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