title: Optimization of third-stage management after second-trimester medical pregnancy termination.
abstract: 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.
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, and The Women and Infants' Research Foundation, Perth, Western Australia.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Dickinson
authors.forename: Dorota A
authors.initials: DA
authors.lastname: Doherty
mesh_terms: 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
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin