Abo Bakr Abbas Mitwaly - Department of Obstetrics and Gynecology, Faculty of Medicine-Assiut University, Assiut, Egypt.
Ahmed Mohamed Abbas - Department of Obstetrics and Gynecology, Faculty of Medicine-Assiut University, Assiut, Egypt.
Mohamed Sayed Abdellah - Department of Obstetrics and Gynecology, Faculty of Medicine-Assiut University, Assiut, Egypt.

Background: Termination of pregnancy in the second trimester using prostaglandins has been shown to be safe and effective. Misoprostol has multipleroutes of administration; oral, vaginal, buccal, rectal and sublingual. Objective: The study aims to compare the efficacy and safety of intrauterine extraamnioticand vaginal misoprostol in a dose of 200 microgram every 4 hours for the termination of pregnancy in cases of second trimester miscarriage. Materials and Methods: A prospective randomized open labeled clinical trial included 180 women with missed miscarriage in gestational age between 13 and 24wks. Patients were randomized to receive subsequent doses of 200 μg misoprostol every 4 hrs either intra uterine extra-amniotic by Foley catheter or vaginallyadministered. Randomization was completed using a computer-generated random table. The primary outcome of this study was the mean duration from the initialmisoprostol dose until complete fetal expulsion (induction-expulsion interval).Results: The mean gestational age was 17.74 wks. The mean time to complete miscarriage in the intra uterine extra-amniotic group was 5.27 hrs, which wassignificantly lower than the vaginal group (9.92 hrs, p=0.001). Side effects were more common in vaginal group. Conclusion: Intra uterine extra-amniotic misoprostol with a dose of 200 μg every 4 hrs appears to be more effective and safer than vaginal misoprostol in induction of second trimester miscarriage.

Misoprostol, Missed miscarriage, Termination of pregnancy, Prostaglandins