A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination

Bebbington, Michael; Kent, Nancy; Lim, Kenneth; Gagnon, Alain; Delisle, Marie France; Tessier, Francine; Wilson, R. Douglas

doi:10.1067/mob.2002.127461

Cited by 80 publications

(49 citation statements)

References 16 publications

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“…1,3,6,[8][9][10][11][12][13][14][15][16][17][18] Use of misoprostol for second trimester pregnancy interruption was initially described by Jain et al in 1994; however, this regimen utilized a relatively low-dose misoprostol regimen (200 ug vaginally every 12 hours). 6 Several recent investigations have suggested that higher dose misoprostol regimens may be more efficacious.…”

Section: Discussionmentioning

confidence: 99%

“…6 Several recent investigations have suggested that higher dose misoprostol regimens may be more efficacious. 1,2,[8][9][10][11][12][13][14][15][16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Such techniques include dilation and evacuation, intraamniotic prostaglandin F 2α instillation, prostaglandin E 2 (PGE 2 ) vaginal suppositories, and high dose oxytocin. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Misoprostol (Cytotec®,), a potent uterotonic agent, has also been shown to be effective for second trimester pregnancy interruption. 1,3,6,[8][9][10][11][12][13][14][15][16][17][18] Several recent comparative investigations have demonstrated that the use of high dose oral or vaginal misoprostol is more efficacious than alternative methods (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…concentrated oxytocin, PGE 2 , etc) for second trimester pregnancy interruption, with an acceptable side-effect profile. 1,3,[8][9][10][11][12][13][14][15][16][17][18] Indeed, we recently demonstrated that a high dose vaginal misoprostol regimen was superior to concentrated oxytocin plus low-dose vaginal PGE 2 with respect to significantly shortened induction-to-delivery interval, fewer side effects, less medication for the treatment of side effects, and lower incidence of retained placenta requiring dilation and curettage, reduction in side effects, and fewer cases of retained placenta requiring dilation and curettage. 18 However, we noted a relatively high live birth rate and therefore devised the current study…”

Section: Introductionmentioning

confidence: 99%

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High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: A randomized trial

Nuthalapaty¹,

Ramsey²,

Biggio³

et al. 2005

American Journal of Obstetrics and Gynecology

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Objective-To compare the efficacy and side effects of a high-dose vaginal misoprostol regimen to concentrated intravenous oxytocin plus low-dose vaginal misoprostol for mid-trimester labor induction.Study Design-Women at 14-24 weeks, with obstetric or fetal indications for delivery and no prior cesarean, were randomly assigned to receive either vaginal misoprostol 600 μg ×1, then 400 μg q 4 hr × 5 (Group 1) or escalating-dose concentrated oxytocin infusions (277-1667 mU/min) plus vaginal misoprostol 400 μg × 1, then 200 μg q 6 hr × 2, then 100 μg × 1 (Group 2). Analysis was by intent to treat. Primary outcomes were live birth rate and induction-to-delivery interval.Results-The intended sample size was 70 women per group; however, the trial was terminated at the initial interim analysis due to a highly significant difference in one of the primary study outcomes. Twenty women were assigned to Group 1 and 18 were assigned to the Group 2. Median induction-to-delivery interval was significantly shorter in Group 1 (12 hr, range 4 -44 hr) versus Group 2 (18 hr, range 7 -36 hr; p=0.01). Induction success rate at 12 hours was significantly higher in the Group 1 (60%), compared to Group 2 (22%, p=.02). No significant difference was noted in the live birth rate between Group 1 and 2 (13%, 0%, p = 0.16). The incidence of retained placenta requiring curettage, chorioamnionitis, intrapartum fever, nausea, emesis, and diarrhea were similar between both groups.Conclusion-Compared to concentrated oxytocin plus low-dose vaginal misoprostol, high-dose vaginal misoprostol significantly shortens mid-trimester labor inductions.

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Section: Discussionmentioning

confidence: 99%

“…6 Several recent investigations have suggested that higher dose misoprostol regimens may be more efficacious. 1,2,[8][9][10][11][12][13][14][15][16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: A randomized trial

Nuthalapaty¹,

Ramsey²,

Biggio³

et al. 2005

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…They concluded that vaginal administration resulted in shorter induction -delivery interval. 12 In a study by Dickinson JE et al, 150 women subjected to different intravaginal misoprostol regimens were compared. The regimens were-200 μg misoprostol at 6 hours interval (group 1), 400 μg misoprostol (group 2) a loading dose of 200 μg (group 3).…”

Section: Discussionmentioning

confidence: 99%

Randomised comparison of oral and vaginal misoprostol when combined with mifepristone for termination of second trimester pregnancy

Madhuri

Veena

Manjunath

2016

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONAdvances in fetal diagnosis have resulted in increased number of second trimester pregnancy terminations. Invasive means of second trimester medical abortion have long been available. In the past few years, however, the ability to safely and effectively accomplish non invasive second trimester abortions has evolved considerably.A combination of mifepristone, a progesterone antagonist, and misoprostol, a synthetic prostaglandin E1 analogue, is effective for medical abortion in second trimester. The latter has the advantages of being cost effective, stable at room temperature and is a strong uterotonic. Mifepristone, (RU 486, a substitute 19-norethisterone derivative) is a progesterone receptor blocker, causes intrauterine fetal demise and sensitises the uterus to the activity of prostaglandins.1 The two drugs together have proven efficacy in first trimester abortion. 2The optimal regimen for second trimester is still under investigation, but is required to have a high complete abortion rate, short induction-abortion interval, low Methods: 60 women who were pregnant between 13 and 20 weeks were included in the study. They were divided into two groups by random sampling method and they all received 200 mg of mifepristone orally on day 1. 36 hours later they received 200 µg of misoprostol vaginally or 400 µg of misoprostol orally every 3 hours as determined by the random sampling method. Main outcome measures were induction abortion interval, complete abortion rate and side effects. Results: There was a statistical difference in the amount of misoprostol required in the oral and the vaginal group, the total dose being higher in the oral group. The mean induction-abortion interval in the vaginal group was 6.2 hrs and oral group was 11.6 hrs and this difference was statistically significant. There was no statistical difference in the complete abortion rate of the two groups. There was no difference in the side effects caused by both routes of misoprostol administration. Conclusion: 200 µg misoprostol inserted vaginally is better than 400 µg of oral misoprostol, 36 hours after administration of tab. Mifepristone 200 mg for termination of second trimester pregnancy.

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Medical treatment for early fetal death (less than 24 weeks)

Neilson

Hickey

Vázquez³

2006

Cochrane Database of Systematic Reviews

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A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination

Cited by 80 publications

References 16 publications

High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: A randomized trial

High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: A randomized trial

Randomised comparison of oral and vaginal misoprostol when combined with mifepristone for termination of second trimester pregnancy

Medical treatment for early fetal death (less than 24 weeks)

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