Human Reproduction, Vol. 16, No. 2, 393,
February 2001
© 2001 European Society of Human Reproduction and Embryology
Letters to the editor |
Misoprostol regimens for termination of second trimester pregnancy
Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1240 N. Mission Road 8K6, Los Angeles, CA 90033, USA
Dear Sir,
We have read with interest the paper by Wong et al. (2000) comparing two regimens of intravaginal misoprostol for termination of pregnancies at 14–20 weeks gestation. In this study, the authors recommend a regimen of intravaginal misoprostol 400 µg every 3 h in parous women and 400 µg every 6 h in primigravid women for termination of second trimester pregnancy.
The authors comment that they could not be certain if the regimen published by Jain et al. (1996) using 200 µg intravaginal misoprostol every 12 h was effective in terminating second trimester pregnancies with a live fetus. In that study, a lethal intracardiac injection of potassium chloride was administered to the fetus within 4 h of the first dose of misoprostol in order to kill the fetus. It is unlikely that this short interval of fetal death significantly affected the abortion rate of 56.7% by 24 h reported in the study. In a subsequent publication by the same author (Jain et al., 1999
), an abortion rate of 63.4% by 24 h was observed in 71 women pregnant with a live fetus. While this rate is lower than the 73% reported by Wong et al. for the 3 h regimen, it is higher than the 60.8% reported for the 6 h regimen and is associated with fewer side-effects than either of the two regimens.
The practice of killing the fetus prior to commencing misoprostol administration is carried out to preclude mandatory post-natal resuscitation. The birth of an unwanted fetus at the cusp of viability, especially one that is chromosomally or morpohologically abnormal, presents legal, ethical and emotional dilemmas to nursing and medical personnel. I would like to enquire of the authors their policy regarding the management of a live-born fetus. Indeed, sonography may be inaccurate by 10% or more in establishing gestational age and fetal weight thus further complicating the situation.
Notes
1 To whom correspondence should be addessed 
References
Jain, J.K. and Mishell, D.R. (1996) A comparison of misoprostol with and without laminaria tents for induction of second trimester abortion. Am. J. Obstet. Gynecol., 175, 173–177.[Web of Science][Medline]
Jain, J.K., Kuo, J. and Mishell, D.R. (1999) A comparison of two dosing regimens of intravaginal misoprostol for second trimester pregnancy termination. Obstet. Gynecol., 93, 571–575.[Web of Science][Medline]
Wong, K.S., Ngai, C.S.W., Yeo, E.L.K. et al. (2000) A comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy: a randomized comparative trial. Hum. Reprod., 15, 709–712.
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