Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination

Topp

Obstetrics &Amp; Gynecology

et al. 2013

Section: Resultsmentioning

confidence: 99%

Mifepristone–Misoprostol Dosing Interval and Effect on Induction Abortion Times

Topp

Obstetrics &Amp; Gynecology

et al. 2013

“…It is possible that this difference between our centers played a role in the shorter IDI according to definition 1 in the center with dilators. Studies assessing the use of misoprostol in the induction of labor for stillbirth or TOP show that IDI is shorter with higher doses, but that this does not have a significant effect on the rate of evacuation within 24 h [9,10] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Induction-to-Delivery Interval in Terminations of Pregnancy with or without Dilapan-S®

Vincienne¹,

Anselem²,

Cordier

et al. 2017

Fetal Diagn Ther

Objective: In France, terminations of pregnancy (TOP) for medical reasons beyond the second trimester use mifepristone and misoprostol. We sought to determine the effectiveness of Dilapan-S®, an osmotic cervical dilator, in shortening the induction-to-delivery interval (IDI). Materials and Methods: This retrospective study of TOP in 2010-2012 compared the results from 2 hospitals with different TOP protocols starting at 16 weeks' gestation, one (164 women) with and one (106) without Dilapan-S®. The principal endpoint was the IDI. Results were analyzed according to 2 definitions of induction onset: definition 1, first dose of misoprostol in both centers, or definition 2, dilator placement if used, and otherwise first dose of misoprostol. Results: With definition 1, the IDI was shorter with dilators (5 h 48 min vs. 10 h 18 min, p < 0.001); the rates of uterine evacuation within 12 and 24 h were higher (94.5 and 100 vs. 68.9 and 91.5%, p < 0.001), and the time between first misoprostol dose and amniotomy was shorter (0 h 47 min vs. 4 h 30 min, p < 0.001). Under definition 2, the IDI was longer with dilators (18 h 24 min vs. 10 h 18 min, p < 0.001), but the rate of evacuation within 24 h did not differ significantly. Conclusion: Dilapan-S® acts on cervical ripening and dilatation, thereby allowing early amniotomy. Assessing potential side effects and women's satisfaction requires prospective trials.

Intl J Gynecology & Obste

“…No direct evidence related to medical management compared with surgical, expectant, or placebo management was identified. Four trials reported that the analysis was intention‐to‐treat (ITT) analysis . Thus, it was not possible to perform true ITT analyses for all comparisons and outcomes.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14–28 weeks of gestation

Cleeve

Fønhus

Lavelanet

2019

Background Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established. Objectives To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. Search strategy Research databases from January 2006 to October 2018. Selection criteria Randomized controlled trials with IUFD cases at 14–28 weeks of gestation. Data collection and analysis We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. Main results Sixteen trials from 1695 citations. When misoprostol is used alone, 400 μg is more effective than 200 μg (RR 0.78; 95% CI, 0.66–0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70–1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85–1.03, low certainty evidence). Certainty of evidence related to mifepristone–misoprostol regimens and safety and acceptability is very low. Conclusions Misoprostol 400 μg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.