Randomized controlled trial of misoprostol for second-trimester pregnancy termination associated with fetal malformation.
OBJECTIVE
Our purpose was to compare the effectiveness, women's views of the termination procedure, and success of umbilical cord culture for vaginal and oral misoprostol versus intra-amniotic prostaglandin PGF(2alpha) for second-trimester pregnancy termination (STPT).


METHODS
We randomized 217 women, 15 to 24 weeks' gestation, into 3 groups. Oral (OM) and vaginal (VM) misoprostol groups received 400 microg of misoprostol every 4 hours for 24 hours. The intra-amniotic PGF(2alpha) (IAPG) group received 40 mg of PGF(2alpha) followed by oxytocin infusion. Women completed self-administered questionnaires 3 weeks after the termination procedure. Umbilical cord samples were collected at delivery for karyotype analysis. The primary outcome was the time from start of the procedure to placental delivery. Secondary outcomes were maternal complications, women's acceptance of the termination procedure, and success rates of umbilical cord culture.


RESULTS
The time was longer for the OM group (30.5+/-14.4 hours) compared with the VM group (18.3+/-8.2 hours) and the IAPG group (21.1+/-10.2 hours), P<.001 for both comparisons. Women in the VM group reported being more willing to repeat the termination method in the future and reported fewer side effects than those in the other groups, P<.001. Failure rates for umbilical cord cultures were 9.6%, 17.0%, and 45.6% for the VM, OM, and IAPG groups, respectively.


CONCLUSIONS
Oral misoprostol is less effective than intra-amniotic PGF(2alpha) or vaginal misoprostol for STPT. Women report vaginal misoprostol more acceptable than other methods. Umbilical cord culture failure rate is highest in the IAPG group.
Akoury
Hani A
HA
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Hannah
Mary E
ME
Chitayat
David
D
Thomas
Martin
M
Winsor
Elizabeth
E
Ferris
Lorraine E
LE
Einarson
Thomas R
TR
Seaward
P G R
PG
Ryan
Greg
G
Willan
Andrew R
AR
Windrim
Rory
R
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000028:Abortion, Induced; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D000650:Amnion; D015237:Dinoprost / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005333:Fetus / Q000002:abnormalities*; D006801:Humans; D007267:Injections; D007275:Injections, Intravenous; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010121:Oxytocin / Q000008:administration & dosage; D017060:Patient Satisfaction; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013997:Time Factors
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D010121:Oxytocin; D015237:Dinoprost