title: A systematic review of more than one dose of misoprostol after mifepristone for abortion up to 10 weeks of gestation.
abstract: OBJECTIVE
  This review aimed to assess the effectiveness, acceptability and safety of regimens that include mifepristone and multiple misoprostol doses for abortion up to 10 weeks of gestation.
  
  
  METHODS
  We searched MEDLINE and reference lists for English-language reports (published between January 1990 and September 2005) of trials evaluating a medication abortion regimen consisting of mifepristone and multiple doses of misoprostol. Eligible trials had to either be restricted to women with less than 10 weeks' gestation or report stratified results that allowed the extraction of data for this subset.
  
  
  RESULTS
  Although we identified 26 eligible studies, only 3 were randomized controlled trials (RCTs), comparing regimens that differed in the repeat-dose misoprostol component. These trials did not detect differences in effectiveness between the randomized groups. One RCT found evidence of higher effectiveness from repeat misoprostol doses among a subgroup of women with more advanced gestations.
  
  
  CONCLUSIONS
  Although clinicians often prescribe a repeat dose of misoprostol to increase effectiveness in medication abortion, the effect of the repeat dose has not been established. Because mifepristone followed by a single misoprostol dose is highly effective in inducing abortion, determining the effect of a repeat misoprostol dose would require a large sample size. The resource expenditure on such large trials might not be warranted. Any future studies should use induction-to-completion time to measure effectiveness and should assess acceptability and side effects.
authors.affiliation: Ipas, Research and Evaluation Unit, Chapel Hill, NC 27516, USA. mfgallo@gmail.com
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
authors.forename: Susan
authors.initials: S
authors.lastname: Cahill
authors.forename: Laura
authors.initials: L
authors.lastname: Castleman
authors.forename: Ellen M H
authors.initials: EM
authors.lastname: Mitchell
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D016239:MEDLINE; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone