Effect of Different Dosages of Intravaginal Misoprostol for Second Trimester Pregnancy Termination

Miscarriage is a common complication of early pregnancy; however; curettage and dilation are considered standard methods taking care of early pregnancy failure. Misoprostol has been used as an alternative agent for termination of early pregnancy. Therefore, this study was aimed to compare the efficacy and side effects of two different intravaginal misoprostol trials for the second trimester pregnancy termination of missed miscarriage between 14 and 23 weeks.
A clinical trial was carried out in Basrah Maternity & Children Hospital during the period from October 2011 to November 2012. A total of 100 women experienced missed miscarriages at 14-23 weeks of gestation were admitted for medical termination of pregnancy. Patients were divided into the following two groups:
Group 1: 50 patients received 400 g of intravaginal misoprostol/8 hours. Group 2: 50 patients received 800 g of intravaginal misoprostol/8 hours. The patients were followed up for 24 hours. The primary outcome measure was induction-miscarriage interval; the secondary outcomes were the rate of successful miscarriage and complete miscarriage; the incidence of side effects was compared in both groups.
The rates of successful termination of pregnancy in both groups 1 and 2 were 86% and 90%, respectively. The success rates of the drug in group 1 were 0%, 12%, 36%, 34%, 10%, and 4% after first, second, third, fourth, fifth, and sixth doses, respectively; whereas, the success rates in group 2 were 24%, 34%, 24%, 12%, 4%, and 0% after first, second, third, fourth, fifth, and sixth doses, respectively. The mean numbers of doses required to achieve response were 3.66 and 2.44 in groups 1 and 2, respectively. The mean induction to miscarriage interval was significantly shorter for group 2 than for
group 1 (15.46 ±9.21 hours and 22.96 ±9.44 hours, respectively) (P<0.00001). Drug dosages showed more side effects in group 2 patients than in group 1 patients with no significant differences. Miscarriages were reported more in group 2 patients (82%) than in group 1 patients (48%) (P<0.001) within 24 hours.
Both trials were effective for terminating the second trimester pregnancy of missed miscarriage. However, 800 mg intravaginal mistoprostol trial resulted in shorter induction-miscarriage interval. The non-significant higher incidence of side effects was reported in group 2 trial than in group 1 trial.