Changes in the concentration of alpha-fetoprotein and placental hormones following two methods of medical abortion in early pregnancy

Abstract

Objective: Measurement of alpha-fetoprotein (AFP) was used to investigate the occurrence of feto-maternal haemorrhage in women undergoing medical abortion.

Design: Three groups of women with amenorrhoea of 56 or less days were studied. A control and a mifepristone group had two blood samples taken 48 h apart. Women undergoing medical abortion with gemeprost had two blood samples taken 24 h apart.

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

Subjects: Three hundred and thirty-five women requesting abortion.

Interventions: Blood samples taken at 24 h or 48 h apart.

Measurements and main results: The rise in concentration of AFP in plasma was much higher (P = 0.01) in the two groups of women in whom abortion was induced by gemeprost or mifepristone than in control women. Whereas only 5% of women in the control group had a significant rise in AFP, 27% and 33% of women in the mifepristone and gemeprost groups, respectively, had a rise in AFP level which exceeded the 95th centile (> or = 38%). The concentration of hCG rose by 48 h in both control and mifepristone groups. Progesterone remained unchanged, and oestradiol decreased (P < 0.02) in the mifepristone group. By 24 h, there was a significant fall in the concentrations of hCG, progesterone and oestradiol in the group who had aborted after being given gemeprost.

Conclusions: Anti-D prophylaxis must be administered to rhesus negative women to avoid rhesus iso-immunisation.

PIP: 335 healthy women undergoing termination of 1st trimester pregnancy with amenorrhea of 56 days or less were studied in order to examine the occurrence of feto-maternal hemorrhage in women. The control group comprised 100 women in early pregnancy. Venous blood was taken on day 0 and 48 hours later. The mifepristone group included blood samples from 140 of the 150 women. Each women received a single oral dose of mifepristone of either 200 mg (n = 50), 400 mg (n = 43) or 600 mg (n = 47). Venous blood was taken in similar fashion, but the 2nd sample was taken before insertion of a 1 mg gemeprost pessary. The gemeprost along group included 95 women who had 1 mg gemeprost pessaries inserted to a maximum dose of 3 mg or until abortion occurred. Blood was collected before insertion of the 1st gemeprost pessary (0 hour) and 24 hours later. The rise in alpha-fetoprotein (AFP) concentration was significantly greater in the groups who had a medical abortion (p = 0.01) compared with the control group. In Group 1, there was a moderate rise in the plasma concentration of AFP (P 0.0001), estradiol (P 0.0002), hCG (P 0.0001) and progesterone (NS) over 48 hours. Only 5% of women had an AFP rise of 38% or greater within 48 hours. In group 2, 61 to 69% of women bled following administration of mifepristone. Women had a significant rise in AFP concentration (P 0.001) within 48 hours, and 27% had an AFP rise 38% or greater. A rise in plasma hCG was demonstrated, while plasma progesterone remained unchanged over 48 hours. There was a significant reduction in plasma estradiol 48 hours after taking mifepristone (P 0.02). All women in group 3 bled following insertion of gemeprost, and 89% aborted within 24 hours after the 1st gemeprost pessary. An overall increase in AFP concentration was detected (P 0.0001). 33% of women had an increase of 38% or greater in AFP. A significant reduction in plasma hCG (p 0.0001), estradiol (P 0.0001) and progesterone (P 0.0001) occurred within 24 hours after abortion.