Publication:

Use of misoprostol for termination of second and third trimester pregnancy with intrauterine foetal death

Background Prostaglandins (PGs) is an alternative method for induction of labour in women with intrauterine foetal death (IUFD). The vaginal route is advantageous because slow peak levels, sustained for long time and fewer side effects. So this study was aimed to investigate the effectiveness of misoprostol in the induction of labour and abortion in 2nd and 3rd trimester pregnancies associated with IUFD. The objective of the study was to assess the efficacy of misoprostol in fixed dosage schedule for the termination of pregnancy in IUFD and to evaluate induction delivery interval with misoprostol.

Methods A prospective study was conducted in department of Obstetrics & Gynaecology in tertiary care centre. Inclusion criteria included women of II or III trimester of pregnancy with IUFD. Singleton pregnancy with longitudinal lie in non-scarred uterus with confirmed intrauterine fetal death with bishop score <6. Exclusion criteria included multiple pregnancy, lie other than longitudinal, scarred uterus, hypersensitivity to misoprostol, Bishop score more than 6. Permission from IEC and written informed consent was taken before study participation. Complete examination and investigation of patient was done and induction with misoprostol was done as per dosage schedule mentioned by WHO Bellago, Italy (Feb 2007). Patient was intensively monitored intraoperatively and postoperatively. Follow-up was done till 15 days postpartum.

Results Out of 107 cases, majority cases were of 22-28 week gestation. Maximum cases (57%) were of age group 21-25years. Induction succeeded in 92 cases with mean induction delivery interval of 13.2 hours. 50% cases had favorable cervix with mean induction delivery interval 9.4 hours and rest had 16.53 hours ID interval with mean ID interval 13.67hours. Complete exclusion was seen in 92 cases (85.98%) and incomplete in 10 cases which required check curettage. Failure of method was seen in 5 cases (4.67%) which were terminated by alternative methods. Most common side effect was abdominal cramp (9.3%) and nausea (5.6%).

Conclusions Vaginal misoprostol is safe and effective in termination of second and third trimester pregnancy in case of intrauterine fetal death.