Intravaginal misoprostol versus sublingual misoprostol for second trimester pregnancy termination: a randomized controlled trial

Abstract

Intravaginal misoprostol versus sublingual misoprostol for second trimester pregnancy termination: a randomized controlled trial Saipin Pongsatha1, *, Theera Tongsong1 1Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand *Correspondence: saipin.pongsatha@cmu.ac.th (Saipin Pongsatha) DOI:10.31083/j.ceog.2021.01.2143 This is an open access article under the CC BY-NC 4.0 license (https://creativecommons.org/licenses/by-nc/4.0/). Submitted: May 14, 2020 Revised: August 09, 2020 Accepted: August 15, 2020 Published: February 15, 2021 Objective: To compare the eȞficacy and adverse eȞfects of 400 mcg misoprostol for second trimester pregnancy termination via the intravaginal or sublingual route. Methods: In this study, 170 women at GA 14-28 weeks underwent termination of pregnancy. They were randomized to receive either intravaginal or sublingual 400 mcg misoprostol at 6 hour intervals until fetal expulsion occurred or within 48 hours aȻter the initiation of the first dose of misoprostol. The primary outcomes were median abortion time and percentage of failure. The secondary outcomes included rates of maternal adverse eȞfects, oxytocin use and analgesia requirement. Results: Intravaginal misoprostol demonstrates significantly greater eȞficacy for pregnancy termination compared to sublingual misoprostol at the same dosage. The median time to abortion was 16.66 hours and 22.88 hours in the intravaginal group and sublingual group respectively. Maternal adverse eȞfects, specifically rate of chill and diarrhea, were statistically higher in the sublingual group. Conclusion: Intravaginal misoprostol was superior to sublingual misoprostol in terms of shorter abortion time and fewer adverse eȞfects. In addition the rate of oxytocin use was found to be higher in the sublingual group. In conclusion misoprostol via the intravaginal route should be considered for second trimester pregnancy termination rather than the sublingual route due to greater eȞficacy and fewer adverse maternal eȞfects. Keywords Intravaginal; Sublingual; Second trimester; Pregnancy termination