Efficacy of Oral versus Vaginal Misoprostol for Termination of Second Trimester Missed Abortion
There has been continuous attempts to find out an ideal method for second trimester pregnancy termination. Second trimester abortions are important from public health point of view because they are responsible for more than half of preventable deaths. Misoprostol is introduced as a new armamentarium in medical management of missed abortion. The ideal dose, route and frequency of administration of misoprostol are still under investigation. The objective of present study was done to compare the safety and efficacy of misoprostol administered orally and vaginally for medical management of second trimester missed abortion. Methodology: During the year 2013-2014 a cross-sectional comparative study was carried out in the department of Obstetrics and Gynaecology at Tripoli Medical Centre (TMC), 120 patients who had second trimester missed abortion, were randomly assigned to receive either oral misoprostol tablets (60 patients), or vaginal misoprostol tablets (60patients) All patients received 600 microgram of misoprostol as a primary dose then 400 microgram every 4hours (hrs) up to three doses. The patients were followed for 48 hrs. Clinical outcome, time taken for expulsion, side effects and duration of hospital stay were compared in the two groups. Result: The mean induction to abortion interval (in hours) in the vaginal group was significantly shorter than in the oral group (10.05 hrs versus 13.10± hrs, P=0.003). The percentage of failed abortion was higher in oral group (13.3%) compared to vaginal group. The result shows higher percentage of cases that had complete abortion in the vaginal group (58.2%) versus (42.3%) in the oral group. Regarding the side effect of misoprostol, the oral group shows more side effects compared to the vaginal group. Whilst the duration of hospital stay was almost equal. Conclusion: Vaginal misoprostol was found to be more effective and safer as compared to oral misoprostol.