Misoprostol for termination of pregnancy in the second or third trimester

Vaginal misoprostol is as effective as other prostaglandin preparations in the termination of second or third trimester of pregnancy, and more effective than oral misoprostol.

A Cochrane review included 38 studies with a total of 3679 subjects. 9 studies included intrauterine death, 5 trials fetal anomaly, and the rest 24 presented the pooled data for intrauterine deaths, fetal anomalies and social reasons.Vaginal misoprostol was as effective as traditional agents in ensuring vaginal birth within 24 hours, (birth not achieved: misoprostol vs gemeprost (PGE1) RR 1.30, 95% CI 0.64 to 2.62, 3 trials, n=235; misoprostol vs PGE2 RR 0.62, 95% CI 0.36 to 1.04, 4 trials, n=251, and misoprostol vs PGF2alpha RR 1.07, 95% CI 0.28 to 4.06, 3 trials, n=213) with a similar induction to birth interval. Vaginal misoprostol was associated with a reduction in the occurrence of maternal gastrointestinal side effects such as nausea, vomiting and diarrhoea when compared with other prostaglandin preparations. Low dose of vaginal misoprostol was less effective than moderate dose [vaginal birth not achieved in 24 hours: low (under 800 mcg) vs moderate dose (800 – 2400 mcg) RR 1.85, 95% CI 1.13 to 3.03; 1 trial, n=150]. The information about rare maternal complications, such as uterine rupture, was limited. Vaginal misoprostol was more effective in ensuring vaginal birth within 24 hours with fewer side effects than oral misoprostol.

Another Cochrane review included 40 trials. Misoprostol in combination with mifepristone was more effective than misoprostol alone (RR 12.13, 95% CI 1.43 to 102.61; 1 trial, n=64). In combination with mifepristone, the induction to abortion interval was shorter with vaginal misoprostol compared to oral misoprostol (mean difference 7.03, 95% CI -0.13 to 14.20; 2 trials, n=237). The combination of mifepristone plus misoprostol was as effective as mifepristone plus gemeprost. Misoprostol was preferably administered vaginally, although among multiparous women sublingual administration appeared equally effective. No randomised trials comparing doses of misoprostol were identified; however low doses of misoprostol appear to be associated with fewer side-effects while moderate doses appear to be more efficient in completing abortion. Four RCTs showed that the induction to abortion interval with 3-hourly vaginal administration of prostaglandins is shorter than 6-hourly administration without an increase in side-effects.

Ədəbiyyat

1. Dodd JM, Crowther CA. 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. Cochrane Database Syst Rev 2010 Apr 14;4:CD004901.
2. Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for mid-trimester termination of pregnancy. Cochrane Database Syst Rev 2011 Jan 19;(1):CD005216.