to compare the induction abortion interval (IAI), dose of misoprostol required and adverse drug reaction (ADR) among both the regimens. P-value <0.05 was taken as statistically significant.Results: Mean age in Group-A was 25.68±3.79 years while in Group-B was 23.40±2.73 years. Both the regimens had success rate of 76% for complete abortion. However, IAI in Group-A was 5.9±4.47 hours whereas in Group-B was 9.6±5.07 hours, which was statistically significant (p= 0.009). A statistically significant difference was also observed in the mean dose of misoprostol between two groups that is, 1000±200µg and 1425±437.41µg respectively (p=0.01). Gestational age was related to IAI from 13 to 17.6 weeks in both groups (p=0.01) while no significant relation was seen between them in more than 17.6 weeks of gestation (p=0.63).Conclusions: Simultaneous administration of mifepristone and misoprostol showed better results than interval regimen in term of significant lesser induction abortion interval, lower dosages of misoprostol required with comparable success rates.

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Second trimester abortion by laminaria followed by vaginal misoprostol or intrauterine prostaglandin F2α: a randomized trial

Contraception ◽

10.1016/s0010-7824(02)00291-3 ◽

2002 ◽

Vol 65 (6) ◽

pp. 411-413 ◽

Cited By ~ 7

Author(s):

B Paz ◽

G Ohel ◽

T Tal ◽

S Degani ◽

E Sabo ◽

...

Keyword(s):

Randomized Trial ◽

Prostaglandin F2α ◽

Second Trimester ◽

Trimester Abortion ◽

Second Trimester Abortion ◽

Vaginal Misoprostol

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Second Trimester Abortion with Vaginal Misoprostol: Is There Any Advantage with Prior Mifepristone Priming? A Comparative Study

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1166 ◽

2012 ◽

Vol 4 (1) ◽

pp. 25-27 ◽

Cited By ~ 1

Author(s):

Partha Mukhopadhyay ◽

Tara Sankar Bag ◽

Amit Kyal ◽

Anup Bhuniya ◽

Tushar Kanti Saha

Keyword(s):

Blood Loss ◽

Comparative Study ◽

Careful Examination ◽

Second Trimester ◽

Trimester Abortion ◽

Group A ◽

Second Trimester Abortion ◽

Vaginal Misoprostol ◽

Group B ◽

Ideal Method

ABSTRACT Objective Second trimester medical termination of pregnancy (MTP) can be done by surgical or nonsurgical methods or by various combinations of the two. Every method has its advantages and disadvantages. An ideal method would be one which was safe, quick and 100% effective, inexpensive and without any immediate or late side-effects. However, in the absence of such, various methods in synergistic combinations have been tried to come close to an ideal method. The successes of medical method now appear to be useful in MTP even in second trimester of pregnancy. Our objective is to investigate the effectiveness of only vaginal misoprostol and compare with oral mifepristone plus vaginal misoprostol in second-trimester induction abortions (≥12 and ≤20 weeks). Methods The patients are selected after careful examination and necessary investigations were divided into group A (n = 62) which received 400 μg of vaginal misoprostol followed by 200 μg vaginal misoprostol 4 hourly till expulsion of fetus or a maximum dose of 2000 μg and group B (n = 60) which received 200 mg of oral mifepristone followed 48 hours later by vaginal misoprostol as in group A. Main outcomes measured were efficacy, blood loss, induction-abortion interval and complication. Results The present study showed that the both methods were effective in 2nd trimester MTP. Average blood loss was lesser in group B (131.66 ml) compared to group A (150 ml). Induction abortion interval was shorter in group B (6.62 hours) than in group A (12.19 hours). Ninty percent of group B and 80.7% of group A had no complications. Success rate was higher in group B. Conclusion Therefore, in our study, pretreatment mifepristone followed by misoprostol was found to be a very effective regimen for 2nd trimester abortion with lesser complications and higher efficacy. How to cite this article Mukhopadhyay P, Bag TS, Kyal A, Bhuniya A, Saha TK. Second Trimester Abortion with Vaginal Misoprostol: Is There Any Advantage with Prior Mifepristone Priming? A Comparative Study. J South Asian Feder Obst Gynae 2012;4(1):25-27.

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