Volume 14, Issue 10 (10-2016)                   IJRM 2016, 14(10): 643-648 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Mitwaly A B A, Abbas A M, Abdellah M S. Intra uterine extra-amniotic versus vaginal misoprostol for termination of second trimester miscarriage: A randomized controlled trial. IJRM 2016; 14 (10) :643-648
URL: http://ijrm.ir/article-1-697-en.html
Intra uterine extra-amniotic versus vaginal misoprostol for termination of second trimester miscarriage: A randomized controlled trial
Abo Bakr Abbas Mitwaly1 , Ahmed Mohamed Abbas * 2, Mohamed Sayed Abdellah1
1- Department of Obstetrics and Gynecology, Faculty of Medicine-Assiut University, Assiut, Egypt
2- Department of Obstetrics and Gynecology, Faculty of Medicine-Assiut University, Assiut, Egypt , bmr90@hotmail.com
Abstract:   (2224 Views)
Background: Termination of pregnancy in the second trimester using prostaglandins has been shown to be safe and effective. Misoprostol has multiple routes of administration; oral, vaginal, buccal, rectal and sublingual.
Objective: The study aims to compare the efficacy and safety of intrauterine extra-amniotic and vaginal misoprostol in a dose of 200 microgram every 4 hours for the termination of pregnancy in cases of second trimester miscarriage.
Materials and Methods: A prospective randomized open labeled clinical trial included 180 women with missed miscarriage in gestational age between 13 and 24 wks. Patients were randomized to receive subsequent doses of 200 μg misoprostol every 4 hrs either intra uterine extra-amniotic by Foley catheter or vaginally administered. Randomization was completed using a computer-generated random table. The primary outcome of this study was the mean duration from the initial misoprostol dose until complete fetal expulsion (induction-expulsion interval).
Results: The mean gestational age was 17.74 wks. The mean time to complete miscarriage in the intra uterine extra-amniotic group was 5.27 hrs, which was significantly lower than the vaginal group (9.92 hrs, p=0.001). Side effects were more common in vaginal group.
Conclusion: Intra uterine extra-amniotic misoprostol with a dose of 200 μg every 4 hrs appears to be more effective and safer than vaginal misoprostol in induction of second trimester miscarriage
Keywords: Misoprostol, Missed miscarriage, Termination of pregnancy, Prostaglandins.
Full-Text [PDF 98 kb]   (804 Downloads) |   |   Full-Text (HTML)  (452 Views)  
Type of Study: Original Article |
References
1. Strauss LT, Gamble SB, Parker WY, Cook DA, Zane SB, Hamdan S. Abortion surveillance- United States, 2004. MMWR Surveill Summ 2007; 56: 1-33.
2. Gamble SB, Strauss LT, Parker WY, Cook DA, Zane SB, Hamdan S. Abortion surveillance - United States, 2005. MMWR Surveill Summ 2008; 57: 1-32.
3. Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol 2004; 103: 729. [DOI:10.1097/01.AOG.0000116260.81570.60]
4. Boulvain M, Kelly A, Lohse C, Stan C, Irion O. Mechanical methods for induction of labour. Cochrane Database Syst Rev 2001; 4: CD001233. [DOI:10.1002/14651858.CD001233]
5. World Health Organization. Safe Abortion: Technical and Policy Guidance for Health Systems. 2nd Ed. Geneva: WHO; 2011.
6. Vimala N, Dadhwal V, Mittal S. Sublingual misoprostol for second-trimester abortion. Int J Gynecol Obstet 2004; 84: 89-90. [DOI:10.1016/S0020-7292(03)00254-6]
7. Borgatta L, Kapp N; Society of Family Planning. Clinical guidelines. Labor induction abortion in the second trimester. Contraception 2011; 84: 4-18. [DOI:10.1016/j.contraception.2011.02.005]
8. Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for mid-trimester termination of pregnancy. Cochrane Database Syst Rev 2011; 1: CD005216. [DOI:10.1002/14651858.CD005216.pub2]
9. Ngoc NT, Shochet T, Raghavan S, Blum J, Nga NT,Minh NT, et al. Mifepristone and Misoprostol Compared with Misoprostol Alone for Second-Trimester Abortion. A randomized Controlled Trial.Obstet Gynecol 2011; 118: 601-608. [DOI:10.1097/AOG.0b013e318227214e]
10. Dodd CM, Crowther CA. Misoprostol versus cervagem for the induction of labour to terminate pregnancy in the second and third trimester: a systematic review. Eur J Obstet Gynecol Reprod Biol 2006; 125: 3-8. [DOI:10.1016/j.ejogrb.2005.10.021]
11. Souza AS, Feitosa FE, Costa AA, Pereira AP, Carvalho AS, Paixão RM, et al. Titrated oral misoprostol solution versus vaginal misoprostol for labor induction. Int J Gynaecol Obstet 2013; 123: 207-12. [DOI:10.1016/j.ijgo.2013.06.028]
12. Toppozada HM, Ismail AA. Intrauterine administration of drugs for termination of pregnancy in the second trimester. Ciln Obstet Gynecol 1990; 327-349.
13. Kapp N, Borgatta L, Stubblefield P, Vragovic O, Moreno N. Mifepristone in second-trimester medical abortion: A randomized controlled trial. Obstet Gynecol 2007; 110: 1304-1310. [DOI:10.1097/01.AOG.0000289577.32274.a5]
14. Wagner M. Off-label use of misoprostol in obstetrics: a cautionary tale. BJOG 2005; 112: 266-268. [DOI:10.1111/j.1471-0528.2004.00445.x]
15. Weeks AD, Fiala C, Safar P. Misoprostol and the debate over off-label drug use. BJOG 2005; 112: 269-272. [DOI:10.1111/j.1471-0528.2004.00490.x]
16. Tang OS, Schweer H, Seyberth HW, Lee SWH, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod 2002; 17: 332-336. [DOI:10.1093/humrep/17.2.332]
17. Fawzy M, Abdel-Hady E. Midtrimester abortion using vaginal misoprostol for women with three or more prior cesarean deliveries. Int J Gynecol Obstet 2010; 110: 50-52. [DOI:10.1016/j.ijgo.2010.02.008]
18. Aronsso A, Bygdeman M, Gemzell-Danielsson K. Effects of misoprostol on uterine contractility following different routes of administration. Hum Reprod 2004; 19: 81-84. [DOI:10.1093/humrep/deh005]
19. Bygdeman M, Gemzell-Danielsson K. An historical overview of second trimester abortion methods. Reprod Health Matt 2008;
20. 16 (Suppl.): 196-204.
21. 60TRezk MA60T, 60TSanad Z60T, 60TDawood R60T, 60TEmarh M60T, 60TMasood A60T. Comparison of intravaginal misoprostol and intracervical Foley catheter alone or in combination for 53Ttermination53T of second trimester 53Tpregnancy53T. 60TJ Matern Fetal Neonat Med60T 2015; 28: 93-96. [DOI:10.3109/14767058.2014.905909]
22. 60TToptas T60T, 60TMendilcioglu I60T, 60TSimsek M60T, 60TTaskin O60T. Intravaginal misoprostol alone versus intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination: an observational study. 60TGinekol Pol60T 2014; 85: 577-581.
23. Wong KS, Ngai CS, Yeo EL, Tang LC, Ho PC. A comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy: a randomized comparative trial. Hum Reprod 2000; 15: 709-712. [DOI:10.1093/humrep/15.3.709]
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb