Abstract
Objective: Our purpose was to compare the efficacy of oral misoprostol with that of vaginal
misoprostol for midtrimester termination of pregnancy. Study Design: Women seen for midtrimester pregnancy termination were randomly assigned to receive
either misoprostol orally in a dose of 200 μg every hour for 3 hours followed by 400
μg every 4 hours or vaginally in a dose of 400 μg every 4 hours. The protocol was
followed for 24 hours, after which time further management was at the discretion of
the attending physician. The primary outcome measure was the induction-to-delivery
interval. Sample size was calculated a priori. Statistical analysis was performed
with the t test for continuous variables and the χ2 test for categorical variables. P <.05 was considered significant. Results: One hundred fourteen women were randomized, with 49 receiving vaginal misoprostol
and 65 receiving oral misoprostol. The two groups were comparable with respect to
maternal age, parity, indication for pregnancy termination, gestational age, and maternal
weight. The mean induction-to-delivery interval was significantly shorter for the
vaginal group (19.6 ± 17.5 hours vs 34.5 ± 28.2 hours, P <.01). Length of stay was also shorter in the vaginal group (32.3 ± 17.3 hours vs
50.9 ± 27.9 hours, P <.01). Significantly more patients in the vaginal group were delivered within 24
hours (85.1% vs 39.5%, P <.01), and more patients in the oral group required changes in the method of induction
when they were undelivered after 24 hours (38.2% vs 7%, P <.01). The only complication was an increase in febrile morbidity in the vaginal
group (25% vs 6.7%, P =.046). This did not result in an increased use of antibiotics, and all the fevers
resolved post partum without further complications. Conclusions: Vaginal administration of misoprostol resulted in a shorter induction-to-delivery
interval. The shorter length of stay should result in improved patient care. (Am J
Obstet Gynecol 2002;187:853-7.)
Keywords
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References
- Absorption kinetics of misoprostol with oral or vaginal administration.Obstet Gynecol. 1997; 90: 88-92
- Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy.Obstet Gynecol. 1997; 90: 735-738
- A randomized trial of oral versus vaginal administration of misoprostol for the purpose of mid-trimester termination of pregnancy.Aust N Z J Obstet Gynaecol. 2001; 41: 407-410
- A comparison of oral and vaginal misoprostol tablets in induction of labour at term.Br J Obstet Gynaecol. 2001; 108: 238-243
- A comparison of oral and vaginal misoprostol for induction of labour at term: a randomized trial.Br J Obstet Gynaecol. 2001; 108: 169-178
- Midtrimester termination of complicated pregnancy with oral misoprostol.Adv Contracept. 1997; 13: 55-61
- Vaginal misoprostol compared with vaginal gemeprost in termination of second trimester pregnancy: a randomized trial.Contraception. 1998; 58: 207-210
- Termination of 2nd and 3rd trimester pregnancies with mifepristone and misoprostol.Eur J Obstet Gynecol Reprod Biol. 1996; 70: 159-163
- Second trimester abortion using intravaginal misoprostol.Int J Gynaecol Obstet. 1998; 60: 161-165
- A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second-trimester abortion.Obstet Gynecol. 1997; 90: 896-900
- A comparison of two dosing regimens of intravaginal misoprostol for second-trimester pregnancy termination.Obstet Gynecol. 1999; 93: 571-575
- The effectiveness of intravaginal misoprostol (Cytotec) in inducing abortion after eleven weeks of pregnancy.Stud Fam Plann. 1993; 224: 319-323
- Risk of uterine rupture during labour among women with a prior cesarean delivery.N Engl J Med. 2001; 345: 3-8
- Disruption of prior uterine incision following misoprostol for labor induction in women with previous cesarean section.Obstet Gynecol. 1998; 91: 828-830
- Uterine rupture and dehiscence associated with intravaginal misoprostol cervical ripening.J Reprod Med. 2000; 45: 823-826
- Separation of cesarean scar during second-trimester intravaginal misoprostol abortion.Obstet Gynecol. 1999; 94: 840
- Uterine rupture during second-trimester abortion associated with misoprostol.Obstet Gynecol. 2001; 98: 976-977
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☆Reprints not available from the authors.
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© 2002 Published by Elsevier Inc.
