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. 2010 Apr 14;2010(4):CD004901.
doi: 10.1002/14651858.CD004901.pub2.

Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death

Jodie M Dodd  1 , Caroline A Crowther
Affiliations

Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death

Jodie M Dodd et al. Cochrane Database Syst Rev. .

Abstract

Background: A woman may need to give birth prior to the spontaneous onset of labour in situations where the fetus has died in utero (also called a stillbirth), or for the termination of pregnancy where the fetus, if born alive would not survive or would have a permanent handicap. Misoprostol is a prostaglandin medication that can be used to induce labour in these situations.

Objectives: To compare the benefits and harms of misoprostol to induce labour to terminate pregnancy in the second and third trimester for women with a fetal anomaly or after intrauterine fetal death when compared with other methods of induction of labour.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009).

Selection criteria: Randomised controlled trials comparing misoprostol with placebo or no treatment, or any other method of induction of labour, for women undergoing induction of labour to terminate pregnancy in the second and third trimester following an intrauterine fetal death or for fetal anomalies.

Data collection and analysis: Both authors independently assessed trial quality and extracted data.

Main results: We included 38 studies (3679 women).Nine studies included pregnancies after intrauterine deaths, five studies included termination of pregnancies because of fetal anomalies when the fetus was still alive and the rest (24) presented the pooled data for intrauterine deaths, fetal anomalies and social reasons.When compared with agents that have traditionally been used to induce labour in this setting (for example, gemeprost, prostaglandin E(2) and prostaglandin F(2alpha)), vaginal misoprostol is as effective in ensuring vaginal birth within 24 hours, with a similar induction to birth interval. Vaginal misoprostol is associated with a reduction in the occurrence of maternal gastrointestinal side effects such as nausea, vomiting and diarrhoea when compared with other prostaglandin preparations. While the different treatments involving various prostaglandin preparations appear comparable for the reported outcomes, the information available regarding rare maternal complications, such as uterine rupture, is limited.

