***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: 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 OBJECTIVE The purpose of this study was to compare the clinical efficacy and side effects of 3 doses of intravaginal misoprostol for second-trimester pregnancy termination . STUDY DESIGN This was a prospect i ve r and omized , double-blind controlled clinical trial of 150 women who underwent pregnancy termination between 14 and 30 weeks of gestation . Three intravaginal misoprostol regimens were compared : 200 microg misoprostol at 6-hour intervals ( group 1 ) , 400 microg misoprostol at 6-hour intervals ( group 2 ) , and a loading dose of 600 microg misoprostol followed by 200 microg at 6-hour intervals ( group 3 ) . RESULTS There was a significant difference in the median time to achieve delivery among the 3 groups : group 1 ( 18.2 hours [ IQ , 13.3 - 32.5 hours ] ) vs group 2 ( 15.1 hours [ IQ , 10.9 - 23.7 hours ] ) vs group 3 ( 13.2 hours [ IQ , 11.2 - 21.7 hours ] ; P = .035 ) . Fifty-nine percent of the women in group 1 , 76 % of the women in group 2 , and 80 % of the women in group 3 delivered within 24 hours ( P = .013 ) . There were 7.8 % of the women in group 1 , 0 % of the women in group 2 , and 2 % of the women in group 3 who were undelivered at 48 hours ( P = .02 ) . There was an increase in the incidence of fever in the first 12 hours ( P = .038 ) and in the incidence of vomiting within 3 hours of the initial dose ( P = .048 ) in group 3 compared with the other groups . CONCLUSION Intravaginal misoprostol 400 microg at 6-hour intervals appears to be the preferred regimen for second-trimester pregnancy termination , with a shorter commencement to delivery interval than the 200 microg regimen and fewer maternal side-effects than the 600 microg loading dose regimen OBJECTIVE To compare the efficacy of vaginal and oral misoprostol for the induction of  labour in women with intra-uterine foetal death ( IUFD ) . DESIGN A prospect i ve r and omised clinical trial , comparing 200 microg oral and 200 microg vaginal misoprostol , six hourly for a maximum of four doses for the induction of labour in women with IUFD . SETTING Ga-Rankuwa hospital ( Department of Obstetrics and Gynaecology ) , Pretoria , South Africa . It is a tertiary institution serving predominantly black indigenous population . MAIN OUTCOME MEASURES The primary outcome measure was the induction to delivery time , and secondary outcome measures were the number of patients requiring augmentation with oxytocin  and all complications were noted . RESULTS Twenty women were r and omised to the vaginal route and 18 to the oral route . The induction to delivery time was shorter with vaginal misoprostol ( 13.5 + /- 8.3 hrs ) compared to oral misoprostol ( 21.4 + /- 13.9 hrs ; p < 0.05 ) . There was no significant difference in the amount of misoprostol needed to achieve successful induction in the two groups . More women ( 10/18 ) who received oral misoprostol required  oxytocin augmentation to complete the induction of labour compared with 4/20 women in the vaginal group ( p < 0.05 ; Odds Ratio 2.8 ; 95 % Cl 1.36 - 4.24 ) . There were no cases of failed induction . The systemic side effects ( shivering , diarrhoea , vomiting and pyrexia ) were more common with oral misoprostol ( 44.5 % ) compared to vaginal misoprostol ( 20 % ) . This difference gives an overall Odds Ratio of 2.2 at 95 % Cl of 1.6 - 2.8(p < 0.05 ) . CONCLUSION Vaginal misoprostol achieved successful induction of labour in women with IUFD in a shorter time than oral misoprostol with significantly less side effects Summary Gemeprost ( Cervagem ) has been used widely compared with Misoprostol ( Cytotec ) alone in second trimester pregnancy termination . This prospect i ve r and omised trial was to evaluate the efficacy of intravaginal Misoprostol ( alone ) and Gemeprost in second trimester termination of pregnancy . A total of 54 women with 27 on each arm were involved . A total of 25 patients ( 92.6 % ) in the Misoprostol group and 22 patients ( 81.5 % ) in the Gemeprost group delivered within 48 h. The Misoprostol group delivered earlier , although average number of tablets required were similar . The side-effects were not significant between the two groups in fact , but there was more pyrexia in the Gemeprost group ( p = 0.004 ) . Misoprostol in second trimester termination of pregnancy is clinical ly as effective and less costly than the st and ard regimen of Gemeprost The object of this study was to compare intravaginal misoprostol and dinoprostone ( prostagl and in E2 ) for second-trimester pregnancy termination , and to examine the role of the nitric oxide donor , glyceryl trinitrate , as a possible alternative to prostagl and ins to induce cervical ripening in second-trimester pregnancy termination . This was a r and omised clinical trial . The trial involved pregnant women between 13 and 28 weeks ' gestation admitted with clear medical or obstetric indications for pregnancy termination , and was carried out in the department of obstetrics and gynecology , Assiut University Hospital , Egypt . Patients were classified into Group A , where pregnancy termination was induced by vaginal misoprostol 100 micrograms every 4 hours with a maximum dose of 500 micrograms ; Group B , where induction was by vaginal dinoprostone 6 mg every 6 hours with a maximum dose of 24 mg ; and Group C , where induction involved vaginal glyceryl trinitrate 500 micrograms every 6 hours with a maximum dose of 2.5 mg . Twenty-four hours after the start of induction , the rate of complete abortion in the three groups was 100 % , 66.67 % and 0 % , respectively . The rate of complete abortion was 100 % in the nitric oxide ( glyceryl trinitrate)-induced group after introducing a complementary procedure . The induction – abortion interval was significantly shorter , the number of doses needed was less and the maximum Bishop score reached was greater with misoprostol than with dinoprostone . A higher rate of side effects occurred with the misoprostol-induced group ( 74 % ) compared with the other two groups ( 46.6 % and 0 % ) . Misoprostol is a cheap , effective drug for second-trimester pregnancy termination with short induction abortion intervals but a higher rate of side effects .  