Volume: 4 Issue: 1
Year: 2016, Page: 3-8,
Introduction: Termination of pregnancy in second trimester is one of the greatest challenges in modern obstetrics practice and is more risky than during first trimester. Now the main concern of the obstetrician is to provide the most effective, safest, and cost effective regimen with least or no complications.
Objectives: To compare the effectiveness and safety of misoprostol alone and its combination with intracervical Foley’s catheter for second trimester termination of pregnancy.
Material and Methods:100 women of 14-28 weeks of pregnancy were enrolled for termination for any indication and were randomized into two groups. Group I (study group): received 200 mcg of misoprostol 6 hourly and intracervical Foley’s catheter. Group II (control group): received only 200 mcg of misoprostol 6 hourly, upto a maximum five doses. The outcomes are measured in terms of success rate of abortion within 48 hours, induction to delivery interval and maternal side effects
Results: The induction to abortion interval was 13.84±5.37 hours in the combined group compared to 22.68±4.82 hours in the misoprostol group (P value<0.001) with success rate of 90% in the combined group and no major complications reported.
Conclusion: Use of intracervical Foley’s catheter improves the efficacy of vaginal misoprostol for termination of midtrimester pregnancy with shorter induction to delivery interval with no significant increase in side effects.
Keywords: Foley’s catheter, misoprostol, second trimester pregnancy termination
1. Lalitkumar S, Bygdeman M, Gemzell-Danielsson K. Midtrimester induced abortion: a review. Hum Reprod Update. 2007; 13(1): 37–52.
2. Champa SJ, Crispens M, Owen J. Complication of midtrimester pregnancy termination: The effect of prior caesarean delivery. Am J Obstet and Gynaecol 1996; 175:889-92.
3. Hackett GA, Reginald P, Paintin DB. Comparison of the Foley’s catheter and dinoprostone for cervical preparation before second trimester abortion. Br J Obstet Gynaecol 1989:96:1432-4.
4. Gemzell-Danielsson K, Lalitkumar S.Second trimester medical abortion with mifepristone-misoprostol and misoprostol alone: a review of methods and management. Reprod Health Matters 2008; 16: 162-172.
5. Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, et al. Risk factors for legal induced abortionrelated mortality in the United States. Obstet Gynecol 2004; 103:729-37.
6. Liu HS, Yu MH, Chang YK, Chu TY. Second and early third trimester pregnancy termination by extra amniotic balloon and intra cervical PGE2. Int J Gynaecol Obstet 1998; 60: 29-34.
7. Yapar EG, Senoz S, Urkutur M, et al: Second trimester pregnancy termination including fetal death: comparison of five different methods. Eur J Obstet Gynecol Reprod Biol. 1996; 69(2): 97–102.
8. Shabana A, Salah H, Kandil M et al. Termination of mid trimester pregnancies: misoprostol versus concurrent weighted Foley catheter and misoprostol. F1000 research 2012; 1:36-40.
9. Lohr PA, Hayes JL, Gemzell-Danielsson K.; Surgical versus medical methods for second trimester induced abortion. Cochrane Database Syst Rev 2008; CD006714.
10. KraliKowski. Extra-Amniotic PGF2a in the termination of pregnancy. S Afr Med J1994;84:321-22.
11. Bozkurt M. Combined oral and vaginal misoprostol use in therapeutic terminations at 14 to 28 weeks of gestation. J Clin med Research2012; 4(9):104-108.
12. Sobia N, Nadra S. Role of Misoprostol for therapeutic termination of pregnancy from 10–28 weeks of gestation. J Pak Med Assoc 2007; 57:129–32.
13. Hamilton J. Historical Review of British Obstetrics and Gynaecology. Edinburgh and London: E &S Livingston Ltd; 1954;1800-950.
14. Embrey MP, Mollison BG. The unfavourable cervix and induction of labour using a cervical balloon. J Obstet Gynaecol Br Commonw 1967; 74:44-8.