Authors' conclusions: The use of vaginal misoprostol in the termination of second and third trimester of pregnancy is as effective as other prostaglandin preparations (including cervagem, prostaglandin E(2) and prostaglandin F(2alpha)), and more effective than oral administration of misoprostol. However, important information regarding maternal safety, and in particular the occurrence of rare outcomes such as uterine rupture, remains limited. Future research efforts should be directed towards determining the optimal dose and frequency of administration, with particular attention to standardised reporting of all relevant outcomes and assessment of rare adverse events. Further information is required about the use of sublingual misoprostol in this setting.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 1 Vaginal birth not achieved in 24 hours.
1.3
1.3. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 3 Mean induction to birth interval.
1.5
1.5. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 5 Analgesia required.
1.6
1.6. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 6 Surgical evacuation of the uterus.
1.7
1.7. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 7 Vomiting.
1.8
1.8. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 8 Nausea.
1.9
1.9. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 9 Diarrhoea.
1.10
1.10. Analysis
Comparison 1 Vaginal misoprostol versus oral misoprostol, Outcome 10 Pyrexia.
2.1
2.1. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 1 Vaginal birth not achieved in 24 hours.
2.2
2.2. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 2 Mean induction to birth interval.
2.3
2.3. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 3 Need for analgesia.
2.4
2.4. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 4 Blood loss > 500 mL.
2.5
2.5. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 5 Mean blood loss.
2.6
2.6. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 6 Need for blood transfusion.
2.7
2.7. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 7 Surgical evacuation of the uterus.
2.8
2.8. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 8 Nausea.
2.9
2.9. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 9 Vomiting.
2.10
2.10. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 10 Diarrhoea.
2.11
2.11. Analysis
Comparison 2 Vaginal misoprostol ‐ 6‐hourly versus 12‐hourly dosing interval, Outcome 11 Pyrexia.
3.1
3.1. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 1 Vaginal birth not achieved in 24 hours.
3.2
3.2. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 2 Mean induction to delivery interval.
3.3
3.3. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 3 Pain (VAS score greater than 5).
3.4
3.4. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 4 Analgesia required.
3.5
3.5. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 5 Mean blood loss.
3.6
3.6. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 6 Surgical evacuation of the uterus.
3.7
3.7. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 7 Nausea.
3.8
3.8. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 8 Vomiting.
3.9
3.9. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 9 Diarrhoea.
3.10
3.10. Analysis
Comparison 3 Vaginal misoprostol versus Gemeprost (PGE1) (alone or with oxytocin), Outcome 10 Pyrexia.
4.1
4.1. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 1 Vaginal birth not achieved in 24 hours.
4.2
4.2. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 2 Mean induction to birth interval.
4.4
4.4. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 4 Analgesia required.
4.5
4.5. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 5 Blood loss > 500 mL.
4.6
4.6. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 6 Need for blood transfusion.
4.7
4.7. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 7 Surgical evacuation of the uterus.
4.8
4.8. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 8 Side effects ‐ any.
4.9
4.9. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 9 Nausea.
4.10
4.10. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 10 Vomiting.
4.11
4.11. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 11 Diarrhoea.
4.12
4.12. Analysis
Comparison 4 Vaginal misoprostol versus PGE2 (alone or with other agents), Outcome 12 Pyrexia.
5.1
5.1. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 1 Vaginal birth not achieved in 24 hours.
5.2
5.2. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 2 Mean induction to birth interval.
5.3
5.3. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 3 Blood loss > 500 mL.
