Role and efficacy of vaginal dinoprostone gel (PGE2) plus vaginal misoprostol (PGE1) in second trimester termination of pregnancy

Abstract

INTRODUCTIONSecond trimester termination contributes approximately 10% to 20% of all induced abortions cases and about 65% to 70% of all fatal complications are related to induced abortions. Various agents are used to ripen the cervix and stimulate uterine contractions and induce abortion after 12 weeks, but available data regarding their safety and effectiveness are limited.1,2 Various agents include hypertonic saline, or hyperosmolar urea, injected intra-amniotically; ethacridine lactate administered intraor extra-amniotically; prostaglandin analogues administered parenterally or intra-or extra-amniotically; and oxytocin injected intravenously or intramuscularly. These methods and routes of administration, however, are invasive and likely to be less safe, and the time to complete abortion is longer when compared to the use of methods such as misoprostol alone, combined dinoprostone and misoprostol combined mifepristone and misoprostol.2-5 Second trimester abortion also includes surgical procedure, but it can result in complications like uterine perforation, cervical incompetence, uterine ABSTRACT Background: The addition of dinoprostone gel (PGE2) to standard regimen of second trimester abortion using vaginal misoprostol (PGE1) reduces failure rate and decrease induction abortion time interval. We evaluated the role and efficacy of vaginal dinoprostone gel with vaginal misoprostol in women undergoing second trimester abortion. Objective of present study was to assess the safety and effectiveness of vaginal dinoprostone gel plus vaginal misoprostol for second trimester termination of pregnancy. Methods: This study was a prospective cohort involving 100 women with 12-20 weeks gestation requesting termination of pregnancy. In study group 0.5mg dinoprostone gel applied vaginally followed by 400µg misoprostol every four hourly (max 3 doses) after six hours of dinoprostone gel application. The mean age of the women study was 27.2 years and mean gestational age was 18.9 weeks. The primary effectiveness of the study was the efficacy of the treatment to terminate pregnancy at 20 hrs. Secondary outcomes were induction abortion interval, failure rate, side effects. statistical analysis of study was carried out using chi square test. Results: At 20 hours, the complete abortion rate was 100%. Within 16 hours 98% women aborted without any significant side effects. Mean induction abortion interval was 14.56 hours. Conclusions: Combination of vaginal dinoprostone gel (PGE2) plus misoprostol (PGE1) is effective, safe and alternate method for second trimester pregnancy termination with. In this protocol induction to abortion interval time is less as compared to other methods of second trimester pregnancy termination.

Identification of drugs using FTIR in a case of illegal abortion: A forensic study

“…But, it is necessary to identify the drugs which have been administrated orally or vaginally to the victim for the purpose of abortion. The suspected drugs which are being practiced for administering for the purpose of abortion are given in Table 1 [4][5][6][7][8][9]. In this paper, the identification of misoprostol has been studied using FTIR.…”

Use of mifepristone plus misoprostol vs cerviprime plus misoprostol for second trimester abortion: A prospective comparative study

“…With the introduction of prostaglandin analogues, the efficacy of medical abortion has improved drastically, and the risk for complications and side effects have reduced. Among prostaglandins, PGE1 and PGE2 have been used in different doses and by various routes for second trimester abortion [3,4] The method of medically induced abortion has further improved with usage of mifepristone [5] . With mifepristone, the induction-to-abortion interval has shortened, and the dose of PG analogues required has reduced.…”