Frequent low-dose misoprostol for termination of second-trimester pregnancy

Abstract

Objectives To determine the efficacy of an application regimen of low-dose frequent misoprostol for second-trimester pregnancy termination.

Methods A total of 250 women between 12 and 20 weeks of gestation who were scheduled for second-trimester pregnancy termination received 200 μg vaginal misoprostol followed by 100 μg oral misoprostol every 2 h until expulsion of the fetus. Mechanical cervical dilatation with a 16-French Foley balloon catheter was performed if no cervical dilatation was observed after 24 h. The main outcome measures were the delivery rate within 24 h and the factors influencing the interval between the onset of induction and abortion. Secondary outcome measures were the side-effects of the regimen and the total misoprostol dose required.

Results With application of this protocol, 245 women (98%) delivered within 24 h of induction. The mean (± standard deviation) misoprostol dose used was 728 ± 297 μg (200–2100 μg). Cox regression analysis revealed that vaginal spotting or nulliparity do not effect the induction–abortion time. On the other hand, using this regimen induction to abortion time tends to be longer in the presence of live fetuses (odds ratio (OR) = 0.45; confidence interval (CI) = 0.2–0.8; p = 0.008) and pregnancies with gestational age > 16 weeks (OR = 0.59; CI = 0.4–0.8; p = 0.003) when compared with cases of in utero death and pregnancies with a gestational age of 12–13 weeks, respectively. Twenty-seven women (10.8%) experienced one or more side-effects attributable to misoprostol.

Conclusion The 100-μg oral misoprostol every 2 h following 200 μg vaginal misoprostol is a highly effective protocol for inducing abortion at 12–20 weeks of pregnancy. Cases with live fetuses or pregnancies with older gestational age (> 16 weeks) deliver in a longer time period.

• Misoprostol
• Induction
• Abortion
• Second trimester

MS 4307

MS 4307