Sublingual versus Vaginal Misoprostol for Medical Termination of Second Trimesteric Pregnancy

Abstract

Second trimester termination of pregnancy is stressful for both patients and physicians with potential morbidity and mortality. Medical management has been shown to be both successful and desirable. Misoprostol is now commonly used as a non-surgical treatment for second trimester terminations, but it is unclear that what are the most effective route of administration and most appropriate dose of misoprostol. Misoprostol, a synthetic analogue of prostaglandin E1 that can be administered through various routes including oral, vaginal, rectal and sublingual routes. Misoprostol acts by one of two mechanisms to reduce blood loss. First, like prostaglandins, prostaglandin analogues increase myometrial contractions. This increase in contraction is the effect of prostaglandins on vascular structures, which stem from both uterine artery and utero-ovarian anastomosis and supply blood to leiomyoma. Through this effect, vascular structures are contracted and blood flow is reduced the second mechanism may be the direct vasoconstrictive impact of misoprostol on uterine arteries. This prospective randomized controlled trial was conducted at Ain Shams University Maternity Hospital to compare between sublingual and vaginal misoprostol in second trimesteric termination of pregnancy regarding the rate of