Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens

Abstract

Objective To compare the efficacy and side effects of three regimens of intravaginal misoprostol for second-trimester abortion.

Methods A total of 118 women requiring second-trimester pregnancy termination were randomly assigned to one of three treatment groups: 400 μg 3-hourly in group A (n = 39), 600 μg 6-hourly in group B (n = 39), and 800 μg 12-hourly in group C (n = 40). Misoprostol tablets moistened with 3 ml of 5% acetic acid were placed into the posterior vaginal fornix.

Results The median induction-abortion times in groups A (8 h [range: 3–64]) and B (9 h [4–81]) were significantly shorter (p < 0.01 and p < 0.05, respectively) than in group C (12.5 [3–72]). Moreover, expulsion rates within 24 hours in groups A (92.3%) and B (92.3%) were significantly higher (p < 0.05 in both cases) than that of group C (75%). Expulsion rate within 48 hours, number of tablets used, number of patients with retained placenta and side effects did not differ between groups.

Conclusions Misoprostol moistened with acetic acid is effective for second-trimester pregnancy termination when given vaginally 3-hourly, 6-hourly or 12-hourly. The former two regimens are significantly more effective than the latter.

KEYWORDS:

• Acetic acid
• Misoprostol
• Moistening of tablets
• Second trimester abortion
• Termination of pregnancy
• Vaginal route

Declaration of interest: The authors report no conflicts of interest. The study did not benefit from any funding. The authors alone are responsible for the content and writing of the paper.