Uterine rupture during second trimester abortion with misoprostol

BACKGROUND: Data are limited regarding the use of misoprostol in the midtrimester, therefore few cases with uterine rupture during the second trimester with a previous uterine scar have been reported in the literature. CASE REPORT: A 23-year-old woman with a prior low transverse cesarean section presented at 26 weeks' gestation for pregnancy termination for a fetal abnormality. She was given 200 microg misoprostol intravaginally every 3 h until regular contractions began. After the fourth dose, she had vaginal bleeding and severe contractions. She aborted completely 2 h later after the last dose. Uterine rupture was diagnosed at the previous cesarean section scar by manual vaginal examination. She underwent emergency laparotomy and the uterus was repaired. CONCLUSION: Misoprostol use in the second trimester in a woman with a uterine scar can trigger severe contractions that can lead to uterine rupture.     

A randomised study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy

Objective To compare the effectiveness of gemeprost and misoprostol as prostaglandins used in combination with mifepristone for induction of mid-trimester termination.
Design Randomised trial.
Setting Scottish teaching hospital.
Sample One hundred women undergoing abortion between 12 and 20 weeks.
Methods Each woman received 200 mg mifepristone and 36–48 hours later either 1 mg gemeprost vaginal pessary every 6 hours for 18 hours or  4 × 200 μg  misoprostol tablets vaginally followed by  2 × 200 μg  misoprostol tablets orally every 3 hours for 12 hours. Success was defined as the percentage of women aborted within 24 hours of the first administration of prostaglandin.
Main outcome measures Prostaglandin–abortion interval and side effects.
Results There were no significant differences in median prostaglandin–abortion interval between gemeprost (6.6 hours 95% CI 6.0–10.7) and misoprostol (6.1 hours 95% CI 5.5–7.5) (   P = 0.22  ). The cumulative abortion rates at 24 hours (96% vs 94%, respectively), the surgical evacuation rates (12% and 10%) and the incidence of vomiting, diarrhoea and pain were similar.
Conclusion Two hundred milligrammes of mifepristone followed 36–48 hours later by either vaginal gemeprost or misoprostol is a highly effective way of inducing abortion in the second trimester of pregnancy.     

Sublingual misoprostol 100 microgram versus 200 microgram for second trimester abortion: a randomised trial

Objectives To compare the efficacy of repeated doses of 100 μg vs. 200 μg misoprostol given sublingually for induction of second trimester abortion.

Methods One hundred and sixty-two women at 15–22 weeks' gestation were randomized to receive every 2 h either 100 μg (group 1; n = 81) or 200 μg (group 2; n = 81) misoprostol sublingually. The primary outcome measure was the abortion rate within 24 h. The secondary outcome measures were the induction-abortion interval, the total misoprostol dose required, and side effects of the regimen.

Results There was no significant difference between the two groups with regard to the abortion rates within 12 h (43.2% in group 1 vs. 48.1% in group 2; p = 0.52; relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.4–1.5) and 24 h (92.6% in group 1 vs. 91.4% in group 2; p = 0.77; RR: 1.11; 95% CI: 0.37–3.6). The induction-abortion intervals in the two groups were of similar length (885 minutes in group 1 vs. 912 minutes in group 2; p = 0.72). When the total dose of misoprostol was compared between the two groups, women belonging to group 2 on average had received significantly more misoprostol than those in group 1 (1274 ± 592 μg [7 ± 3 doses] vs. 614 ± 432 μg [6 ± 4 doses], respectively; p = 0.000).

Conclusions Sublingual administration of repeated doses of 100 μg misoprostol for abortion induction appears to be equally effective to that of repeated doses of 200 μg.     

Pretreatment with mifepristone (RU 486) reduces interval between prostaglandin administration and expulsion in second trimester abortion

Summary. The effect of pretreatment with mifepristone on prostaglandin-induced abortion was investigated in a double-blind randomized trial involving 100 women in the second trimester of pregnancy. The women were randomly allocated to receive either 600 mg oral mifepristone or placebo tablets 36 h before the administration of gemeprost pessaries. The median interval between administration of prostaglandin and abortion was significantly shorter in the mifepristone group (6.8 h) compared with the placebo group (15.8 h). The women pretreated with mifepristone required significantly fewer gemeprost pessaries to induce abortion and experienced significantly less pain than the women who had received placebo.     

Pretreatment with mifepristone (RU 486) reduces interval between prostaglandin administration and expulsion in second trimester abortion

The effect of pretreatment with mifepristone on prostaglandin-induced abortion was investigated in a double-blind randomized trial involving 100 women in the second trimester of pregnancy. The women were randomly allocated to receive either 600 mg oral mifepristone or placebo tablets 36 h before the administration of gemeprost pessaries. The median interval between administration of prostaglandin and abortion was significantly shorter in the mifepristone group (6.8 h) compared with the placebo group (15.8 h). The women pretreated with mifepristone required significantly fewer gemeprost pessaries to induce abortion and experienced significantly less pain than the women who had received placebo.     

First trimester abortion with mifepristone and three doses of sublingual misoprostol: a pilot study

OBJECTIVE: To evaluate the efficacy and safety of a medical abortion regimen with multiple doses of sublingual misoprostol 24 h after mifepristone. METHODS: The regimen was designed on the basis of pharmacokinetics of various routes of administration of misoprostol. Forty women < or = 8 weeks' gestation were given mifepristone 200 mg orally, followed 24 h later by three doses of misoprostol 200 microgm sublingually 6 h apart. They were followed up on day 3 and day 14 with transvaginal ultrasound. Pain and bleeding were assessed using a visual analogue scale and acceptability, by a questionnaire. RESULTS: Abortion outcome was assessed in terms of onset of pain and vaginal bleeding, time of expulsion of products and duration of vaginal bleeding. Seventy-five per cent of women experienced pain within 2 h after first dose of misoprostol. Bleeding began at a mean of 1.41 h after pain and expulsion at a mean of 6.1 h after first dose of misoprostol. Complete expulsion was confirmed in all women (100%) by ultrasound on day 14. The longest duration of bleeding was 12 days (mean 7.2 days) with 87.5% bleeding for < 10 days. Acceptability was 100% but 70% perceived pain to be moderate and 67.5% bleeding to be light or slightly more than menses. CONCLUSIONS: Medical abortion using three doses of sublingual misoprostol administered 24 h after mifepristone appears to be the most appropriate in terms of pharmacokinetics of the drugs. This pilot study associates the regimen with a short abortion process, which appears to be safe, highly efficacious and acceptable.     

Experience with misoprostol in the management of missed abortion in the second trimester.

The aim of this study was to determine the effectiveness and safety of misoprostol (cytotec, Searle) used during labour in women with missed abortion in the second trimester of pregnancy. Labour was induced in 42 women with missed abortion at the Women's Health and Action Research Centre, Benin City, Nigeria with intermittent vaginal administration of 100 microg tablets of misoprostol every 6 h. All women achieved successful vaginal delivery with five women requiring post-delivery uterine evacuation. The gestational ages of the women at the time of induction ranged between 13-24 weeks with a median of 17 weeks. The median dose of misoprostol resulting in successful delivery was 1,100 microgand ranged between 300 microg to 3,100 microg. Side-effects were minimal with five patients experiencing shivering, two women experiencing fever, while three vomited during the period of the induction. These results confirm the efficacy and safety of misoprostol for induction of labour in second trimester missed abortion in Nigerian women. We conclude that misoprostol is effective in the management of missed abortion in the second trimester in Nigeria.     

Second trimester medical abortion with mifepristone followed by unlimited dosing of buccal misoprostol in Armenia

Objectives: The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia.

Methods: Women seeking to terminate 13–22 week pregnancies were enrolled in the study. Participants swallowed 200?mg mifepristone in the clinic and were instructed to return to the hospital for induction 24–48?h later. During induction, women were given 400?μg buccal misoprostol every 3?h until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery.

