2ND TRIMESTER PREGNANCY TERMINATION INCLUDING FETAL DEATH - COMPARISON OF 5 DIFFERENT METHODS

Objective: To compare the efficacy of methods for second trimester pre gnancy termination. Methods: A prospective randomized study of women u ndergoing pregnancy termination between 14 and 28 weeks gestation. Thr ee hundred and forty patients with poor cervical condition (Bishop sco re 14) in whom one of five termination methods were used were assessed : (i) extraamniotic administration of ethacridine lactate (82 patients ); (ii) intracervical prostaglandin (PG) E(2) gel (100 patients); (iii ) intravenous infusion of concentrated oxytocin (36 patients); (iv) va ginal misoprostol (49 patients); and (v) balloon insertion (73 patient s). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine c ontractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures. Results: T he efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% (81/82) of the patie nts in ethacridine group; 97.3% (35/36) of the patients in concentrate d oxytocin group; 90.0% (90/100) of the patients in PGE(2) group; 97.2 % (71/73) of the patients in balloon group; 77.5% (38/49) of the patie nts in misoprostol group (P = 0.000, P < 0.01, Wilcoxon (Gehan) statis tic). The overall median induction-abortion interval +/- S.D. (in h) i n each group were as follows: ethacridine lactate: 15.7 +/- 9.6, PGE(2 ) gel: 20.0 +/- 14.5, concentrated oxytocin: 12.2 +/- 14.4, misoprosto l: 24.0 +/- 22.2, balloon: 16.0 +/- 15.4 (one way ANOVA, P = 0.003, P < 0.01). Conclusion: In comparison with the five methods, the use of e xtraamniotic ethacridine, intravenous concentrated oxytocin, and ballo on was found to provide more effective treatment than intracervical PG E(2) and misoprostol in terms of achievement of abortion within 24 and 48 h.