Intravaginal misoprostol versus sublingual misoprostol for second trimester pregnancy termination: A randomized controlled trial

Objective: To compare the efficacy and adverse effects of 400 mcg misoprostol for second trimester pregnancy termination via the intravaginal or sublingual route. Methods: In this study, 170 women at GA 14-28 weeks underwent termination of pregnancy. They were randomized to receive either intravaginal or sublingual 400 mcg misoprostol at 6 hour intervals until fetal expulsion occurred or within 48 hours after the initiation of the first dose of misoprostol. The primary outcomes were median abortion time and percentage of failure. The secondary outcomes included rates of maternal adverse effects, oxytocin use and analgesia requirement. Results: Intravaginal misoprostol demonstrates significantly greater efficacy for pregnancy termination compared to sublingual misoprostol at the same dosage. The median time to abortion was 16.66 hours and 22.88 hours in the intravaginal group and sublingual group respectively. Maternal adverse effects, specifically rate of chill and diarrhea, were statistically higher in the sublingual group. Conclusion: Intravaginal misoprostol was superior to sublingual misoprostol in terms of shorter abortion time and fewer adverse effects. In addition the rate of oxytocin use was found to be higher in the sublingual group. In conclusion misoprostol via the intravaginal route should be considered for second trimester pregnancy termination rather than the sublingual route due to greater efficacy and fewer adverse maternal effects.