A randomized comparative study on vaginal administration of acetic acid-moistened versus dry misoprostol for mid-trimester pregnancy termination

Bhattacharjee, Nabendu; Saha, Shyama Prasad; Ganguly, Rajendra Prasad; Patra, Kajal Kumar; Jha, Tulika; Barui, Gangotri; Saha, Manimala

doi:10.1007/s00404-011-1949-z

Cited by 15 publications

(11 citation statements)

References 22 publications

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“…[ 22 ] Also, the rate of complete abortion between 68% and 81% was reported in previous studies using misoprostol alone. [ 23 24 25 26 ] The rate complete abortion in the present study was 42.6% in women who received sublingual misoprostol alone, which was lower than previous reports. The variations between findings may explain by different doses and gestational age in studied women.…”

Section: Discussioncontrasting

confidence: 76%

The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial

Naghshineh¹,

Allame²,

Farhat³

2015

J Res Med Sci

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Background:In developing countries it is important to the exploration of available and safe regimens for medical abortion. The present study was designed to assess the effect of letrozole compared to placebo pretreatment followed by sublingual misoprostol for therapeutic abortion in eligible women with gestational age less than 17 weeks.Materials and Methods:In this randomized control trail, 130 women eligible for legal abortions were randomly divided into two groups of case and controls. Cases received daily oral dose of 10 mg letrozole 10 mg letrozole for three days followed by sublingual misoprostol. Controls received daily oral dose of placebo followed by sublingual misoprostol. The dose of misoprostol was administrated according to ACOG guidelines based on patients’ gestational age. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed as main outcomes.Results:Complete abortion was observed in 46 (76.7%) letrozole group and 26 (42.6%) controls (P < 0.0001). Also, in 14 subjects of letrozole group and 35 subjects in placebo group, the placenta was not delivered during follow-up and curettage was performed. The mean interval induction-to-abortion was 5.1 h in letrozole group and 8.9 h in control (P < 0.0001). The cumulative rates of the induction-of-abortion time were a significant difference between the two groups (P < 0.0001). The incidence and severity of side-effects was comparable for the two groups (P = 0.9).Conclusion:Letrozole could be a quite beneficial adjuvant to misoprostol for induction of complete abortion in those who are candidates for legal medical abortion.

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Section: Discussioncontrasting

confidence: 76%

The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial

Naghshineh¹,

Allame²,

Farhat³

2015

J Res Med Sci

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“…The average time from the start of the Induction to the expulsion of the fetus was not significantly different between the both groups at 24 hours and 48 hours. This is consistent with other studies that used vaginal misoprostol for the induction of labour (8,10). There was, also, no correlation between the vaginal pH and the duration and outcome with the induction of labour in these studies.…”

Section: Discussionsupporting

confidence: 82%

The Effect of Vaginal pH on the Efficacy of Vaginal Misoprostol for the Induction of Midtrimester Pregnancy Termination

Zanjani¹,

Kohpayeh²,

Karimi³

2017

Obstet Gynecol Cancer Res

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“…Some studies discussed the administration of different types of misoprostol, such as gel form and powder form, however the efficacy was not improved 34, 35 . Some studies discussed the efficacy of moistened misoprostol by acetic acid or normal saline, conclusion was made that vaginal misoprostol either moistened with normal saline or acetic acid was comparable in terms of efficacy and adverse effects 36–38 . Some studies reported different methods to combine misoprostol with laminaria tents or castor oil, however these studies did not focus on the efficacy of these methods to produce abortion for women with missed abortion 39, 40 .…”

Section: Discussionmentioning

confidence: 99%

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Marwah

Wang

et al. 2017

Sci Rep

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The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were included in our analysis. Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug, lower-dose regimens (200 ug or 400 ug) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours. In terms of efficacy, the most effective treatment was sublingual misoprostol of 600 ug and the least effective was oral misoprostol of 400 ug. In terms of tolerability, vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects. Misoprostol is a non-invasive, effective medical method for completion of abortion in missed abortion. Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose. The ideal dose and medication interval of misoprostol however needs to be further researched.Missed abortion is defined as unrecognized intrauterine death of the embryo or fetus without expulsion of the products of conception. It constitutes approximately 15% of clinically diagnosed pregnancies 1 . Women experiencing a missed abortion may have no self-awareness due to the lack of obvious symptoms.With around 95% success rate, surgical evacuation is regarded as the standard treatment for missed abortion, which had been widely performed all over the world in the past 50 years 2 . However, the costs of surgery and hospitalization, as well as the complications associated with surgery and anaesthesia are a major unresolved concern. Besides infection and bleeding, decreased fertility caused by intrauterine adhesions may be unacceptable for women with missed abortion, who have not yet fulfilled their motherhood desires. Some studies have thus suggested that expectant or medical management might be more suitable instead of surgical evacuation 3,4 .Expectant management has been reported with unpredictable success rate ranging from 25-76% 5-7 . Waiting for spontaneous expulsion of the products of conception would waste much time, during which women may suffer uncertainty and anxiety 5 . When additional surgical evacuation is needed owing to failure, they may suffer from an emotional breakdown. It is thus not recommended for missed early miscarriage due to the risks of emergency surgical treatment and blood transfusion 8 .Misoprostol is a synthetic prostaglandin E1 analogue which was originally developed to prevent non-steroidal anti-inflammatory drugs related gastric ulcers. However it has been used for various other indications in obstetrics and gynaecology. Medical manag...

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A randomized comparative study on vaginal administration of acetic acid-moistened versus dry misoprostol for mid-trimester pregnancy termination

Abstract: Moistening misoprostol tablets with 5% acetic acid before vaginal application creates no difference in outcomes when compared with those after the vaginal application of dry tablets for the termination of second-trimester pregnancy.

Cited by 15 publications

References 22 publications

The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial

The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial

The Effect of Vaginal pH on the Efficacy of Vaginal Misoprostol for the Induction of Midtrimester Pregnancy Termination

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

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