5.4
5.4. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 4 Need for blood transfusion.
5.5
5.5. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 5 Surgical evacuation of the uterus.
5.6
5.6. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 6 Side effects ‐ any.
5.7
5.7. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 7 Nausea.
5.8
5.8. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 8 Vomiting.
5.9
5.9. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 9 Diarrhoea.
5.10
5.10. Analysis
Comparison 5 Vaginal misoprostol versus PGF2alpha, Outcome 10 Pyrexia.
6.1
6.1. Analysis
Comparison 6 Vaginal misoprostol versus vaginal misoprostol and oxytocin, Outcome 1 Mean induction to birth interval.
6.2
6.2. Analysis
Comparison 6 Vaginal misoprostol versus vaginal misoprostol and oxytocin, Outcome 2 Surgical evacuation of the uterus.
6.4
6.4. Analysis
Comparison 6 Vaginal misoprostol versus vaginal misoprostol and oxytocin, Outcome 4 Vomiting.
6.5
6.5. Analysis
Comparison 6 Vaginal misoprostol versus vaginal misoprostol and oxytocin, Outcome 5 Diarrhoea.
6.6
6.6. Analysis
Comparison 6 Vaginal misoprostol versus vaginal misoprostol and oxytocin, Outcome 6 Pyrexia.
7.2
7.2. Analysis
Comparison 7 Vaginal misoprostol versus glyceryl tri‐nitrate, Outcome 2 Need for analgesia.
7.3
7.3. Analysis
Comparison 7 Vaginal misoprostol versus glyceryl tri‐nitrate, Outcome 3 Blood loss > 500 mL.
7.4
7.4. Analysis
Comparison 7 Vaginal misoprostol versus glyceryl tri‐nitrate, Outcome 4 Surgical evacuation of the uterus.
7.5
7.5. Analysis
Comparison 7 Vaginal misoprostol versus glyceryl tri‐nitrate, Outcome 5 Side effects ‐ any.
7.6
7.6. Analysis
Comparison 7 Vaginal misoprostol versus glyceryl tri‐nitrate, Outcome 6 Vomiting.
7.7
7.7. Analysis
Comparison 7 Vaginal misoprostol versus glyceryl tri‐nitrate, Outcome 7 Diarrhoea.
7.8
7.8. Analysis
Comparison 7 Vaginal misoprostol versus glyceryl tri‐nitrate, Outcome 8 Pyrexia.
8.1
8.1. Analysis
Comparison 8 Vaginal misoprostol versus vaginal misoprostol and laminaria, Outcome 1 Vaginal birth not achieved in 24 hours.
8.2
8.2. Analysis
Comparison 8 Vaginal misoprostol versus vaginal misoprostol and laminaria, Outcome 2 Blood loss > 500 mL.
8.3
8.3. Analysis
Comparison 8 Vaginal misoprostol versus vaginal misoprostol and laminaria, Outcome 3 Need for blood transfusion.
8.4
8.4. Analysis
Comparison 8 Vaginal misoprostol versus vaginal misoprostol and laminaria, Outcome 4 Vomiting.
8.5
8.5. Analysis
Comparison 8 Vaginal misoprostol versus vaginal misoprostol and laminaria, Outcome 5 Diarrhoea.
8.6
8.6. Analysis
Comparison 8 Vaginal misoprostol versus vaginal misoprostol and laminaria, Outcome 6 Pyrexia.
9.1
9.1. Analysis
Comparison 9 Vaginal misoprostol versus vaginal misoprostol and nitric oxide donor, Outcome 1 Vaginal birth not achieved in 24 hours.
9.2
9.2. Analysis
Comparison 9 Vaginal misoprostol versus vaginal misoprostol and nitric oxide donor, Outcome 2 Mean induction to birth interval.
9.3
9.3. Analysis
Comparison 9 Vaginal misoprostol versus vaginal misoprostol and nitric oxide donor, Outcome 3 Side effects ‐ any.
10.1
10.1. Analysis
Comparison 10 Oral misoprostol versus PGF2alpha, Outcome 1 Mean induction to birth interval.
10.2
10.2. Analysis
Comparison 10 Oral misoprostol versus PGF2alpha, Outcome 2 Surgical evacuation of the uterus.
10.3
10.3. Analysis
Comparison 10 Oral misoprostol versus PGF2alpha, Outcome 3 Nausea.
10.4
10.4. Analysis
Comparison 10 Oral misoprostol versus PGF2alpha, Outcome 4 Vomiting.
10.5
10.5. Analysis
Comparison 10 Oral misoprostol versus PGF2alpha, Outcome 5 Diarrhoea.
10.6
10.6. Analysis
Comparison 10 Oral misoprostol versus PGF2alpha, Outcome 6 Pyrexia.
11.1
11.1. Analysis
Comparison 11 Combined oral and vaginal misoprostol versus vaginal misoprostol alone, Outcome 1 Vaginal birth not achieved in 24 hours.
11.2
11.2. Analysis
Comparison 11 Combined oral and vaginal misoprostol versus vaginal misoprostol alone, Outcome 2 Mean induction to birth interval.
11.3
11.3. Analysis
Comparison 11 Combined oral and vaginal misoprostol versus vaginal misoprostol alone, Outcome 3 Need for analgesia.
11.5
11.5. Analysis
Comparison 11 Combined oral and vaginal misoprostol versus vaginal misoprostol alone, Outcome 5 Surgical evacuation of the uterus.
11.6
11.6. Analysis
Comparison 11 Combined oral and vaginal misoprostol versus vaginal misoprostol alone, Outcome 6 Nausea.
11.7
11.7. Analysis
Comparison 11 Combined oral and vaginal misoprostol versus vaginal misoprostol alone, Outcome 7 Vomiting.
11.8
11.8. Analysis
