Comparative study of sublingual versus vaginal misoprostol following mifepristone in early first trimester medical termination of pregnancy - a prospective study
B. L Pathak, Shikha Hajong Roy
Aim: To compare the efficacy and side effects of sublingual versus vaginal administration of misoprostol after a single oral dose of 200 mg of mifepristone in termination of early first trimester pregnancy. Methods: This is a randomised prospective study comparing the use of sublingual misoprostol with vaginal misoprostol in combination with mifepristone for termination of pregnancy up to 63 days. A total of 100 women who requested legal termination of pregnancy were randomised into two groups and given 200mg of oral mifepristone followed 48 hours later by either 800 microgram of sublingual (n=50) or vaginal (n=50) misoprostol. Results: Complete abortion occurred in 96% of women in the sublingual group and 94% in the vaginal group. There was no case of ongoing pregnancy or missed abortion. The median duration of bleeding was 14.65 days in sublingual group and 14.96 days in vaginal group. There were no serious complications reported. Fever, chills and gastrointestinal side effects (nausea and diarrhoea) were significantly more common in the sublingual group. Conclusion: The combination of mifepristone and misoprostol is effective for medical abortion up to 63 days of gestation. Both the sublingual and vaginal are effective routes of administration. Further randomised trials are required to find out the optimal dose of sublingual misoprostol that can give the highest complete abortion rate and lower incidence of side effects.