Termination of early pregnancy with RU 486 (mifepristone) in combination with a prostaglandin analogue (sulprostone).
The antiprogestin RU 486 (mifepristone) has been shown to induce abortion when administered in early pregnancy, but the rate of incomplete abortion is high, around 40%. As blockage of the progesterone receptor increases the myometrial sensitivity to prostaglandins, a combination of RU 486 and a prostaglandin E2-analogue was tested for termination of pregnancy. One hundred and sixteen women, with a gestational length of less than 49 days from the first day of the last menstrual period, were treated with a daily dose of 50 or 100 mg RU 486 for 3 to 6 days, complemented with an intramuscular dose of 0.25 mg sulprostone (16-phenoxy-PGE2-sulfonylamide) on the last day of RU 486 treatment. The results confirmed that a reduction of treatment duration to 3 days is just as effective for inducing abortion (91% complete abortion) as a 4-6-day treatment regimen (95% complete abortion). Six patients had an incomplete abortion and in one the pregnancy continued unaffected. Side effects included intense uterine pain after the prostaglandin administration (16%), vomiting associated with the antiprogestin intake (9%) and after the prostaglandin administration (9%). One woman needed emergency curettage due to heavy bleeding. Six percent of the treated patients had a decrease in hemoglobin exceeding 20 g/l during the first week but no patient needed blood transfusion. No serious side effects were recorded.
Swahn
M L
ML
Department of Obstetrics and Gynecology, Karolinska Sjukhuset, Stockholm, Sweden.
Bygdeman
M
M
D000019:Abortifacient Agents / Q000009:adverse effects; D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects; D000028:Abortion, Induced; D000293:Adolescent; D000328:Adult; D015232:Dinoprostone / Q000009:adverse effects / Q000031:analogs & derivatives*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D015735:Mifepristone / Q000009:adverse effects; D011247:Pregnancy; D011379:Prognosis; D014463:Ultrasonography
D000019:Abortifacient Agents; D000020:Abortifacient Agents, Nonsteroidal; D004338:Drug Combinations; D015735:Mifepristone; C016767:sulprostone; D015232:Dinoprostone