Comparison of Prostaglandin E2 And Misoprostol for Induction in Second Trimester Miscarriage in Patients Presented in Independent University Hospital Faisalabad
DOI:
https://doi.org/10.70749/ijbr.v3i4.974Keywords:
Misoprostol, Prostaglandin E2, Second-Trimester Pregnancy Termination, Induction of Labor, Efficacy Comparison, Intrauterine Fetal Demise (IUD), Missed MiscarriageAbstract
Objectives: To compare the efficacy of Misoprostol and Prostaglandin E2 (PGE-2) for induction in second-trimester miscarriage, considering demographic and clinical factors. Study Settings: This randomized controlled trial was conducted at the Department of Gynecology, Independent Medical University, Faisalabad, over six months. Duration of Study: The study was conducted after ethical approval and spanned six months. Data Collection: A total of 130 women aged 18-40 years with a gestational age of 13-28 weeks requiring second-trimester pregnancy termination due to intrauterine fetal demise (IUD) or missed miscarriage were included. Participants were randomized into two groups: Misoprostol group (n = 65): Received 50 mcg Misoprostol orally every 4 hours, up to five doses if needed. PGE-2 group (n = 65): Received 0.5 mg PGE-2 intra-vaginally, up to three doses if needed. Efficacy was defined as complete abortion (expulsion of all products of conception), confirmed via ultrasound 12 hours post-treatment. Results: The mean age was 29.32 ± 6.78 years (Misoprostol) vs. 27.25 ± 6.53 years (PGE-2). The majority had a gestational age of >18-28 weeks (78.5% Misoprostol, 55.4% PGE-2). Parity was 0-3 in 81.5% (Misoprostol) and 58.5% (PGE-2). The induction-to-delivery time was similar (12.11 ± 3.12 hours for Misoprostol vs. 12.29 ± 2.83 hours for PGE-2). However, the Misoprostol group required more doses (3.23 ± 1.44 vs. 1.91 ± 0.82, p < 0.05). Complete abortion was achieved in 95.4% of Misoprostol cases vs. 76.9% of PGE-2 cases. Incomplete abortion occurred in 4.6% of Misoprostol patients vs. 23.1% of PGE-2 patients. Misoprostol showed a significantly higher success rate in patients >30 years (p = 0.005) and gestational age >18-28 weeks (p = 0.002). Conclusion: Misoprostol is more effective than PGE-2 for second-trimester miscarriage induction, demonstrating higher efficacy, shorter induction-to-delivery times, and a favorable safety profile. Given its cost-effectiveness and ease of administration, Misoprostol should be considered the preferred agent for second-trimester pregnancy termination.
Downloads
References
Velipasaoglu, M., Ozdemir, C. Y., Ozek, B., Ayaz, R., & Tanir, H. M. (2017). Sequential use of Foley catheter with misoprostol for second trimester pregnancy termination in women with and without caesarean scars: A prospective cohort study. The Journal of Maternal-Fetal & Neonatal Medicine, 31(5), 677-681. https://doi.org/10.1080/14767058.2017.1293037
Lerma, K., & Blumenthal, P. D. (2020). Current and potential methods for second trimester abortion. Best Practice & Research Clinical Obstetrics & Gynaecology, 63, 24-36. https://doi.org/10.1016/j.bpobgyn.2019.05.006
Pongsatha, S., Suntornlimsiri, N., & Tongsong, T. (2024). Comparing the outcomes of termination of second trimester pregnancy with a live fetus using intravaginal misoprostol between women with and without previous cesarean section. BMC Pregnancy and Childbirth, 24(1). https://doi.org/10.1186/s12884-024-06442-x
Begum, T., Begum, F., Meherunnessa, M., & Islam, N. (2022). Effect of Misoprostol in third trimester of pregnancy- A multi-center study in Bangladesh. Scholars International Journal of Obstetrics and Gynecology, 5(9), 391-395. https://doi.org/10.36348/sijog.2022.v05i09.002
Ahmed, T. A., & Mohammed, A. H. (2023). Brief Overview About Prostaglandins & Misoprostol For Cervical Ripening. Journal of Pharmaceutical Negative Results, 14(2).
