Use of Misoprostol in First and Second Trimester Abortion

Abstract

The use of misoprostol in medical termination of first and second term pregnancies and cervical priming in surgically induced termination of pregnancies has been studied extensively. A survey is given on the available literature (MEDLINE to May 1998) on the usage as a single medication or in combination with mifepristone or methotrexate. A review is given on literature concerning side effects and complications. Misoprostol is a most promising, cheap, and effective agent, which does not need cool storage like other prostaglandins. The use of misoprostol as an abortifacient has, however, not been supported by the manufacturer. This leads to the situation (similar to mifepristone/RU 486) that it is used and researched, but probably will not be officially approved for this specific indication.

High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: A randomized trial

“…1,3,6,[8][9][10][11][12][13][14][15][16][17][18] Use of misoprostol for second trimester pregnancy interruption was initially described by Jain et al in 1994; however, this regimen utilized a relatively low-dose misoprostol regimen (200 ug vaginally every 12 hours). 6 Several recent investigations have suggested that higher dose misoprostol regimens may be more efficacious.…”

“…6 Several recent investigations have suggested that higher dose misoprostol regimens may be more efficacious. 1,2,[8][9][10][11][12][13][14][15][16][17][18] .…”

“…[1][2][3][4][5][6][7] Such techniques include dilation and evacuation, intraamniotic prostaglandin F 2α instillation, prostaglandin E 2 (PGE 2 ) vaginal suppositories, and high dose oxytocin. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Misoprostol (Cytotec®,), a potent uterotonic agent, has also been shown to be effective for second trimester pregnancy interruption. 1,3,6,[8][9][10][11][12][13][14][15][16][17][18] Several recent comparative investigations have demonstrated that the use of high dose oral or vaginal misoprostol is more efficacious than alternative methods (e.g.…”

“…concentrated oxytocin, PGE 2 , etc) for second trimester pregnancy interruption, with an acceptable side-effect profile. 1,3,[8][9][10][11][12][13][14][15][16][17][18] Indeed, we recently demonstrated that a high dose vaginal misoprostol regimen was superior to concentrated oxytocin plus low-dose vaginal PGE 2 with respect to significantly shortened induction-to-delivery interval, fewer side effects, less medication for the treatment of side effects, and lower incidence of retained placenta requiring dilation and curettage, reduction in side effects, and fewer cases of retained placenta requiring dilation and curettage. 18 However, we noted a relatively high live birth rate and therefore devised the current study…”

Comparison of intracervical laminaria plus vaginal misoprostol and vaginal misoprostol only with variable dosages for medical abortion within 12 hours

“…In addition, it is inexpensive and storable at room temperature, and causes fewer side effects [6,7]. Much research has been carried out to defi ne the most effective and best tolerated dosage and route of administration, but previous studies have reported its success rate mostly within 24 hours [8,9]. In this study, we compared the effectiveness of intracervical laminaria plus vaginal misoprostol and vaginal misoprostol only with variable dosages by analyzing the rate of spontaneous gestational sac expulsion for medical abortion within 12 hours.…”