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Effect of Oral Misoprostol After Second-Trimester Delivery: A Randomized, Blinded Study

From the Department of Obstetrics and Gynecology, Arnold Palmer Hospital for Children and Women, Orlando, Florida.

Address reprint requests to: S. J. Carlan, MD, Orlando Regional Healthcare, Department of Obstetrics and Gynecology, 105 West Miller Street, Orlando, FL 32806; E-mail: scarlan{at}orhs.org.

OBJECTIVE: To determine whether serial oral misoprostol shortens the third stage of labor in second-trimester pregnancy loss.

METHODS: This was a randomized, double-blind, placebo-controlled study of women between 13 and 28 weeks’ gestation admitted for spontaneous or induced pregnancy termination. Subjects were randomized to receive either misoprostol (200 µg) or placebo orally every hour for a maximum of three doses if the placenta had not delivered spontaneously within 10 minutes of the fetus. A dilute oxytocin infusion was given to women in both groups. The patients were managed expectantly until intervention was required or up to 6 hours when curettage was scheduled.

RESULTS: One hundred eighteen women were randomized to misoprostol and 119 randomized to placebo. Fifty-eight (49%) and 55 (46%) of the misoprostol and placebo groups, respectively, did not receive their medication (P = .65, ² test). There was no difference between the groups with regard to demographic features, method of pregnancy termination, or gestational age. Sixty-seven (57%) and 62 (52%) of the misoprostol and placebo groups, respectively, completed the third stage of labor within 2 hours (P = .47, ² test). There was no statistically significant difference in the median time from fetus to placenta (60 versus 91 minutes in the misoprostol versus placebo group, P = .57, Mann-Whitney U test). There was no difference between the groups in the incidence of hemorrhage, need for transfusion, or curettage rate.

CONCLUSION: The therapeutic use of oral misoprostol in the third stage of labor in second-trimester pregnancy loss does not reduce the time to complete spontaneous placental delivery.