Second Trimester Abortion with Vaginal Misoprostol: Is There Any Advantage with Prior Mifepristone Priming? A Comparative Study

Abstract

Objective: Second trimester medical termination of pregnancy (MTP) can be done by surgical or nonsurgical methods or by various combinations of the two. Every method has its advantages and disadvantages. An ideal method would be one which was safe, quick and 100% effective, inexpensive and without any immediate or late side-effects. However, in the absence of such, various methods in synergistic combinations have been tried to come close to an ideal method. The successes of medical method now appear to be useful in MTP even in second trimester of pregnancy. Our objective is to investigate the effectiveness of only vaginal misoprostol and compare with oral mifepristone plus vaginal misoprostol in second-trimester induction abortions (≥12 and ≤20 weeks). Methods:The patients are selected after careful examination and necessary investigations were divided into group A (n = 62) which received 400 µg of vaginal misoprostol followed by 200 µg vaginal misoprostol 4 hourly till expulsion of fetus or a maximum dose of 2000 µg and group B (n = 60) which received 200 mg of oral mifepristone followed 48 hours later by vaginal misoprostol as in group A. Main outcomes measured were efficacy, blood loss, induction-abortion interval and complication. Results:The present study showed that the both methods were effective in 2nd trimester MTP. Average blood loss was lesser in group B (131.66 ml) compared to group A (150 ml). Induction abortion interval was shorter in group B (6.62 hours) than in group A (12.19 hours). Ninty percent of group B and 80.7% of group A had no complications. Success rate was higher in group B.Conclusion: Therefore, in our study, pretreatment mifepristone followed by misoprostol was found to be a very effective regimen for 2nd trimester abortion with lesser complications and higher efficacy.

Efficacy of Mifepristone and Misoprostol Compared to Misoprostol Alone in the Medical Management of the First-trimester Missed Miscarriages

“…Compared to 82 (24%) of the 348 women in the placebo plus misoprostol group, 59 (17%) of the 348 women in the mifepristone plus misoprostol group did not spontaneously pass the gestational sac within 7 days. 12,13 conclusIon In contrast to misoprostol treatment alone, according to our research, pretreatment with mifepristone and misoprostol increased the rate of missed miscarriage resolution by 7 days. To maximize the likelihood of successful miscarriage management and decrease the need for surgical evacuation, like D&E particularly in primigravidas, we advise offering mifepristone pretreatment before misoprostol to women who have had a missed miscarriage.…”

Medical regimens for abortion at 12 weeks and above: a systematic review and meta-analysis

“…Seven trials with 1026 total subjects compared combination mifepristone–misoprostol to misoprostol only ( Fig. 2 , Supplements 4 and 5) [ 18 , [26] , [27] , [28] , [29] , [30] , [31] ]. The combination regimen resulted in lower rates of ongoing pregnancy at 24 h (RR 0.12, 95% CI 0.04–0.35) and 48 h (RR 0.22, 95% CI 0.08–0.60 at 48 h, low certainty evidence).…”

“…The WHO used the results of this review to directly inform its recent Medical management of abortion guidance [ 11 ]. Our review builds on the 2011 Cochrane review [ 5 ] of second-trimester medical abortion methods by evaluating 26 new trials [ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] ]. Based on our analysis, we recommend a regimen of mifepristone 200 mg 1 to 2 days before misoprostol 400 mcg every 3 h via vaginal, sublingual or buccal routes.…”

Efficacy of vaginal isosorbide mononitrate with misoprostol versus oral mifepristone and misoprostol in induction of second trimester abortions: An RCT at a tertiary hospital

“…Isosorbide mononitrate has been used in earlier studies for cervical ripening in induction of labour at full term pregnancy [11,21] . It has been used earlier for cervical ripening before first trimester surgical evaluation [12][13][14][15][16][17][18][19] Present study is a prospective, randomized, case controlled study between 2017-2019, to compare the efficacy, safety and acceptability of two medical methods in induction of second trimester Abortions at S.C. Government teaching hospital, a tertiary care centre, HIMS, Hassan. This study is conducted to compare efficacy, safety of vaginal isosorbide mononitrate 40ugm followed by vaginal misoprostol 400ugm and repeated 4 th hourly versus oral mifepristone 200ugm followed 24 hrs later by 4 th hourly vaginal misoprostol-400 u gm.…”