A COMPARISON OF TWO PROTOCOLS OF INTRAVAGINAL MISOPROSTOL FOR SECOND TRIMESTER MEDICAL TERMINATION OF PREGNANCY

Intravaginal Misoprostol

Abstract

Objective: To compare the efficacy and side effect profiles of two different dosage protocols of intra-vaginal misoprostol.

Study Design: Randomized control trial.

Setting: Department of Gynaecology and Obstetrics, Combined Military Hospital, Lahore.

Duration of Study: From March 2004 to May 2005.

Material and Methods: Total of 128 women, aged 19 – 39 years, planned for 2nd trimester pregnancy termination, was randomly assigned to two groups of 64 women each. Group – I women received vaginal misoprostol 200µg four hourly for a maximum of 6 doses in 24 h. Women in group – II received vaginal misoprostol 200µg six hourly for a maximum of four doses in 24 hours. If abortion did not occur in 24 h, the same regimens were repeated. Without successful abortion in 48 hours, misoprostol administration was abandoned in favour of surgical induction.

Results: The median induction to abortion interval in group – I (14.4 h was significantly shorter than in group – II (18 h) (p < 0.01). The incidence of fever was more common in group – I (p = 0.01). The pregnancy related symptoms decreased in both groups after misoprostol and decrease in breast tenderness was most marked two to three hours after administration. Misoprostol induced fever at least five hours after administration in up to 37.5% women, this peak being slightly higher and occurring earlier in group – I than in group – II. Lower abdominal pain peaked after three to four hours in group – I and after five to six hours in group – II, with no significant difference in pain intensity or analgesic requirements. Other common side effects were diarrhea followed by nausea and vomiting in both the groups.

Conclusion: Protocol of 200µg misoprostol administered four hourly / 24 hours is more effective in reducing induction – abortion interval and inducing successful abortion within 48 hours without any major increase in side effects.