Second Trimester Medical Termination of Pregnancy with Combined Intracervical and Intravaginal Misoprostol: Comparative Analysis with Intravaginal Misoprostol—A Pilot Study

Abstract

Context Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. Objective To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. Materials and MethodsIn this IRB approved prospective study, twenty-two women (mean age 25.4 ± 3.2 years, range 23-32 years; mean BMI 22.3 ± 3.4 kg/m 2 ; mean parity 2.1 ± 1.4, average gestational age 17.9 ± 2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. Results Mean induction-abortion interval for intravaginal group and combination group was comparable (t = 7.9 ± 1.8 and 6.5 ± 3.5 h, respectively). Three patients required surgical evacuation for incomplete abortion (n = 2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6 h was more in the intracervical-intravaginal group (36.3 %). Patients with intracervical misoprostol complained of abdominal pain more often than

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

“…Two studies included women who underwent induced fetal demise immediately before abortion [ 17 , 18 ]. Nine studies included a total of 172 women with a scarred uterus [ 16 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ]. In three studies, women with a scarred uterus comprised 22% of the population [ 18 , 21 , 22 ].…”

“…Four trials with 347 total subjects compared oral to vaginal routes of misoprostol ( Fig. 9 , Supplements 12A and 13A) [ 19 , 22 , 50 , 51 ]. The oral group had higher ongoing pregnancy rates at 24 h (RR 3.60, 95% CI 1.99–6.51, moderate certainty evidence) and 48 h (RR 8.01, 95% CI 1.74–36.87, low certainty evidence).…”

“…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.…”

Efficacy of misoprostol alone for second trimester termination

“…Availability of the health care centre in urban areas may help the women to decide in earlier and correct stage to terminate the pregnancy; but the rural women is mostly in dilemma and post termination care is found substantial [6,28,29,30] . The major factors that are influencing and disturbing the termination process for the individual are age, age at sexual activity onset, emotional/ sentimental, educational background, income issues, religion, occupation, fear about abortion procedure, availability of appropriate health care, cooperation of the family, location of abortion, types of treatment, post abortion care and other ethical and legal issues [14,31,32] . Many studies suggested that the parity is a major factor that influencing the success of medical termination of pregnancy.…”

“…Also, it was found for better local drug action. Thus the overall dosage of the drug and its side effects is reduced [14] . For STT, the dual-therapeutic effect of mifepristone and misoprostol seems to have the highest and the shortest time interval of termination.…”