Randomized comparison of vaginal (200 mu g every 3 h) and oral (400 mu g every 3 h) misoprostol when combined with mifepristone in termination of second trimester pregnancy

It is known that when misoprostol is given at 200 mu g every 3 h after mife pristone pretreatment, the vaginal route is more effective than the oral ro ute. However, women prefer the oral route, This randomized study was to tes t our hypothesis that oral misoprostol 400 mu g is as effective as vaginal misoprostol 200 mu g when given every 3 h in termination of second trimeste r pregnancy after priming with mifepristone, A total of 142 patients was ra ndomly assigned to group 1 (200 mg mifepristone + 400 mu g oral misoprostol every 3 h up to five doses) or group 2 (200 mg mifepristone + 200 mu g vag inal misoprostol every 3 h up to five doses). The incidence of side-effects and the preference study were assessed through a standardized questionnair e during and after the abortion. For the oral group, both the incidence of diarrhoea (40.0 versus 23.2%, P = 0.03) and the amount of drug used (1734 c ompared with 812 mu g, P < 0.0001) were significantly higher than that of t he vaginal group but the incidence of fever appeared to be lower (not signi ficant). There was no significant difference in complete abortion rate: 81. 4% in the oral group and 75.4% in the vaginal group. The median induction-a bortion interval was similar in the two groups (10.4 versus 10.0 h), The pe rcentage of women who aborted in 24 h was also similar: 57/70 (81.4%) in th e oral group and 58/69 (87.0%) in the vaginal group. Overall, 82.0% of wome n preferred the oral route. Oral misoprostol (400 mu g) given every 3 h up to five doses, when combined with mifepristone, was as effective as the vag inal (200 mu g) route in second trimester termination of pregnancy. This re gimen could also be offered to those women who found repeated vaginal admin istration unacceptable.