Comparison 11 Combined oral and vaginal misoprostol versus vaginal misoprostol alone, Outcome 8 Diarrhoea.
12.1
12.1. Analysis
Comparison 12 Combined oral and vaginal misoprostol versus oral misoprostol alone, Outcome 1 Vaginal birth not achieved in 24 hours.
12.2
12.2. Analysis
Comparison 12 Combined oral and vaginal misoprostol versus oral misoprostol alone, Outcome 2 Need for analgesia.
12.3
12.3. Analysis
Comparison 12 Combined oral and vaginal misoprostol versus oral misoprostol alone, Outcome 3 Surgical evacuation of the uterus.
12.4
12.4. Analysis
Comparison 12 Combined oral and vaginal misoprostol versus oral misoprostol alone, Outcome 4 Nausea.
12.5
12.5. Analysis
Comparison 12 Combined oral and vaginal misoprostol versus oral misoprostol alone, Outcome 5 Vomiting.
12.6
12.6. Analysis
Comparison 12 Combined oral and vaginal misoprostol versus oral misoprostol alone, Outcome 6 Diarrhoea.
13.1
13.1. Analysis
Comparison 13 Combined oral and vaginal misoprostol versus dilation and evacuation, Outcome 1 Nausea.
13.2
13.2. Analysis
Comparison 13 Combined oral and vaginal misoprostol versus dilation and evacuation, Outcome 2 Vomiting.
13.3
13.3. Analysis
Comparison 13 Combined oral and vaginal misoprostol versus dilation and evacuation, Outcome 3 Diarrhoea.
14.1
14.1. Analysis
Comparison 14 Sublingual misoprostol versus vaginal misoprostol, Outcome 1 Vaginal birth not achieved in 24 hours.
14.2
14.2. Analysis
Comparison 14 Sublingual misoprostol versus vaginal misoprostol, Outcome 2 Induction to delivery interval.
14.3
14.3. Analysis
Comparison 14 Sublingual misoprostol versus vaginal misoprostol, Outcome 3 Analgesic requirements.
14.4
14.4. Analysis
Comparison 14 Sublingual misoprostol versus vaginal misoprostol, Outcome 4 Vomiting.
14.5
14.5. Analysis
Comparison 14 Sublingual misoprostol versus vaginal misoprostol, Outcome 5 Diarrhoea.
14.6
14.6. Analysis
Comparison 14 Sublingual misoprostol versus vaginal misoprostol, Outcome 6 Pyrexia.
15.1
15.1. Analysis
Comparison 15 Sublingual misoprostol versus oral misoprostol, Outcome 1 Vaginal birth not achieved within 24 hours.
15.2
15.2. Analysis
Comparison 15 Sublingual misoprostol versus oral misoprostol, Outcome 2 Induction to delivery interval.
15.3
15.3. Analysis
Comparison 15 Sublingual misoprostol versus oral misoprostol, Outcome 3 Analgesic requirements.
15.4
15.4. Analysis
Comparison 15 Sublingual misoprostol versus oral misoprostol, Outcome 4 Vomiting.
15.5
15.5. Analysis
Comparison 15 Sublingual misoprostol versus oral misoprostol, Outcome 5 Diarrhoea.
15.6
15.6. Analysis
Comparison 15 Sublingual misoprostol versus oral misoprostol, Outcome 6 Pyrexia.
16.1
16.1. Analysis
Comparison 16 Sublingual misoprostol 100 mcg versus sublingual misoprostol 200 mcg, Outcome 1 Induction to delivery interval.
16.2
16.2. Analysis
Comparison 16 Sublingual misoprostol 100 mcg versus sublingual misoprostol 200 mcg, Outcome 2 Vomiting.
16.3
16.3. Analysis
Comparison 16 Sublingual misoprostol 100 mcg versus sublingual misoprostol 200 mcg, Outcome 3 Diarrhoea.
16.4
16.4. Analysis
Comparison 16 Sublingual misoprostol 100 mcg versus sublingual misoprostol 200 mcg, Outcome 4 Pyrexia.
17.1
17.1. Analysis
Comparison 17 Vaginal misoprostol ‐ low (< 800 mcg cumulative dose) versus moderate (800 mcg ‐2400 mcg cumulative dose), Outcome 1 Vaginal birth not achieved in 24 hours.
17.2
17.2. Analysis
Comparison 17 Vaginal misoprostol ‐ low (< 800 mcg cumulative dose) versus moderate (800 mcg ‐2400 mcg cumulative dose), Outcome 2 Pain (VAS score > 5).
17.3
17.3. Analysis
Comparison 17 Vaginal misoprostol ‐ low (< 800 mcg cumulative dose) versus moderate (800 mcg ‐2400 mcg cumulative dose), Outcome 3 Need for analgesia.
17.4
17.4. Analysis
Comparison 17 Vaginal misoprostol ‐ low (< 800 mcg cumulative dose) versus moderate (800 mcg ‐2400 mcg cumulative dose), Outcome 4 Surgical evacuation of the uterus.
17.5
17.5. Analysis
Comparison 17 Vaginal misoprostol ‐ low (< 800 mcg cumulative dose) versus moderate (800 mcg ‐2400 mcg cumulative dose), Outcome 5 Nausea.
17.6
17.6. Analysis
Comparison 17 Vaginal misoprostol ‐ low (< 800 mcg cumulative dose) versus moderate (800 mcg ‐2400 mcg cumulative dose), Outcome 6 Vomiting.
17.7
17.7. Analysis
Comparison 17 Vaginal misoprostol ‐ low (< 800 mcg cumulative dose) versus moderate (800 mcg ‐2400 mcg cumulative dose), Outcome 7 Diarrhoea.
18.1
18.1. Analysis
Comparison 18 Vaginal misoprostol ‐ moderate dose (cumulative dose 2400 mcg) versus high dose (cumulative dose 3200 mcg), Outcome 1 Mean induction to birth interval.
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Update of

