TITLE:
Comparative Study of Sublingual and Vaginal Misoprostol in Second Trimester Induced Abortion
AUTHORS:
Rupali Modak, Dilip Kumar Biswas, Arindam Ghosh, Amitava Pal, Tapan Kumar Mandal
KEYWORDS:
Misoprostol, Sublingual, Vaginal Route, Mid Trimester Abortion
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.13,
September
9,
2014
ABSTRACT: Background: To identify an
effective misoprostol-only regime for the termination of second trimester
pregnancy. Objectives: To compare the efficacy, safety and acceptability of
sublingual and vaginal misoprostol for second trimester pregnancy termination.
Methods: In a prospective randomized comparative study, over 138 pregnant women
at 13 - 20 weeks (91 - 140 days) of gestation requiring medical abortion were
randomly assigned to the sublingual or vaginal route for misoprostol
administration with dose schedule of 400 mcg every 3 hours up to 5 doses within
24 hours. The course of misoprostol was repeated if the woman did not abort
within 24 hours. Primary outcome was the efficacy of the treatment to terminate
pregnancy completely at 24 and 48 hours. Secondary outcomes measured were
induction-abortion interval, side effects, failure rate, and women’s perception
to these treatments. Results: At 24 h, the complete abortion rate was87.88% in the vaginal administration
group and 79.41% in sublingual group (difference 8.5%, 95%CI: 3.8 to 13.2). No significant
difference in the complete abortion rates was observed at 48 h(90.91% versus
88.24% difference: 2.7%, 95% CI: ?0.04 to 5.4) when vaginal and sublingualgroups were compared. Mean
induction-abortion interval in sublingual and vaginal groups was 12.28 h (95%
CI of mean 11.019 - 13.541 h) and 13.11 h (95% CI of mean 12.0301 - 14.1899 h)
respectively; p = 0.485. The rates of side effects were similar in both groups
except for fever, which was more common in vaginal group. Significantly more
women in the sublingual group preferred the route as compared to vaginal
administration (RR 1.618. 95% CI: 1.277 - 2.050; p