[Termination of pregnancy in the 2nd trimester: mifepriston/misoprostol preferable to sulprostone].
OBJECTIVE
To compare the efficacy of sulprostone and mifepristone/misoprostol when used for termination of pregnancy (TOP) in the 2nd trimester.


METHODS
Comparative retrospective cohort study.


METHODS
Data were collected on all women whose pregnancies were terminated in the 2nd trimester, in the presence of severe fetal defects, between 1996 and 2007 at the Radboud University Nijmegen Medical Centre, the Netherlands. From the start of 1996 until the end of 2001 TOPs were performed using sulprostone. In 2001 the treatment was switched to the combination mifepristone/misoprostol. The primary outcome measure was the time interval between the initiation of prostaglandin medication and the birth of the infant.


RESULTS
158 patients met the inclusion criteria: 51 women were treated with sulprostone, 107 women with mifepriston/misoprostol. The duration of treatment in the mifepristone/misoprostol group (median 8.7 hours, range: 1.1-72.0 hours) was significantly shorter than in the sulprostone group (median 21.3 hours, range: 7.8-265.0 hours). In the mifepristone/misoprostol group significantly more women (94%) delivered within 24 hours than in the sulprostone group (55%). In the mifepristone/misoprostol group anti-emetics and pain relief were given significantly less often than in the sulprostone group 5 versus 12% and 54 versus 90%, respectively). There was no statistically significant difference in the number of women with post partum blood loss (6 versus 6%), (suspected) placental remnants (33 versus 43%) or fever (12 versus 4%).


CONCLUSIONS
In termination of pregnancy in the 2nd trimester mifepristone/misoprostol was more effective than sulprostone. Given the disadvantages of sulprostone in comparison with mifepristone/misoprostol, sulprostone no longer deserves a place in termination of pregnancy in the 2nd trimester.
Ebbers
Sabine
S
Universitair Medisch Centrum St Radboud, afd. Verloskunde & Gynaecologie, Nijmegen, The Netherlands. sabineebbers@hotmail.com
Creemers
Johan W T
JW
Lotgering
Fred K
FK
D000019:Abortifacient Agents / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D015331:Cohort Studies; D015232:Dinoprostone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005315:Fetal Diseases / Q000235:genetics / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D015735:Mifepristone / Q000627:therapeutic use*; D016595:Misoprostol / Q000627:therapeutic use*; D010298:Parity; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000019:Abortifacient Agents; D016595:Misoprostol; D015735:Mifepristone; C016767:sulprostone; D015232:Dinoprostone