Koh DSC, et al. - The effectiveness and safety of intravaginal misoprostol 200 μg, 400 μg and gemeprost regimens for second-trimester termination of pregnancy (TOP) were compared in this study. It was concluded that the intravaginal misoprostol 400 μg at 4-hour intervals was the most efficacy regimen but was related to a high incidence of fever. Misoprostol 200 μg showed similar effectiveness as gemeprost and had the lower incidence of diarrhoea. Gemeprost ought not to be the first line for medical therapy given the cost, storage requirements and lower efficacy.

Methods

• For this study, they designed a randomised controlled trial.
• A three-armed randomised controlled trial (Clinical Trial Certificate 1100015) where 116 women undergoing second-trimester TOP were given intravaginal misoprostol 200 μg (n=37), misoprostol 400 μg (n=40) or gemeprost 1 mg (n=39) at 4-hour intervals until abortion occurred with a maximum of five doses.

Results

• In this study, they found the misoprostol 400 μg group had the highest incidence of successful abortions (92.5%) compared to the misoprostol 200 μg (70.3%; p=0.017) and gemeprost 1 mg (74.4%; p=0.037) within 48 hours.
• No significant difference was seen in abortion rate between misoprostol 200 μg and gemeprost.
• The misoprostol 400 μg group had the highest incidence of fever (70.0%) compared to misoprostol 200 μg (24.3%; p<0.001) and gemeprost 1 mg (46.2%; p=0.041).
• The gemeprost group had the highest incidence of diarrhoea (38.5%) compared to misoprostol 400 μg (10.0%; p=0.004) and misoprostol 200 μg (8.1%; p=0.003) groups.