A prospective randomised comparison of sublingual and vaginal misoprostol in second trimester termination of pregnancy

Abstract

Objective: To compare the efficacy, side effects and acceptability of sublingual and vaginal misoprostol for second trimester medical abortion. Design: Prospective randomised controlled trial. Setting: Tertiary referral unit and a teaching hospital. Population: Two hundred and twenty-four women at 12 to 20 weeks of gestation. Methods: The women were randomised to receive either sublingual or vaginal misoprostol 400 μg every 3 hours for a maximum of five doses. The course of misoprostol was repeated if the woman did not abort within 24 hours. Main outcome measures: The success rate at 48 hours, induction-to-abortion interval and the side effects. Results: There was no significant difference in the success rate at 48 hours (sublingual: 91%; vaginal: 95%). However, the success rate at 24 hours was significantly higher in the vaginal group (85%) compared with the sublingual group (64%). There was no difference in the median induction-to-abortion interval (sublingual: 13.8 hours; vaginal: 12.0 hours). Significantly more women in the sublingual group preferred the route to which they were assigned when compared with the vaginal group. The incidence of fever was also less in the sublingual group. Conclusion: The use of vaginal misoprostol for second trimester medical abortion resulted in a higher success rate than sublingual misoprostol at 24 hours but the abortion rate was similar at 48 hours. Vaginal misoprostol should be the regimen of choice but sublingual misoprostol is also an effective alternative.