MISOPROSTOL FOR THE PURPOSE OF MID-TRIMESTER TERMINATION OF PREGNANCY: A COMPARATIVE STUDY WITH PROSTAGLANDIN F2 ALPHA
AbstractObjective: To compare the efficacy of misoprostol verses prostaglandin F2α (PGF2α) in themedical management of termination of mid-trimester pregnancy due to medical reasons. Methods:This experimental study was conducted in Obstetrics and Gynaecology Department, BahawalVictoria Hospital, Bahawalpur for a period of 6 months from April 2005 to September 2005. Timeinterval between induction with misoprostol or PGF2α and expulsion of foetus, number of tabletsof misoprostol used and total dose of injection PGF2α used for termination of pregnancy as well asthe complications experienced with both drugs. Fifty patients of 18–35 years of age wererandomly selected who presented to Gynaecology and Obstetrics outdoor with mid-trimester foetalloss or congenitally malformed foetus incompatible to life, confirmed on ultrasonography. Thesewomen were randomised to receive either intravaginal misoprostol or extra-amniotic PGF2α.Results: Ninety-six percent of cases were managed successfully with Misoprostol as compared to92% where PGF2α was tried (p>0.5). Mean induction to expulsion duration for misoprostol andPGF2α were 9.02±4.57 and 16.04±6.22 hours respectively (p<0.5). Complications profile was lowespecially in cases of PGF2α and only one case experienced significant haemorrhage. Conclusion:Misoprostol and PGF2α were found to be of same success rate but former was found to be moreefficacious in terms of induction to expulsion duration.Keywords: Misoprostol, Mid-trimester foetal death, PGF2α, Abortion, Pregnancy, Outcome,Second trimester termination of pregnancy
Karim SMW, Trussell RR, Patel RC, Hillier R. Response of
pregnant Human Uterus to prostaglandin F2α-induction of labour.
Embrey MP. The effect of prostaglandins on the human pregnant
uterus. J Obstet Gynaecol 1969;79:783–89.
Machenzie IZ, Embrey MP. Cervical ripening with prostaglandin
E2 gel. BMJ 1977;2:1381–82.
Jail G, Malik RM. Induction of labor –An Audit of indications
and obstetrics outcome in a tertiary care hospital. Pak Postgrad
Med J 2003;14:116–20.
Krali Kowski-A. Extra-amniotic prostaglandin F2 alpha in the
termination of pregnancy. S Afr Med J 1994;84:321–33.
Andresen DM, Jensen JS, Uldbjerg N. Misoprostol-a safe
preparation for induction of labor? Ugeskr Laeger.
Sobia N, Nadra S. Role of Misoprostol for therapeutic
termination of pregnancy from 10–28 weeks of gestation. J Pak
Med Assoc 2007;57:129–32.
Carbonell J, Varela L, Velazco A. Early abortion with
microgram of Misoprostol by the vaginal route. Contrcept
Nagina FL , Iffat J, Samia S, Tabassum S, Khadija B, Saima W,
et al. Therapeutic termination of second trimester pregnancies
with low dose Misoprostol. J Coll Physicians Surg Pak
Henshaw RC, Kooper K, El-Rafaey H, Smith NC, Templeton
AA. Medical Management of miscarriage: non- surgical uterine
evacuation of incomplete and inevitable spontaneous abortion.
Aston K, Arthur I, Masson GM, Jenkins JM. Progestogen
therapy and prevention of functional ovarian cysts during
pituitary desensitisation with GnRH agonists. Br J Obstet
Roztocil A, Koudel Ka M, Jelinek J, Miklica J, Pilka L. Labor
Induction with extra amniotic administration of PGE2 vaginal
tablet. Cheska Gynekol 1996;61:221–6.
Chohan MA, Ansari A, Rana S. Midtrimester induction of
Labour. Pak J Obstet Gynaecol 1999;12:51–5.
J Ayub Med Coll Abbottabad 2010;22(4)
Srisomboon J, Pongpisuttinum S. Efficacy of intracervicovaginal
misoprostol in second-trimester pregnancy termination a
comparison between live and dead fetuses. J Obstet Gynaecol
Ghorab MN, El Helw BA. Second-trimester termination of
pregnancy by extra-amniotic prostaglandin F2α or endocervical
misoprostol. A comparative study. Acta Obstet Gynecol Scand
Fariha A, Nadra S, Naila I. Therapeutic abortions; efficacy of
intra-vaginal Misoprostol in comparison to extra amniotically
administered Prostaglandin F2α. Professional Med J
Ramsay PS, Savage K, Lincoln T, Oven J. Vaginal misoprostol
VS concentrated Oxytocin and vaginal PGE2 for second-trimester
labor induction. Obstet Gynecol 2004;104:138–45.
Perry KG, Rinehart BK, Terone DA, Martin RW, Mag WL,
Robert WE. Second trimester uterine evacuation: A comparison
of intra-amniotic [15 S]-15 methyl-prostaglandin F2 alpha and
intravaginal misoprostol. Am J Obstet Gynecol 1999;181:1057–
Samina S. Efficacy of Dinoprostone, intracervical foleys and
Misoprostol in labor induction. J Coll Physicians Surg Pak
A Koury HA, Hannch ME, Chitayat D, Thoma M, Winson E,
Feoois LE, et al. Randomized controlled trial of misoprostol for
second-trimester pregnancy termination associated with fetal
malformation. Am J Obstet Gynecol. 2004;190;755–62.
Shannon G, Brothers LP, Philip NM, Winikoff B. Infection after
medical abortion: a review of literature. Contraception
Sherris J, Bingham A, Burns MA, Girrin S, Westley E, Grmez.
Misoprostol use in developing countries: results from a
multicountry study. Int J Gynaecol Obstet 2005;88:76–81.