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Abstract

Hemorrhage remains a major complication during second-trimester abortions, particularly in dilation and evacuation procedures. The use of prophylactic uterotonic agents plays a critical role in minimizing perioperative blood loss and related morbidity.  This study aimed to compare the efficacy of three prophylactic regimens-misoprostol alone, misoprostol with oxytocin, and misoprostol with methylergometrine- in reducing hemorrhagic complications during the second-trimester dilation and evacuation procedure. A prospective, hospital-based comparative study was conducted at the Department of Obstetrics and Gynecology, Tikrit Teaching Hospital, Iraq, from April to December 2024. Ninety women diagnosed with second-trimester missed abortion (14–27 weeks of gestation) and scheduled for D&E were randomly allocated into three groups (n=30 each). Group I received rectal misoprostol; Group II received misoprostol plus intravenous oxytocin; Group III received misoprostol with intravenous and oral methylergometrine. Outcomes included estimated blood loss, need for transfusion, reoperation, retained products of conception, and need for referral to higher care. Data were analyzed using SPSS v22, with significance set at p < 0.05. The misoprostol–oxytocin group exhibited significantly lower rates of blood transfusion (3.3%) and reoperation (3.3%) compared to the misoprostol-only group (26.7% and 23.3%, respectively; p < 0.05). All three regimens effectively reduced RPOC post-intervention (p < 0.001), but no significant differences were observed among groups in final RPOC rates. The combination of misoprostol and oxytocin demonstrated superior efficacy in minimizing hemorrhagic complications during second-trimester D&E compared to other regimens. These findings support the adoption of dual uterotonic prophylaxis to enhance maternal safety during surgical abortion procedures‎.

Keywords: Second-trimester abortion, Hemorrhage prevention, Dilation and evacuation, Misoprostol, Oxytocin

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