Vaginal misoprostol administered at home after mifepristone for abortion - RU486

Journal of Family Practice, April, 1997 by Eric A. Schaff, Lisa S. Stadalius, Steven H. Eisinger, Peter Franks

The acceptability questionnaire reflected the experience at the follow-up visit when TVS documented a completed abortion. Most of the side effects from the medications and acute symptoms would be accurately reflected, but prolonged bleeding or other symptoms may be underreported.

A disadvantage of mifepristone is that it is not known to be an effective treatment for ectopic pregnancy; therefore, an intrauterine pregnancy should be identified. The earliest pregnancies identified by TVS are identified 32 to 33 days after amenorrhea, and abdominal ultrasound reveals them approximately 1 week later. Therefore, if using ultrasound for dating a pregnancy, initial evaluations should be delayed until a gestational sac can be identified. With close monitoring, methotrexate may prove to be a safer medication to induce abortion in very early pregnancies if ectopic pregnancy has not been ruled out.

CONCLUSIONS

Self-administration of vaginal misoprostol at home after taking mifepristone in the office was highly effective, sale, and acceptable to women. The study required one less visit than the European protocol requires. A larger multicenter trial, currently in progress, will help determine whether a second dose of misoprostol in initial nonrespondent shortens their expulsion interval. Mifepristone-induced abortion appears to occur within a significantly shorter time interval compared with methotrexate-induced abortions. Mifepristone and home administration of vaginal misoprostol is a safe and acceptable alternative to surgical abortion.

ACKNOWLEDGMENTS

The authors want to thank Larry Lader, President of The Abortion Rights Mobilization, for his dedication in bringing mifepristone to the United States and making this study possible, David Home, PhD, Assistant Professor of Chemistry, Columbia University, for overseeing the manufacturing process, and the dedicated work of our counselors and staff.