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Link to original content: http://pubmed.ncbi.nlm.nih.gov/21249669/
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Review
. 2011 Jan 19;2011(1):CD005216.
doi: 10.1002/14651858.CD005216.pub2.

Medical methods for mid-trimester termination of pregnancy

Hajo Wildschut  1 , Marieke I Both, Suzanne Medema, Eeke Thomee, Mark F Wildhagen, Nathalie Kapp
Affiliations
Review

Medical methods for mid-trimester termination of pregnancy

Hajo Wildschut et al. Cochrane Database Syst Rev. .

Abstract

Background: With the improvement of ultrasound technology, the likelihood of detection of major fetal structural anomalies in mid-pregnancy has increased considerably. Upon the detection of serious anomalies, women typically are offered the option of pregnancy termination. Additionally, there are still many reasons other than fetal anomalies why women seek abortion in the mid-trimester.

Objectives: To compare different methods of second trimester medical termination of pregnancy for their efficacy and side-effects.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, Popline and reference lists of retrieved papers and other sources.

Selection criteria: All randomised controlled trials (RCTs) examining medical regimens for termination of pregnancy of a singleton living fetus between 12-28 weeks' gestation were analysed. The outcome measures were the induction to abortion interval, abortion rate within 24 hours, need for surgical evacuation, blood loss, uterine rupture, pain, and side-effects.Trials including >20% fetal death, multiple pregnancies, previous uterine scars and regimens which involved cervical preparation were excluded.

Data collection and analysis: Two authors selected the trials and three authors extracted data.

Main results: Fourty RCTs were included, addressing various agents for pregnancy termination and methods of administration. When used alone, misoprostol was an effective inductive agent, though it appeared to be more effective in combination with mifepristone. However, the evidence from RCTs is limited.Misoprostol was preferably administered vaginally, although among multiparous women sublingual administration appeared equally effective. A range of doses of vaginally administered misoprostol has been used. No randomised trials comparing doses of misoprostol were identified; however low doses of misoprostol appear to be associated with fewer side-effects while moderate doses appear to be more efficient in completing abortion. Four RCTs showed that the induction to abortion interval with 3-hourly vaginal administration of prostaglandins is shorter than 6-hourly administration without an increase in side-effects.Many studies reported the need for surgical evacuation. Indications for surgical evacuation include retained products of the placenta and heavy vaginal bleeding. Fewer women required surgical evacuation when misoprostol was administrated vaginally compared with women receiving intra-amniotical PGF(2a) . Mild, self-limiting diarrhoea was more common among women who received misoprostol compared to other agents.

Authors' conclusions: Medical abortion in the second trimester using the combination of mifepristone and misoprostol appeared to have the highest efficacy and shortest abortion time interval. Where mifepristone is not available, misoprostol alone is a reasonable alternative. The optimal route for administering misoprostol is vaginally, preferably using tablets at 3-hourly intervals. Apart from pain, the side-effects of vaginal misoprostol are usually mild and self limiting. Conclusions from this review are limited by the gestational age ranges and variable medical regimens, including dosing, administrative routes and intervals of medication, of the included trials.

