Oral versus Vaginal Misoprostol for Termination of Second Trimester Missed Abortion

  • Dr. kajal abdulkareem salem D.G.O. Maternity Teaching Hospital
  • Dr. ghada saadullah al-sakkal C.A.B.O.G. Lecturer in Obstetrics and Gynecological Department. College of Medicine, HMU
Keywords: Misoprostol, missed abortion, uterine hyper stimulation

Abstract

Background and Objectives: Misoprostol is a synthetic analogue of prostaglandin E1. It became an important drug in obstetric practice because of its uterotonic and cervical ripening effects. This study was done to compare the effectiveness of it in oral versus vaginal route for termination of second trimester missed abortion.

Methods: From 1st of October 2008 to the end of June 2009 at maternity teaching hospital in Erbil, a clinical comparative study was done on 90 patients who had second trimester missed abortion, They were randomly assigned to receive either oral misoprostol tablets(45 patients) in dose of 200 microgram every 4 hours or vaginal misoprostol tablets (45 patients) in dose of 200 microgram every 4 hours. The patients were followed for 48 hours.

Results: The mean induction to abortion interval was significantly shorter for vaginal group (9.98�4.56hours versus 13.30�6.24hours, P=0.005). More patients in vaginal group aborted within 24 hours (95.6% versus 82.22%, P-value=0.045) .The vaginal group required less number of doses than the oral group (2.09�0.90 versus 2.84�1.24, P=0.001). Gastrointestinal side effects of misoprostol were significantly more in the oral group. Conclusions: Misoprostol was effective drug for termination of second trimester abortion. Vaginal misoprostol resulted in shorter induction to abortion interval, less doses required and fewer side effects than oral misoprostol.

References

Baker PN, Johnson I., Jones G, Kean L, Kenny LC, Mires G et al. Second trimester miscarriage. Baker PN. Obstetrics by ten teachers. London. Edward Arnold. 2006. 18th edition. pp116-124.

Grudzinskas JG. Miscarriage, ectopic pregnancy and trophoblast disease. In: Dewhurst's text book of Obstetrics and Gynecology for postgraduates. London, Black well science Ltd; 1999. sixth edition. pp61-64.

Edmonds K, Gebbie AE, Hay P, Ingamells S, Monga A, Norman J et al .Disorders of early pregnancy. Monga A. Gynecology by ten teachers, London. Edward Arnold. 2006. 18th edition. pp89-102.

Ramsey PS, Savage K, Lincoln T, Owen J . Vaginal misoprostol versus concentrated oxytocin and vaginal PGE2 for second-trimester labor induction.J Obstet Gynecol. 2004; 104:138–45.

Cunningham FG ,Leveno KJ ,Bloom SL ,Hauth JC ,Gilstrap L .Williams Obstetrics. Mc Graw Hill. USA. 2005. 22th edition. pp231-248.

Ramos LS, Delke I .Induction of labor and pregnancy termination for fetal abnormality. In: James DK, Steer PhJ, Weiner CP and Conik B. (ed).High risk pregnancy (management options). USA. 2006. 3rd edition. pp1404- 1418.

Dickinson JE, Evans SF .The optimization of intravaginal misoprostol dosing schedules in second-trimester pregnancy termination. Is J Obstet Gynecol. 2002;

; 470–4.

Bebbington MW, Kent N, Lim K, Gagnon A, Delisle MF. A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination. Am J.Obstet Gynecol. 2002 ; 187:853–857.

Feldman DM, Borgida AF, Rodis JF, Leo MV, and Campbell WA. A randomized comparison of two regimens of misoprostol for second-trimester pregnancy termination. Am.J.Obstet.Gynecol. 2003 ; 189: 710-3.

Tang OS, Schweer H, Seyberth HW, Lee SW and Ho PC .Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002 ;17:332–336.

Scheepers HCJ, van Erp EJM, van den Bergh AS. Use of misoprostol in first and second trimester abortion: a review. Obstet Gynecol Survey. 1999. ;54(9) pp592-600.

Gilbert A, Reid R .A randomized trial of oral versus vaginal administration of misoprostol for the purpose of mid-trimester termination of pregnancy. Aust. N.Z.J. obstetr.Gynecol; 2001. 41:407-410.

Fadalla FA, Mirghani OA, Adam I. Oral misoprostol versus vaginal misoprostol for termination of pregnancy with intrauterine fetal demise in the second-trimester. International J. Obstet Gynecol. 2004; 86:pp52-53.

Aronsson A, Bygdeman M and Gemzell-Danielsson K. Effects of misoprostol on uterine contractility following different routes of administration. Hum Reprod. 2004; 19(1):pp81–84

Dickinson JE, Evans SF . A comparison of oral misoprostol with vaginal misoprostol administration in second-trimester pregnancy termination for fetal abnormality.J Obstet.Gynecol. 2003; 101:1294-9

Behrashi M, Mahdian M . Vaginal versus oral Misoprostol for second-trimester pregnancy termination .J. Biolog. Scien. 2008; 11(21): pp2505-2508.

Saha S, Bal RS, Ghosh P .Medical abortion in the late second trimester. A comparative study with misoprostol through vaginal versus oral followed by vaginal route.J.Indian Med. Assoc. 2006; 104:81-82.

Dickinson JE. Misoprostol for second-trimester pregnancy termination in women with a prior cesarean delivery. J Obstet Gynecol. 2005; 105 (2):325-356.

Published
2018-10-29
How to Cite
salem, D. kajal, & al-sakkal, D. ghada. (2018). Oral versus Vaginal Misoprostol for Termination of Second Trimester Missed Abortion. Zanco Journal of Medical Sciences (Zanco J Med Sci), 14(3 Special), 20-25. Retrieved from https://www.hmu.edu.krd/zjmsjournal/index.php/zjms/article/view/496
Section
Original Articles