Sublingual versus vaginal misoprostol for second trimester termination: a randomized clinical trial.
OBJECTIVE
To evaluate the efficacy of two routes of administration of misoprostol (sublingual and vaginal) for medical termination of second trimester pregnancies.


METHODS
One hundred and thirty-four women referred for second trimester termination were enrolled in this randomized clinical trial. They were divided to receive 400 μg every 6 h misoprostol either sublingually or vaginally. They were followed for 48 h, at which point they underwent D&C if the termination was not complete. Efficacy was defined as successful termination without the need for interventions.


RESULTS
There were no differences between the vaginal and sublingual groups in terms of tablets mean dose of misoprostol applied (1360 ± 2.4 vs. 1320 ± 2.3) or endometrial thickness after termination of pregnancy (13.02 ± 5.2 vs. 13.3 ± 6.6 mm). The success rate was 61.2 % (n = 41) in the vaginal group versus 70.1 % (n = 47) in the sublingual group (p = 0.3). Twenty-six patients (38.8 %) in the vaginal group underwent D&C due to retained tissue, compared with 20 patients (29.8 %) in the sublingual group. In primigravids, the success rate was significantly higher in the sublingual group than vaginal group. There was no significant difference with regards to complications between the two groups.


CONCLUSIONS
The sublingual route of misoprostol administration has the same efficacy as the vaginal route and can be applied for second trimester pregnancy termination in primigravid women in outpatient settings due to its simple administrations.
Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. fatedavari@yahoo.com
Fateme Davari
FD
Tanha
Tahmineh
T
Golgachi
Nasrin
N
Niroomand
Mahsa
M
Ghajarzadeh
Reza
R
Nasr
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000286:Administration, Sublingual; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010298:Parity; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol