Mifepristone and misoprostol for cervical ripening in surgical abortion between 12 and 14 weeks of gestation: a randomized controlled trial

Abstract

Objective: Misoprostol and mifepristone are the two substances recommended for cervical preparation during first-trimester surgical abortions to decrease intraoperative bleeding and complications. The objective of the study was to evaluate whether the combination of mifepristone and misoprostol for cervical preparation in an elective surgical abortion between 12 and 14 weeks of gestation can reduce blood loss in comparison to misoprostol or mifepristone alone.

Study design: A randomized controlled trial was performed in Marseille, France between May 2013 and May 2014. Women requesting a surgical abortion under general anesthesia between 12 and 14 weeks of gestation were 198, randomized into three groups: one received 400μg oral misoprostol 3h before surgery, one 200mg oral mifepristone 36h before surgery, and the other, both treatments. The main outcome was the quantity of intraoperative bleeding. The secondary outcomes were duration of intervention, ease of dilatation, and complications.

Results: The quantity of intraoperative bleeding differed significantly between the groups (p=0.001): 222±64mL in the combination group, 329±129mL in the misoprostol group, and 276±119mL in the mifepristone group. The combination was associated with a shorter operative duration (p=0.001): 5±2min in the combination group, 7±5min in the misoprostol group, and 7±3min in the mifepristone group. A hemorrhage was observed for 5 of 55 women (9%) in the combination group, 13 of 51 (25%) in the misoprostol group, and 9 of 56 (16%) in the mifepristone group (p=0.08). No cervical laceration or uterine perforation was reported.

Conclusions: The combination of mifepristone and misoprostol in cervical preparation for elective surgical abortions between 12 and 14 weeks of gestation significantly reduced blood loss in comparison to misoprostol or mifepristone alone.

Keywords: Abortion; Cervical priming; Mifepristone; Misoprostol; Termination of pregnancy.