Comparison of oral versus vaginal misoprostol for mid-trimester pregnancy termination

Abstract

Objective: To compare the efficacy and safety of oral versus vaginal administration of misoprostol for second trimester pregnancy termination.

Study design: Interventional, quasi experimental study.

Place and duration of study: The Department of Obstetrics and Gynaecology Unit-II, Fatima Jinnah Medical College/Sir Ganga Ram Hospital, Lahore, from August, 2003 to October, 2004.

Methodology: Sixty pregnant women at second trimester of gestation who were candidates for therapeutic termination of pregnancy were recruited for the study. Grandmultipara, women who had scarred uterus and history of hypersensitivity to prostaglandins were excluded. The subjects were assigned into two groups. Group 1 (n=30) had misoprostol orally, while the group 2 (n=30) received the drug by the vaginal route. Dosage regimen was similar in both groups that was 200 microg 4 hours apart till expulsion of fetus or maximum of upto 5 doses. Main outcome measures of the study were induction-expulsion interval, need for surgical evacuation and maternal complications.

Results: The mean induction-expulsion interval in the group 1 and 2 was 11.8+/-8.3 and 12.8+/-8.5 hours respectively, which was not different statistically. The process of expulsion was complete in 53.3% of subjects in both groups by misoprostol only, while 36.6% required surgical evacuation in oral group versus 33.3% in vaginal group. The rate of failed induction in groups 1 and 2 was 10% and 13.3% respectively. There was no reported case of nausea, diarrhea, headache, dizziness, shivering, pyrexia and hyperstimulation in both the groups. However, a case of vomiting (3.3%) was observed in the vaginal group.