Joined oral and vaginal misoprostol use in remedial terminations at 14 to 28 weeks of gestation.


Cemal İpekçi Kutlar

This study involved an investigation of the effectiveness and complications of oral and vaginal misoprostol use on the termination of second trimester pregnancies. A total of 103 cases were recruited from the medical records of the Gynecology and Obstetrics Clinic of Taksim Research and Training Hospital and �?ırnak İdil State Hospital. Women underwent therapeutic termination of pregnancy between the 14 to 28th week of gestation using the defined combined misoprostol regimen. After the women were admitted, 200 μg vaginal (100 μg intracervical, 100 μg into the posterior fornix), 200 μg oral doses and 200 μg of sequential doses were administered in the 2nd and 4th hour. Subjects were excluded from the study if they were out of the defined gestational weeks using additional drugs with misoprostol; their data has not been recorded in detail. Of the 103 cases, 86 had an abortion within 24 h and the mean expulsion time was calculated as 15.42 ± 7.14 h (min 6.39 to max 20.03) in this group. The success rate for the 24 h was found to be 83.4%. Six more cases had an abortion when the second dose was given. The mean expulsion time was found to be 9.31 ± 3.26 h (min 6.45 to max 13.21) for the second 24 h. The success rate over 48 h rose to 89.3%. The total expulsion time was 18.30 ± 8.74 h. There was a history of previous caesarean sections in 2 out of 11 cases that did not have an abortion and one of these cases underwent a hysterotomy. The pregnancy was terminated by evacuation and curettage, as abortion did not occur despite 3 different high dose misoprostol regimens as in the other cases. Pregnancies of the remaining 9 cases were terminated with different misoprostol doses, oxytocin infusion and the evacuation and curettage method. When complication rates were evaluated, analgesic requiring pain (18.4%) was the leading complication, followed by nausea (11.6%), fever (7.7%), headaches and dizziness (5.8%), transfusion-requiring haemorrhage (3.8%) and diarrhea (1.9%). Uterine rupture or death did not occur. A combined misoprostol regimen is relatively safe with acceptable side effects when used carefully for the termination of second trimester pregnancies.

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