PubMed Disclaimer

Conflict of interest statement

None declared

Figures

1.1
1.1. Analysis
Comparison 1 Comparison: mifepristone+misoprostol versus mifepristone+gemeprost, Outcome 1 Induction to abortion interval.
1.2
1.2. Analysis
Comparison 1 Comparison: mifepristone+misoprostol versus mifepristone+gemeprost, Outcome 2 Abortion within 24 hours.
1.3
1.3. Analysis
Comparison 1 Comparison: mifepristone+misoprostol versus mifepristone+gemeprost, Outcome 3 Surgical evacuation.
1.4
1.4. Analysis
Comparison 1 Comparison: mifepristone+misoprostol versus mifepristone+gemeprost, Outcome 4 Pain.
1.5
1.5. Analysis
Comparison 1 Comparison: mifepristone+misoprostol versus mifepristone+gemeprost, Outcome 5 Nausea.
1.6
1.6. Analysis
Comparison 1 Comparison: mifepristone+misoprostol versus mifepristone+gemeprost, Outcome 6 Vomiting.
1.7
1.7. Analysis
Comparison 1 Comparison: mifepristone+misoprostol versus mifepristone+gemeprost, Outcome 7 Diarrhoea.
2.1
2.1. Analysis
Comparison 2 Comparison: mifepristone+misoprostol versus placebo+misoprostol, Outcome 1 Abortion within 24 hours.
2.2
2.2. Analysis
Comparison 2 Comparison: mifepristone+misoprostol versus placebo+misoprostol, Outcome 2 Surgical evacuation.
2.3
2.3. Analysis
Comparison 2 Comparison: mifepristone+misoprostol versus placebo+misoprostol, Outcome 3 Pain.
2.4
2.4. Analysis
Comparison 2 Comparison: mifepristone+misoprostol versus placebo+misoprostol, Outcome 4 Nausea.
2.5
2.5. Analysis
Comparison 2 Comparison: mifepristone+misoprostol versus placebo+misoprostol, Outcome 5 Vomiting.
3.1
3.1. Analysis
Comparison 3 Comparison: mifepristone+misoprostol, vaginal versus oral, Outcome 1 Induction to abortion interval.
3.2
3.2. Analysis
Comparison 3 Comparison: mifepristone+misoprostol, vaginal versus oral, Outcome 2 Abortion within 24 hours.
3.3
3.3. Analysis
Comparison 3 Comparison: mifepristone+misoprostol, vaginal versus oral, Outcome 3 Surgical evacuation.
3.4
3.4. Analysis
Comparison 3 Comparison: mifepristone+misoprostol, vaginal versus oral, Outcome 4 Pain.
3.5
3.5. Analysis
Comparison 3 Comparison: mifepristone+misoprostol, vaginal versus oral, Outcome 5 Nausea.
3.6
3.6. Analysis
Comparison 3 Comparison: mifepristone+misoprostol, vaginal versus oral, Outcome 6 Vomiting.
3.7
3.7. Analysis
Comparison 3 Comparison: mifepristone+misoprostol, vaginal versus oral, Outcome 7 Diarrhoea.
4.1
4.1. Analysis
Comparison 4 Comparison: mifepristone+misoprostol, vaginal versus sublingual, Outcome 1 Surgical evacuation.
4.2
4.2. Analysis
Comparison 4 Comparison: mifepristone+misoprostol, vaginal versus sublingual, Outcome 2 Pain.
4.3
4.3. Analysis
Comparison 4 Comparison: mifepristone+misoprostol, vaginal versus sublingual, Outcome 3 Nausea.
4.4
4.4. Analysis
Comparison 4 Comparison: mifepristone+misoprostol, vaginal versus sublingual, Outcome 4 Vomiting.
4.5
4.5. Analysis
Comparison 4 Comparison: mifepristone+misoprostol, vaginal versus sublingual, Outcome 5 Diarrhoea.
5.1
5.1. Analysis
Comparison 5 Comparison: mifepristone+misoprostol, oral versus sublingual, Outcome 1 Abortion within 24h.
5.2
5.2. Analysis
Comparison 5 Comparison: mifepristone+misoprostol, oral versus sublingual, Outcome 2 Pain (need of analgesic).
5.3
5.3. Analysis
Comparison 5 Comparison: mifepristone+misoprostol, oral versus sublingual, Outcome 3 Nausea.
5.4
5.4. Analysis
Comparison 5 Comparison: mifepristone+misoprostol, oral versus sublingual, Outcome 4 Diarrhoea.
6.1
6.1. Analysis
Comparison 6 Comparison: dosing interval of misoprostol following mifepristone, Outcome 1 Abortion within 24 hours.
6.2
6.2. Analysis
Comparison 6 Comparison: dosing interval of misoprostol following mifepristone, Outcome 2 Surgical evacuation.
6.3
6.3. Analysis
Comparison 6 Comparison: dosing interval of misoprostol following mifepristone, Outcome 3 Pain (need for analgesia).
6.4
6.4. Analysis
Comparison 6 Comparison: dosing interval of misoprostol following mifepristone, Outcome 4 Nausea.
6.5
6.5. Analysis
Comparison 6 Comparison: dosing interval of misoprostol following mifepristone, Outcome 5 Diarrhoea.
7.1
7.1. Analysis
Comparison 7 Comparison: dosage of mifepristone, Outcome 1 Induction to abortion interval.
7.2
7.2. Analysis
Comparison 7 Comparison: dosage of mifepristone, Outcome 2 Abortion within 24h.
7.3
7.3. Analysis
Comparison 7 Comparison: dosage of mifepristone, Outcome 3 Surgical evacuation.
7.4
7.4. Analysis
Comparison 7 Comparison: dosage of mifepristone, Outcome 4 Pain.
7.5
7.5. Analysis
Comparison 7 Comparison: dosage of mifepristone, Outcome 5 Vomiting.
7.6
7.6. Analysis
Comparison 7 Comparison: dosage of mifepristone, Outcome 6 Diarrhoea.
8.1
8.1. Analysis
Comparison 8 Comparison: combined regimen of mifepristone and gemeprost, Outcome 1 Abortion within 24 hours.
8.2
8.2. Analysis
Comparison 8 Comparison: combined regimen of mifepristone and gemeprost, Outcome 2 Blood loss.
8.3
8.3. Analysis
Comparison 8 Comparison: combined regimen of mifepristone and gemeprost, Outcome 3 Surgical evacuation.
8.4
8.4. Analysis
Comparison 8 Comparison: combined regimen of mifepristone and gemeprost, Outcome 4 Vomiting.
8.5
8.5. Analysis
