Clinical Outcomes of Intravaginal Misoprostol Use in Cases with Therapeutic Abortion Indications

INTRODUCTION: This study aimed to evaluate the clinical outcomes of intravaginal misoprostol for therapeutic abortion indications and to determine whether this regimen represents a safe and effective option in routine practice.
METHODS: This prospective observational study included 36 patients (mean age 27.5 ± 6.8 years; mean gestational age 16.3 ± 8.5 weeks) admitted with therapeutic abortion indications. Following baseline ultrasound and pelvic examination with modified Bishop scoring, intravaginal misoprostol was administered every 6 hours: 200 µg for pregnancies ≤20 weeks and 100 µg for >20 weeks, until expulsion. Patients were monitored with 2-hourly vital signs and post-expulsion uterine revision when indicated. Outcomes analyzed included success rates, adverse events, and induction-to-delivery intervals.
RESULTS: The mean age of patients was 27.5 ± 6.8 years, with gestational ages ranging from 7–40 weeks. Most cases (80.6%) occurred at ≤20 weeks. The overall successful abortion rate was 97.2%. Mean induction-to-delivery intervals was significantly shorter at ≤20 weeks (583 ± 437 min) compared to >20 weeks (1183 ± 933 min; p < 0.001). Dose escalation beyond the initial dose occurred in over half of patients in both gestational groups (51.7% at ≤20 weeks and 57.2% at >20 weeks). Only one patient experienced transient diarrhea; no severe complications occurred.
DISCUSSION AND CONCLUSION: Intravaginal misoprostol demonstrates high efficacy and safety for therapeutic abortion across all gestational ages, with appropriate adjustments in dosing. Initial higher doses at ≤20 weeks and cautious dosing escalation beyond 20 weeks appear effective and safe.

Keywords: Misoprostol, Therapeutic abortion, Pregnancy termination, İntravaginal administration, Trimester.