Second and Third Medical Termination of Pregnancy with Misoprostol without Mifepristone

Abstract

Background: Advances in prenatal diagnosis make it possible to detect many fetal pathologies for which a termination of pregnancy (TOP) is possible in France. In pregnancies which go beyond 3 months, the use of prostaglandins combined with mifepristone has simplified this procedure. Since mifepristone must be taken 48 h before using prostaglandins, we have used only misoprostol intravaginally. Methods: Our report deals with a continuous series of terminated pregnancies in the second and third trimesters. The time period in question is January 1, 1996 through July 31, 2001. When this treatment was used within the first 30 weeks of gestation, four tablets (800 µg) of misoprostol were administered intravaginally. When there were no contractions, two additional tablets (400 µg) of misoprostol were given orally every 3 h, not exceeding 3 times. Beyond 30 weeks of amenorrhoea, because of the risk of uterine rupture, the initial dose was lower: 1/4 tablet (50 µg) of misoprostol intravaginally was increased to 100 µg (1/2 tablet) every 3 h until expulsion. Results: In the second and third trimesters, 55 pregnancies were terminated medically; only 1 case was not successful. In the other 54 cases, the average time interval between administering misoprostol intravaginally and expulsion was 12.7 ± 8 h. Side effects included nausea or vomiting for 12 patients (22%) and hyperthermia for 11 patients (20%). Thirty-three patients (60%) had no side effects at all. In 10 cases (18%), the fetus and the placenta were removed in one movement. In 11 cases (20%), the placenta had to be removed by artificial means. In 7 cases (13%), a curettage with a curette foam was done. In the long run perspective, only 1 patient needed a curettage to remove placental residue. Conclusion: Treatment by misoprostol without mifepristone during the second and third trimesters makes it possible to terminate a pregnancy easily and quickly without significant complications.

Mifepristone‐ and misoprostol‐induced mid‐trimester termination of pregnancy: A review of 272 cases

“…24 These rates are lower than those reported in recent papers when misoprostol is used alone. 26,27 The proportion of women requiring transfusions is higher than that reported by Ashok et al, in which 0.7% (seven of 999) had a transfusion. 1 This difference is statistically significant where P < 0.05 (relative rate = 3.69, 95% CI = 1.30,10.42).…”

Late Termination of Pregnancy for Fetal Anomaly

“…28 Inductionto-delivery intervals of 12.7 hours were reported with misoprostol alone given intravaginally 800 g and then 400 g given orally every 3 hours up to a total dose of 1200 ug. Ninety eight percent of TOPs in the second and third trimester are successful following intravaginal administration of misoprostol alone.…”

Delivery Course of Macerated Stillborn Fetuses in the Third Trimester

“…4) delivery should be induced with vaginal or intracervical PGE 2 ␣ gel, and in mature findings by amniotomy and oxytocin stimulation. In the study by Langer et al [21] , 55 pregnancies were terminated medically in the second and third trimesters, only 1 case was not successful. In the other 54 cases, the average time interval between administering misoprostol intravaginally and expulsion was 12.7 8 8 h. In 18%, the fetus and the placenta were removed in 1 movement.…”