Comparison 8 Comparison: combined regimen of mifepristone and gemeprost, Outcome 5 Diarrhoea.
9.1
9.1. Analysis
Comparison 9 Comparison: misoprostol versus PGF, Outcome 1 Induction to abortion interval.
9.2
9.2. Analysis
Comparison 9 Comparison: misoprostol versus PGF, Outcome 2 Abortion within 24 hours.
9.3
9.3. Analysis
Comparison 9 Comparison: misoprostol versus PGF, Outcome 3 Surgical evacuation.
9.4
9.4. Analysis
Comparison 9 Comparison: misoprostol versus PGF, Outcome 4 Nausea.
9.5
9.5. Analysis
Comparison 9 Comparison: misoprostol versus PGF, Outcome 5 Vomiting.
9.6
9.6. Analysis
Comparison 9 Comparison: misoprostol versus PGF, Outcome 6 Diarrhoea.
10.1
10.1. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 1 Induction to abortion interval.
10.2
10.2. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 2 Abortion within 24 hours.
10.3
10.3. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 3 Blood loss (mL).
10.4
10.4. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 4 Surgical evacuation.
10.5
10.5. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 5 Pain.
10.6
10.6. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 6 Nausea.
10.7
10.7. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 7 Vomiting.
10.8
10.8. Analysis
Comparison 10 Comparison: misoprostol versus gemeprost, Outcome 8 Diarrhoea.
11.1
11.1. Analysis
Comparison 11 Comparison: misoprostol versus dinoprost, Outcome 1 Abortion within 24 hours.
11.2
11.2. Analysis
Comparison 11 Comparison: misoprostol versus dinoprost, Outcome 2 Blood loss.
11.3
11.3. Analysis
Comparison 11 Comparison: misoprostol versus dinoprost, Outcome 3 Surgical evacuation.
11.4
11.4. Analysis
Comparison 11 Comparison: misoprostol versus dinoprost, Outcome 4 Pain (need analgesia).
11.5
11.5. Analysis
Comparison 11 Comparison: misoprostol versus dinoprost, Outcome 5 Vomiting.
11.6
11.6. Analysis
Comparison 11 Comparison: misoprostol versus dinoprost, Outcome 6 Diarrhoea.
12.1
12.1. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 1 Induction to abortion interval.
12.2
12.2. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 2 Abortion within 24 hours.
12.3
12.3. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 3 Blood loss (mL).
12.4
12.4. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 4 Pain.
12.5
12.5. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 5 Surgical evacuation.
12.6
12.6. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 6 Nausea.
12.7
12.7. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 7 Vomiting.
12.8
12.8. Analysis
Comparison 12 Comparison: misoprostol, vaginal versus oral, Outcome 8 Diarrhoea.
13.1
13.1. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 1 Induction to abortion interval.
13.2
13.2. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 2 Abortion within 24 hours.
13.3
13.3. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 3 Blood loss.
13.4
13.4. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 4 Pain.
13.5
13.5. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 5 Surgical evacuation.
13.6
13.6. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 6 Nausea.
13.7
13.7. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 7 Vomiting.
13.8
13.8. Analysis
Comparison 13 Comparison: misoprostol, vaginal versus sublingual, Outcome 8 Diarrhoea.
14.1
14.1. Analysis
Comparison 14 Comparison: misoprostol, tablet versus gel, Outcome 1 Abortion within 24 hours.
14.2
14.2. Analysis
Comparison 14 Comparison: misoprostol, tablet versus gel, Outcome 2 Blood loss > 500 mL.
14.3
14.3. Analysis
Comparison 14 Comparison: misoprostol, tablet versus gel, Outcome 3 Surgical evacuation.
14.4
14.4. Analysis
Comparison 14 Comparison: misoprostol, tablet versus gel, Outcome 4 Pain.
14.5
14.5. Analysis
Comparison 14 Comparison: misoprostol, tablet versus gel, Outcome 5 Nausea.
14.6
14.6. Analysis
Comparison 14 Comparison: misoprostol, tablet versus gel, Outcome 6 Vomiting.
14.7
14.7. Analysis
Comparison 14 Comparison: misoprostol, tablet versus gel, Outcome 7 Diarrhoea.
15.1
15.1. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 1 Induction to abortion interval.
15.2
15.2. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 2 Abortion within 24 hours.
15.3
15.3. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 3 Blood loss (mL).
15.4
15.4. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 4 Blood loss (>500 mL).
15.5
15.5. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 5 Surgical evacuation.
15.6
15.6. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 6 Pain.
15.7
15.7. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 7 Nausea.
15.8
15.8. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 8 Vomiting.
15.9
15.9. Analysis
Comparison 15 Comparison: time interval misoprostol, Outcome 9 Diarrhoea.
16.1
16.1. Analysis
Comparison 16 Comparison: time interval gemeprost, Outcome 1 Abortion within 24 hours.
16.2
16.2. Analysis
Comparison 16 Comparison: time interval gemeprost, Outcome 2 Surgical evacuations.
16.3
16.3. Analysis
Comparison 16 Comparison: time interval gemeprost, Outcome 3 Pain.
17.1
17.1. Analysis
Comparison 17 Comparison: low dose versus high dose of misoprostol, Outcome 1 Induction to abortion interval.
17.2
17.2. Analysis
Comparison 17 Comparison: low dose versus high dose of misoprostol, Outcome 2 Pain.
17.3
17.3. Analysis
Comparison 17 Comparison: low dose versus high dose of misoprostol, Outcome 3 Nausea.
17.4
17.4. Analysis
Comparison 17 Comparison: low dose versus high dose of misoprostol, Outcome 4 Vomiting.
17.5
17.5. Analysis
Comparison 17 Comparison: low dose versus high dose of misoprostol, Outcome 5 Diarrhoea.
18.1
18.1. Analysis
Comparison 18 Comparison: PGE2 versus PGF2, Outcome 1 Induction to abortion interval.
18.2
18.2. Analysis
Comparison 18 Comparison: PGE2 versus PGF2, Outcome 2 Abortion within 24 hours.
18.3
18.3. Analysis
Comparison 18 Comparison: PGE2 versus PGF2, Outcome 3 Pain.
18.4
18.4. Analysis
Comparison 18 Comparison: PGE2 versus PGF2, Outcome 4 Nausea.
18.5
18.5. Analysis
Comparison 18 Comparison: PGE2 versus PGF2, Outcome 5 Vomiting.
18.6
18.6. Analysis
Comparison 18 Comparison: PGE2 versus PGF2, Outcome 6 Diarrhoea.
19.1
19.1. Analysis
Comparison 19 Comparison: PGE2 versus PGF2+oxytocin, Outcome 1 Induction to abortion interval.
19.2
19.2. Analysis
Comparison 19 Comparison: PGE2 versus PGF2+oxytocin, Outcome 2 Surgical evacuation.
19.3
19.3. Analysis
Comparison 19 Comparison: PGE2 versus PGF2+oxytocin, Outcome 3 Pain.
19.4
19.4. Analysis
Comparison 19 Comparison: PGE2 versus PGF2+oxytocin, Outcome 4 Vomiting.
19.5
19.5. Analysis
Comparison 19 Comparison: PGE2 versus PGF2+oxytocin, Outcome 5 Diarrhoea.
20.1
20.1. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 1 Induction to abortion interval.
20.2
20.2. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 2 Abortion within 24 hours.
20.3
20.3. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 3 Blood loss >100 ml.
20.4
20.4. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 4 Blood loss >500 ml.
20.5
20.5. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 5 Nausea.
20.6
20.6. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 6 Vomiting.
20.7
20.7. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 7 Diarrhoea.
20.8
20.8. Analysis
Comparison 20 Comparison: PGF2 versus hypertonic saline, Outcome 8 Surgical evacuation.
21.1
21.1. Analysis
Comparison 21 Comparison: combined regimen PGF2+hypertonic saline, Outcome 1 Induction to abortion interval.
21.2
21.2. Analysis
Comparison 21 Comparison: combined regimen PGF2+hypertonic saline, Outcome 2 Abortion within 24 hours.
21.3
21.3. Analysis
Comparison 21 Comparison: combined regimen PGF2+hypertonic saline, Outcome 3 Blood loss (>500 ml).
21.4
21.4. Analysis
Comparison 21 Comparison: combined regimen PGF2+hypertonic saline, Outcome 4 Surgical evacuation.
21.5
21.5. Analysis
Comparison 21 Comparison: combined regimen PGF2+hypertonic saline, Outcome 5 Nausea.
21.6
21.6. Analysis
Comparison 21 Comparison: combined regimen PGF2+hypertonic saline, Outcome 6 Vomiting.
21.7
21.7. Analysis
Comparison 21 Comparison: combined regimen PGF2+hypertonic saline, Outcome 7 Diarrhoea.
22.1
22.1. Analysis
Comparison 22 Comparison: PGE1 versus PGF2+hypertonic saline, Outcome 1 Induction to abortion interval.
22.2
22.2. Analysis
Comparison 22 Comparison: PGE1 versus PGF2+hypertonic saline, Outcome 2 Abortion within 24h.
22.3
22.3. Analysis
Comparison 22 Comparison: PGE1 versus PGF2+hypertonic saline, Outcome 3 Blood loss (>300ml).
22.4
22.4. Analysis
Comparison 22 Comparison: PGE1 versus PGF2+hypertonic saline, Outcome 4 Surgical evacuation.
22.5
22.5. Analysis
Comparison 22 Comparison: PGE1 versus PGF2+hypertonic saline, Outcome 5 Pain (pethidine).
22.6
22.6. Analysis
Comparison 22 Comparison: PGE1 versus PGF2+hypertonic saline, Outcome 6 Vomiting.
22.7
22.7. Analysis
Comparison 22 Comparison: PGE1 versus PGF2+hypertonic saline, Outcome 7 Diarrhoea.
23.1
23.1. Analysis
Comparison 23 Comparison: prostaglandin versus ethacridine lactate, Outcome 1 Induction to abortion interval.
23.2
23.2. Analysis
Comparison 23 Comparison: prostaglandin versus ethacridine lactate, Outcome 2 Abortion within 24h.
23.3
23.3. Analysis
Comparison 23 Comparison: prostaglandin versus ethacridine lactate, Outcome 3 Blood loss.
23.4
23.4. Analysis
Comparison 23 Comparison: prostaglandin versus ethacridine lactate, Outcome 4 Nausea.
23.5
23.5. Analysis
Comparison 23 Comparison: prostaglandin versus ethacridine lactate, Outcome 5 Vomiting.
23.6
23.6. Analysis
Comparison 23 Comparison: prostaglandin versus ethacridine lactate, Outcome 6 Diarrhoea.
24.1
24.1. Analysis
Comparison 24 Comparison: ethacridine lactate versus normal saline, Outcome 1 Induction to abortion interval.
24.2
24.2. Analysis
Comparison 24 Comparison: ethacridine lactate versus normal saline, Outcome 2 Blood loss (need for blood transfusion).
24.3
24.3. Analysis
Comparison 24 Comparison: ethacridine lactate versus normal saline, Outcome 3 Pain (use of analgestics).
24.4
24.4. Analysis
Comparison 24 Comparison: ethacridine lactate versus normal saline, Outcome 4 Vomiting (use of antimetics).
24.5
24.5. Analysis
Comparison 24 Comparison: ethacridine lactate versus normal saline, Outcome 5 Uterine rupture.
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References

