الفهرس 
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Abstract
Second trimester termination of pregnancy is stressful for both patients and physicians with potential morbidity and mortality. Medical management has been shown to be both successful and desirable. Misoprostol is now commonly used as a non-surgical treatment for second trimester terminations, but it is unclear that what are the most effective route of administration and most appropriate dose of misoprostol.
Misoprostol, a synthetic analogue of prostaglandin E1 that can be administered through various routes including oral, vaginal, rectal and sublingual routes. Misoprostol acts by one of two mechanisms to reduce blood loss. First, like prostaglandins, prostaglandin analogues increase myometrial contractions. This increase in contraction is the effect of prostaglandins on vascular structures, which stem from both uterine artery and utero-ovarian anastomosis and supply blood to leiomyoma. Through this effect, vascular structures are contracted and blood flow is reduced the second mechanism may be the direct vasoconstrictive impact of misoprostol on uterine arteries.
This prospective randomized controlled trial was conducted at Ain Shams University Maternity Hospital to compare between sublingual and vaginal misoprostol in second trimesteric termination of pregnancy regarding the rate of complete abortion in 24 and 48 hours from administration of the medication, induction-to-abortion time, need for oxytocin, need for surgical evacuation, overall satisfaction and adverse outcome. A total of 110 women were included and divided into two groups, group A sublingual route and group B vaginal route of misoprostol administration.
This study showed no statistically significant differences according to initial demographic characteristic data, indications of abortion, initial vital signs and hemoglobin levels, also no significant differences between women of both groups regarding the rates of complete expulsion of the fetus 52 (94.5%) vs. 50 (90.9%) and membranes 50 (90.9%) vs. 49 (89.1%) in 24 and 48 hours from administration of the medication also there were no significant differences between groups regarding rates of complete expulsion of the fetus and placenta stratified by gestational age. there were no significant differences between women of both groups (1200 vs. 1600 mg), p >0.05 regarding total misoprostol dose and need for oxytocin 12 (40%) vs. 18 (32.7%) or surgical evacuation 5 (9.1%) vs. 6 (10.9%). there were no significant differences between women of both groups regarding time-to-onset of contraction (60 vs. 60 mins), time-to-expulsion of the fetus +480 vs. 480 mins), time-to-complete abortion (720 vs. 960 mins), duration of hospital stays (24 vs. 24 hours) or adverse outcomes. the median satisfaction degree and rates of unsatisfied women were significantly better among women of the sublingual group when compared to women of the vaginal group, (50 vs 1) p< 0.001).
Finally, we concluded that both sublingual and vaginal routes of Misoprostol are equally effective, safe, inexpensive and acceptable method. Sublingual route is better and preferred by women.