Timing of pain and bleeding after mifepristone-induced abortion.
Previous studies of medical abortion with mifepristone and a prostaglandin have reported percentages of subjects who experience cramping and/or bleeding relative to prostaglandin use. This is the first analysis of cramping and bleeding onset patterns in subjects treated with low-dose (200 mg) mifepristone and 800 microg vaginal misoprostol at 24, 48, or 72 h after mifepristone. We analyzed the cramping and bleeding onset patterns in subjects up to 8 weeks pregnant who used 800 microg vaginal misoprostol at 24, 48, or 72 h after 200 mg of oral mifepristone. We collected data from subjects' symptom diaries and divided symptom onset into 3 categories: before misoprostol use, 0--12 h following misoprostol, and more than 12 h after misoprostol. Of the 2,302 subjects, cramping and bleeding onset data were available for 2,030 (88%) and 2,123 (92%), respectively. Across all groups, 230 (11%) experienced cramping and 445 (21%) experienced bleeding before misoprostol use. There was a significantly higher percentage of subjects who experienced early cramping and/or early bleeding between the three treatment groups, and this was related to the interval between mifepristone and misoprostol. In the 12 h following misoprostol administration, cramping and bleeding patterns were similar in the three groups. The longer subjects waited to insert misoprostol, the more likely they were to experience early cramping and/or bleeding. After misoprostol insertion, cramping and bleeding patterns are similar regardless of treatment group. Patients and providers cannot rely on symptom onset to predict treatment success.
Columbia University College of Physicians and Surgeons, New York, NY, USA.
L J
LJ
De Nonno
C
C
Westhoff
S
S
Fielding
E
E
Schaff
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000028:Abortion, Induced / Q000009:adverse effects* / Q000379:methods; D000328:Adult; D004334:Drug Administration Schedule; D004412:Dysmenorrhea / Q000139:chemically induced*; D005260:Female; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage / Q000009:adverse effects*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D018709:Statistics, Nonparametric; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000139:chemically induced*
D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone