Abstract
The objectives of this prospective non-concurrent cohort study were to confirm the
efficacy of vaginal misoprostol for early pregnancy termination and to determine whether
the incidence of side effects is lower with prophylactic loperamide and acetaminophen.
Two-hundred women with an intrauterine pregnancy ≤56 days gestational age seeking
medical pregnancy termination in an ambulatory research clinic were enrolled in the
study. One-hundred participants (group 1) ingested 4 mg of loperamide and 500 mg of
acetaminophen before the vaginal placement of 800 μg of misoprostol moistened with
2 mL of saline. If abortion had not occurred, the same regimen was repeated every
24 h (maximum three doses). One-hundred participants (group 2) from the same clinic
who previously underwent the same misoprostol regimen without prophylactic medication
served as a control group for comparison with respect to abortion success and the
incidence of side effects. The rate of successful abortion was not statistically significantly
different between the two groups (group 1 93%, group 2 89%). The incidence of opiate
analgesic use was significantly less in group 1 (4%) compared with group 2 (16%) (OR
0.22, 95% CI 0.06–0.73, p = 0.01). There was a significantly lower incidence of diarrhea
in group 1 (23%) compared with group 2 (44%) (OR 0.38, 95% CI 0.20–0.73, p = 0.003).
There was no difference in the incidence of fever/chills or the incidence of emesis
between the two groups. Vaginal misoprostol is effective for termination of pregnancy
≤56 days and the incidence of diarrhea and the use of opiate analgesia is significantly
reduced with prophylactic loperamide and acetaminophen.
Keywords
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© 2001 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
