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The Journal of Obstetrics and Gynecology of India

, Volume 68, Issue 6, pp 456–461 | Cite as

Prospective Comparative Study of Oral Versus Vaginal Misoprostol for Second-Trimester Termination of Pregnancy

  • Suyash S. Bhandekar
  • Anahita R. ChauhanEmail author
  • Arun Ambadkar
Original Article
  • 51 Downloads

Abstract

Background

Various medical methods for second-trimester medical termination of pregnancy (MTP) exist. Misoprostol alone has been used with myriad variations in route and dosage. Comparison between oral and vaginal routes of misoprostol forms the basis of this study.

Methods

This was a prospective comparative study of misoprostol for second-trimester (14–20 weeks) MTP, comparing oral versus vaginal routes. Sixty patients were randomly allotted to two groups; 30 received oral misoprostol 400 µg 4 h up to a maximum of five doses (2000 µg), and 30 received vaginal misoprostol in the same dose and duration. In both groups, oxytocin infusion was started if abortion did not occur. Efficacy of oral versus vaginal misoprostol, induction–abortion interval (AI) and need for surgical intervention were analyzed.

Results

Both groups were well matched in terms of age, parity, previous LSCS, mean gestational age and indication for MTP. Overall mean induction–abortion interval was 19.59 h (21.66 vs. 18.57 h, oral vs. vaginal, respectively), with vaginal group taking lesser time (p 0.09). Sixty percentage in oral group required five doses, while 70% in vaginal group required 3–4 doses of misoprostol (p 0.010). 23.7 versus 6.7% in oral versus vaginal group required check curettage (p 0.038). There were no major complications, and there was only one failure in oral group.

Conclusions

Though both oral and vaginal misoprostol are safe, vaginal route appears to be more efficacious for second-trimester MTP.

Keywords

Misoprostol Abortion interval Second-trimester MTP Curettage 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the Institutional Ethics Committee and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Balsarkar G. Recent advances in medical methods of abortion. Accessed on 18 October 2017. Available from http://www.fogsi.org/wp-content/uploads/2015/05/pdf/editor/dr_reshma_pai/12.pdf.
  2. 2.
    Nkwabong E, Mbu RE, Fomulu JN. How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study. BMC Womens Health. 2014;9(14):108.CrossRefGoogle Scholar
  3. 3.
    Potdar P, Barua A, Dalvie S, et al. “If a woman has even one daughter, I refuse to perform the abortion”: sex determination and safe abortion in India. Reprod Health Matters. 2015;23(45):114–25.CrossRefGoogle Scholar
  4. 4.
    Zurbriggen R, Keefe-Oates B, Gerdts C. Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina. Contraception. 2017;.  https://doi.org/10.1016/j.contraception.2017.07.170.CrossRefPubMedGoogle Scholar
  5. 5.
    Jones RK, Jerman J. Characteristics and circumstances of U.S. women who obtain very early and second-trimester abortions. PLoS ONE. 2017;12(1):e0169969. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28121999.CrossRefGoogle Scholar
  6. 6.
    Niinimäki M, Mentula M, Jahangiri R, et al. Medical treatment of second-trimester fetal miscarriage. A retrospective analysis. PLoS ONE. 2017;12(7):e0182198. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28753654.CrossRefGoogle Scholar
  7. 7.
    Bangal VB, Patel NH, Borawake SK. Efficacy and safety of vaginal misoprostol in second trimester medical termination of pregnancy. IOSR J Pharm. 2012;2(3):444–7.Google Scholar
  8. 8.
    Tanha FD, Golgachi T, Niroomand N, et al. Sublingual versus vaginal misoprostol for second trimester termination: a randomized clinical trial. Arch Gynecol Obstet. 2013;287:65–9.CrossRefGoogle Scholar
  9. 9.
    Ting WH, Peng FH, Lin HH, et al. Factors influencing the abortion interval of second trimester pregnancy termination using misoprostol. Taiwan J Obstet Gynecol. 2015;54(4):408–11.CrossRefGoogle Scholar
  10. 10.
    Rahimi-Sharbaf F, Adabi K, Valadan M, et al. The combination route versus sublingual and vaginal misoprostol for the termination of 13 to 24 week pregnancies: a randomized clinical trial. Taiwan J Obstet Gynecol. 2015;54(6):660–5.CrossRefGoogle Scholar
  11. 11.
    Milani F, Sharami SH, Arjmandi S. Comparison of sublingual and vaginal misoprostol for second-trimester pregnancy terminations. J Fam Reprod Heal. 2014;8(1):41–4.Google Scholar
  12. 12.
    Garg G, Takkar N, Sehgal A. Buccal versus vaginal misoprostol administration for the induction of first and second trimester abortions. J Obstet Gynecol India. 2015;65(2):111–6.CrossRefGoogle Scholar
  13. 13.
    Desai GS, Chandavarkar A, Gopal S, et al. Second trimester medical termination of pregnancy with combined intracervical and intravaginal misoprostol: comparative analysis with intravaginal misoprostol—a pilot study. J Obstet Gynecol India. 2016;66(S1):157–60.CrossRefGoogle Scholar
  14. 14.
    Nautiyal D, Mukherjee K, Perhar I, et al. Comparative study of misoprostol in first and second trimester abortions by oral, sublingual, and vaginal routes. J Obstet Gynecol India. 2015;65(4):246–50.CrossRefGoogle Scholar
  15. 15.
    Pluchon M, Winer N. Misoprostol in case of termination of pregnancy in the second and third trimesters. Trials [French]. J Gynecol Obstet Biol Reprod (Paris). 2014;43(2):162–8.CrossRefGoogle Scholar
  16. 16.
    Clouqueur É, Coulon C, Vaast P, et al. Use of misoprostol for induction of labor in case of fetal death or termination of pregnancy during second or third trimester of pregnancy: efficiency, dosage, route of administration, side effects, use in case of uterine scar [French]. J Gynecol Obstet Biol Reprod (Paris). 2014;43(2):146–61.CrossRefGoogle Scholar
  17. 17.
    Sajjan GR, Patil N, Kaur M, et al. Complete cervical avulsion with intravaginal misoprostol for second trimester pregnancy termination. Case Rep Obstet Gynecol. 2012;2012:931497.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Bhattacharjee N, Saha SP, Ganguly RP, et al. A randomized comparative study on vaginal administration of acetic acid—moistened versus dry misoprostol for mid-trimester pregnancy termination. Arch Gynecol Obstet. 2012;285(2):311–6.CrossRefGoogle Scholar
  19. 19.
    Huang MC, Hsieh CH, Huang JP, et al. Comparison of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion. Taiwan J Obstet Gynecol. 2017;56(3):312–4.CrossRefGoogle Scholar
  20. 20.
    Morris JL, Winikoff B, Dabash R, et al. FIGO’s updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynecol Obstet. 2017;138(3):363–6.CrossRefGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2017

Authors and Affiliations

  • Suyash S. Bhandekar
    • 1
  • Anahita R. Chauhan
    • 1
    Email author
  • Arun Ambadkar
    • 2
    • 3
  1. 1.Department of Obstetrics and GynecologySeth G.S. Medical College and K.E.M. HospitalMumbaiIndia
  2. 2.Department of Obstetrics and GynecologyB.J. Medical CollegePuneIndia
  3. 3.Seth G.S. Medical College and K.E.M. HospitalMumbaiIndia

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