Prostin E2 is also effective in termination of second-trimester pregnancy but is expensive and may require high doses to be administered . Glyceryl trinitrate is an effective drug for cervical ripening ( softening ) but it has no role in the stimulation of uterine contractions Objective To compare the effectiveness of vaginal misoprostol  administered 6 or 12 hourly for second trimester pregnancy termination OBJECTIVE To evaluate the induction-to-abortion time of 3 pharmacokinetic-based protocol s at 13 - 20 weeks of gestation . STUDY DESIGN A r and omized trial was conducted on 153 patients . The oral group ( n = 51 ) received 100 microg misoprostol orally every 2 hours , the vaginal group ( n = 51 ) received 200 microg misoprostol vaginally every 4 hours , and the sublingual group ( n = 51 ) received 100 microg misoprostol sublingually every 2 hours . RESULTS The mean induction-to-delivery time was shorter in the sublingual group ( mean , 651 + /- 507 ) as compared to the vaginal group ( mean , 1,056 + /- 634 , p = 0.01 ) . The number of patients who delivered within 12 hours was significantly higher in the sublingual group ( n = 39 , 78 % ) as compared to the oral ( n = 26 , 52 % ) and vaginal ( n = 20 , 40 % ) groups ( p < 0.001 ) . The numbers of patients who delivered within 24 hours were comparable in the sublingual ( n = 47 , 94 % ) and oral ( n = 46 , 92 % ) groups but higher than in the vaginal group ( n = 39 , 78 % ; p = 0.02 ) . The total misoprostol dose was 543 + /- 422 microg in the sublingual group , 878 + /- 533 microg in the vaginal group and 741 + /- 413 microg in the oral group ( p < 0.001 ) . CONCLUSION A pharmacokinetic-based application of 100 microg of sublingual misoprostol every 4 hours is more effective for induction of second-trimester abortion as compared to 100 microg oral misoprostol every 2 hours and 200 microg vaginal misoprostol every 4 hours Objective : To compare the efficacy of a combined regimen of misoprostol with vaginal misoprostol for early 2nd-trimester pregnancy termination . Methods : This is a prospect i ve study that includes 79 pregnant women who requested legal termination of 2nd-trimester pregnancy between 13 and 22 weeks . Two regimens of misoprostol were used . Group 1 : 400 µg of oral plus 400 µg vaginal misoprostol every 8 h ( combined regimen ) and group 2 : 400 µg of vaginal misoprostol every 3 h up to a maximum of five doses ( vaginal regimen ) . Results : The induction-to-abortion interval was significantly longer in group 1 ( 25.5 ± 24.45 h ) than in group 2 ( 15 ± 7.14 h ) ( p = 0.016 ) . The abortion rate within 24 h in group 1 was of 56.8 vs. 85.7 % in group 2 ( p = 0.006 ) . The hazard rate for vaginal delivery within 24 h was found to be 2.277-fold greater in the group with the combined therapy once controlled for plausible confounders . Conclusions : Our study suggests that oral misoprostol combined with vaginal misoprostol does not reduce the induction-to-abortion interval compared to an exclusively vaginal route when used for early 2nd-trimester pregnancy termination BACKGROUND Intrauterine fetal death is a major problem in obstetrics particularly in developing countries such as Ug and a. Induction of labour in cases of fetal death using the available method of oxytocin is often difficult , expensive and frustrating . OBJECTIVES To compare the effectiveness of vaginal misoprostol and intravenous oxytocin in induction of labour in women with intrauterine fetal death . METHODS One hundred and twenty mothers were allocated in a r and omised controlled way to one of the two induction groups . Oxytocin infusion was titrated based on patient response . The starting dose was 50 mcg ( 1/4 tablet ) in misoprostol group and the dose was doubled every six hours till effective contractions were achieved . The two groups were compared for induction to delivery intervals , costs of the drugs and their safety during induction . RESULTS The success rate within 48 hours of induction was 100 % in the misoprostol group and 96.7 % in oxytocin group . The mean induction to delivery time was significantly longer in the oxytocin group compared with the misoprostol group ( 23.3 versus 12.4 hours ; p= 0.004 ) . In the gestational age before 28 
    Output:
    
MAIN RESULTS We included 38 studies ( 3679 women).Nine studies included pregnancies after intrauterine deaths , five studies included termination of pregnancies because of fetal anomalies when the fetus was still alive and the rest ( 24 ) presented the pooled data for intrauterine deaths , fetal anomalies and social reasons .When compared with agents that have traditionally been used to induce labour in this setting ( for example , gemeprost , prostagl and in E(2 ) and prostagl and in F(2alpha ) ) , vaginal misoprostol is as effective in ensuring vaginal birth within 24 hours , with a similar induction to birth interval .
Vaginal misoprostol is associated with a reduction in the occurrence of maternal gastrointestinal side effects such as nausea , vomiting and diarrhoea when compared with other prostagl and in preparations .
While the different treatments involving various prostagl and in preparations appear comparable for the reported outcomes , the information available regarding rare maternal complications , such as uterine rupture , is limited .
The use of vaginal misoprostol in the termination of second and third trimester of pregnancy is as effective as other prostagl and in preparations ( including cervagem , prostagl and in E(2 ) and prostagl and in F(2alpha ) ) , and more effective than oral administration of misoprostol .