Efficacy of Intravaginal Misoprostol in Different Media for First and Second Trimester Termination of Pregnancy


ABSTRACT:BACKGROUND:Medical abortion becomes the 1st choice for early 1st and 2nd trimester termination of pregnancy in many countries although dilatation and evacuation is commonly used in USA ,Medical abortion has been more patchy in its introduction in England and Walse and there continuous to be significant variation in its provision across health authorities .Medical method are often favored because they appear more physiological ,like a miscarriage and avoid the need for uterine instrumentation and also share the advantages of low rate of complication and failure.OBJECTIVE:To evaluate the effect of different media ( acetic acid , normal saline or dry)on the efficacy of intravaginal misoprostol used for induction of first and second trimester abortion.PATIENTS AND METHOD:During the 12 months of the study period, 90 pregnant women seeking termination of early pregnancy loss up to 24 weeks, as an indication for induction of abortion, their mean age were 27.7±5.5 years, and mean weight 72.3±3.9 kg.The first 30 pregnant patients received intravaginal 400μg misoprostol moistened with 2 ml of 5% acetic acid for 4hours interval up to 5 doses for 24 hours ,if the participant failed to achieve abortion the same regimen repeat for the next 24 hours, including 8 primiparous and 22 multiparous. Next 30 patients received intravaginal 400μg misoprostol moistened in 2ml of normal saline for 4 hours interval up to 5 doses for 24 hours ,if abortion failed then the trial repeated once again , including 15 primiparous and 15 multiparous. The last 30 patients received dry intravaginal 400μg misoprostol , 4hours intervals up to 5 doses for 24 hours. if abortion failed the same regimen repeat for the next 24 hours, including 10 primiparous and 20 multiparous.RESULT:All patients aborted within 48 hour. Significantly shorter induction –abortion interval for the moistened misoprostol tablet in acetic acid ( mean 8.3 ±2.2 hours), P value (0.000) ,than induction- abortion interval for moistened misoprostol tablet in normal saline (mean 19.5±7.7 hours) , and dry misoprostol tablet (mean23.1± 8.8hours) .The number of doses required to achieve response for moistened misoprostol in acetic acid was significantly less(mean 1.5±0.5), P value (0.000),than that required for moistened misoprostol in normal saline( mean 3.1±0.8),and for the dry misoprostol tablet (mean 3.7±0.8). The side effects being of no statistical significant.CONCLUSION:Acidic medium enhance the effect of misoprostol administered for induction of abortion. Moistening intra vaginal misoprostol may affect the pharmacokinetics of the drug to achieve a constant plasma profile.