References to studies included in this review

Akoury 2004 {published data only}
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Hamoda 2005 {published data only}
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Mehta 1975 b {published data only}
    1. Mehta A, Ghatge V, Dave S, CHaina M, Shah P. Termination of second trimester pregnancies: a blind study using hypertonic saline and prostaglandins F2a ‐ a preliminary report. Journal of Obstetrics and Gynaecology India 1975;25(2):165‐75. - PubMed
Muzsnai 1979 a {published data only}
    1. Muzsnai D, Kerenyi T. Use of prostaglandin, hypertonic saline and oxytocin for second‐trimester abortion. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1979;9/6:385‐9. - PubMed
Muzsnai 1979 b {published data only}
    1. Muzsnai D, Kerenyi T. Use of prostaglandin, hypertonic saline and oxytocin for second‐trimester abortion. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1979;9/6:385‐9. - PubMed
Muzsnai 1979 c {published data only}
    1. Muzsnai D, Kerenyi T. Use of prostaglandin, hypertonic saline and oxytocin for second‐trimester abortion. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1979;9/6:385‐9. - PubMed
Muzsnai 1979 d {published data only}
    1. Muzsnai D, Kerenyi T. Use of prostaglandin, hypertonic saline and oxytocin for second‐trimester abortion. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1979;9/6:385‐9. - PubMed
Ngai 2000 {published data only}
    1. Ngai SW, Tang OS, Ho PC. Randomized comparison of vaginal (200 µg every 3 hrs) and oral (400 µg every 3 hrs) misoprostol when combined with mifepristone in termination of second trimester pregnancy. Human Reproduction 2000;15(10):2205‐8. - PubMed
Nielsen 1975 {published data only}
    1. Nielsen KR, Gregersen E, Larsen JF, Olsen CE. Prostaglandin F2alpha and oxytocin compared with hypertonic saline and oxytocin for the induction of second trimester abortion.. Acta Obstetricia et Gynecologica Scandinavica. Supplement 1975;37:57‐60. - PubMed
Nuutila 1997 a {published data only}
    1. Nuutila M, Toivonen J, Ylikorkala O, Halmesmäki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second‐trimester abortion. Obstetrics and Gynecology 1997;90(6):896‐900. - PubMed
Nuutila 1997 b {published data only}
    1. Nuutila M, Toivonen J, Ylikorkala O, Halmesmäki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second‐trimester abortion. Obstetrics and Gynecology 1997;90(6):896‐900. - PubMed
Nuutila 1997 c {published data only}
    1. Nuutila M, Toivonen J, Ylikorkala O, Halmesmäki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second‐trimester abortion. Obstetrics and Gynecology 1997;90(6):896‐900. - PubMed
Olund 1978 {published data only}
    1. Olund A, Larsson B. Comparison of extra‐amniotic instillation of rivanol and PGF2a either separately or in combination followed by oxytocin for second trimester abortion. Acta Obstetricia et Gynecologica Scandinavica 1978;57:333‐6. - PubMed
Ozerkan 2009 {published data only}
    1. Ozerkan K, Ocakoglu G, Rehimli S, Uncu G, Develioglu O. A comparison of low‐dose and high‐dose protocols of vaginal misoprostol for second trimester termination of pregnancy. Clinical and Experimental Obstetrics & Gynecology 2009;36(4):245‐7. - PubMed
Pongsatha 2008 {published data only}
    1. Pongsatha S, Tongsong T. Randomized comparison of dry tablet insertion versus gel form of vaginal misoprostol for second trimester pregnancy termination. The Journal of Obstetrics and Gynaecology Research 2008;34(2):199‐203. - PubMed
Sorensen 1984 {published data only}
    1. Sorensen SS, Wolf P. Randomized trial of intracervical prostaglandin E2 gel and intra‐amniotic prostaglandin F2alfa for induction of second trimester abortion. Contraception 1984;29(2):171‐9. - PubMed
Steyn 1993 {published data only}
    1. Steyn DW, Pienaar MP. Mid‐trimester termination of pregnancy‐‐a randomised controlled trial of two prostaglandin regimens. South African Medical Journal 1993;83(10):737‐8. - PubMed
Su 2005 {published data only}
    1. Su LL, Biswas A, Choolani M, Kalaichelvan V, Singh K. A prospective, randomized comparison of vaginal misoprostol versus intra‐amniotic prostaglandins for midtrimester termination of pregnancy. American Journal of Obstetrics and Gynecology 2005;193(4):1410‐4. - PubMed
Tang 2004 {published data only}
    1. Tang OS, Chan CC, Kan AS, Ho PC. A prospective randomized comparison of sublingual and vaginal misoprostol in second trimester termination of pregnancy. BJOG 2004;111:1001‐5. - PubMed
Tang 2005 {published data only}
    1. Tang OS, Chan CC, Kan AS, Ho PC. A prospective randomized comparison of sublingual and oral misoprostol when combined with mifepristone for medical abortion at 12‐20 weeks gestation. Human Reproduction 2005;20(11):3062‐6. - PubMed
Thong 1996 {published data only}
    1. Thong KJ, Lynch P, Baird DT. A randomised study of two doses or gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy. Contraception 1996;54(2):97‐100. - PubMed
von Hertzen 2009 {published data only}
    1. Hertzen H, Piaggio G, Wojdyla D, Nguyen TM, Marions L, Okoev G, et al. WHO Research Group on Post‐ovulatory Methods of Fertility Regulation. Comparison of vaginal and sublingual misoprostol for second trimester abortion: randomised controlled equivalence trial. Human Reproduction 2009;24(1):106‐12. - PubMed
Waldron 1990 {published data only}
    1. Waldron KW, Renou PM, Lolatgis N, Morris ND, Mamers PM, Oldham J, Healy DL. Second‐trimester termination with 16,16 dimethyl‐PGE1‐methyl ester (gemeprost) compared with a regimen that included intra‐amniotic PGF2a and hypertonic saline. Reproduction, Fertility, and Development 1990;2:495‐8. - PubMed
Webster 1996 {published data only}
    1. Webster D, Penney GC, Templeton A. A comparison of 600 and 200 mg mifepristone prior to second trimester abortion with the prostaglandin misoprostol. British Journal of Obstetrics and Gynaecology 1996;103(7):706‐9. - PubMed
WHO 1976 {published data only}
    1. No authors listed. Comparison of intra‐amniotic prostaglandin F2alpha and hypertonic saline for induction of second‐trimester abortion. British Medical Journal 1976;1:1373‐6. - PMC - PubMed
Wong 1998 {published data only}
    1. Wong KS, Ngai CS, Wong AY, Tang LC, Ho PC. Vaginal misoprostol compared with vaginal gemeprost in termination of second trimester pregnancy. A randomized trial. Contraception 1998;58(4):207‐10. - PubMed
Wong 2000 {published data only}
    1. Wong KS, Ngai CS, Yeo EL, Tang LC, Ho PC. A comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy: a randomized comparative trial. Human Reproduction 2000;15(3):709‐12. - PubMed
Zauva 1989 {published data only}
    1. Zauva BL, Gupta I, Dhall GI. Mid‐trimester abortion by extra‐amniotic emcredil versus normal saline. The Australian & New Zealand Journal of Obstetrics & Gynaecology 1989;29(3(2)):299‐302. - PubMed

