Risk factors for unsuccessful medical abortion with mifepristone and misoprostol.
BACKGROUND
The aim of this study was to determine the effectiveness of medical abortions with mifepristone and misoprostol following the approval of medical abortion in Israel.


METHODS
A retrospective review of 377 consecutive medical records at an ambulatory care unit of a university medical centre was performed, screening all women undergoing medical abortion with mifepristone and misoprostol. Transvaginal ultrasonographic study and serum beta hCG measurement were performed 14-20 days after the procedure. The clinical outcome was defined as complete expulsion of intrauterine contents with (failed group) or without (successful group) surgical intervention.


RESULTS
Surgical intervention was performed in 7.4% of patients. Residual products of conception were confirmed in 89%. Older age, previous spontaneous abortions, multigravidity, and earlier follow-up visit were independently associated with unsuccessful medical abortion. Significant differences were found in mean serum beta hCG and mean endometrial thickness in the successful versus failed procedure groups.


CONCLUSIONS
Medical termination of pregnancy with mifepristone and misoprostol is >90% effective. High risk group for failure of the procedure can be characterised. An algorithm of follow up using follow-up visit date, serum beta hCG and sonographic endometrial stripe is suggested to define high risk patients for failed medical abortion.
Haimov-Kochman
Ronit
R
Division of Obstetrics and Gynecology, Hadassah Hebrew University Hospital, Jerusalem, Israel. kochman@hadassah.rog.il
Arbel
Revital
R
Sciaky-Tamir
Yael
Y
Brzezinski
Amnon
A
Laufer
Neri
N
Yagel
Simcha
S
D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000021:Abortifacient Agents, Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods; D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015735:Mifepristone / Q000009:adverse effects* / Q000627:therapeutic use; D016595:Misoprostol / Q000009:adverse effects* / Q000627:therapeutic use; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging
D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D016595:Misoprostol; D015735:Mifepristone