  • doi: 10.1002/14651858.CD004901

References

References to studies included in this review

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Makhlouf 2003 {published data only}
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Munthali 2001 {published data only}
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Nakintu 2001 {published data only}
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Niromanesh 2005 {published data only}
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    1. Nor Azlin MI, Abdullah HS, Zainul Rashid MR, Jamil MA. Misoprostol (alone) in second trimester terminations of pregnancy: as effective as Gemeprost?. Journal of Obstetrics and Gynaecology 2006;26(6):546‐9. - PubMed
Nuutila 1997 {published data only}
    1. Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second‐trimester abortion. Obstetrics & Gynecology 1997;90(6):896‐900. - PubMed
Nyende 2004 {published data only}
    1. Nyende L, Towobola OA, Mabina MH. Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra‐uterine foetal death. East African Medical Journal 2004;81(4):179‐82. - PubMed
Owen 1999 {published data only}
    1. Owen J, Hauth JC. Vaginal misoprostol vs concentrated oxytocin plus low‐dose prostaglandin E2 for second trimester pregnancy termination. Journal of Maternal‐Fetal Medicine 1999;81(4):179‐82. - PubMed
Perry 1999 {published data only}
    1. Perry KG, Rinehart BK, Terrone DA, Martin RW, May WL, Roberts WE. Second trimester uterine evacuation: a comparison of intra‐amniotic (15‐S)‐15‐methyl‐prostaglandin F2alpha and intravaginal misoprostol. American Journal of Obstetrics and Gynecology 1999;181:1057‐61. - PubMed
Pongsatha 2004 {published data only}
    1. Pongsatha S, Tongsong T. Intravaginal misoprostol for pregnancy termination. International Journal of Gynecology & Obstetrics 2004;87:176‐7. - PubMed
Ramsey 2004 {published data only}
    1. Ramsey PS, Savage K, Lincoln T, Owen J. Vaginal misoprostol versus concentrated oxytocin and vaginal PGE2 for second‐trimester labor induction. Obstetrics & Gynecology 2004;104(1):138‐45. - PubMed
Su 2005 {published data only}
    1. Su L‐L, Biswas A, Choolani M, Kalaichelvan V, Singh K. A prospective randomized comparison of vaginal misoprostol versus intra‐amniotic prostaglandins for midtrimester termination of pregnancy. American Journal of Obstetrics and Gynecology 2005;193:1410‐4. - PubMed
Zuo 1998 {published data only}
    1. Zuo WL, Wang P, Wu BS. A randomized comparison of misoprostol and carprost for termination of second trimester pregnancy. Chinese Journal of Clinical Pharmacology 1998;14(4):197‐200.

