Mifepristone followed by misoprostol or Ethacridine lactate and oxytocin for second trimester abortion: a RCT

Vatsla Dadhwal (IN), Sita Garimella (IN), Kavita Khoiwal (IN), Aparna Sharma (IN), Perumal Vanamail (IN), Dipika Deka (IN)

[Dadhwal] All India Institute of Medical Sciences, [Garimella] All India Institute of Medical Sciences, [Khoiwal] All India Institute of Medical Sciences, [Sharma] All India Institute of Medical Sciences, [Vanamail] All India Institute of Medical Sciences, [Deka] All India Institute of Medical Sciences

Context – Extraamniotic ethacridine lactate (EEL) and oxytocin infusion has the disadvantage of long induction abortion interval (IAI) and lower success rates compared to mifepristone and misoprostol regimen, for second trimester abortion . Priming with mifepristone may make this method comparable to misoprostol regimen. Thus, giving a method with increased safety of margin in women with uterine scar and grandmultiparas. Objective - compare two methods of second trimester abortion , misoprostol vs EEL and oxytocin after priming with mifepristone Methods – Patients: 120 women undergoing second trimester abortion (13-20 weeks gestation). Women with medical disorders, moderate to severe anemia and uterine scar were excluded. Intervention: All women received mifepristone 200mg and were then randomized to two groups, to receive further treatment after 36 hours. Group A (n=60), received 400 microgram misoprostol vaginally every 3 hours to a maximum of 5 doses . In Group B (n=60), EEL instillation was followed by oxytocin infusion 6 hrs later (upto 100miu/min). Main outcome measures : success rate defined as percentage of abortions within 24 hours of administration of misoprostol or EEL , IAI defined as the time from use of misoprostol or EEL to expulsion of fetus and placenta. Other outcomes compared were side effects; overall patient satisfaction and pain perception on visual analogue scale and blood loss (as determined by difference in pre and post procedure haemoglobin . Results - Mean age of the patients in group A and group B was 29.10+3.5 and 27.45+3.8 years respectively . Mean POG was similar in both the groups ,16.94+1.85 and 16.57+1.79 weeks respectively. Success rate was 100% in group A and 98.3% in group B (p = 0.31), mean IAI was significantly shorter in group A than group B (8.2+2.3 hours & 10.9+2.6 hours respectively; p = 0.001). 96.7% women in group A had some side effect compared to 75% in group B (p=0.001). Haemoglobin fall after procedure was significantly higher in group A (0.70+0.33gm%) than group B (0.52+0.23 gm%) (p= 0.001). Pain perception was significantly lower in group B (p = 0.04) but overall satisfaction with the procedure was similar in both the groups. Conclusion – Regimen of mifepristone with EEL and oxytocin had equal success rate compared to mifepristone and misoprostol. Women who received mifepristone and misoprostol had shorter IAI but more blood loss and side effects.