Randomized controlled trial comparing efficacy between a vaginal misoprostol loading and non‐loading dose regimen for second‐trimester pregnancy termination

Pongsatha, Saipin; Tongsong, Theera

doi:10.1111/jog.12147

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…In second-trimester procedures, repeat doses of misoprostol are typically administered without mifepristone until expulsion occurs, leading to successful completion in 26%-96% of women, depending on the dose, dosing interval, route, and allowed time to completion (many only document completion up to 15 hours after initiation of misoprostol) [9][10][11][12][13][14][15]. Regimens that include mifepristone before misoprostol have demonstrated completion rates of 63%-100% and typically result in shorter times to expulsion [6,[16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 98%

A double‐blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14–21 weeks of pregnancy

Dabash

Chelli

Hajri³

et al. 2015

Intl J Gynecology & Obste

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Section: Introductionmentioning

confidence: 98%

A double‐blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14–21 weeks of pregnancy

Dabash

Chelli

Hajri³

et al. 2015

Intl J Gynecology & Obste

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“…We did not find any study comparing different doses of vaginal misoprostol regimens in the first trimester of pregnancy, however, a randomized controlled trial by Pongsatha et al 25 compared the vaginal misoprostol loading and non-loading dose regimens and revealed that a loading dose of misoprostol was significantly related to higher rates of adverse effects and comparable success rate, they concluded that loading dose of misoprostol is not more effective than non-loading dose to induce abortion in second trimester, 25 that was in contrast to all studies ,evaluating the misoprostol effect, on the first trimester of pregnancy.…”

Section: Discussionmentioning

confidence: 83%

Comparison of the effect between two doses of vaginal misoprostol in the termination of first-trimester pregnancy: a double-blinded randomized trial

Farzaneh¹,

Khosravi²,

Hosseini³

et al. 2018

OGIJ

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Comparison of the effect between two doses of vaginal misoprostol in the termination of firsttrimester pregnancy: a double-blinded randomized trial Submit Manuscript | http://medcraveonline.com IntroductionThe management of pregnancy termination by induced abortion is a prevalent obstetrics and gynecologic operation, however, it is invasive and in some cases risky procedure.1,2 Therefore, some specialists have presented medical abortion as an alternative for surgical abortion especially in mothers with early gestational age less than 7 weeks.3 Mifepristone was the first agent used for medical termination of pregnancy 4 and some years later methotrexate was approved for medical abortion.5 Prostaglandin agents are the most common drugs, to achieve the medical termination in women in the first and second trimester of pregnancy. 4 Misoprostol is a synthetic analog of prostaglandin E1 that firstly was approved by the Food and Drug Administration (FDA) for peptic ulcer 4 and later it has been administered in patients with unwilling pregnancy to induce abortion. 5,6 Bugalho et al. 7 administered vaginal misoprostol for medical abortion and demonstrated that it was effective agent to terminate the pregnancy and the successful rate was about 80%, 7 furthermore, these results repeated in some other trials used misoprostol and revealed it is high efficient agent with low serious side effects in women under medical abortion. 8−12To increase the efficacy of misoprostol, it has been used in combination with other agents such as methotrexate and mifepristone for the termination of pregnancy in the first trimester and reported a highly efficacy ranged from 83-97%.13,14 On the other hand, recent experiences proved that women are more satisfied with medical abortion using misoprostol. In this regard, a study by Zikopoulos revealed that 91.3% of the women are satisfied with medical termination and they were very keen to choose it again and recommended it to other women.15 Some other practices confirmed more efficacies with higher doses of misoprostol.16−20 Therefore, in this randomized double-blinded clinical trial we compared the efficacy of two doses of vaginal misoprostol for elective termination of pregnancies in women with gestational age less than 96 days. Materials and methodsThe study was prospectively conducted at Imam Hussein University Hospital between 2013 and 2014. The research has been approved by the ethic committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran (registration number sbmu. rec.1393.553). Our plan is comparison of the effect between two doses of vaginal misoprostol in the termination of first-trimester pregnancy. The criteria for enrollment were singleton pregnancy, indication for pregnancy termination due to either fetal or maternal causes or gestational age ≤96 days (e.g, missed abortion, blighted ovum, and maternal medical problem). The exclusion criteria were Review Article AbstractBackground and aim: a higher dose of misoprostol may increase its efficacy on the termination of pr...

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“…Pongsatha 7 et al compared a vaginal misoprostol LD regimen (600 mcg, then 400 mcg 6 hourly) with a nonloading dose regimen (400 mcg 6 hourly) in 157 women and found both equally effective with adverse drug effects associated more with loading dose regimens.…”

Section: Discussionmentioning

confidence: 99%

Effect of Lowering the Dose of Misoprostol for Second Trimester Termination of Pregnancy Along With Mifepristone

Singal¹,

Gupta²,

Pasrija³

et al. 2018

jemds

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BACKGROUND In India, second trimester termination is reportedly performed in about 11-14% of women. However, abortion is grossly underreported in the official data. A large number of termination of pregnancies is done by unaccredited centres due to various reasons and thus it is extremely important to ensure the safety of the regimen when used in a low-resource setting. So, we conducted a study to determine if lowering the dose of misoprostol significantly compromises the efficacy of second trimester abortion regimens. Aims and Objectives-To study if decreasing the dose of misoprostol used for second trimester termination of pregnancy significantly alters the efficacy of the regimen and also if it is more acceptable in terms of complications and side effects. MATERIALS AND METHODS 100 women seeking termination of pregnancy between 12-20 weeks of gestation were randomised into two equal groups using computerised random number tables. Women were given Tab. Mifepristone 200 mg orally followed by 36 hours and later by Tab. Misoprostol 400 mcg or 200 mcg vaginally 3 hourly for a maximum of 5 doses in Group R1 and R2 respectively. Comparison was done using stringent and non-stringent criteria depending on whether a check curettage was required or not. Statistical analysis was done using Chi-square/ Fisher's exact test for qualitative variables and student's 't' test for quantitative variables. Settings and Design-A prospective randomised comparative study at a District Hospital. RESULTS The two groups were comparable in terms of age, parity and gravidity. Success rate at the end of 72 hours was 82% and 88% in Group R1 and R2 respectively using stringent criteria and 98% and 96% using non-stringent criteria. Mean induction abortion interval was 42.89 (± 9.66) in R1 and 43.09 (± 8.62) in R2 using stringent criteria. We found that regimens are comparable in terms of safety, success, induction-abortion interval and side effects.

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Randomized controlled trial comparing efficacy between a vaginal misoprostol loading and non‐loading dose regimen for second‐trimester pregnancy termination

Abstract: Vaginal misoprostol in the loading dose regimen had a similar efficacy to the non-loading dose regimen but was associated with more adverse maternal effects.

Cited by 13 publications

References 14 publications

A double‐blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14–21 weeks of pregnancy

A double‐blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14–21 weeks of pregnancy

Comparison of the effect between two doses of vaginal misoprostol in the termination of first-trimester pregnancy: a double-blinded randomized trial

Effect of Lowering the Dose of Misoprostol for Second Trimester Termination of Pregnancy Along With Mifepristone

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