Optimization of third-stage management after second-trimester medical pregnancy termination.
OBJECTIVE
Comparison of 3 regimens for third-stage management after second-trimester intravaginal misoprostol termination.


METHODS
Prospective randomized trial. Three third-stage management strategies were compared: 10 units of intramuscular oxytocin (group 1), 600 microg oral misoprostol (group 2), or no additional medication (group 3) after fetal expulsion. Primary study outcome was the incidence of placental retention.


RESULTS
Two hundred fifty-one women were randomly assigned to the groups. There was a significant difference in placental retention rates: group 1, 8 of 83 (10%) vs group 2, 24 of 83 (29%) vs group 3, 26 of 85 (31%); P = .002. Blood loss was significantly lower in group 1, 100 mL (interquartile ranges, 50-200) vs group 2, 200 mL (interquartile ranges, 100-370) vs group 3, 200 mL (interquartile ranges, 100-375); P < .001. Requirement for blood transfusion: group 1, 1 of 83 (1%) vs group 2, 1 of 83 (1%) vs group 3, 5 of 85 (6%); P = .103.


CONCLUSIONS
Intramuscular oxytocin administered after fetal delivery after second-trimester medical termination significantly increases placental expulsion rates and decreases short-term postpartum blood loss.
Dickinson
Jan E
JE
School of Women's and Infants' Health, The University of Western Australia, and The Women and Infants' Research Foundation, Perth, Western Australia.
Doherty
Dorota A
DA
D000028:Abortion, Induced / Q000379:methods; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007749:Labor Stage, Third / Q000187:drug effects*; D016595:Misoprostol / Q000008:administration & dosage; D010120:Oxytocics; D010121:Oxytocin / Q000008:administration & dosage; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin