Second trimester termination of pregnancy for fetal anomaly or death: comparing mifepristone/misoprostol to gemeprost.
OBJECTIVE
To assess the effect of changing the regimen for second trimester induction of labour from gemeprost to mifepristone/misoprostol.


METHODS
A retrospective study at a university teaching hospital over the 5-year period 1993-1997. SUBJECTS, METHODS and REGIMENS: 68 patients, 34 in the gemeprost group and 34 in the mifepristone/misoprostol group. The gemeprost group received 1mg vaginally every 3h to a maximum of five doses. The mifepristone/misoprostol group were pre-treated with 600 mg mifepristone orally followed by 800 microg misoprostol vaginally and then 400 microg orally every 3h to a maximum of four oral doses.


METHODS
Induction to abortion interval; delivery within 24h.


RESULTS
The mifepristone/misoprostol group had a lower induction to abortion interval compared to the gemeprost group (median 8.9h versus 19.8h, respectively, p<0.01). The mifepristone/misoprostol regimen was more successful than the gemeprost regimen; 94% versus 68%, respectively, aborted without extra medical or surgical intervention, p=0.02. There were no significant differences in side effects, analgesia requirements or complications between the two groups. Three patients with previous Caesarean sections had a ruptured uterus; two from the gemeprost group and one from the mifepristone/misoprostol group.


CONCLUSIONS
The new mifepristone/misoprostol regimen was more effective in second trimester induction of labour. Induction of labour with misoprostol or gemeprost should be used with care in patients with a previous Caesarean section.
Department of Obstetrics and Gynaecology, University College Hospital, London, UK. pleroux@iafrica.com
P A
PA
le Roux
G S
GS
Pahal
L
L
Hoffman
R
R
Nooh
H
H
El-Refaey
C H
CH
Rodeck
D000015:Abnormalities, Multiple; D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000032:Abortion, Therapeutic / Q000379:methods*; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D000527:Alprostadil / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D005260:Female; D005313:Fetal Death; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D017584:Reproductive History; D012189:Retrospective Studies; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D015735:Mifepristone; C021182:gemeprost; D000527:Alprostadil