Comparing two regimens of intravaginal misoprostol with intravaginal gemeprost for second-trimester pregnancy termination: a randomised controlled trial

Abstract

Intravaginal misoprostol 400 µ g at 4- hour intervals was the most effective regimen but was associated with a high incidence of fever. Misoprostol 200 µg demonstrated similar effectiveness as gemeprost and had lower incidence of diarrhoea. Gemeprost should not be first line for medical therapy given the cost, storage requirements and lower efficacy.

Medical regimens for abortion at 12 weeks and above: a systematic review and meta-analysis

“…One trial ( N = 50) compared vaginal vs. buccal routes of misoprostol (Appendix 6D, Supplement 3 D) [ 41 ]. Another trial ( N = 339) compared sublingual vs. buccal routes of misoprostol (Appendix 6E, Supplement 3 E) [ 42 ]. We found no differences in any outcomes across all comparisons.…”

“…The WHO used the results of this review to directly inform its recent Medical management of abortion guidance [ 11 ]. Our review builds on the 2011 Cochrane review [ 5 ] of second-trimester medical abortion methods by evaluating 26 new trials [ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] ]. Based on our analysis, we recommend a regimen of mifepristone 200 mg 1 to 2 days before misoprostol 400 mcg every 3 h via vaginal, sublingual or buccal routes.…”

Second-trimester abortion: women often lack the choice they should be offered

“…In this issue, Koh et al 1 from Singapore report on their randomised study of three vaginal prostaglandin regimens for mid-trimester termination of pregnancy 2. This article addresses gaps in knowledge both of the optimum dose of the most commonly used agent, misoprostol, and of the relative efficacy of the product licensed for this indication, gemeprost.…”

“…As the independent sector becomes less able to source the required pool of skilled surgical providers, medical termination may increasingly become the default position for late terminations throughout the UK. Against that background, Koh et al’s RCT2 provides useful information on different regimens for mid-trimester medical abortion. Unlike comparisons between surgical and medical procedures, comparisons of differing medical procedures provide a relative abundance of data, including a Cochrane Review comparing 36 RCTs 12.…”