***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve r and omized double-blind placebo-controlled trial was conducted in 13 subjects to find out whether mifepristone treatment could facilitate termination of second trimester pregnancy by sulprostone . The women received either 600 mg oral mifepristone or placebo tablets 36 hours before the administration of intramuscular sulprostone 0.5 mg every 6 hours . The median interval between the administration of sulprostone and abortion in the mifepristone group ( 4.6 hours ) was significantly shorter than that in the placebo group ( 20 hours ) . The amount of sulprostone required was also significantly less in the mifepristone group . There was no significant difference in the incidence of side effects or analgesic requirement between the two groups . We conclude that oral mifepristone is useful in facilitating termination of second trimester pregnancies  by sulprostone Objective To compare intramuscular ( IM ) prostagl and in 15 methyl-F2α ( 15M-PGE2α ) with prostagl and in E2 ( PGE2 ) vaginal suppositories for second-trimester abortion in terms of efficacy and side effects . Methods Fifty-one women were r and omized to receive either 15M-PGF2α IM injections or PGE2 intravaginal suppositories for second-trimester abortion . Efficacy and side effects of the two agents were analyzed by two-tailed t tests , x2 analysis with Fisher exact test , and survival analysis . Results The mean times to rupture of membranes , delivery of fetus , and delivery of placenta were significantly less for women receiving PGE2 vaginal suppositories . The cumulative abortion rate after 24 hours for the PGE,2 group was 96 % , compared with 69 % for the 15M-PGF2α group . Although there were few differences in side effects , the 15M-PGF2α group had significantly fewer headaches , fevers , and chills . Conclusion Intravaginal PGE2 is superior to IM 15M-PGF2α for second-trimester abortion Objective The aim of this r and omized prospect i ve study was to compare efficacy and side effects of saline moistened misoprostol with dry misoprostol , administered 800 μg intravaginally every 6 h up to a maximum of 3 doses in 24 h for second trimester pregnancy termination . Material s and methods A total of 81 women seeking termination of second trimester pregnancy ( 55 fetal death , 17 fetal structural anomaly , 5 chromosomal abnormality , 4 other reasons ) were r and omly assigned to one of two treatment groups : ( 1 ) intravaginal non-moistened ( dry ) misoprostol in group A ( n = 40 ) or ( 2 ) misoprostol moistened with 3 ml of saline in group B ( n = 41 ) . Results All of the patients in either group aborted within 48 h ( 100 % success rate ) . Delivery was achieved in a median ( interquartile range ) of 13 ( 40 ) h with the group A protocol and 12 ( 36 ) h with the group B protocol ( P = 0.652 ) . Delivery with first dose , delivery within 12 h and delivery within 24 h were similar ( P > 0.05 ) in group B ( 34.1 , 87.5 and 60 % , respectively ) and group A ( 25 , 82.9 , 46.3 , respectively ) . Both treatment regimens were tolerable and with similar side effects . Conclusion Misoprostol moistened with saline was not more effective  than dry misoprostol for second trimester pregnancy termination OBJECTIVE To study the effect of mifepristone for priming and induction of second-trimester abortion in conjunction with a high-concentration oxytocin drip . STUDY DESIGN Prospect i ve , r and omized , placebo-controlled , pilot study . Thirty patients with 14 - 25 weeks ' gestational age abortion received either 600 mg of mifepristone or placebo in 3 identical capsules followed , 48 hours later , by a high-concentration oxytocin drip ( HCOD ) . RESULTS The mifepristone group showed significantly higher success rates as compared to the placebo group ( 92.3 % vs. 52.9 % , p<0.05 ) . The time interval to abortion ( from beginning of HCOD ) was also significantly shorter in the mifepristone group as compared to the placebo group ( 11.3 + /- 6.0 hours vs. 17.6 + /- 6.5 hours , p < 0.05 ) . Probability of success as calculated by the Kaplan-Meier method was found to be highly significant ( log rank test p = 0.001 ) . CONCLUSION