Efficacy and Safety of Moistened versus Dry Misoprostol for Mid-trimester Pregnancy Termination: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 BIXue-han ¹ , WANGJing ¹ , YUYang ² , DUNWang-qing ² , WUHao-sen ² , WUCai-liang ³ , YANGYong-xiu ¹

1. Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Lanzhou 730000, China;
2. School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China;
3. The First Clinical Medicine School of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

Keywords：

Abortion; Misoprostol; Moistened tablet; Dry tablet; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160143

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the efficacy and safety of moistened versus dry misoprostol for mid-trimester pregnancy termination. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 11, 2015), Web of Science, WanFang Data, CBM and CNKI were searched to collect randomized controlled trials (RCTs) about misoprostol for mid-trimester pregnancy termination from inception to Nov. 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Five RCTs involving 742 patients were included. The results of meta-analysis showed that, compared with dry tablet, moistened tablet could reduce induction-abortion interval (MD=-0.41, 95% CI-0.75 to-0.08, P=0.02), while there were no significant differences between two groups in completely abortion within 24 hours or 48 hours, nausea, vomiting, chill, fever, diarrhea, retained placenta, blood loss and total dose of misoprostol. Conclusion Current evidence shows that, compared with the dry misoprostol, the moistened misoprostol for treating mid-trimester pregnancy termination could reduce the induction-abortion interval without increasing adverse reactions. Due to the limited quality of quantity of included studies, more high-quality and large-scale RCTs are needed to prove the above conclusion.

Citation： BIXue-han, WANGJing, YUYang, DUNWang-qing, WUHao-sen, WUCai-liang, YANGYong-xiu. Efficacy and Safety of Moistened versus Dry Misoprostol for Mid-trimester Pregnancy Termination: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2016, 16(8): 926-932. doi: 10.7507/1672-2531.20160143 Copy

1.	Sedgh G, Singh S, Shah IH, et al. Induced abortion:incidence and trends worldwide from 1995 to 2008. Lancet, 2012, 379(9816):625-632.
2.	Hammond C. Recent advances in second-trimester abortion:an evidence-based review. Am J Obstet Gynecol, 2009, 200(4):347-356.
3.	Yilmaz B, Kelekci S, Ertas IE, et al. Randomized comparison of second trimester pregnancy termination utilizing saline moistened or dry misoprostol. Arch Gynecol Obstet, 2007, 276(5):511-516.
4.	Pongsatha S, Tongsong T. Randomized comparison of dry tablet insertion versus gel form of vaginal misoprostol for second trimester pregnancy termination. J Obstet Gynaecol Res, 2008, 34(2):199-203.
5.	Bhattacharjee N, Saha SP, Ganguly RP, et al. A randomized comparative study on vaginal administration of acetic acidmoistened versus dry misoprostol for mid-trimester pregnancy termination. Arch Gynecol Obstet, 2012, 285(2):311-316.
6.	方侠.维生素C溶液湿化米索前列醇终止14~20周妊娠的临床观察.中国计划生育学杂志, 2010, 18(11):679-680.
7.	徐阳, 左文莉, 吴北生.米非司酮加米索前列醇干湿片剂用于中期引产.中国生育健康杂志, 2007, 18(6):336-339.
8.	Ho P C. I149 clinical use of misoprostol in gynaecology. International Journal of Gynecology & Obstetrics, 119(Suppl 3):S197.
9.	Higgins JP, Thompson SG. Quantifying heterogeneity in a metaanalysis. Stat Med, 2002, 21(11):1539-1558.
10.	李萃萃, 李向莲, 李幼平, 等.我国示范乡镇卫生院基本药物循证评价与遴选之二十:人工流产.中国循证医学杂志, 2012, 12(8): 1024-1029.
11.	Crane JM, Delaney T, Hutchens D. Oral misoprostol for premature rupture of membranes at term. Am J Obstet Gynecol, 2003, 189(3): 720-724.
12.	Oppegaard KS, Lieng M, Berg A, et al. A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women:a randomised controlled trial. BJOG, 2010, 117(1):53-61.
13.	Votipka JR. Misoprostol for cervical ripening and labor induction. J Fam Pract, 1997, 45(1):20.
14.	Alfirevic Z, Keeney E, Dowswell T, et al. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG, 2016.
15.	Tang OS, Schweer H, Seyberth HW, et al. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod, 2002, 17(2):332-336.
16.	胡丽芬, 蔡王英.不同给药途径应用米索前列醇在无痛人工流产术中的效果比较.中国妇幼保健, 2015, 30(07):1071-1073.
17.	Lee VCY, Yung SSF, Li RHW, et al. A randomized comparison of pharmacokinetics of a single vaginal dose of dry misoprostol or misoprostol moistened with normal saline or with acetic acid. Hum Reprod, 2011, 26(11):2981-2987.
18.	侯淑萍, 程利南.国产米索前列醇不同给药途径的血药浓度变化研究.中国计划生育学杂志, 2010, 18(12):736-739.
19.	Creinin MD, Carbonell JL, Schwartz JL, et al. A randomized trial of the effect of moistening misoprostol before vaginal administration when used with methotrexate for abortion. Contraception, 1999, 59(1):11-16.
20.	Gilles JM, Creinin MD, Barnhart K, et al. A randomized trial of saline solution-moistened misoprostol versus dry misoprostol for firsttrimester pregnancy failure. Am J Obstet Gynecol, 2004, 190(2):389-394.
21.	Sanchez-Ramos L, Danner CJ, Delke I, et al. The effect of tablet moistening on labor induction with intravaginal misoprostol:a randomized trial. Obstet Gynecol, 2002, 99(6):1080-1084.
22.	Geller PA, Klier CM, Neugebauer R. Anxiety disorders following miscarriage. J Clin Psychiatry, 2001, 62(6):432-438.
23.	Klier CM, Geller PA, Neugebauer R. Minor depressive disorder in the context of miscarriage. J Affect Disord, 2000, 59(1):13-21.
24.	Nansel TR, Doyle F, Frederick MM, et al. Quality of life in women undergoing medical treatment for early pregnancy failure. J Obstet Gynecol Neonatal Nurs, 2005, 34(4):473-481.

