الفهرس 
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Abstract
Miscarriage is the most common complications of pregnancy, occurring in 10 – 20% of clinically recognized pregnancies.
Methods for induction of miscarriage can be surgical in form of vacuum aspiration, dilatation and curettage, and hysterotomy.
Or pharmacological methods include prostaglandins, mifepristone and oxytocin.
Misoprostol is a prostaglandin E1 analogue, has been shown to have both safety and efficacy for induction of abortion.
In most trials vaginal route has been chosen, because this route has been most successful for other prostaglandins and because misoprostol has far longer half-life when administered vaginally than orally.
With the ever increasing concentration of estrogen in the maternal circulation leading to term pregnancy, the belief that this could be a trigger for the onset of labor led to studies exploring estrogens for induction of miscarriage.
The aim of this work is to compare the safety and effectiveness of vaginal estradiol with misoprostol for induction of second trimester miscarriage.
A prospective double blind clinical study was carried out from September 2016 to February 2017 at Ain Shams University Hospital on total of 200 pregnant women at gestational age from 13 to 24 weeks. Patients were selected according to inclusion and exclusion criteria of the study. They were assigned to receive either vaginal misoprostol 200 mcg for abortion at 13-17 wks or 100 mcg for abortion 18 – 24 wks alone or vaginal misoprostol with same doses with vaginal estradiol 2mg. Misoprostol alone was repeated every 6 hours in both groups for 24 hours. Patients who didn’t abort after receiving the 4 doses, were subjected to 24 hours rest after which they started to receive another dose of misoprostol alone 6 hours apart of maximum 4 dose.
Time of expulsion of fetus and placenta were recorded. Side effects, vaginal bleeding, hemoglobin and hematocrit pre and post abortion were also recorded.
Surgical evacuation was done to the patients with incomplete miscarriage or with vaginal bleeding affecting their general condition.
Hysterotomy was done to the patients who didn‘t abort or with vaginal bleeding affect their general condition before expulsion of fetus.
There were statistically significant reduction in the time needed for abortion of fetus in the first 24 hours (94,9%). Number of misoprostol doses (p=0.022), time till delivery of placenta (P=0.009) which were found significantly less in combined estradiol and misoprostol group.