Lubna Javed, Mariam Malik, Naheed Jamal, Shahida Sheikh, Fozia Farzana.
Mid-trimester termination of Pregnancy - comparison of sublingual with Vaginal Misoprostol.
Biomedica Jan ;20(1):56-9.

This paper compares the efficacy, side effects and patient`s satisfaction of sublingual with vaginal misoprostol for mid-trimester termination of pregnancy. The study was performed in the department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore. One hundred patients presenting for termination of pregnancy between 13-24 wks of gestation were selected. They were divided into two groups, group I was managed with sublingual and group II with vaginal misoprostol. The dose of misoprostol was 200 pg repeated at intervals of 6 hours up to a maximum of four doses. The primary outcome measure was induction expulsion interval and secondary outcomes were maternal complications, and women`s acceptance of the termination procedure. Successful termination was achieved in 96% patients in group I and 94% in group II. The patients in the two groups were comparable regarding their parity, gestational age and indications for termination. As regards the dosage, 76% in each group required a dose of 400 - 600 ug (P value 0.000). Induction expulsion interval was < 12 hrs in 92% patients in group 1 and 88% in group II, a difference not statistically significant (P value > 0.005). Pyrexia > 38°C was found in 8% and 6% in each group respectively while 8% in group I and 4% in group II had nausea and vomiting. So, sublingual misoprostol is as effective as vaginal misoprostol but with more nausea and vomiting, which can be managed easily. As a conclusion misoprostol can play a very important role in the practice of obstetrics and gynecology in resource poor countries where cost of other prostaglandins is prohibitively high and temperature maintenance is a problem. In proper dosage the risk of complications is low and most of the patients achieve completion of expulsion in less than 12 hrs by both routes.

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