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Previous Volume 331:290-293 August 4, 1994 Number 5 Next

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ABSTRACT

Background The most widely used medical method of terminating second-trimester pregnancy is the intravaginal administration of prostaglandin E₂ (dinoprostone [PGE₂]). This treatment is highly effective but is associated with severe gastrointestinal side effects and hyperpyrexia.

Methods We conducted a prospective, randomized trial comparing the efficacy and safety of misoprostol, a prostaglandin E₁ analogue (200 µg intravaginally every 12 hours), with the efficacy and safety of PGE₂ (20 mg intravaginally every 3 hours). The study population included 55 pregnant women between 12 and 22 weeks' gestation who were undergoing termination of pregnancy for either intrauterine fetal death (37 women) or medical or genetic reasons (18 women).

Results The rate of successful abortions within 24 hours was 81 percent (22 of 27 women) with PGE₂ and 89 percent (25 of 28 women) with misoprostol (P = 0.47). All the women who received misoprostol had successful abortions within 38 hours. Among those who had an abortion within 24 hours, the mean interval from treatment to abortion was similar in both groups (10.6 hours with PGE₂ and 12.0 hours with misoprostol, P = 0.33). The rate of complete abortion, defined as the passage of the fetus and the placenta simultaneously, was 32 percent for PGE₂ and 43 percent for misoprostol (P = 0.56). Certain side effects were more frequent in the women receiving PGE₂ than in those receiving misoprostol: pyrexia (63 percent vs. 11 percent; P<0.001), uterine pain (67 percent vs. 57 percent, P = 0.58), vomiting (33 percent vs. 4 percent, P = 0.005), and diarrhea (30 percent vs. 4 percent, P = 0.012). The average cost per treatment was $315.30 for PGE₂, as compared with $0.97 for misoprostol.

Conclusions Misoprostol is at least as effective as PGE₂ for the termination of second-trimester pregnancy involving either a dead or a living fetus, but it is less costly, is easier to administer, and is associated with fewer adverse effects.

Source Information

From the Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.

Address reprint requests to Dr. Jain at Women's and Children's Hospital, Los Angeles County-University of Southern California Medical Center, 1240 N. Mission Rd., Rm. L1009, Los Angeles, CA 90033.

Full Text of this Article

Related Letters:

Second-Trimester Abortion
Sauvage L. R., Stanford J. B., Weed S. E., Toffler W. L., Young J. M., Jain J. K., Mishell D. R., Rosenfield A.
Extract | Full Text  
N Engl J Med 1994; 331:1715-1716, Dec 22, 1994. Correspondence

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