A randomized trial comparing oral misoprostol with intra-amniotic prostaglandin F2alpha for second trimester terminations

OBJECTIVE

To compare the efficacy of oral misoprostol with that of intra-amniotic prostaglandin F2alpha (PGF2alpha) for second trimester pregnancy termination.

METHODS

One hundred seventeen women with pregnancies of between 16 and 22 weeks' gestation were randomly assigned after insertion of laminaria to receive either oral misoprostol 400 microg every 4 hours (to a maximum of four doses) or intra-amniotic PGF2alpha 40 mg. The rate of complete abortion within 24 hours was the primary outcome for power analysis. Secondary outcome measures were the rate of dilatation and curettage (D&C) for retained placenta and the rates of fever and gastrointestinal complications.

RESULTS

Patient characteristics were similar in both groups. The rate of complete abortion within 24 hours was similar in the misoprostol (63%) and PGF2alpha (66%) groups. The rate of retained placenta requiring D&C was significantly greater in the PGF2alpha group (22.4% vs. 3.4%, P = 0.002). There were no differences in other maternal morbidities. Parous patients treated with oral misoprostol had a significantly greater rate of complete abortion than nulliparous patients (84% vs. 57%, P = 0.04).

CONCLUSIONS

Oral misoprostol is as effective as intra-amniotic PGF2alpha for second trimester pregnancy termination when laminaria is inserted before treatment. Parous patients have a higher success rate than nulliparous patients with use of oral misoprostol. Oral misoprostol is associated with a very low rate of placental retention.

Fertility in zebu cattle (Bos indicus) after prostaglandin administration and artificial insemination

A total of 137 cycling zebu cows, each receiving a single dose of prostaglandin PGF(2alpha)were used in an oestrus synchronization programme on three different farms. Of the cows on the three farms, 60.6 and 90.5% showed overt oestrus and luteolysis, respectively. Pregnancy rate to fixed time inseminations following single injection of PGF(2alpha)was 61.4% for farm 1, significantly higher than the values of 45.7 and 46.9% for farms 2 and 3, respectively. The pregnancy rates to second service of rebred cows were 53.3, 50.0 and 50.0% for the three farms, respectively, with no significant differences between each. Fertility classification of the cows based on progesterone (P(4)) concentration showed that 6.6% of cows on the three farms were incorrectly diagnosed as having corpora lutea; 2.9% of them had incomplete luteolysis and 5.1% may have lost their embryos between days 21 and 45 post-insemination. The pregnancy rate was 10% higher in the rainy season than in the dry season. Cows with body condition scores of 3 and 4 had a higher overall pregnancy rates than those with a body condition score of 2. The findings of this study further confirm the luteolytic efficacy of prostaglandin in inducing oestrus in zebu cattle and indicate that the nutritional status of the cows must be satisfactory before embarking on oestrus synchronization programmes.

Termination of early pregnancy by two regimens of mifepristone with misoprostol and mifepristone with PG05--a multicentre randomized clinical trial in China

A multicentre randomized open clinical trial was conducted to compare the efficacy and side effects of two regimens of mifepristone with misoprostol, and mifepristone with PG05 for termination of early pregnancy (amenorrhoea < = 49 days). Six-hundred women in early pregnancy, who requested medical abortion were randomly allocated into 3 groups. In group 1 (n = 301), an initial dose of mifepristone 50 mg was given, followed by 25 mg every 12 hours up to a total dose of 150 mg mifepristone, plus a single oral dose of misoprostol 600 micrograms in the morning of the third day. In group 2 (n = 150), the same regimen of mifepristone was given, but dl-15-methyl PGF2 alpha (PG05) 1 mg vaginal suppository was inserted on the third day. In group 3 (n = 149), a single dose of mifepristone 200 mg was given and misoprostol 600 micrograms was used as in group 1. The complete abortion rate were 94.4%, 97.3%, and 94.6% for group 1, 2 and 3, respectively. 3.0, 2.0 and 2.7% of women had incomplete abortion, and 1.7, 0.7 and 2.0% of women in the 3 groups were treatment failures; in the remaining 1% in group 1 and 0.7% in group 3, treatment outcome could not be determined. There were no significant differences among the 3 groups. Lower abdominal pain was the main complaint which was reported by 82% of the subjects after PGs administration. The incidence of diarrhoea in PG05 group (38.7%) was significantly higher than that in the other two groups (21.6 and 20.1%) (P < 0.001), and so was vomiting. It was concluded that misoprostol, as an orally effective prostaglandin, in combination with mifepristone for induced abortion of early pregnancy was as effective as PG05 vaginal suppository. Besides, it has advantages of convenience of use, less side effects, easy storage and transfer, and low cost.