Abstract
Objective: Misoprostol and sulprostone are prostaglandins that can be used for the termination
of second and third trimester pregnancy. The aim of the present study was to compare
the effectiveness of both agents for the termination of second and third trimester
pregnancy in cases of congenital or genetic abnormalities, and for the induction of
labour in cases of intra-uterine foetal death. Study design: We collected data from all women who had been treated with misoprostol in the second
or third trimester of pregnancy between January 2001 and July 2002 in cases of congenital
or genetic abnormalities, and for the induction of labour in cases of intra-uterine
foetal death. In cases where the foetus was alive, misoprostol was usually (77%) combined
with mifepristone. Women were matched to women who had been treated with sulprostone
for termination of second and third trimester pregnancy before 2001. We matched for
hospital, previous vaginal delivery, intra-uterine death and duration of pregnancy.
The primary outcome measure was time to delivery. Results: Since the treatment effect was different in patients in whom labour was induced
for intra-uterine death and patients in whom labour was induced while the foetus was
alive, the analysis was stratified for this parameter. In 94 patients with intra-uterine
death, there was no significant difference in time to delivery, blood loss, operative
removal of the placenta and need for pain relief between misoprostol and sulprostone.
In vital pregnancy (n=96), time to delivery was significantly shorter in the misoprostol group. The relative
risk for haemorrhage exceeding 1000 ml in this group was 0.40 (95% confidence interval, CI, 0.13–1.2). We observed no
significant differences with respect to operative removal of the placenta or need
for pain relief. Conclusion: In cases of intra-uterine death, the effectiveness of misoprostol for termination
of pregnancy is comparable to that of sulprostone. In vital pregnancy, combination
of mifepristone and misoprostol is more effective than sulprostone alone.
Keywords
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Article info
Publication history
Accepted:
December 5,
2003
Received in revised form:
August 27,
2003
Received:
May 26,
2003
Identification
Copyright
© 2003 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
