title: Therapeutic termination of second trimester pregnancies with low dose misoprostol.
abstract: OBJECTIVE
  To determine the effectiveness of 50 microg misoprostol for midtrimester termination of pregnancies.
  
  
  METHODS
  Experimental, cross-sectional study.
  
  
  METHODS
  Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005.
  
  
  METHODS
  The study subjects were 54 pregnant women admitted during the 2nd trimester (14-26 weeks) of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder (hypertension or diabetes) or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50 microg misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects.
  
  
  RESULTS
  The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 (range 4 - 48 hours). Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4+/-15.9 hours in alive fetuses (t -value:1.9, p: 0.05). Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness.
  
  
  CONCLUSIONS
  Vaginal administration of 50 microg misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect.
authors.affiliation: Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Nagina Fatima
authors.initials: NF
authors.lastname: Liaquat
authors.forename: Iffat
authors.initials: I
authors.lastname: Javed
authors.forename: Samia
authors.initials: S
authors.lastname: Shuja
authors.forename: Tabassum
authors.initials: T
authors.lastname: Shoaib
authors.forename: Khadija
authors.initials: K
authors.lastname: Bano
authors.forename: Saima
authors.initials: S
authors.lastname: Waheed
authors.forename: Afia
authors.initials: A
authors.lastname: Ansar
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000032:Abortion, Therapeutic / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol