Termination of pregnancy using vaginal misoprostol-only regimen: Analysis of number of doses needed for successful termination

Year 2023, Volume: 40 Issue: 4, 710 - 714, 03.01.2024

Murat Aykut Özek , Tuncay Yüce

Abstract

The aim of this study was to determine course number of misoprostol to successfully terminate a pregnancy according to gestational age. We retrospectively analyzed 365 consecutive terminations of pregnancies from the hospital records and our Perinatology Unit registry. The study cohort was divided into three; according to the trimesters of the pregnancy. The course number of vaginal misoprostol, hemoglobin levels and indications of pregnancy terminations were compared. More than half of the medical terminations of pregnancies were due to fetal central nervous system anomalies (51,2%). The course number needed for successful termination of pregnancy was significantly higher in the second trimester of pregnancy, compared to the first trimester group (p=0.0002). There was no significant difference between first and third trimesters (p=0.652). Increased number of courses of misoprostol was directly associated with drop in hemoglobin levels, regardless of gestational week or parity. Vaginal misoprostol alone is still safe and effective method for termination of pregnancy. The number of courses needed for expulsion of the fetus is significantly higher during the second trimester of the pregnancy and as course number increased, the reduction in hemoglobin levels was more pronounced.

Keywords

pregnancy, termination, vaginal, misoprostol

Supporting Institution

None

Project Number

None

Thanks

None

References

• 1. World Health Organization Model List of Essential Medicines – 22nd List, 2021. Geneva. World Health Organization; 2021 (WHO/MHP/HPS/EML/202102).
• 2. Abubeker FA, Lavelanet A, Rodriguez MI, Kim C. Medical termination for pregnancy in early first trimester (</= 63 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review. BMC Womens Health. 2020;20(1):142. Epub 2020/07/09. doi: 10.1186/s12905-020-01003-8. PubMed PMID: 32635921; PubMed Central PMCID: PMCPMC7339463.
• 3. Ho PC. Development of medical termination of pregnancy: a review. BJOG. 2017;124(13):1942-7. Epub 2017/09/01. doi: 10.1111/1471-0528.14905. PubMed PMID: 28856795.
• 4. Aslan H, Yildirim G, Ongut C, Ceylan Y. Termination of pregnancy for fetal anomaly. Int J Gynaecol Obstet. 2007;99(3):221-4. Epub 2007/09/25. doi: 10.1016/j.ijgo.2007.05.047. PubMed PMID: 17889880.
• 5. Ozyuncu O, Orgul G, Tanacan A, Aktoz F, Guleray N, Fadiloglu E, et al. Retrospective analysis of indications for termination of pregnancy. J Obstet Gynaecol. 2019;39(3):355-8. Epub 2018/11/16. doi: 10.1080/01443615.2018.1506427. PubMed PMID: 30428730.
• 6. Morris JL, Winikoff B, Dabash R, Weeks A, Faundes A, Gemzell-Danielsson K, et al. FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynaecol Obstet. 2017;138(3):363-6. Epub 2017/06/24. doi: 10.1002/ijgo.12181. PubMed PMID: 28643396.
• 7. Bearak J, Popinchalk A, Ganatra B, Moller AB, Tuncalp O, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. Lancet Glob Health. 2020;8(9):e1152-e61. Epub 2020/07/28. doi: 10.1016/S2214-109X(20)30315-6. PubMed PMID: 32710833.
• 8. Ganatra B, Gerdts C, Rossier C, Johnson BR, Jr., Tuncalp O, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372-81. Epub 2017/10/02. doi: 10.1016/S0140-6736(17)31794-4. PubMed PMID: 28964589; PubMed Central PMCID: PMCPMC5711001.
• 9. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33. Epub 2014/08/12. doi: 10.1016/S2214-109X(14)70227-X. PubMed PMID: 25103301.
• 10. Hacettepe University Institute of Population Studies TRPoTDoSaBaT, Ankara, Turkey. 2018 Turkey Demographic and Health Survey. 2019.
• 11. S B. The Ministry of Health of Turkey, Health Statistics Yearbook, 2019. General Directorate of Health Information Systems, Ministry of Health, Turkey, 2021. 2021.
• 12. Turkey: Law No. 2827 of 1983 Population Planning Law [Turkey], 24 May 1983, available at: https://www.refworld.org/docid/4c4476752.html [accessed 22 December 2021].
• 13. Baumann S, Darquy S, Miry C, Duchange N, Moutel G. Termination of pregnancy for foetal indication in the French context analysis of decision-making in a Multidisciplinary Centre For Prenatal Diagnosis. J Gynecol Obstet Hum Reprod. 2021;50(8):102067. Epub 2021/01/24. doi: 10.1016/j.jogoh.2021.102067. PubMed PMID: 33484935.
• 14. Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for mid-trimester termination of pregnancy. Cochrane Database Syst Rev. 2011(1):CD005216. Epub 2011/01/21. doi: 10.1002/14651858.CD005216.pub2. PubMed PMID: 21249669; PubMed Central PMCID: PMCPMC8557267.