Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial

Abstract

This new regimen of 800 microg of vaginal misoprostol every 6 h for a maximum of three doses in 24 h was an effective alternative method for second trimester abortion. In addition, misoprostol moistened with acetic acid was significantly more effective than misoprostol moistened with saline.

Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens

“…The regimens of group B (600 mg every 6 h) and C (800 mg every 12 h) in the present study achieve shorter induction-abortion intervals than was observed in previous studies with the same dosage schedules of misoprostol tablets not moistened with acetic acid [3][4][5][6][12][13][14][15] . Moistening the tablets of misoprostol with acetic acid before vaginal administration increases the abortifacient efficacy.…”

“…a Chi-Square test tablets moistened with 3 ml of 5 % acetic acid and (ii) tablets moistened with 3 ml of saline 3 . This study showed that a new regimen of 800 mg of vaginal misoprostol every 6 h for a maximum of three doses in 24 h was effective and that misoprostol moistened with acetic acid was significantly more effective than moistened with saline 3 .…”

“…Misoprostol, a synthetic analogue of naturally occurring prostaglandin E 1 , is now being used for medical termination of pregnancy during the second trimester [3][4][5][6][7][8][9][10][11][12][13][14][15] . Recent studies have compared various dosages (from 100 to 800 mg), intervals between doses (from 3 to 12 h), and routes of administration.…”

“…Absorption of misoprostol from the vagina may vary according to the medium in which the tablet is placed. Misoprostol tablets disintegrate better in an acidic medium 18 ; various studies have shown that moistening of misoprostol tablets with acetic acid is associated with greater efficacy than moistening with saline 3,19,20 .…”

Vaginal drug administration in the hospital setting

“…Other clinical trial results suggest that moistening the misoprostol tablets in acetic acid solution before vaginal insertion optimizes dissolution, as pH values in loco are known to affect the pharmacokinetics of this drug. 70 Another interesting approach for misoprostol delivery has been the use of a vaginal insert similar to the commercially available inserts used for dinoprostone. The major clinical advantages of this system involve the controlled release of misoprostol from the hydrogel polymer contained in the insert, allowing for its gradual absorption into the systemic circulation and a reasonably rapid decrease in plasmatic levels after removal, which makes hyperstimulation controllable and reversible.…”