Second-trimester uterine evacuation:: A comparison of intra-amniotic (15S)-15-methyl-prostaglandin F2α and intravaginal misoprostol

OBJECTIVE: Our purpose was to compare the efficacy, safety and adverse effects of intra-amniotically administered (15S)-15-methyl-prostaglandin F-2 alpha and intravaginally administered misoprostol for second-trimester uterine evacuation. STUDY DESIGN: Fifty-one patients were randomly assigned to receive either a single 2.5-mg intra-amniotic injection of (15S)-15-methyl-prostaglandin F-2 alpha (n = 26) or two 200-mu g intravaginal doses of misoprostol (n = 25) at 12-hour intervals. The primary outcome measured was evacuation of the uterus within 24 hours. RESULTS: The mean time from initiation of termination to uterine evacuation was less in the prostaglandin group than in the misoprostol group (17.5 +/- 8.6 hours vs 22.3 +/- 12.5 hours), but this was not statistically significant (P > .05). The rate of successful fetal evacuation at 24 hours was significantly higher in the prostaglandin group than in the misoprostol group (88% vs 60%, P = .02). The complete-abortion rate and the incidence of adverse effects were similar in both groups. CONCLUSION: The use of an intra-amniotic injection of (15S)-15-methyl-prostaglandin F-2 alpha for midtrimester pregnancy termination is safe and is associated with a greater number of successful uterine evacuations within 24 hours, without an increase in adverse effects, than intravaginal administration of misoprostol.