Our results suggest that mifepristone is very effective for priming and induction of second-trimester abortion and shortens significantly the time interval to evacuation following HCOD BACKGROUND The pharmacokinetic parameters of four different routes of administration of a single dose of 400 microg of misoprostol were studied . METHODS A total of 40 women undergoing termination of pregnancy by suction evacuation was r and omized by computer model to receive 400 microg of misoprostol by one of four routes : ( i ) sublingual ( ii ) oral ( iii ) vaginal and ( iv ) vaginal with addition of water . Venous blood sample s were taken at 0 , 1 , 2 , 5 , 10 , 20 , 30 , 45 , 60 , 120 , 240 and 360 min after the administration of misoprostol . Misoprostol acid ( MPA ) was determined in serum sample s using gas chromatography/t and em mass spectrometry . RESULTS Sublingual misoprostol achieved the highest serum peak concentration ( Cmax ) ( 574.8 + /- 250.7 pg/ml ) of MPA and this was significantly higher than those in the other groups [ Oral : 287.6 + /- 144.3 pg/ml ( P < 0.01 ) , vaginal : 125.2 + /- 53.8 pg/ml ( P < 0.001 ) and vaginal with water : 162.8 + /- 57.1 pg/ml ( P < 0.001 ) ] . The time to peak concentration ( Tmax ) was similar in both the sublingual ( 26.0 + /- 11.5 min ) and oral groups ( 27.5 + /- 14.8 min ) and was significantly shorter than those in both vaginal groups . The area under the MPA concentration versus time curve up to 360 min in the sublingual group ( 743.7 + /- 291.2 pg.h/ml ) was significantly greater than those in oral ( 402.8 + /- 151.6 pg.h/ml , P < 0.05 ) and vaginal ( 433.7 + /- 182.6 pg.h/ml , P < 0.05 ) groups , but no significant difference was found between sublingual and vaginal administration if water ( 649.3 + /- 333.8 pg.h/ml ) was added . CONCLUSION The new sublingual route of administration of misoprostol demonstrated a great potential to be developed into a method of medical abortion It is known that when misoprostol is given at 200 microg every 3 h after mifepristone pretreatment , the vaginal route is more effective than the oral route . However , women prefer the oral route . This r and omized study was to test our hypothesis that oral misoprostol 400 microg is as effective as vaginal misoprostol 200 microg when given every 3 h in termination of second trimester pregnancy after priming with mifepristone . A total of 142 patients was r and omly assigned to group 1 ( 200 mg mifepristone + 400 microg oral misoprostol every 3 h up to five doses ) or group 2 ( 200 mg mifepristone + 200 microg vaginal misoprostol every 3 h up to five doses ) . The incidence of side-effects and the preference study were assessed through a st and ardized question naire during and after the abortion . For the oral group , both the incidence of diarrhoea ( 40.0 versus 23.2 % , P = 0.03 ) and the amount of drug used ( 1734 compared with 812 microg , P < 0.0001 ) were significantly higher than that of the vaginal group but the incidence of fever appeared to be lower ( not significant ) . There was no significant difference in complete abortion rate : 81.4 % in the oral group and 75.4 % in the vaginal group . The median induction-abortion interval was similar in the two groups ( 10.4 versus 10.0 h ) . The percentage of women who aborted in 24 h was also similar : 57/70 ( 81.4 % ) in the oral group and 58/69 ( 87.0 % ) in the vaginal group . Overall , 82.0 % of women preferred the oral route . Oral misoprostol ( 400 microg ) given every 3 h up to five doses , when combined with mifepristone , was as effective as the vaginal ( 200 microg ) route in second trimester termination of pregnancy . This regimen could also be offered to those women who found repeated vaginal administration unacceptable 9-Deoxo-16,16-dimethyl 9-methylene PGE2 was given as a vaginal suppository at 0 and 8 hours to 37 patients . Two different doses were given , a 75-mg and 60-mg dose . The larger dose achieved an 86 % abortion rate at 24 hours and for the smaller dose it was 53 % . When an intramuscular injection of 15-methyl PGF2 alpha Tham was added at 24 hours , the success rate was 91 % and 80 % at 36 hours . The incidence of gastrointestinal side effects were significantly reduced when compared to vaginal administration of either PGE2 or 15-methyl PGF2 alpha methyl ester . The incidence of temperature elevation was similar to that achieved with the use of vaginal PGE2 but higher than with the use of vaginal 15-methyl PGF2 alpha methyl ester We report the results of a large‐scale trial with mifepristonc ( RU 486 ) followed by the administration of a prostagl and in ( PG ) analogue for the medical termination of early pregnancy . Altogether , 16,173 patients from 300 centers were evaluated . 