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Randomized Controlled Trial
. 2008 Dec;112(6):1303-1310.
doi: 10.1097/AOG.0b013e31818d8eb4.

Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial

Beverly Winikoff  1 , Ilana G Dzuba, Mitchell D Creinin, William A Crowden, Alisa B Goldberg, Juliana Gonzales, Michelle Howe, Jeffrey Moskowitz, Linda Prine, Caitlin S Shannon
Affiliations
Randomized Controlled Trial

Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial

Beverly Winikoff et al. Obstet Gynecol. 2008 Dec.

Abstract

Objective: To study the efficacy, safety, and acceptability of oral immediately swallowed and buccal misoprostol 800 mcg after mifepristone 200 mg for terminating pregnancy through 63 days since the last menstrual period (LMP).

Methods: This seven-site study randomly assigned 966 women seeking abortions to oral or buccal misoprostol 800 mcg 24-36 hours after mifepristone 200 mg with 7-14-day follow-up.

Results: Success rates in the oral and buccal groups were 91.3% (389 of 426) and 96.2% (405 of 421), respectively (P=.003; relative risk [RR] 0.95, 95% confidence interval [CI] 0.92-0.98). Ongoing pregnancy occurred in 3.5% (15 of 426) of women who took oral misoprostol compared with 1.0% (4 of 421) of women in the buccal group (P=.012; RR 3.71, 95% CI 1.24-11.07). Through 49 days since the LMP, oral and buccal regimens performed similarly, but success with oral misoprostol decreased as pregnancy advanced. In pregnancies of 57-63 days since the LMP, success with oral misoprostol fell below 90%, whereas that with buccal remained high (oral 85.1% [97 of 114], buccal 94.8% [109 of 115], P=.015, RR 0.90, 95% CI 0.82-0.98). Furthermore, in this gestational age group, there were significantly more ongoing pregnancies among women who took misoprostol orally (7.9% [9 of 114]) compared with buccally (1.7% [2 of 115]; P=.029, RR 4.54, 95% CI 1.0-20.55). Adverse effect profiles were similar, although fever and chills were reported approximately 10% more often among women who took buccal misoprostol. Satisfaction and acceptability were high for both methods.

Conclusion: Buccal misoprostol 800 mcg after mifepristone 200 mg is a good option for medical abortion through 63 days since the LMP. Oral misoprostol 800 mcg is also a safe and effective alternative, although success rates diminish with increasing gestational age.

Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00386867

Level of evidence: I.

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References

    1. ACOG. ACOG practice bulletin. Clinical management guidelines of obstetrician-gynecologists. Number 67, October 2005. Medical management of abortion. Obstet Gynecol 2005;106:871–82.
    1. National Abortion Federation. NAF protocol for mifepristone/misoprostol in early abortion. Washington (DC): NAF; 2006.
    1. Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion. Evidence-based Clinical Guideline No. 7. London (UK): RCOG Press; 2004.
    1. Arvidsson C, Hellborg M, Gemzell-Danielsson K. Preference and acceptability of oral versus vaginal administration of misoprostol in medical abortion with mifepristone. Eur J Obstet Gynecol Reprod Biol 2005;123:87–91.
    1. Tang OS, Miao BY, Lee SW, Ho PC. Pilot study on the use of repeated doses of sublingual misoprostol in termination of pregnancy up to 12 weeks gestation: efficacy and acceptability. Hum Reprod 2002;17:654–8.

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