References to studies excluded from this review

Allahbadia 1992 {published data only}
    1. Allahbadia G. Comparative study of midtrimester termination of pregnancy using hypertonic saline, ethacridine lactate, prostaglandin analogue and iodine‐saline. Journal of the Indian Medical Association 1992;90(9):237‐9. - PubMed
Ballard 1981 {published data only}
    1. Ballard CA. The vaginal administration of 9‐deoxo‐16,16‐dimethyl‐9‐methylene PGE2 for second trimester abortion. Contraception 1981;24(2):151‐7. - PubMed
Ben‐Meir 2009 {published data only}
    1. Ben‐Meir A, Erez Y, Feigenberg T, Hamani Y, Laufer N, Rojansky N. Mifepristone followed by high‐dose oxytocin drip for second‐trimester abortion. The Journal of Reproductive Medicine 2009;54(8):511‐6. - PubMed
Caliskan 2005 {published data only}
    1. Caliskan E, Dilbaz S, Doger E, Ozeren S, Dilbaz B. Randomized comparison of 3 misoprostol protocols for abortion induction at 13‐20 weeks of gestation. The Journal of Reproductive Medicine 2005;50(3):173‐80. - PubMed
Caliskan 2009 {published data only}
    1. Caliskan E, Doger E, Cakiroglu Y, Corakci A, Yucesoy I. Sublingual misoprostol 100 microgram versus 200 microgram for second trimester abortion: a randomised trial. The European Journal of Contraception & Reproductive Health Care 2009;14(1):55‐60. - PubMed
Carbonell 2008 {published data only}
    1. Carbonell JL, Torres MA, Reyes R, Ortega L, García‐Gallego F, Sánchez C. Second‐trimester pregnancy termination with 600‐μg vs. 400‐μg vaginal misoprostol and systematic curettage post expulsion: a randomized trial. Contraception 2007;77(1):50‐5. - PubMed
Dickinson 1998 {published data only}
    1. Dickinson JE, Godfrey M, Evans SF. Efficacy of intravaginal misoprostol in second‐trimester pregnancy termination: a randomized controlled trial. The Journal of Maternal‐Fetal Medicine 1998;7(3):115‐9. - PubMed
Dickinson 2002 {published data only}
    1. Dickinson JE, Evans SF. The optimization of intravaginal misoprostol dosing schedules in second trimester pregnancy termination. American Journal of Obstetrics and Gynecology 2002;186(3):470‐4. - PubMed
Dickinson 2003 {published data only}
    1. Dickinson JE, Evans SF. A comparison of oral misoprostol with vaginal misoprostol administration in second‐trimester pregnancy termination for fetal abnormality. Obstetrics and Gynecology 2003;101(6):1294‐9. - PubMed
Feldman 2003 {published data only}
    1. Feldman DM, Borgida AF, Rodis JF, Leo MV, Campbell WA. A randomized comparison of two regimens of misoprostol for second‐trimester pregnancy termination. American Journal of Obstetrics and Gynecology 2003;189(3):710‐3. - PubMed
Frydman 1988 {published data only}
    1. Frydman R, Fernandez H, Pons JC, Ulmann A. Mifepristone (RU486) and therapeutic late pregnancy termination: a double‐blind study of two different doses. Human Reproduction 1988;3(6):803‐6. - PubMed
Ghorab 1998 {published data only}
    1. Ghorab MN, Helw BA. Second‐trimester termination of pregnancy by extra‐amniotic prostaglandin F2alpha or endocervical misoprostol. A comparative study. Acta Obstetricia et Gynecologica Scandinavica 1998;77(4):429‐32. - PubMed
Ghosh 1980 {published data only}
    1. Ghodh AK, Konar JR. The relative value of two concentrations of hypertonic saline for midtrimester abortion. International Journal of Gynaecology and Obstetrics 1980;17:368‐71. - PubMed
Gilbert 2001 {published data only}
    1. Gilbert A, Reid R. A randomised trial of oral versus vaginal administration of misoprostol for the purpose of mid‐trimester termination of pregnancy. The Australian & New Zealand Journal of Obstetrics & Gynaecology 2001;41(4):407‐10. - PubMed
Goswami 1982 {published data only}
    1. Goswami BK, Raha A, Gupta A, Mukherjee K. Midtrimester abortion by ethacridine lactate. Journal of the Indian Medical Association 1982;79(1‐2):7‐9. - PubMed
Guix 2005 {published data only}
    1. Guix C, Palacio M, Figueras F, Bennasar M, Zamora L, Coll O, et al. Efficacy of two regimens of misoprostol for early second‐trimester pregnancy termination. Fetal Diagnosis and Therapy 2005;20(6):544‐8. - PubMed
Herabutya 2001 {published data only}
