Role of misoprostol for therapeutic termination of pregnancy from 10 -28 weeks of gestation.

OBJECTIVE To assess efficacy, safety and cost effectiveness of misoprostol (prostaglandin E1 analogue) for termination of pregnancy. METHODS A descriptive study was conducted from March 2003 to December 2004, at Fauji Foundation Hospital Rawalpindi. A total of 200 patients, at 10-28 weeks of gestation, requiring termination of pregnancy were included. Each woman received first dose of 400 microg of misoprostol vaginally. Second dose of 400 microg of misoprostol was administered after 4 hours, according to the cervical dilatation, softening and uterine contractions. Oxytocin infusion was started after six hours of administration of first dose of Misoprostol, depending upon the uterine contractility. The process of abortion was monitored to assess the outcome measures. RESULTS Successful abortion was seen in 137 (68%) patients, with induction to delivery interval of 12.2 hours. In 40 (20%) patients surgical evacuation was performed. Out of 40 patients, 27 (13.5%) underwent surgical evacuation due to incomplete abortion and 13 (6.5%) for excessive per-vaginal bleeding. A total of 23 (12%) patients had failure of method for induction of abortion and needed either repeat dose of misoprostol after 24 hours or other methods of induction (besides misoprostol). Side effects included nausea, vomiting, diarrhoea and fever. Mean hospital stay for induction of abortion was 31 hours. CONCLUSION Misoprostol is safe, efficacious and a cost effective drug for induction of the first and the second trimester abortions.