Objective: To compare the success rate of second trimester pregnancy termination by sublingual misoprostol with and without loading vaginal misoprostol.

Material and Method: The present study was a prospective, randomized controlled trial. Singleton pregnant women of 14 to 24 weeks of gestation who had indication for pregnancy termination were recruited. After the inform consent was signed, the participants were divided into two groups. The study group received misoprostol 800 μg in vagina followed by sublingual misoprostol 400 μg every three hours. The control group received only sublingual misoprostol 400 μg every three hours. Maximum doses of sublingual misoprostol in both groups were no more than five doses. If the process was not complete, another repeated course of misoprostol 400 μg sublingual every three hours was required.

Results: Fifty participants were recruited. The success rate of pregnancy termination at 24 hours of study and control group were 92% and 64% (p-value 0.037), respectively. The median induction-to-abortion time was 8.17 and 11.33 hours for study and control group (p-value 0.087). There was no difference in side effects and satisfaction between both groups.

Conclusion: Vaginal misoprostol suppository followed by sublingual administration for second trimester termination of pregnancy was more efficient than sublingual administration alone in first 24 hours.

Keywords: Termination of pregnancy, Medical abortion, Misoprostol, Cytotec, Abortion