Korean J Obstet Gynecol.  2012 Apr;55(4):230-236. 10.5468/KJOG.2012.55.4.230.

Comparison of intracervical laminaria plus vaginal misoprostol and vaginal misoprostol only with variable dosages for medical abortion within 12 hours

• Shin JE
• Kwon JY
• Lee Y
• Shin JC
• Park IY

• KMID: 1992618
• DOI: http://doi.org/10.5468/KJOG.2012.55.4.230

Abstract

OBJECTIVE
To compare the effectiveness of intracervical laminaria plus vaginal misoprostol and vaginal misoprostol only with variable dosages by analyzing the rate of spontaneous gestational sac expulsion for medical abortion within 12 hours.
METHODS
This study was performed in 94 patients for missed abortion at Department of Obstetrics and Gynecology, St. Paul's Hospital, the Catholic University of Korea for 5 years (2004-2008). Forty seven patients were managed with laminaria insertion and intravaginal misoprostol 200 microg, 400 microg, or 800 microg at admission or outpatient clinic. The others were treated with only misoprostol at the same dose. We analyzed the rate of spontaneous expulsion of gestational sac within 12 hours.
RESULTS
In non-laminaria group, spontaneous expulsion rate increased according to the doses of misoprostol (4.2%, 37.5%, and 33.3%, in 200 microg, 400 microg, and 800 microg, respectively, P =0.028). Between groups with the same misoprostol doses, no difference was observed in the spontaneous expulsion of the fetal sac within 12 hours according to the use of laminaria. On multivariate logistic regression analysis, factors that were associated significantly and independently with spontaneous expulsion of conceptus were misoprostol > or =400 microg and gestational age.
CONCLUSION
Treatment of missed abortion with 400 or 800 microg misoprostol vaginally is safe and acceptable method, and reduced the number of surgical interventions.

Keyword

Misoprostol; Laminaria; Missed abortion; Pregnancy

MeSH Terms

Abortion, Missed
Ambulatory Care Facilities
Female
Gestational Sac
Gynecology
Humans
Korea
Laminaria
Logistic Models
Misoprostol
Obstetrics
Pregnancy
Misoprostol

Reference

1. Ulmann A, Silvestre L, Chemama L, Rezvani Y, Renault M, Aguillaume CJ, et al. Medical termination of early pregnancy with mifepristone (RU 486) followed by a prostaglandin analogue. Study in 16,369 women. Acta Obstet Gynecol Scand. 1992. 71:278–283.

2. Ho PC, Ngai SW, Liu KL, Wong GC, Lee SW. Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy. Obstet Gynecol. 1997. 90:735–738.

3. Kushwah DS, Kushwah B, Salman MT, Verma VK. Acceptability and safety profile of oral and sublingual misoprostol for uterine evacuation following early fetal demise. Indian J Pharmacol. 2011. 43:306–310.

4. Margulies M, Campos Pérez G, Voto LS. Misoprostol to induce labour. Lancet. 1992. 339:64.

5. Bebbington MW, Kent N, Lim K, Gagnon A, Delisle MF, Tessier F, et al. A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination. Am J Obstet Gynecol. 2002. 187:853–857.

6. Conrad JT, Ueland K. The stretch modulus of human cervical tissue in spontaneous, oxytocin-induced, and prostaglandin E2-induced labor. Am J Obstet Gynecol. 1979. 133:11–14.

7. Ercan CM, Coksuer H, Karasahin KE, Alanbay I, Aydogan U, Parlak A, et al. Comparison of different preoperative sublingual misoprostol regimens for surgical termination of first trimester pregnancies: a prospective randomized trial. J Reprod Med. 2011. 56:247–253.

8. Ngai SW, To WK, Lao T, Ho PC. Cervical priming with oral misoprostol in pre-labor rupture of membranes at term. Obstet Gynecol. 1996. 87:923–926.

9. Scheepers HC, van Erp EJ, van den Bergh AS. Use of misoprostol in first and second trimester abortion: a review. Obstet Gynecol Surv. 1999. 54:592–600.

10. Kulier R, Kapp N, Gulmezoglu AM, Hofmeyr GJ, Cheng L, Campana A. Medical methods for first trimester abortion. Cochrane Database Syst Rev. 2011. 11:CD002855.

11. Vejborg TS, Nilas L, Rørbye C. Medical management of first trimester miscarriage according to ultrasonographic findings. Acta Obstet Gynecol Scand. 2007. 86:604–609.

12. Jain JK, Dutton C, Harwood B, Meckstroth KR, Mishell DR Jr. A prospective randomized, double-blinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy. Hum Reprod. 2002. 17:1477–1482.

13. Zikopoulos KA, Papanikolaou EG, Kalantaridou SN, Tsanadis GD, Plachouras NI, Dalkalitsis NA, et al. Early pregnancy termination with vaginal misoprostol before and after 42 days gestation. Hum Reprod. 2002. 17:3079–3083.

14. Singh K, Fong YF, Dong F. A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks. BJOG. 2003. 110:175–180.

15. Tang OS, Wong KS, Tang LC, Ho PC. Pilot study on the use of repeated doses of misoprostol in termination of pregnancy at less than 9 weeks of gestation. Adv Contracept. 1999. 15:211–216.

16. Li YT, Hsieh JC, Hou GQ, Chen TH, Chu YC, Lin TC, et al. Simultaneous use of mifepristone and misoprostol for early pregnancy termination. Taiwan J Obstet Gynecol. 2011. 50:11–14.

17. Ngoc NT, Blum J, Raghavan S, Nga NT, Dabash R, Diop A, et al. Comparing two early medical abortion regimens: mifepristone+misoprostol vs. misoprostol alone. Contraception. 2011. 83:410–417.

18. Cabrera Y, Fernández-Guisasola J, Lobo P, Gámir S, Alvarez J. Comparison of sublingual versus vaginal misoprostol for second-trimester pregnancy termination: a meta-analysis. Aust N Z J Obstet Gynaecol. 2011. 51:158–165.

19. Cunningham F, Leveno K, Bloom S, Hauth J, Rouge D, Spong C. Williams obstetrics. 2010. 23rd ed. New York: McGraw-Hill Professional.

20. Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet. 2007. 99:Suppl 2. S160–S167.

21. Kim JO, Han JY, Choi JS, Ahn HK, Yang JH, Kang IS, et al. Oral misoprostol and uterine rupture in the first trimester of pregnancy: a case report. Reprod Toxicol. 2005. 20:575–577.

22. Orioli IM, Castilla EE. Epidemiological assessment of misoprostol teratogenicity. BJOG. 2000. 107:519–523.