A comparative study of successful abortion rate of mifepristone –misoprostol combination versus extra amniotic ethacridine lactate – misoprostol for termination of second trimester pregnancy at tertiary health care center

Abstract               Background: Mid-trimester abortion constitutes 10–15% of all induced abortions but is responsible for two-thirds of all major complications. There is a gradual increase in second trimester abortions because of the wide-scale introduction of prenatal screening programs detecting women whose pregnancies are complicated by serious fetal abnormalities. Aims and Objectives: To study successful abortion rate of mifepristone –Misoprostol combination versus exrtaamniotic ethacridine lactate–misoprostol for termination of second trimester pregnancy at tertiary health care center. Methodology: This was a cross-sectional study carried out in the department of OBGY during the one-year period i.e. January 2017 to January 2018 in the patients who needed medical termination of pregnancy in the second trimester of pregnancy. During the one year period there were 60 patients with written explained consent were given exrtaamniotic ethacridine (Group E) mifepristone –Misoprostol (Group M) randomly. Abortion interval (Hrs.) and Outcome etc. were noted. The statistical analysis was done by chi-square test and calculated by SPSS 19 version software. Result: In our study we have seen that the Abortion interval (Hrs.)- <12 were 6.67% and 26.67%; 12-18 were 43.33% and 66.67%; 18-24 were 50.00% and 6.67% respectively in Group M and Group E . The complete Outcome of Abortion 80.00% and 90.00% ; Incomplete was 20.00% and 10.00% respectively in Group M and Group E this was comparable with each other (X2=1.17, df=1, p<0.27). Conclusion: It can be concluded from our study that mifepristone –Misoprostol was superior to exrtaamniotic ethacridine lactate – misoprostol with respect to less induction to Abortion interval but the outcome in terms of success full abortion was comparable in both of them.

Key Word: mifepristone –Misoprostol, exrtaamniotic ethacridine lactate– misoprostol, MTP, Second trimester abortion.

INTRODUCTION

Mid-trimester abortion constitutes 10–15 % of all induced abortions but is responsible for two-thirds of all major complications. There is a gradual increase in second trimester abortions because of the wide-scale introduction of prenatal screening programs detecting women whose pregnancies are complicated by serious fetal abnormalities. During the last decade, medical methods for mid-trimester induced abortions have shown a considerable development and have become safe and more accessible. Misoprostol has emerged as a critical component of these regimens both as a stand-alone method and in combination with other medications like mifepristone. The combination of mifepristone and misoprostol is the most effective and fastest regimen¹. However, mifepristone is not widely available and is expensive. Misoprostol is being more widely used because it is inexpensive and stable at room temperature. It can be absorbed via oral, vaginal, sublingual, buccal, and rectal routes. Initially, misoprostol was used orally for medical abortion. Many clinical trials have found vaginal administration to be more effective than oral administration². There has been suggestive evidence showing that absorption through vaginal route is inconsistent³. Recently, the use of sublingual misoprostol has been explored for medical abortion. A pharmacokinetic study has demonstrated that sublingual administration could achieve the peak concentration in the shortest time and has the highest bioavailability⁴. Previous studies have shown that sublingual misoprostol is effective in first trimester medical abortion^5,6. A pilot study has demonstrated that it was feasible for second trimester medical abortion⁷ So, we have studied abortion rate of mifepristone–Misoprostol combination versus exrtaamniotic ethacridine lactate–misoprostol for termination of second trimester pregnancy at tertiary health care center.

METHODOLOGY

This was a cross-sectional study carried out in the department of OBGY during the one year period i.e. January 2017 to January 2018 in the patients who needed medical termination of pregnancy in the second trimester of pregnancy. During the one year period there were 60 patients with written explained consent were given exrtaamniotic ethacridine (Group E) mifepristone –Misoprostol (Group M) randomly. Abortion interval (Hrs.) and Outcome etc. were noted. The statistical analysis was done by chi-square test and calculated by SPSS 19 version software.

RESULT

Table 1: Distribution of the patients as per the Induction to abortion interval

(X²=15.03, df=2, p<0.005)

The Abortion interval (Hrs.)- <12 were 6.67% and 26.67%; 12-18 were 43.33% and 66.67%; 18-24 were 50.00% and 6.67% respectively in Group M and Group E

Table 2: Distribution of the patients as Abortion outcome

   (X²=1.17, df=1, p<0.27)

The complete Outcome of Abortion 80.00% and 90.00%; Incomplete was 20.00% and 10.00% respectively in Group M and Group E this was comparable with each other (X²=1.17, df=1, p<0.27)

DISCUSSION

Termination of pregnancy during mid trimester is among the most controversial areas of gynecological practice.^13,14 It has moral, emotional, social and technical issues.^13,14 Many medical and surgical methods have been tried for 2nd trimester MTP with varying success and induction abortion interval.¹⁵ Reasons for termination are fetal demise, fetal anomalies, failure of contraception, determination of genetic and metabolic disorders, to safeguard maternal health.^15-17 A combination of mifepristone, and misoprostol is effective for medical abortion in second trimester. Pretreatment with mifepristone adds to the efficacy of misoprostol as an abortifacient.³ A combination of Mifepristone, a progesterone antagonist, and Misoprostol, a synthetic prostaglandin E1 analogue, is effective for medical abortion in second trimester. Pre-treatment with Mifepristone adds to the effectiveness of Misoprostol as an abortifacient.3 Cohen first described the use of Ethacridine lactate for second trimester abortion by extraamniotic route in 1946, since then it has been extensively used for midtrimester MTP.¹⁶ In our study we have seen that The Abortion interval (Hrs.)- <12 were 6.67% and 26.67%; 12-18 were 43.33% and 66.67%; 18-24 were 50.00% and 6.67% respectively in Group M and Group E . The complete Outcome of Abortion 80.00% and 90.00% ; Incomplete was 20.00% and 10.00% respectively in Group M and Group E this was comparable with each other (X²=1.17, df=1, p<0.27). These findings are similarto Hemavathi. G et al ¹⁸ they found that In the present study the mean induction abortion interval for group 1 was 19.56±1.82 hours and group 2 was 14.13±2.72 hours. This was statistically significant. Of the 40 cases in each group, 37 had complete abortion i.e. 92.5% 3 cases (7.5%) from both the groups had incomplete abortion and was supplemented with check curettage in both groups.

CONCLUSION

It can be concluded from our study that mifepristone –Misoprostol was superior to exrtaamniotic ethacridine lactate–misoprostol with respect to less induction to Abortion interval but the outcome in terms of success full abortion was comparable in both of them.

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