48 women ( 0.3 % ) were lost to follow‐up prior to , and 416 ( 2.6 % ) after the PG administration , and therefore the efficacy was evaluated in 15,709 women . Overall . the success rate was 95.3 % . with no statistical difference regarding the nature and dose of PG used . The median duration of bleeding was 8 days , being 12 days or less in 89.7 % of the women . Bleeding was significant cnough to necessitate a vacuum aspiration or a dilatation and curettage in 0.8 % of the cases . A blood transfusion was necessary in 0.1 % of the women ( 11 patients ) . Serious cardio‐vascular side‐effects were reported in 4 cases after the PG ( sulpro/tonc ) injection : they consisted of one acute myocardial infa rct ion attributed to a coronary spasm . and in marked hypotension in the other 3 woman . All patients recovered uneventfully . In conclusion , RU 486 followed by a PG analogue provides an efficient and safe medical alternative to surgery for early pregnancy termination , provided that the recommended protocol is adequately followed and the contraindications to prostagl and ins are respected OBJECTIVE The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for second-trimester pregnancy termination . STUDY DESIGN We performed a r and omized clinical trial in patients who were at 14 to 23 weeks of gestation and who were admitted for medical termination of pregnancy . All patients received 800 microg of vaginal misoprostol and were assigned r and omly to 400 microg of oral misoprostol or 400 microg of vaginal misoprostol every 8 hours . Efficacy and side effects were compared . The mean induction time of the study group was compared with that of an historic control group that had received 400 microg vaginally every 12 hours . RESULTS Forty-three women were assigned r and omly , 22 women to vaginal misoprostol and 21 women to oral misoprostol .  Induction time and hospital stay were slightly shorter for the oral group ; however , the differences were not significant . Side effects were similar for both groups . CONCLUSION After an initial 800 microg dose of vaginal misoprostol , a regimen of 400 microg of oral misoprostol every 8 hours is as effective as the same dose of vaginal misoprostol with no additional side effects , which provides a convenient alternative for midtrimester pregnancy termination Sixty patients were r and omized to low-dose and high-dose groups , receiving a maximum total dose 1400 g of misoprostol by the vaginal route to compare the efficacy of the protocol s for second trimester termination of pregnancy . Outcome measures to be compared between the groups were success rates , time to term 
    Output:
    
When used alone , misoprostol was an effective inductive agent , though it appeared to be more effective in combination with mifepristone .
Misoprostol was preferably administered vaginally , although among multiparous women sublingual administration appeared equally effective .
No r and omised trials comparing doses of misoprostol were identified ; however low doses of misoprostol appear to be associated with fewer side-effects while moderate doses appear to be more efficient in completing abortion .
Indications for surgical evacuation include retained products of the placenta and heavy vaginal bleeding .
Medical abortion in the second trimester using the combination of mifepristone and misoprostol appeared to have the highest efficacy and shortest abortion time interval .
Where mifepristone is not available , misoprostol alone is a reasonable alternative .
Apart from pain , the side-effects of vaginal misoprostol are usually mild and self limiting .