Medical abortion in the first trimester: the use of serum hCG and endometrial thickness as markers of completeness.
OBJECTIVE
The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We assessed endometrial thickness, determined by ultrasound and serum-human chorionic gonadotropin (s-hCG) as markers of successful management.


METHODS
Prospective trial involving 255 women, with a gestation of 62 days or less, who were to undergo medical abortion. In addition to our established routines of performing clinical and ultrasound examinations, we also determined the s-hCG level prior to treatment and at follow-up.


RESULTS
Of the 255 subjects treated during the study, 20 (7.8%) were lost to follow-up. The overall complete abortion rate was 94.0%. Fourteen subjects required vacuum aspiration, nine of them prior to the scheduled follow-up and five thereafter. None of the pregnancies were ongoing. A decrease of 99% in s-hCG levels was noted in 99% of the women, when levels determined prior to mifepristone intake and those measured 15-71 days post-abortion were compared.


CONCLUSIONS
This study confirms that s-hCG levels drop sharply after medical abortion. To assess the completeness of medical abortion, we recommend that clinical examination to be combined with determination of s-hCG. Ultrasonography should be carried out only when indicated.
Parashar
Pooja
P
Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway.
Iversen
Ole Erik
OE
Midbøe
Grete
G
Myking
Ole
O
Bjørge
Line
L
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000379:methods* / Q000592:standards*; D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D004717:Endometrium / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015735:Mifepristone / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage; D009664:Norway; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D006063:Chorionic Gonadotropin; D016595:Misoprostol; D015735:Mifepristone