Induction of second trimester abortion with mifepristone and gemeprost

Abstract

Objective: To determine the efficacy of a new regimen of the antiprogestogen mifepristone and gemeprost for midtrimester abortion.

Design: Prospective study.

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

Subjects: One hundred women undergoing midtrimester abortion.

Interventions: Women were pretreated with 200 mg mifepristone 36 h before prostaglandin; 1 mg gemeprost was administered every 6 h for the first 24 h. If abortion had not occurred, 1 mg gemeprost was administered 3 hourly over the next 12 h.

Measurement and main results: Ninety-six percent and 99% women aborted within 24 h and 48 h, respectively. The median prostaglandin-abortion interval was significantly shorter in multigravidae compared to primigravida (6.6 vs 8.2 h, P < 0.01). The median number of gemeprost pessaries to induce abortion was only two and 47% of women required one pessary. The incidence of vomiting and diarrhoea was 31% and 5%, respectively. Eighty-four percent of women required intramuscular diamorphine for analgesia. Thirty-three percent of women required an evacuation of the uterus following abortion.

Conclusions: The shortened induction-delivery interval following pretreatment with mifepristone makes it possible to conduct midtrimester abortion on a daycare basis.

PIP: In Scotland, gynecologists used 200 mg mifepristone followed 36 hours later by 1 mg gemeprost pessary every 6 hours for the first 24 hours and, if termination did not occur, every 3 hours for the next 12 hours, to induce second trimester abortion (12-21 weeks gestation) in 100 women 13-42 years old, attending the Simpson Maternity Pavilion of the Edinburgh Royal Infirmary. Most women only required 2 pessaries (range, 1-9). 47 only needed 1 pessary. 96 and 99 women experienced an abortion within 24 hours and 48 hours, respectively. The median interval between gemeprost administration and abortion was 7.5 hours (range, 2.9-52.3 hours). Just 1 woman experienced the abortion after 48 hours, and she required intravenous infusion of oxytocin. The interval for primigravidas was significantly longer than for multigravidas (8.2 hours vs. 6.6 hours; p .01). 31 women vomited after insertion of the gemeprost pessary. 5 experienced diarrhea after gemeprost administration. 84 required intramuscular diamorphine for analgesia. Evacuation of the uterus was required in 33 women after they expelled the fetus. 24 of these women retained the placenta. None of the 100 women required a blood transfusion. These results compared favorably with those of a similar study using 600 mg mifepristone in combination with 1 mg gemeprost every 3 hours. In other words, clinical efficacy was not lost with a reduction in the dose of both mifepristone and gemeprost. These results demonstrated that 200 mg mifepristone followed by 1 mg gemeprost pessary is a cost-effective, simple, and noninvasive method to induce a second trimester abortion on an outpatient basis.