15. Imran F, Anser A, Danish N, Fatima N. Misoprostol for the purpose of mid trimester termination of pregnancy: A comparative study with prostaglandin F2 alpha. J Ayub Med Coll Abbotabad 2010; 22: 87-91.
16. Ezimokhai M, Nwabinelli JN. The use of Foley’s catheter in ripening of unfavourable cervix prior to induction of labour. Br J Obstet Gynaecol.1980; 87:281-6.
17. Newmann SJ, Dalve-Endres A, Diedrich JT, et al. Cervical preparation for second trimester dilation and evacuation. Cochrane Database Syst Rev. 2010; (8): CD007310.
18. Bo8yd PA, Tondi F, Hicks NR, Chamberlain PF. Autopsy after termination of pregnancy for fetal anomaly: retrospective cohort study. BMJ.2004; 328: 137.
19. Hamoda H, Ashok PW, Flett GM, Templeton A. A randomized trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion at 13-20 weeks gestation. Hum Reprod. 2005; 20: 2348-2354.
20. Ashok PW, Templeton A, Wagaarachchi PT, Flett GM. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception. 2004; 69: 51- 58.
21. Kunwar S, Saha PK, Goel P, Huria A, Tandon R, et al. Second trimester pregnancy termination with 400 µg vaginal misoprostol: efficacy and safety. Biosci Trends2010;4: 351- 354.
22. Rezk M A, Abo-Elnasr M , Al-Halaby A. Combined use of intracervical foley catheter and vaginal misoprostol for termination of second trimester pregnancy: Clinical Obst, Gyn and Reprod Med,2015; Volume 1(3): 79-83.
23. Thomas IL, Chenoweth JN, Tronc GN .Preparations for induction of labour of the unfavorable cervix with Foley catheter compared with vaginal prostaglandin. Aust N Z J Obstet Gynaecol. 1986; 26(1): 30–5.
24. St Onge RD, Conners GT. Preinduction cervical ripening: A comparison of intracervical prostaglandin E2 gel versus the Foley catheter. Am J ObstetGynecol. 1995; 172(2 Pt 1): 687–90.
25. Kierce MJ, Thiery M, Parewijck W, et al. Chronic stimulation of uterine prostaglandin synthesis during cervical ripening before the onset of labor. Prostaglandins. 1983; 25(5): 671–82.
26. A Koury HA, Hannch ME, Chitayat D, Thoma M, Winson E, Feoois LE, et al. Randomized controlled trial of misoprostol for second-trimester pregnancy termination associated with fetal malformation. Am J Obstet Gynecol. 2004; 190; 755–62.
27. Kooper K,Smith NC,Henshaw RC, El-Rafaey H. Templeton A. Medical Management of miscarriage: non- surgical uterine evacuation of incomplete and inevitable spontaneous abortion. BMJ .1993; 306:894–5.
28. Ghorab MNM, El Helw BA. Second trimester termination of pregnancy by extra amniotic prostaglandin F 2 with intracervical misoprostol: A comparative study. Acta Obstet Gynaecol Scand. 1998; 77; 429-32.
29. Toptas T, Mendilcioglu I, Simsek M, Taskin O. Intravaginal misoprostol alone versus intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination: an observational study. Ginekol Pol.2014; 85: 577-581.
30. Rezk MA, Sanad Z, Dawood R, Emarh M, Masood A. Comparison of intravaginal misoprostol and intracervical Foley catheter alone or in combination for termination of second trimester pregnancy. J Matern Fetal Neonatal Med. 2015; 28: 93-96.
31. Gómez Ponce de León R, Wing DA.Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy - a systematic review. Contraception 2009; 79(4): 259–71.
32. Ashok PW, Penny GC, Flett GM, et al. An effective regimen for early medical abortion: a report of 2000 consecutive cases. Hum Reprod. 1998; 13(10): 2962–5.
Subha, Sarojini, Ipsita, Vivekanand,Ranjan. Comparison of intravaginal misoprostol alone and in combination with intracervical Foley’s catheter for termination of second trimester pregnancy - 3 years study at a tertiary care hospital. Perspectives in medical research 2016;4:1:3-8.