A prospective, randomized comparison of vaginal misoprostol versus intra-amniotic prostaglandins for midtrimester termination of pregnancy

Objective The purpose of this study was to compare the efficacy and adverse effects of vaginal misoprostol and intra-amniotic PGF2α for midtrimester abortion. Study design One hundred thirty-two women between 12 and 24 weeksʹ gestation, seeking abortion in a tertiary hospital, were randomized to receive vaginal misoprostol (400 μg every 3 hours) or intra-amniotic PGF2α (carboprost 1.5 mg). Main outcome measures were induction-to-abortion interval, success rates at 24 and 48 hours, and adverse effects. Results Successful abortion rates at 24 and 48 hours between intra-amniotic PGF2α and vaginal misoprostol were not statistically different. However, vaginal misoprostol results in a significantly shorter mean induction-to-abortion interval, compared with intra-amniotic PGF2α (misoprostol: 16.2 hours; intra-amniotic PGF2α: 20.8 hours; P = .006), particularly among multiparous women (misoprostol: 13.1 hours; intra-amniotic PGF2α 18.3 hours; P = .011) and for gestation below 130 days (misoprostol: 14.6 hours; intra-amniotic PGF2α: 20.2 hours; P = .015). Fever and shivering were commoner with vaginal misoprostol. Conclusion Vaginal misoprostol should be the regimen of choice for midtrimester abortion, particularly for multiparous women and women in the early second trimester.