Comparison of two methods of late termination of pregnancy for fetal anomalies
Urška Gruden, Barbara Šajina-Stritar, Nataša Vrhkar, Nataša Tul-Mandić Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia - firstname.lastname@example.org
Objective: To compare results of intra-amniotic injection of carboprost (IA method) with mifepristone-misoprostol oral/vaginal application (MI-MI method) for termination of pregnancy (TOP) for fetal anomalies after 22 weeks. Methods: We collected data from women requiring TOP after 22w for fetal anomalies from January 2011 to December 2012. After the maternal request and ethical committee approval, feticide was performed followed by IA injection of carboprost 4 ml or by application of mifepristone 200 mg orally and misoprostol vaginally 24-36 hours later. Mifepristone was optional. The first dose of misoprostol was 100 mcg vaginally, continued every 3 hours bucally with rising doses 100-400 mcg until labour started. We collected data about gestational age, parity, average time from beginning of procedure to labour and need for surgical evacuation of the placenta after TOP. We analyzed data using the statistical program SPSS. Results: We included 74 women, 24 in the IA group and 50 in the MI-MI group. Mean gestational age was 26w 2/7 (22w 1/7 -36w 2/7). Mifepristone was administered to 29 of 50 women in the MI-MI group TOP was successful in 24 (100 %) cases after IA and in 49 (98 %) cases after MI-MI. The average time from beginning of TOP procedure until labour was 24.8 hours in IA group and 17.4 hours after misoprostol application in the MI-MI group. Surgical evacuation of the uterus was done in 15 cases (65.2 %) in IA group and 13 cases (26 %) in the MI-MI group. In cases where mifepristone was combined with misoprostol the time interval from administration of vaginal misoprostol to labour was 5.5 hours, shorter than in cases where only misoprostol was used. Conclusions: Both methods are safe and effective, but the MI-MI method has more advantages. These are non-invasiveness, less surgical intervention for retained placenta, shorter interval from beginning of procedure to labour and lower costs.