Misoprostol for second and third trimester termination of pregnancy: A review of practice at the Women's and Children's Hospital, Adelaide, Australia

Abstract

Aims: To assess clinical outcomes for women undergoing induction of labour either for fetal anomaly or following intrauterine fetal death using intravaginal misoprostol. Methods: Between January 1999 and December 2002, clinical outcomes for women who were admitted to the delivery suite of the Women's and Children's Hospital, South Australia, were prospectively collected and entered onto a database by the attending midwife. The effect of cumulative dose of misoprostol, indication for induction of labour, parity and gestational age were assessed. Results: One hundred and ninety nine women were admitted during the study period. Women who required in excess of 800 µg of misoprostol were more likely to have side-effects (57/78 women dose > 800 µg misoprostol versus 71/121 women dose ≤ 800 µg, RR 0.80 95% CI 0.66–0.98), in particular diarrhoea (12/78 women dose > 800 µg misoprostol versus 5/121 women dose ≤ 800 µg, RR 0.27 95% CI 0.10–0.73) and elevated temperature (46/78 women dose > 800 µg misoprostol versus 36/121 women dose ≤ 800 µg, RR 0.50 95% CI 0.36–0.70). Women with an intrauterine fetal death (IUFD) were less likely to require in excess of 800 µg of misoprostol to effect the termination (10/56 women IUFD versus 70/143 women fetal anomaly, RR 0.36 95% CI 0.20–0.66), had a shorter induction to birth interval (mean 13.2 h ± 7.5 h, women IUFD versus 21.2 ± 17.5 h, women fetal anomaly, WMD −8.02 95% CI −11.49 to −4.55) and were more likely to give birth within 24 h of the induction process commencing (48/56 women IUFD versus 106/143 women fetal anomaly, RR 1.16 95% CI 1.00–1.34). Conclusions: Side-effects increase with increasing dose of misoprostol. Induction following intrauterine fetal death is associated with a need for lower doses of misoprostol and a shorter induction to birth interval.