    1. Herabutya Y, Chanrachakul B, Punyavachira P. Second trimester pregnancy termination: a comparison of 600 and 800 micrograms of intravaginal misoprostol. The Journal of Obstetrics and Gynaecology Research 2001;27(3):125‐8. - PubMed
Hidar 2001 {published data only}
    1. Hidar S, Fekih M, Chaieb, Bibi M, Mellouli R, Khairi H. Oxytocin and misoprostol administered intravaginally for termination of pregnancy at 13 to 29 weeks of amenorrhea. A prospective randomized trial [Apport de l'association d'oxytocine au misoprostol administre en intravaginal au cours des interruptions de grossesses entre 13 et 29 semaines d'amenorrhee]. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 2001;30(5):439‐43. - PubMed
Hill 1991 {published data only}
    1. Hill NC, Selinger M, Ferguson J, MacKenzie IZ Hill NC, Selinger M, Ferguson J, et al. Mid‐trimester termination of pregnancy with 16,16‐dimethyl‐trans‐delta 2 PGE1 vaginal pessaries: a comparison with intra‐ and extra‐amniotic prostaglandin E2 administration. International Journal of Gynaecology and Obstetrics 1991;35(4):337‐40. - PubMed
Ho 1993 {published data only}
    1. Ho PC, Ma HK. Termination of second trimester pregnancy with sulprostone and mifepristone: a randomized double‐blind placebo‐controlled trial. Contraception 1993;47:123‐9. - PubMed
Jain 1994 {published data only}
    1. Jain JK, Mishell DR Jr. A comparison of intravaginal misoprostol with prostaglandin E2 for termination of second‐trimester pregnancy. The New England Journal of Medicine 1994;331(5):290‐3. - PubMed
Jain 1999 {published data only}
    1. Jain JK, Kuo J, Mishell DR Jr. A comparison of two dosing regimens of intravaginal misoprostol for second‐trimester pregnancy termination. Obstetrics and Gynecology 1999;93(4):571‐5. - PubMed
Jansen 2008 {published data only}
    1. Jansen NE, Pasker‐De Jong PC, Zondervan HA. Mifepristone and misoprostol versus dilapan and sulprostone for second trimester termination of pregnancy. The Journal of Maternal‐Fetal & Neonatal Medicine 2008;21(11):847‐51. - PubMed
Jarnbert 1999 {published data only}
    1. Järnbert A, Klang B, Thi Vinh N, Ngoc Hamb N. Comparative study of cervical laminar tents prior to extra‐amniotic injection of ethacridine lactate (rivanol) and a condom‐nelathon catheter method for second‐trimester pregnancy interruption in Vietnam. Gynecologic and Obstetric Investigation 1999;48:113‐8. - PubMed
Kamali 1998 {published data only}
    1. Kamali P, Hohmann M, Herrero J, Künzel W. Gemeprost, sulprostone and dinoprostone for induced abortion in the 15th‐24th week of pregnancy. Zentralblatt fur Gynakologie 1998;120(6):293‐300. - PubMed
Kapp 2007 (2) {published data only}
    1. Kapp N, Todd CS, Yadgarova KT, Alibayeva G, Nazarova D, Loza O, Babadjanova GS. A randomized comparison of misoprostol to intrauterine instillation of hypertonic saline plus a prostaglandin F2α analogue for second‐trimester induction termination in Uzbekistan. Contraception 2007;76(6):461‐6. - PubMed
Klinte 1983 {published data only}
    1. Klinte I, Hamberger L, Wiqvist N. Second‐trimester abortion by extra‐amniotic instillation of Rivanol combined with intravenous administration of oxytocin or prostaglandin F2 alpha. Acta Obstetricia et Gynecologica Scandinavica 1983;62(4):303‐6. - PubMed
le Roux 2002 {published data only}
    1. Roux PA, Tregoning SK, Zinn PM, Spuy ZM. Inhibition of progesterone secretion with trilostane for midtrimester termination of pregnancy: randomized controlled trials. Human Reproduction 2002;17(6):1483‐9. - PubMed
Manabe 1981 {published data only}
    1. Manabe Y, Manabe A. Abortion during mid‐pregnancy by rivanol‐catheter supplemented with PGF2a drip‐infusion or quinine hydrochloride. Contraception 1981;23(6):621‐8. - PubMed
Munthali 2001 {published data only}
    1. Munthali J, Moodley J. The use of misoprostol for mid‐trimester therapeutic termination of pregnancy. Tropical Doctor 2001;31(3):157‐61. - PubMed
Nigam 2006 {published data only}
    1. Nigam A, Singh VK, Prakash A. Vaginal vs. oral misoprostol for mid‐trimester abortion. International Journal of Gynaecology and Obstetrics 2006;92(3):270‐1. - PubMed
Niromanesh 2005 {published data only}
    1. Niromanesh S, Hashemi‐Fesharaki M, Mosavi‐Jarrahi A. Second trimester abortion using intravaginal misoprostol [brief communication]. International Journal of Gynaecology and Obstetrics 2005;89(3):276‐7. - PubMed
