Mifepristone Combined Misoprostol Vaginally For Termination Midtrimester Pregnancy: A Systematic Review

BackgroundInduction of labour in second trimester in pregnancy accounts for 10-15% of induction of labor .At present, intra-amniotic injection of Rivanol is a conventional method in second trimester to terminate pregnancy . It has been widely used at clinical because of the high range of drug safety and high successful rate, but it is an invasive operation, and long hospital stay, postpartum hemorrhagemuch higher residual placental membranes to be conventional curettage, uterine perforation, infection and increased incidence of complications , is not conducive to women's health. Mifepristone (mifepristone, RU486) was developed in 1981, an anti-progesterone and anti-glucocorticoid drug, it plays through the progesterone and glucocorticoid receptors , it can terminate early pregnancy, anti-implantation, induce menstruation and promote cervical ripening, increase the sensitivity of the uterine pregnant uterine for prostaglandins.Since 90 years, mifepristone combined prostaglandin drugs against early pregnancy widely used in clinical practice , several clinical trials found that this combinated method is effective in terminating second trimester of pregnancy . It is difficult to make an objective evaluation because of the lack of randomized comparative clinical study. To compare the clinical efficacy,advantages and disadvantages of mifepristone combined misoprostol vaginally with intra-amniotic injection of rivanol, this study collect all the mifepristone and misoprostol vaginalrivanol trimester termination of intra-amniotic injection of the quality assessment of randomized controlled trials and data analysis, according to Cochrane systematic review methods, misoprostol vaginal administration of mifepristone in the clinical evaluation of efficacy and safety in order to provide the best evidence for clinical applications and further research.ObjectivesTo compare mifepristone/misoprostol vaginally with intra-amniotic injection of ethacridine lactate of ind ucing abortion in the second trimester of pregnancy with regard to efficacy, side effects, adverse events and acceptability.MethodsWe searched the Pub-Med, The Cochrane library, VIP, CNKI, Wanfang, CBM, FMJS, FEBMT to identify randomized controlled trials (RCT)of living preparation of mifepristone/misoprostol versus intra-amniotic injection of ethacridine lactate for the termination of the second trimester pregnancy. The quality of the included trials was assessed. RevMan 5.0.24 software was used to conduct meta-analysis.ResultsTwenty-seven RCTs involving 4976 patients were included.Meta-analysis showed that the combination of mifepristone and misoprostol vaginally comparing with intra-amniotic injection of ethacridine lactate has higher success rate and complete abortion rate, lower incomplete abortion rate, tissue residue rate, dilation and curettage of uterus rate, shorter labor and has shorter time of induced contractions after treatment, medication to the delivery and less hemorrhage, the difference were statistically significant. As to the side effects, Cervico-vaginal injury rate, nausea, vomiting are statistically significant, tonic contractions, diarrhea and fever were not significant.ConclusionsMifepristone and vaginal misoprostol for termination of mid-pregnancy is more efficacy than the intra-amniotic injection of Rivanol ,has lower rate of tissue residues, dilation and curettage of uterus rate, less blood loss, lower rate of Cervico-vaginal injury. It is a safe and effective method of pregnancy termination of mid-term.