***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 
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    ***EXAMPLES*** 
    Input: 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 OBJECTIVE To compare the efficacy of sublingual and vaginal misoprostol in the medical management of missed miscarriage . METHODS Fifty women diagnosed as having missed miscarriage of gestational age less than 20 weeks were assigned r and omly to receive 400 microg of either sublingual or vaginal misoprostol every three hours , up to a maximum of five doses . The primary outcome measures were , complete evacuation of products of conception , mean induction to delivery time and the occurrence of side effects . RESULTS There was no significant difference in complete evacuation rates between the sublingual misoprostol and the vaginal misoprostol groups ( 52 % vs. 48 % , p = 0.571 ) mainly within the first 24 hours . Mean induction to delivery time was also similar for both groups ( 13.07 + /- 6.95 hours for sublingual versus 13.29 + /- 5.63 hours for vaginal group ) as was the total number of doses required ( 4.44 + /- 1.04 for sublingual versus 4.52 + /- 0.96 for vaginal misoprostol ) . Side effects were seen in 18 women ( 72 % ) in the sublingual group compared to 5 women ( 20 % ) in the vaginal group ( p < 0.001 ) . The incidence of unpleasant taste was significantly higher in the sublingual group than in the vaginal group ( 60 % versus 4 % , p = < 0.001 ) . CONCLUSION Sublingual misoprostol is as effective as vaginal misoprostol for medical management of missed miscarriage but is associated with an increased risk of side effects especially an unpleasant taste In a prospect i ve clinical trial the effectiveness of a combination of 400 mg of mifepristone ( antiprogesterone ) and 400 g misoprostol ( synthetic prostagl and in E1 analogue ) , both taken orally , was evaluated for the treatment of missed abortion . Of the 31 patients included , 16 ( 52 % ) had an empty uterine cavity at follow up six days after inclusion , 11 ( 35 % ) required surgical evacuation for retained intrauterine products of conception found at follow up , and four ( 13 % ) required emergency surgical evacuation due to severe pain or bleeding . The results do not support the use of mifepristone and misoprostol for women wishing the miscarriage to be resolved quickly Objectives To compare complete abortion rate , duration of abortion , and side effects between 600 μg powdery sublingual misoprostol and 600 μg sublingual misoprostol tablet for management of embryonic death or anembryonic pregnancy . Material s and methods Fifty-four pregnant women up to 13 weeks of gestation diagnosed with embryonic death or anembryonic pregnancy were r and omized to receive 600 μg powdery sublingual misoprostol or 600 μg sublingual misoprostol tablet . Complete abortion was evaluated by transvaginal ultrasound at 48 h. Results Twenty-six patients received 600 μg  powdery sublingual misoprostol and 28 patients received 600 μg sublingual misoprostol  tablet . Complete abortion rate was 34.6 % in powdery sublingual misoprostol group and 32.1 % in sublingual misoprostol tablet group ( P = 0.847 ) . Duration of abortion  in powdery sublingual misoprostol group and sublingual misoprostol tablet group was similar ( 34.7 ± 18.8 vs. 36.9 ± 17.8 h , respectively , P = 0.656 ) . There was no significant difference in the side effects between both groups . Conclusions Single dose of 600 μg of powdery sublingual misoprostol does not improve its efficacy for management of embryonic death or anembryonic pregnancy when compared to sublingual misoprostol tablet This prospect i ve study was carried out at a tertiary care hospital on 50 women with missed abortion up to 13 weeks who were given 600 μg misoprostol sublingually every 3 h for a maximum of three doses . Success rate was 86 % ( up to 72 h ) , and the acceptability of the method was 69.7 % . Sublingual misoprostol is a non-invasive , effective and safe medical method for completion of abortion in missed abortion Background : It has been established that sublingual ( SL ) route of misoprostol has a great potential to be developed for medical abortion , but there is dearth of evidence to reveal satisfaction rate and safety profile among patients of oral and SL routes . Thus , this study was conducted to provide an insight into the acceptability and safety profile of the same . Material s and Methods : A r and omized controlled trial was carried out by giving 200 mg mifepristone orally , followed by administration of 600 μg misoprostol  orally to 50 women and sublingually to 50 women . The primary endpoints of study were measurements of acceptability and safety profile parameters ( average blood loss , nausea , vomiting , diarrhea , hot flushes , fever ) of both the groups . The secondary endpoints of the study were number of doses required for complete abortion , success rate and the induction to evacuation interval in both the groups . Results : SL route of administration was more acceptable than the oral route ( P = 0.009 ) . Average blood loss was higher in the oral group than in the SL group ( P = 0.001 ) . Amongst the side effects , 