title: Early pregnancy termination with vaginal misoprostol combined with loperamide and acetaminophen prophylaxis.
abstract: The objectives of this prospective non-concurrent cohort study were to confirm the efficacy of vaginal misoprostol for early pregnancy termination and to determine whether the incidence of side effects is lower with prophylactic loperamide and acetaminophen. Two-hundred women with an intrauterine pregnancy < or =56 days gestational age seeking medical pregnancy termination in an ambulatory research clinic were enrolled in the study. One-hundred participants (group 1) ingested 4 mg of loperamide and 500 mg of acetaminophen before the vaginal placement of 800 mirog of misoprostol moistened with 2 mL of saline. If abortion had not occurred, the same regimen was repeated every 24 h (maximum three doses). One-hundred participants (group 2) from the same clinic who previously underwent the same misoprostol regimen without prophylactic medication served as a control group for comparison with respect to abortion success and the incidence of side effects. The rate of successful abortion was not statistically significantly different between the two groups (group 1 93%, group 2 89%). The incidence of opiate analgesic use was significantly less in group 1 (4%) compared with group 2 (16%) (OR 0.22, 95% CI 0.06-0.73, p = 0.01). There was a significantly lower incidence of diarrhea in group 1 (23%) compared with group 2 (44%) (OR 0.38, 95% CI 0.20-0.73, p = 0.003). There was no difference in the incidence of fever/chills or the incidence of emesis between the two groups. Vaginal misoprostol is effective for termination of pregnancy < or = 56 days and the incidence of diarrhea and the use of opiate analgesia is significantly reduced with prophylactic loperamide and acetaminophen.
authors.affiliation: Women's and Children's Hospital, LAC+USC Medical Center, Department of Obstetrics and Gynecology, Los Angeles, CA 90033, USA. jjain@hsc.usc.edu
authors.forename: J K
authors.initials: JK
authors.lastname: Jain
authors.forename: B
authors.initials: B
authors.lastname: Harwood
authors.forename: K R
authors.initials: KR
authors.lastname: Meckstroth
authors.forename: D R
authors.initials: DR
authors.lastname: Mishell
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced; D000082:Acetaminophen / Q000008:administration & dosage*; D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000930:Antidiarrheals / Q000008:administration & dosage*; D015331:Cohort Studies; D003967:Diarrhea / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005334:Fever / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D008139:Loperamide / Q000008:administration & dosage*; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D017060:Patient Satisfaction; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000453:epidemiology
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018712:Analgesics, Non-Narcotic; D000930:Antidiarrheals; D016595:Misoprostol; D000082:Acetaminophen; D008139:Loperamide