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Randomized controlled trial of misoprostol for second-trimester pregnancy termination associated with fetal malformation.

Abstract：

OBJECTIVE:Our purpose was to compare the effectiveness, women's views of the termination procedure, and success of umbilical cord culture for vaginal and oral misoprostol versus intra-amniotic prostaglandin PGF(2alpha) for second-trimester pregnancy termination (STPT). STUDY DESIGN:We randomized 217 women, 15 to 24 weeks' gestation, into 3 groups. Oral (OM) and vaginal (VM) misoprostol groups received 400 microg of misoprostol every 4 hours for 24 hours. The intra-amniotic PGF(2alpha) (IAPG) group received 40 mg of PGF(2alpha) followed by oxytocin infusion. Women completed self-administered questionnaires 3 weeks after the termination procedure. Umbilical cord samples were collected at delivery for karyotype analysis. The primary outcome was the time from start of the procedure to placental delivery. Secondary outcomes were maternal complications, women's acceptance of the termination procedure, and success rates of umbilical cord culture. RESULTS:The time was longer for the OM group (30.5+/-14.4 hours) compared with the VM group (18.3+/-8.2 hours) and the IAPG group (21.1+/-10.2 hours), P<.001 for both comparisons. Women in the VM group reported being more willing to repeat the termination method in the future and reported fewer side effects than those in the other groups, P<.001. Failure rates for umbilical cord cultures were 9.6%, 17.0%, and 45.6% for the VM, OM, and IAPG groups, respectively. CONCLUSION:Oral misoprostol is less effective than intra-amniotic PGF(2alpha) or vaginal misoprostol for STPT. Women report vaginal misoprostol more acceptable than other methods. Umbilical cord culture failure rate is highest in the IAPG group.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Akoury HA,Hannah ME,Chitayat D,Thomas M,Winsor E,Ferris LE,Einarson TR,Seaward PG,Ryan G,Willan AR,Windrim R

doi

10.1016/j.ajog.2003.09.037

subject

Has Abstract

pub_date

2004-03-01 00:00:00

pages

755-62

issue

eissn

0002-9378

issn

1097-6868

pii

S0002937803011864

journal_volume

190

pub_type

临床试验,杂志文章,随机对照试验

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Randomized controlled trial of misoprostol for second-trimester pregnancy termination associated with fetal malformation.