Results: A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24?h after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3?h (range 4–17.4) with a mean of 9.5?±?2.5?h. A median of four misoprostol doses (range 2–6) with a mean of 4?±?1 misoprostol doses were administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers.

Conclusion: The medical abortion regimen of 200?mg mifepristone followed 24?h later by induction with 400?μg buccal misoprostol administered every 3?h, with no limit on the number of doses used for the termination of pregnancies of 13–22 weeks’ gestation is an effective and acceptable option for women.     

Combined administration of misoprostol in the first and second trimester missed abortion cases

OBJECTIVE: We aimed to investigate the effectiveness and adverse effects of combined (vaginal + oral) administration of misoprostol in missed abortion cases. MATERIAL AND METHODS: 48 missed abortion cases between 8 and 20 weeks of gestation were enrolled in this study. Misoprostol-induced medical abortion was planned; the first dose (200 microg) was administered intravaginally and subsequent doses (200 microg each) orally every following hour. A maximum of six doses (1200 microg) were used. Revision curettage was performed on all subjects who aborted. RESULTS: The mean time interval from the first dose of misoprostol until the abortion was 6.27 +/- 3.02 hours. The success rate was 95% for the whole group. We observed misoprostol-related trembling in one patient and fever in two patients. CONCLUSION: We believe that our low-dose combined misoprostol protocol is a safe, effective and well-tolerated method with minimal adverse effects for the termination of both first and second trimester pregnancy losses.     

A randomized comparison of mifepristone and self-administered oral or vaginal misoprostol for early abortion

In France, mifepristone in association with orally administered misoprostol is widely used for the early termination of pregnancy (up to 49 days' gestation). In other centers, mifepristone in association with vaginally administered misoprostol has also been used. The aim of the present study was to compare the efficacy and tolerance of mifepristone in association with misoprostol administered orally or vaginally for the termination of pregnancy of up to 49 days' gestation.

A total of 237 women were enrolled in the study. All women received 600 mg mifepristone administered orally and 400 μg misoprostol administered either orally (n = 119) or vaginally (n = 118). A second dose of 400 μg misoprostol was administered if women had not expelled the pregnancy within 3 h. Women were randomized into treatment groups according to the day of their admission.

The overall success rate was 98.7% and there was no significant difference in efficacy between the two groups. There was one treatment failure in the group in which misoprostol was administered orally. Of those women who aborted within 3 h of administration of the first dose of misoprostol, the route of administration of misoprostol did not influence the time to abortion. Of the women who received a second dose of misoprostol, the time to abortion was shorter in those who received misoprostol orally (52 min versus 77 min).

Tolerance was assessed by visual analog scales and was similar for both groups. In both groups, women preferred the oral route of administration.     

Cardiac output response to prostaglandin E2-induced abortion in the second trimester

Maternal cardiac output changes were evaluated in 10 patients undergoing second-trimester abortion induced by prostaglandin E2 suppositories. The peak cardiac output increased by an average of 64.5% above preinduction values. This is similar to the percent increase described during oxytocin-induced labor at term. Inasmuch as resting cardiac output tends to be higher in midpregnancy than at term, absolute values during prostaglandin E2 induction were higher than those observed in laboring term patients.     

应用不同剂量米非司酮中期引产对胎儿脐血染色体稳定性影响的临床研究

目的探讨米非司酮用于中期引产对胎儿姐妹染色单体交换率(SCE)和微核(MN)率的影响。评估不同剂量米非司酮对母亲及胎儿染色体稳定性影响。方法选择符合研究条件的中期引产患者120例,随机分为4组,1～4组分别口服米非司酮0、150、200、300mg加水囊引产,于产后取脐血进行SCE交换试验和细胞分裂阻滞法MN试验。结果各组胎儿脐血SCE率进行单因素方差分析(P>0.05)差异无显著性。各组胎儿脐血MN率经KruskalwallisH非参数检验(P>0.05),差异无显著性。结论孕妇应用150、200、300mg剂量米非司酮引产,不会引起其子代SCE和MN增加。