Comparison of Oral Versus Vaginal Misoprostol for Legal Abortion in Iranian Women

Abstract

Background:Considering the different available results on effectiveness of various doses of misoprostol and different methods of administration, as well as legal issues of abortion in Iran, the aim of this study was to compare oral and vaginal misoprostol for legal abortion in pregnant women. Methods:This randomized double-blind clinical trial study was performed on 70 pregnant women applying for abortion referring to Besat Hospital in Sanandaj in 2014 -2015. Pregnant women were divided randomly into two oral misoprostol and vaginal misoprostol groups by simple sampling. In both groups, misoprostol 200 μg every 6 hours up to six times (36 hours) was used. To make the study double-blind, placebo was used. The data collection instrument was a questionnaire. The effectiveness of misoprostol (the excretion of gestation products) and its side effects (bleeding, fever, etc.) were studied in two groups. Data were analyzed using SPSS Ver.18 software, t-test, Chi-square test and Fisher exact test. Results:The results showed that there were no significant differences statistically between oral (82.3%) and vaginal (80%) misoprostol groups in terms of response to treatment (the excretion of gestation products). Although in our study, the need for curettage in the vaginal group (42.8) was higher than oral group (34.3), the difference was not statistically significant. Intervals of consuming oral misoprostol pills to the excretion of gestation products in the oral and vaginal groups were 4.09 ± 1.56 and 3.67 ± 1.4 hours, respectively (P > 0.05). In terms of complications, only two cases of oral misoprostol group experienced complications. Conclusions:Although the risk of complications in oral method and the need for curettage in vaginal group is high, effectiveness of oral and vaginal misoprostol for induction of legal abortion is similar.

Comparison of Effectiveness and Patient Satisfaction of Vaginal Versus Oral Misoprostol in Treatment of Missed Miscarriage

“…However, in spite of the logical explanation that vaginal misoprostol may be more effective than oral misoprostol due to their pharmacokinetic differences, in our study, there was no statistically significant difference in terms of response to treatment between oral misoprostol and vaginal misoprostol (P = 0.928). Although there are some studies that their results are contrary to our findings [1], [8], [13], [14], [15], [16], [17], there are some studies that support our findings [9], [18].…”

“…Patient satisfaction is an important factor to be considered in the treatment of missed abortion because except the physical pain that these patients have, they are emotionally involved because of the loss of their child. They also suffer grief and depression [9]. Our study does not show a significant difference between patients’ satisfaction of vaginal group and the oral group at the time of discharge (p = 0.991).…”

“…Some studies revealed that vaginal misoprostol is more effective than oral one in the expulsion of uterine content [8]. However, some other studies showed that there is not any significant difference between oral misoprostol and vaginal form of that [9]. Another important issue that should be considered in the treatment of missed abortion is the acceptability and satisfaction of the patient with the administered treatment.…”

“…Because patients of having missed abortion experience grief, anxiety and depression, the method of treatment may affect their emotional state [10]. Some trials have concluded that women have higher satisfaction with oral misoprostol [11] while some other findings were against the superiority of oral misoprostol over the vaginal form of that considering the patient’s satisfaction [9].…”

Sublingual v/s vaginal misoprostol for second trimester termination of pregnancy: A comparative study

“…Higher curettage rate was seen in the vaginal group. 11 From our study we conclude that misoprostol can be used by either sublingual or vaginal route for effective second trimester pregnancy termination. Both routes are almost equally effective and safe to be used in the second trimester MTP.…”