Main Findings
Based on our study results, when low dose (LD) vaginal misoprostol (as a single method) is used in pregnancy terminations under 34 weeks of gestation, the rate of vaginal delivery without the need for additional termination method is found 91%. This rate is similar to the results obtained in other studies using high-dose vaginal misoprostol or multiple methods (mifepristone, cervical balloon catheter, oxytocin).8, 10-13 In the current study, a very low-dose misoprostol regimen had given according to both the recommendations in the FIGO guideline and the studies published in the literature.5, 8, 10-12 In a previous study presented by Torriente et al., a comparison was made between patients with and without prior C/S history in the second trimester, and the success rate was found to be 88-93%.10 However, in that study, the distribution of gestational weeks (13-20 weeks) was quite different from our study, and high-dose misoprostol (1200-1400 µg) was preferred in both groups.3 In the present study, the rate of delivery below 24 weeks of gestation with the LD vaginal misoprostol regimen (single method) was 94%; it was found 86% above 24 weeks of gestation. Although prior C/S (31.1% vs 22.3%) rate was higher in the group under <24 gestational weeks, the difference was found significantly higher. Cetin et al reported in their study compared the regimen by FIGO with a different LD regimen of misoprostol.11 However, in this study, the gestational week was limited to 12-24, and the effect of pregnancies with and without a history of cesarean section was not compared. In many studies in which the efficacy of misoprostol was discussed, it was stated that this positive effect may be mostly related to dose and dose range.9, 14 Despite the higher a prior history of C/S rate in Gx group, the higher birth rate with the single method may be associated with the use of misoprostol at a higher dose below the 24th gestational week (Gx) than in the other group (Gy).
In the present study, when the group below 24 weeks of gestation (Gx) was compared with 24-34 weeks of gestation (Gy), there was an inverse correlation between total misoprostol dose and total treatment time, time until delivery and hospital stay, and the result was statistically significant. Since higher doses of misoprostol were used in patients without a history of cesarean delivery (G1-G3), both under 24 weeks of gestation and between 24-34 weeks of gestation compared to patients with a history of cesarean section (G2-G4), delivery took place in a shorter time, therefore the hospital stay has also been shortened. Since the most important difference between the regimens administered in our study was the misoprostol dose used, it is inevitable to obtain this result between the groups. However, no significant difference was found in the rates of transfusion need (0.8-2.5%) and admission to MICU (0.4-0.9%) in the groups using higher doses. Upon this result, it shows that it is possible to reach effective treatment with lower doses at all gestational weeks without increasing maternal comorbidity compared to other studies in the literature using higher doses in ToP.2, 9, 14