Original research articleInduction of second trimester abortion (12–20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases
Introduction
For more than two decades, prostaglandins or their analogues have been used frequently for medical abortion. This method has proved to be a safe alternative to surgical termination of pregnancy [1].
There are different types of prostaglandin analogues that can be used for second trimester medical abortion. The two most commonly used prostaglandin analogues, gemeprost and misoprostol, have both been shown to be safe and effective when combined with mifepristone [2], [3], [4], [5]. Since only the former was licensed for the purpose of medical abortion, it was more widely used in the past. However, as compared to misoprostol, gemeprost is expensive and requires specific conditions for storage and transfer [6]. Therefore, in recent years, there is a trend to use misoprostol for second trimester abortion.
Misoprostol is a synthetic analogue of naturally occurring prostaglandin E1. It is used for prophylaxis and treatment of gastroduodenal ulcers [7]. Due to its uterotonic effect, it is contraindicated in pregnancy. Unlike gemeprost, it can be taken orally and is associated with fewer gastrointestinal side effects [8].
The use of mifepristone, a progesterone receptor blocker, prior to second trimester abortion with prostaglandin has been shown to significantly reduce the time between the first administration of a prostaglandin to expulsion of the fetus [9], [10]. This antigestagen targets cells of the endometrium and myometrium and sensitizes the pregnant uterus to exogenous prostaglandin. It has been demonstrated that a dose of 200 mg mifepristone is sufficient for this purpose without the loss of efficacy [8], [11].
It has been reported previously that the combination of oral mifepristone 200 mg followed by vaginally and orally administered misoprostol provides a noninvasive and effective regimen for first and mid-trimester termination of pregnancy [3], [12]. The purpose of this study is to report the effectiveness and safety of this regimen in clinical practice over a period of 2.5 years in Edinburgh.
Section snippets
Materials and methods
Three-hundred and eighty-six consecutive women admitted to the Edinburgh Royal Infirmary for abortion with gestational age of 12–20 weeks' gestation between February 2002 and August 2004 were studied. A database was set up to collect the data of all women undergoing termination of pregnancy during this study period. Abortion was carried out under the conditions of the 1967 United Kingdom Abortion Act.
Women admitted were either referred by their general practitioners, the family planning unit or
Results
Table 1 shows the characteristics of the 386 women who underwent second trimester abortion, and Table 2 shows the treatment outcomes for these women.
Two women (0.5%) aborted after 200 mg mifepristone without misoprostol. One of them was a nulliparous woman (33 years old) at 14 weeks of gestation, and the other woman (20 years old), at 15 weeks of gestation, had a previous delivery and two previous abortions. Neither of them had excessive bleeding, and curettage was not performed.
Following the
Discussion
This study confirms the efficacy of this combination of mifepristone and misoprostol regimen for termination of pregnancy between 12 and 20 weeks' gestation. The median induction-to-abortion interval (6.7 h) is comparable to previous studies using this combination [3], [6], [11]. The complete abortion rate of 95.0% in this study is comparable to previous studies using mifepristone and misoprostol (95.7%) [11]. The regimen used in our study is similar to a previous study by Ashok and Templeton
Acknowledgment
We would like to thank the medical and nursing staff at the Bruntsfield Suite in the New Royal Infirmary of Edinburgh for their help in this study. We would also like to thank Dr. A Colin Duncan and Dr. Nirmala Mary for their statistical support.
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Risk factors of surgical evacuation following second-trimester medical termination of pregnancy
2012, ContraceptionCitation Excerpt :However, in comparison with first-trimester TOP, it is associated with an increased risk of retained placenta and surgical evacuation [2]. The risk of surgical removal of the placenta or placental tissue has been reported to vary from 5% to 30% in second-trimester medical TOP [3–10]. However, few studies have been carried out to analyze the risk factors of surgical evacuation after second-trimester medical TOP performed with mifepristone and misoprostol.
Labor induction abortion in the second trimester: Release date February 2011 - SFP Guideline 20111
2011, ContraceptionCitation Excerpt :One of the most commonly used regimens is mifepristone 200 mg followed 36–48 h by misoprostol 800 mcg vaginally, then an additional 400 mcg vaginally every 3 h, to a maximum of 5 doses in 12 h. If abortion is not complete at that time, the woman has a 12-h rest before starting the cycle again [14,32–34]. In the largest published series (n =1002, gestational ages 13–21 weeks), 97% of women aborted within 24 h, with mean induction times of 5.9 h for multiparous women and 6.6 h for nulliparous women [14].