Outcome of First Trimester Induced Abortions Using Misoprostol by Buccal and Vaginal Routes

INTRODUCTION

Abortion is defined as termination of pregnancy up to 20 weeks of gestation or less than 500 grams birth weight.¹ Worldwide more than 1/5th of all pregnancies nearly 53 million are terminated each year of which around 43 million are in developing countries and 10 million are in developed nations. In India the incidence of illegal abortions is high. Most abortion-related deaths are due to illegal abortions. Access to safe abortion services has become a need of the hour. Medication abortion using Misoprostol is safe. The Central Drug Standard Organization, Directorate General of Health has approved a combi pack of medical termination of pregnancy (MTP) kit that includes 1 tablet of Mifepristone (200 mg) and 4 tablets of Misoprostol (200 μg) each for the MTP up to 63 days of gestation or 9 weeks.²

Misoprostol can be given by oral/buccal/vaginal/rectal route etc. The vaginal route of administration of Misoprostol is a commonly used and effective route, but it is uncomfortable for the patients and not accepted by many patients since it requires repeated per vaginal examinations. Other advantages of the buccal route over the vaginal includes its acceptability and less chances of infection, as reported by various studies.^3,4

This study was carried out to study the outcome of first-trimester induced abortion using Misoprostol by buccal and vaginal routes.⁵

MATERIALS AND METHODS

This study was carried out at a Tertiary care center in central India from October 2018 to September 2020, after obtaining permission from the institutional ethical committee. The study design was a prospective observational study. The study included 110 pregnant women based on the inclusion criteria. Every alternate patient was assigned to each group, i.e., vaginal and buccal groups. Informed written consent was obtained from all study subjects after giving information regarding the procedure, the drugs used, the associated side effects, and the failure rate of the procedure.

RESULTS

DISCUSSION

Medication abortion can be safely administered and it requires less assistance than surgical methods and it is preferred by many patients. In our study, the study subjects among both groups were comparable to each other.

In our study, the mean age of study subjects was 27.51 years in the vaginal group and 27.04 years in the buccal group, which is comparable to other studies.^6,7

In our study, maximum study subjects were multiparas, which is comparable to other studies.⁶

In our study, there was no statistically significant difference among the gestational age of study subjects in both the buccal and vaginal groups. This is comparable to other studies.⁷

The time interval between the administration of Misoprostol and the onset of bleeding is considered an induction-abortion interval. The interval was less in the vaginal group as compared to a buccal group and the difference is statistically significant. The results are comparable to the study conducted by Raj and Pradhan⁷ and Nath and Kumar.⁸

The mean induction-abortion interval was 3.72 hours in the vaginal group and 4.02 hours in the buccal group. The difference was statistically not significant. Similar results were observed in the study conducted by Nath and Kumar.⁸

In our study, no statistically significant differences were noted among side effects, except for altered taste in a buccal group. The findings were consistent with studies conducted by Khan et al.⁶ and Nath and Kumar.⁸

The rate of complete abortion was 92.7% in the vaginal group and 91% in a buccal group (p-value = 0.72) showing both routes were equally effective. Similar results were noted in studies conducted by Khan et al.,⁶ Raj and Pradhan⁷ and Nath and Kumar.⁸

In our study, the satisfaction rate was 89% in the vaginal group and 92% in a buccal group. The difference is not significant. The results are comparable to the study conducted by Nath and Kumar.⁸

CONCLUSION

Provision of safe abortion services using medical abortion can help to bring down the rate of illegal and unsafe abortions; especially in developing countries where healthcare facilities are not as easily available as in developed countries.

It can be concluded from our study that, the efficacy of buccal Misoprostol is comparable to vaginal Misoprostol in first trimester MTP up to 63 days of gestation.

ACKNOWLEDGMENT

The authors would like to thank Dr. Sarika Thakare for extending her inputs and guidance throughout the study.

ETHICAL APPROVAL

The authors have obtained prior ethical approval from the institutional ethical committee.

Research Involving Human Participants and/or Animals: This article does not contain any studies with human participants or animals performed by any of the authors.

REFERENCES

1. Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics, 25th edition. p.532. McGraw Hill Education. New York. ISBN: 978-1-259-64432-0.

2. Megh M, FOGSI. Comprehensive abortion care and post abortion contraception, FOGSI focus; 2012. p.15.

3. Middleton T, Schaff E, Fielding SL, et al. Randomized trial of mifepristone and buccal or vaginal misoprostol for abortion through 56 days of last menstrual period. Contraception 2005;72(5):328–332. DOI: 10.1016/j.contraception.2005.05.017.

4. Schaff EA, DiCenzo R, Fielding SL, et al. Comparison of misoprostol plasma concentrations following buccal and sublingual administration. Contraception 2005;71(1):22–25. DOI: 10.1016/j.contraception.2004.06.014.

5. Cunningham FG, Leveno KJ, Bloom SL, et al. Early pregnancy loss. In: Whittle MJ, Rodeck CH (Eds); (2014). W Jauniaux E, Kaminopetros P, El-Rafaey H (1999). Fetal medicine: Basic science and clinical practice. Edinburgh: Churchill Livingstone. p. 837.

6. Khan ZH, Akhter S, Gupta S. Effectiveness of vaginal versus buccal misoprostol for first trimester induced abortions: A comparative study. J Evolution Med Dent Sci 2017;6(59):4363–4366. DOI: 10.14260/Jemds/2017/943.

7. Raj R, Pradhan A. Randomized control study of reduced dose of oral vs vaginal misoprostol with mifepristone for early MTP. Journal of Evolution of Medical and Dental Sciences 2015;4(105):17078–17082. DOI: 10.14260/jemds/2015/2588.

8. Nath AG, Kumar A. On efficacy and acceptability of early medical abortion by mifepristone with oral or vaginal misoprostol. J Evolution Med Dent Sci 2017;6(66):4757–4760. DOI: 10.14260/Jemds/2017/1030.