1. Sedgh G, Singh S, Shah IH, et al. Induced abortion:incidence and trends worldwide from 1995 to 2008. Lancet, 2012, 379(9816):625-632.
2. Hammond C. Recent advances in second-trimester abortion:an evidence-based review. Am J Obstet Gynecol, 2009, 200(4):347-356.
3. Yilmaz B, Kelekci S, Ertas IE, et al. Randomized comparison of second trimester pregnancy termination utilizing saline moistened or dry misoprostol. Arch Gynecol Obstet, 2007, 276(5):511-516.
4. Pongsatha S, Tongsong T. Randomized comparison of dry tablet insertion versus gel form of vaginal misoprostol for second trimester pregnancy termination. J Obstet Gynaecol Res, 2008, 34(2):199-203.
5. Bhattacharjee N, Saha SP, Ganguly RP, et al. A randomized comparative study on vaginal administration of acetic acidmoistened versus dry misoprostol for mid-trimester pregnancy termination. Arch Gynecol Obstet, 2012, 285(2):311-316.
6. 方侠.维生素C溶液湿化米索前列醇终止14~20周妊娠的临床观察.中国计划生育学杂志, 2010, 18(11):679-680.
7. 徐阳, 左文莉, 吴北生.米非司酮加米索前列醇干湿片剂用于中期引产.中国生育健康杂志, 2007, 18(6):336-339.
8. Ho P C. I149 clinical use of misoprostol in gynaecology. International Journal of Gynecology & Obstetrics, 119(Suppl 3):S197.
9. Higgins JP, Thompson SG. Quantifying heterogeneity in a metaanalysis. Stat Med, 2002, 21(11):1539-1558.
10. 李萃萃, 李向莲, 李幼平, 等.我国示范乡镇卫生院基本药物循证评价与遴选之二十:人工流产.中国循证医学杂志, 2012, 12(8): 1024-1029.
11. Crane JM, Delaney T, Hutchens D. Oral misoprostol for premature rupture of membranes at term. Am J Obstet Gynecol, 2003, 189(3): 720-724.
12. Oppegaard KS, Lieng M, Berg A, et al. A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women:a randomised controlled trial. BJOG, 2010, 117(1):53-61.
13. Votipka JR. Misoprostol for cervical ripening and labor induction. J Fam Pract, 1997, 45(1):20.
14. Alfirevic Z, Keeney E, Dowswell T, et al. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG, 2016.
15. Tang OS, Schweer H, Seyberth HW, et al. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod, 2002, 17(2):332-336.
16. 胡丽芬, 蔡王英.不同给药途径应用米索前列醇在无痛人工流产术中的效果比较.中国妇幼保健, 2015, 30(07):1071-1073.
17. Lee VCY, Yung SSF, Li RHW, et al. A randomized comparison of pharmacokinetics of a single vaginal dose of dry misoprostol or misoprostol moistened with normal saline or with acetic acid. Hum Reprod, 2011, 26(11):2981-2987.
18. 侯淑萍, 程利南.国产米索前列醇不同给药途径的血药浓度变化研究.中国计划生育学杂志, 2010, 18(12):736-739.
19. Creinin MD, Carbonell JL, Schwartz JL, et al. A randomized trial of the effect of moistening misoprostol before vaginal administration when used with methotrexate for abortion. Contraception, 1999, 59(1):11-16.
20. Gilles JM, Creinin MD, Barnhart K, et al. A randomized trial of saline solution-moistened misoprostol versus dry misoprostol for firsttrimester pregnancy failure. Am J Obstet Gynecol, 2004, 190(2):389-394.
21. Sanchez-Ramos L, Danner CJ, Delke I, et al. The effect of tablet moistening on labor induction with intravaginal misoprostol:a randomized trial. Obstet Gynecol, 2002, 99(6):1080-1084.
22. Geller PA, Klier CM, Neugebauer R. Anxiety disorders following miscarriage. J Clin Psychiatry, 2001, 62(6):432-438.
23. Klier CM, Geller PA, Neugebauer R. Minor depressive disorder in the context of miscarriage. J Affect Disord, 2000, 59(1):13-21.
24. Nansel TR, Doyle F, Frederick MM, et al. Quality of life in women undergoing medical treatment for early pregnancy failure. J Obstet Gynecol Neonatal Nurs, 2005, 34(4):473-481.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Moistened versus Dry Misoprostol for Mid-trimester Pregnancy Termination: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content