Mifepristone and misoprostol in medical induction of abortion

American Family Physician,  August, 1995  

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An estimated 30 million abortions are performed annually throughout the world, making the safety of the procedure a matter of global public health importance. The medical termination of pregnancy with a combination of mifepristone and a prostaglandin analog has been shown to be relatively safe and effective, compared with vacuum termination, up to 63 days from the onset of amenorrhea. Two prostaglandins, intramuscular sulprostone and vaginal gemeprost, have been widely available in Europe. However, sulprostone was recently withdrawn because of its association with three cases of myocardial infarction. Gemeprost is safe, but expensive, and requires special storage conditions. The prostaglandin misoprostol has attracted attention because it is inexpensive and can be taken orally. El-Refaey and colleagues compared the safety and efficacy of oral versus vaginal use of misoprostol after administration of mifepristone.

Women in Scotland who sought abortion within 63 days from the start of amenorrhea were included in the study. A total of 270 women received 600 mg of oral mifepristone and were then allowed to go home after the hemoglobin concentration was measured. Thirty-six to 48 hours later, the women were randomly assigned to receive 800 mg of misoprostol either orally or vaginally. The study had two primary endpoints: expulsion of the conceptus within four hours after administration of the prostaglandin and induced abortion without the need for a surgical procedure.

Seven women had abortions after administration of mifepristone but before administration of misoprostol; these women were not included in the final analysis. Ninety-three percent of the remaining women who received vaginal misoprostol had abortion within four hours, compared with only 78 percent of women who received oral misoprostol. Expulsion of the conceptus without surgical intervention occurred in 95 percent of women who received vaginal misoprostol, compared with 87 percent of women who received oral misoprostol. The continued pregnancy rate was 1 percent in women who received vaginal misoprostol, compared with 7 percent who received the oral formulation. The majority of women in both groups reported fatigue, nausea and hot flushes, although a significantly greater percentage of the oral misoprostol group reported vomiting and diarrhea.

These results indicate that the vaginal administration of misoprostol following mifepristone is more effective and better tolerated than oral administration of misoprostol for the medical induction of first-trimester abortion. (New England Journal of Medicine, April 13, 1995, vol. 332, p. 983.)

COPYRIGHT 1995 American Academy of Family Physicians
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