34 % in the SL group and 52 % in the oral group had nausea ( P = 0.264 ) , 22 % in the SL group and 44 % in the oral group had vomiting ( P = 0.031 ) , 48 % in the SL group and 86 % in the oral group had diarrhea ( P < 0.05 ) , hot flushes were presented by 24 % in the SL group and 50 % in the oral group ( P < 0.05 ) , fever was presented by 20 % in the SL group and 44 % in the oral group ( P < 0.05 ) , and the number of cases aborted with only one dose was higher ( 86 % ) in the SL group as compared to 63 % in the oral group ( P = 0.004 ) . The evacuation ( success ) rates were 92 % in the SL group and 84 % in the oral group ( P = 0.218 ) and the mean ± SD induction to evacuation intervals in the SL and oral groups were 5.6 ± 4.54 hours and 9.44 ± 5.61 hours , respectively ( P = 0.0002 ) . Conclusion : The SL route had fewer undesirable effects , was more satisfactory , required less number of doses and was more acceptable to the patient compared to the oral route AIM To compare the efficacy , side effects and patient satisfaction between 800 microg versus 400 microg intravaginal misoprostol for early pregnancy failure . MATERIAL AND METHOD Women diagnosed as early pregnancy failure were r and omly assigned to receive either 800 microg or 400 microg intravaginal misoprostol . The second dose was administered if there was no evidence of abortion in 24 h. The treatment failure was reffered to no complete abortion within 48 h. Dilatation and curettage was performed if the patients had heavy vaginal bleeding or evidence of incomplete abortion or no complete abortion . RESULTS 25 patients were r and omized to receive 800 microg and 25 patients were to receive 400 microg misoprostol .  Complete abortion was not significantly different between the 2 groups ( 72 % , 76 % respectively ) . Although median time to abortion in the 800 microg group was significantly shorter , the patients experienced more side effects especially fever which was significantly different ( P = 0.04 ) . In the 800 microg group , 2 patients had heavy vaginal bleeding and one patient developed endometritis . There was no significant difference in the patients ' satisfaction between both groups . CONCLUSIONS 400 microg of vaginal misoprostol are as effective as 800 microg in producing complete abortion in early pregnancy failure with less side effects and similar patient satisfaction This study was design ed to investigate the use of oral mifepristone ( RU 486 ) for the induction of natural expulsion of concepti in women with spontaneously interrupted pregnancy in the first trimester . It consisted of a double-blind placebo-controlled study of mifepristone ( 600 mg ) against placebo . A total of 46 women consulting for interrupted pregnancy were diagnosed at ultrasound with no clinical sign of miscarriage . Measurements were made of the occurrence of natural expulsion , the frequency of complete expulsion , the need for subsequent surgical evacuation , analgesia and the need for transfusion . Natural expulsion occurred within 5 days in 82 % of patients receiving mifepristone treatment versus 8 % of placebo-treated patients ( P < 0.001 ) . All patients experienced bleeding after RU 486 and two needed emergency aspiration for haemorrhagic expulsion . The treatment failed in four patients , who underwent evacuation under local anaesthesia . In the control group , 19 patients underwent evacuation  under local ( n = 10 ) or general ( n = 9 ) anaesthesia . It was concluded that a st and ard oral pilot dose of 600 mg of mifepristone induces natural expulsion in 82 % of women with non-developing first trimester intrauterine pregnancies AIM To evaluate the efficacy of two routes of misoprostol administration ( sublingual and vaginal ) for the treatment of missed abortion . METHODS Two hundred and twenty women with confirmed missed abortion who received 400 microg/6 h misoprostol either sublingually or vaginally , were included in this r and omized control trial . All women were admitted to hospital for follow-up care for 2 days . If the pregnancy was not completely evacuated during this time , the patient underwent immediate surgical completion . Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention . RESULTS The effectiveness was high in the sublingual group and statistically different ( sublingual 84.5 % , vaginal 46.4 % P = 0.000 RR = 0.54 95%CI = 0.442 - 0.681 ) . The groups differed in terms of complications like bleeding ( 88.2 % vs 65.5 % ) , pain ( 85.5 % vs 56.4 % ) , diarrhea ( 69.1 % vs 36.4 % ) and fever ( 23.6 % vs 13.3 % ) in the sublingual group versus the vaginal group , but the mean time to expulsion was shorter ( 9.68 h SD = 5.51 95%CI = 8.61 - 10.57 ) in the sublingual group than the vaginal group ( 16.64 h SD = 14.01 95%CI 
    Output:
    
Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug , lower-dose regimens ( 200 ug or 400 ug ) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours .
In terms of tolerability , vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects .
Misoprostol is a non-invasive , effective medical method for completion of abortion in missed abortion .
Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose .