Induction of abortion with mifepristone and misoprostol in early pregnancy

Abstract

Objective: To investigate the clinical efficacy of the combination of mifepristone and an orally active prostaglandin, misoprostol, for early medical termination.

Design: Women with amenorrhoea < or = 56 days were given 200 mg mifepristone. 48 h later, 600 micrograms misoprostol was given orally.

Setting: Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh.

Subjects: 100 women requesting medical termination of pregnancy.

Interventions: Evacuation of uterus for incomplete abortion or on-going pregnancies.

Results: One woman had an incomplete abortion prior to administration of misoprostol. 92 (93%) out of 99 women had complete abortion following administration of misoprostol. There were three on-going pregnancies (3.0%, 95% confidence limits (CL) 0.6-8.6) and four incomplete abortions with this regimen (4.0%, 95% CL 1.1-10.0). 24% women vomited and 7% had diarrhoea following administration of misoprostol. 62% did not require any analgesia.

Conclusions: The combination of misoprostol with mifepristone is inexpensive, simple, effective, noninvasive and an acceptable alternative to current regimens for medical termination.

PIP: Misoprostol is a stable, orally active synthetic analogue of prostaglandin E, which is used for the prophylaxis and treatment of peptic ulcer. It is cheap, effective, and associated with fewer gastrointestinal side effects. Misoprostol has an uterotonic effect and it is contraindicated for women in early pregnancy. Preliminary reports suggest that misoprostol in combination with mifepristone at a dose of 200 mg or 600 mg may be as effective as gemeprost or sulprostone for inducing early abortion but with fewer side effects. The authors report their experience using misoprostol together with mifepristone to induce abortion in 100 women in early pregnancy. 100 women requesting medical termination of pregnancy at the Medical Termination Unit of Simpson Memorial Maternity Pavilion, Edinburgh, with amenorrhea of or less than 56 days were given 200 mg mifepristone; 48 hours later they were given 600 ug misoprostol orally. The study found the combination of misoprostol with mifepristone to be inexpensive, simple, effective, noninvasive, and an acceptable alternative to current regimens for medical termination. One woman had an incomplete abortion prior to the administration of misoprostol, 93% of 99 women had complete abortion following administration of misoprostol, there were three ongoing pregnancies and four incomplete abortions, 24% of the women vomited and 7% had diarrhea following administration of misoprostol, and 62% did not require analgesia.