Efficacy and safety of intravaginal misoprostol and intracervical foley's catheter ballooning in second trimester pregnancy termination

Abstract

Background Termination of pregnancy in second trimester is one of the greatest challenges in modern obstetrics practice and is more risky than during first trimester. Now the main concern of the obstetrician is to provide the most effective, safest, and cost-effective regimen with least or no complications. Objective To compare the efficacy and safety of intravaginal misoprostol alone and in combination with intracervical Foley's catheter ballooning for termination of pregnancy at second trimester. Patients and methods This prospective randomized clinical study was conducted at Alzahra University Hospital and Alglaa Teaching Hospital from June 2019 till June 2020. A total of 100 pregnant women with second trimester who missed abortion were randomly divided into two groups: group I included 50 patients who received misoprostol 200-mg tab intravaginally per 6 h till maximum of four doses, in addition to intracervical Foley's catheter being placed till the catheter got expelled out spontaneously or after 24 h. Group II included 50 patients who received only misoprostol (200 μg) tab, same dose as group I. Results In this study, the success of abortion within 24 h was 42 (84%) cases in group I and 29 (58%) cases in group II. The failure of abortion after 48 h was 6% (three cases) in group I and in 18% (nine cases) in group II. The mean induction to abortion time was 14.26 h in group I and 17.243 in group II, with P value of 0.002. There was a significant decrease in the need for surgical evacuation [three (6%) cases − in group I compared with seven (14%) cases in group II]. There is no significant difference between both groups regarding complications (lower abdominal pain, postabortion bleeding, vomiting, headache, and fever); all these complications were mild. Conclusion Combined use of intravaginal misoprostol and intracervical Foley's catheter has a shorter induction to abortion time than misoprostol alone and less need for surgical evacuation, with no significant increase in adverse effects.