Randomised comparison of oral and vaginal misoprostol when combined with mifepristone for termination of second trimester pregnancy

Abstract

INTRODUCTIONAdvances in fetal diagnosis have resulted in increased number of second trimester pregnancy terminations. Invasive means of second trimester medical abortion have long been available. In the past few years, however, the ability to safely and effectively accomplish non invasive second trimester abortions has evolved considerably.A combination of mifepristone, a progesterone antagonist, and misoprostol, a synthetic prostaglandin E1 analogue, is effective for medical abortion in second trimester. The latter has the advantages of being cost effective, stable at room temperature and is a strong uterotonic. Mifepristone, (RU 486, a substitute 19-norethisterone derivative) is a progesterone receptor blocker, causes intrauterine fetal demise and sensitises the uterus to the activity of prostaglandins.1 The two drugs together have proven efficacy in first trimester abortion. 2The optimal regimen for second trimester is still under investigation, but is required to have a high complete abortion rate, short induction-abortion interval, low Methods: 60 women who were pregnant between 13 and 20 weeks were included in the study. They were divided into two groups by random sampling method and they all received 200 mg of mifepristone orally on day 1. 36 hours later they received 200 µg of misoprostol vaginally or 400 µg of misoprostol orally every 3 hours as determined by the random sampling method. Main outcome measures were induction abortion interval, complete abortion rate and side effects. Results: There was a statistical difference in the amount of misoprostol required in the oral and the vaginal group, the total dose being higher in the oral group. The mean induction-abortion interval in the vaginal group was 6.2 hrs and oral group was 11.6 hrs and this difference was statistically significant. There was no statistical difference in the complete abortion rate of the two groups. There was no difference in the side effects caused by both routes of misoprostol administration. Conclusion: 200 µg misoprostol inserted vaginally is better than 400 µg of oral misoprostol, 36 hours after administration of tab. Mifepristone 200 mg for termination of second trimester pregnancy.