Komal Devi, Shazia Aftab, Reena, Huma Baloch, Devi Kumari, & Samina Ayaz. (2021). Role of misoprostol 4 hourly versus 6 hourly in medical termination of pregnancy in 2nd trimester. The Professional Medical Journal, 28(11), 1645-1649. https://doi.org/10.29309/tpmj/2021.28.11.6285
Teimoori, B., Esmaeilpoor, M., Khaefi Ashkezari, A., & Farzaneh, F. (2019). Comparison of induction abortion in the first trimester using Misoprostol alone and Misoprostol with estrogen priming. International Journal of Women's Health and Reproduction Sciences, 7(3), 404-407. https://doi.org/10.15296/ijwhr.2019.66
Qazi, Q., Fatima, S. S., Wahab, S., & Syed, W. (2019). Efficacy of misoprostol and prostaglandin E2 gel for induction of labor in term pregnancy. Journal of Postgraduate Medical Institute, 33(4). https://www.jpmi.org.pk/index.php/jpmi/article/view/2502
Ahmad, S., Meraj, B. U. S. H. R. A., & Mobusher, I. (2015). Comparison of misoprostol and PGF2 alpha for second trimester termination of pregnancy. PJMHS, 9(2), 526. https://pjmhsonline.com/2015/apr_june/pdf/526%20%20%20Comparison%20of%20Misoprostol%20and%20PGF2%20Alpha%20for%20Second%20Trimester%20Termination%20of%20Pregnancy.pdf
Dundar, Ö., Müngen, E., Tütüncü, L., Muhcu, M., Bodur, S., & Yergök, Y. Z. Second trimester termination of pregnancy: comparing intracervical prostaglandin E2 (dinoprostone) to intravaginal misoprostol. Perinatal Journal, 14(1), 19-25. https://www.perinataljournal.com/Archive/Article/20060141004
Joensuu‐Manninen, H., Kuvaja, P., & Talvensaari‐Mattila, A. (2010). Clinical efficacy of mifepristone and misoprostol in second trimester pregnancy termination. Acta Obstetricia et Gynecologica Scandinavica, 89(12), 1552-1556. https://doi.org/10.3109/00016349.2010.513427
Drezett, J., Bessa, M. M., Pedroso, D., Fernandes Silva, A. C., Gebrim, L. H., De Vasconcellos, R. M., & De Abreu, L. C. (2014). Misoprostol for induction of second trimester abortion in pregnancies resulting from sexual violence: Effectiveness analysis of a protocol applied in the Brazilian Public Health Service. Reprodução & Climatério, 29(3), 105-111. https://doi.org/10.1016/j.recli.2015.04.001
Ak, M., Dolanbay, M., & Kütük, M. S. (2023). An analysis of misoprostol effectiveness in second trimester pregnancy terminations. Journal of Surgery and Medicine, 7(3), 00-00. https://doi.org/10.28982/josam.7713
Ahmed, S. Meraj, B. & Mobusher, I. (2015). Comparison of Misoprostol and PGF2 Alpha for Second Trimester Termination of Pregnancy. PJMHS 9, 526-8. https://pjmhsonline.com/2015/apr_june/pdf/526%20%20%20Comparison%20of%20Misoprostol%20and%20PGF2%20Alpha%20for%20Second%20Trimester%20Termination%20of%20Pregnancy.pdf
Borgatta, L. (2011). Labor induction termination of pregnancy. The Global Library of Women's Medicine. https://doi.org/10.3843/glowm.10444
Sanchez-Ramos, L., Levine, L. D., Sciscione, A. C., Mozurkewich, E. L., Ramsey, P. S., Adair, C. D., ... & McKinney, J. A. (2024). Methods for the induction of labor: efficacy and safety. American Journal of Obstetrics and Gynecology, 230(3), S669-S695. https://doi.org/10.1016/j.ajog.2023.02.009
Swathi, M., Andallu, R., Balasaraswathi, M., & Suvarna, V. (2022). A comparative study of second trimester termination of pregnancy with mifepristone and misoprostol vs misoprostol alone in 50 cases. EUREKA: Health Sciences, (6), 15-22. https://doi.org/10.21303/2504-5679.2022.002726
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