Nor Azlin 2006 {published data only}
    1. Nor Azlin MI, Abdullah HS, Zainul Rashid MR, Jamil MA. Misoprostol (alone) in second trimester terminations of pregnancy: as effective as gemeprost?. Journal of Obstetrics and Gynaecology 2006;26(6):546‐9. - PubMed
Nuthalapaty 2005 {published data only}
    1. Nuthalapaty FS, Ramsey PS, Biggio JR, Owen J. High‐dose vaginal misoprostol versus concentrated oxytocin plus low‐dose vaginal misoprostol for midtrimester labor induction: a randomized trial. American Journal of Obstetrics and Gynecology 2005;193(3 Pt 2):1065‐70. - PMC - PubMed
Olund 1979 {published data only}
    1. Olund A. The effect of indomethacin on the instillation‐abortion interval in rivanol‐induced mid‐trimester abortion. Acta Obstetricia et Gynecologica Scandinavica 1979;58(1):121‐2. - PubMed
Owen 1996 {published data only}
    1. Owen J, Hauth JC. Concentrated oxytocin plus low‐dose prostaglandin E2 compared with prostaglandin E2 vaginal suppositories for second‐trimester pregnancy termination. Obstetrics and Gynecology 1996;88(1):110‐3. - PubMed
Owen 1999 {published data only}
    1. Owen J, Hauth JC. Vaginal misoprostol vs. concentrated oxytocin plus low‐dose prostaglandin E2 for second trimester pregnancy termination. J Matern Fetal Med 1999;8(2):48‐50. - PubMed
Perry 1999 {published data only}
    1. Perry KG Jr, Rinehart BK, Terrone DA, Martin RW, May WL, Roberts WE. Second‐trimester uterine evacuation: A comparison of intra‐amniotic (15S)‐15‐methyl‐prostaglandin F2alpha and intravaginal misoprostol. American Journal of Obstetrics and Gynecology 1999;181(5):1057‐61. - PubMed
Pulkkinen 1980 {published data only}
    1. Pulkkinen MO, Kajanoja P, Kivikoski A, Saastamoinen J, Selander K, Tuimala R. Abortion with sulprostone, a prostaglandin E2 derivative. International Journal of Gynaecology and Obstetrics 1980;18(1):40‐3. - PubMed
Ragab 1976 {published data only}
    1. Ragab MI, Edelman DA. Midtrimester abortion: a comparison of intra‐amniotic Prostaglandin F2a and hypertonic saline. International Journal of Gynaecology and Obstetrics 1976;14:393‐6. - PubMed
Ramsey 2004 {published data only}
    1. Ramsey PS, Savage K, Lincoln T, Owen J. Vaginal misoprostol versus concentrated oxytocin and vaginal PGE2 for second trimester labor induction. Obstetrics and Gynecology 2004;104(1):138‐45. - PubMed
Shukla 1984 {published data only}
    1. Shukla S, Sapre S, Olyai P. Mid‐trimester pregnancy termination with ethacridine lactate. Journal of the Indian Medical Association 1984;82(12):432‐4. - PubMed
Sørensen 1986 {published data only}
    1. Stampe Sørensen S, Heisterberg L, Wolf P. Midtrimester abortion by intracervical prostaglandin E2. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1986;21(3):165‐71. - PubMed
Thong 1993 {published data only}
    1. Thong KJ, Baird DT. Induction of second trimester abortion with mifepristone and gemeprost. British Journal of Obstetrics and Gynaecology 1993;100(8):758‐61. - PubMed
Thong KJ, Baird 1992 {published data only}
    1. Thong KJ, Baird DT. A study of gemeprost alone, dilapan of mifepristone in combination with gemeprost for the termination of second trimester pregnancy. Contraception 1992;46:11‐7. - PubMed
Wong 1996 {published data only}
    1. Wong KS, Ngai CS, Chan KS, Tang LC, Ho PC. Wong KS, Ngai CS, et al. Termination of second trimester pregnancy with gemeprost and misoprostol: a randomized double‐blind placebo‐controlled trial. Contraception 1996;54(1):23‐5. - PubMed
Yapar 1996 {published data only}
    1. Yapar EG, Senoz S, Orkiittir M, Batioglu S, Gokmen O. Second trimester pregnancy termination including fetal death:comparison of five different methods. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1996;69:97‐102. - PubMed
Yilmaz 2007 {published data only}
    1. Yilmaz B, Kelekci S, Ertas IE, Ozel M, Sut N, Mollamahmutoglu L, Danisman N. Randomized comparison of second trimester pregnancy termination utilizing saline moistened or dry misoprostol. Archives of Gynecology and Obstetrics 2007;276(5):511‐6. - PubMed

Additional references

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MeSH terms