References to studies excluded from this review

Ayudhaya 2006 {published data only}
    1. Ayudhaya OP, Herabutya Y, Chanrachakul B, Ayuthaya NI, O‐Prasertsawat P. A comparison of the efficacy of sublingual and oral misoprostol 400 microgram in the management of early pregnancy failure: a randomized controlled trial. Journal of the Medical Association of Thailand 2006;89(Suppl 4):S5‐S10. - PubMed
Biswas 2007 {published data only}
    1. Biswas SC, Dey R, Jana R, Chattopadhyay N. Comparative study of intravaginal misoprostol and extra amniotic ethacridine lactate instillation for mid trimester pregnancy termination. Journal of Obstetrics and Gynaecology of India 2007;57(3):211‐3.
El‐Refaey 1995 {published data only}
    1. El‐Refaey H, Templeton A. Induction of abortion in the second trimester by a combination of misoprostol and mifepristone: a randomized comparison between two misoprostol regimens. Human Reproduction 1995;10(2):475‐8. - PubMed
Eng 1997 {published data only}
    1. Eng NS, Guan AC. Comparative study of intravaginal misoprostol with gemeprost as an abortifacient in second trimester missed abortion. Australian and New Zealand Journal of Obstetrics and Gynaecology 1997;37(3):331‐4. - PubMed
Gonzalez 2001 {published data only}
    1. Gonzalez JA, Carlan SJ, Alverson MW. Outpatient second trimester pregnancy termination. Contraception 2001;63(2):89‐93. - PubMed
Guix 2005 {published data only}
    1. Guix C, Palacio M, Figueras F, Bennasar M, Zamora L, Coll O, et al. Efficacy of two regimens of misoprostol for early second‐trimester pregnancy termination. Fetal Diagnosis and Therapy 2005;20(6):544‐8. - PubMed
Herabutya 2001 {published data only}
    1. Herabutya Y, Chanrachakul B, Punyavachira P. Second trimester pregnancy termination: A comparison of 600 and 800 micrograms of intravaginal misoprostol. Journal of Obstetrics and Gynaecology Research 2001;27(3):125‐8. - PubMed
Marquette 2005 {published data only}
    1. Marquette GP, Skoll MA, Dontigny L. A randomized trial comparing oral misoprostol with intra‐amniotic prostaglandin f2alpha for second trimester terminations. Journal of Obstetrics & Gynaecology Canada: JOGC 2005;27(11):1013‐8. - PubMed
Nigam 2006 {published data only}
    1. Nigam A, Singh VK, Prakash A. Vaginal vs. oral misoprostol for mid‐trimester abortion. International Journal of Gynecology & Obstetrics 2006;92(3):270‐1. - PubMed
Saha 2006 {published data only}
    1. Saha S, Bal R, Ghosh S, Krishnamurthy P. Medical abortion in late second trimester‐‐a comparative study with misoprostol through vaginal versus oral followed by vaginal route. Journal of the Indian Medical Association 2006;104(2):81‐2, 84. - PubMed
Yapar 1996 {published data only}
    1. Yapar EG, Senoz S, Urkutur M, Batioglu S, Gokmen O. Second trimester pregnancy termination including fetal death: comparison of five different methods. European Journal of Obstetrics & Gynecology and Reproductive Biology 1996;69:97‐102. - PubMed

References to studies awaiting assessment

Abdel Fattah 1997 {published data only}
    1. Abdel Fattah IH. PGE1 analogue for the induction of midtrimester abortion in cases of intrauterine fetal death. Acta Obstetricia et Gynecologica Scandinavica Supplement 1997;76(167:2):26.
Agrawal 2006 {published data only}
    1. Agrawal S, Rath SK. Misoprostol for second trimester medical abortion ‐ a comparison of three routes of administration [abstract]. 49th All India Congress of Obstetrics and Gynaecology; 2006 Jan 6‐9; Cochin, Kerala State, India. 2006:47.
Nuthalapaty 2004 {published data only}
    1. Nuthalapaty F, Ramsey P, Biggio J, Owen J. Comparative efficacy of high dose vaginal misoprostol for mid‐trimester labor induction [abstract]. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S73.
Roy 2003 {published data only}
    1. Roy G, Ferreira E, Hudon L, Marquette G. The efficacy of oral versus vaginal misoprostol for second‐trimester termination of pregnancy: a double‐blind, randomized, placebo controlled trial [abstract]. American Journal of Obstetrics and Gynecology 2003;189(6 Suppl 1):S70.
Surita 1997 {published data only}
    1. Surita FGC. Misoprostol versus laminaria for cervical ripening in intrauterine fetal death. Acta Obstetricia et Gynecologica Scandinavica Supplement 1997;76(167:2):32.

Additional references

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Boulvain 2001
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French 2001
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Gulmezoglu 2007
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Higgins 2002
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Hofmeyr 2003
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Hutton 2001
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Kelly 2001
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Mariani‐Neto 1987
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Medema 2005
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