title: A two-pill sublingual misoprostol outpatient regimen following mifepristone for medical abortion through 70 days' LMP: a prospective comparative open-label trial.
abstract: OBJECTIVE
  To test the effectiveness and acceptability of an outpatient medical abortion protocol with 200 mg mifepristone and 400 mcg sublingual misoprostol at 64-70 days' last menstrual period (LMP) and compare it to the already known efficacy of the 57-63 days' LMP gestational age range.
  
  
  METHODS
  We conducted a prospective, comparative open-label trial in six hospitals and clinics in Ukraine, Georgia, India and Tunisia. We enrolled 714 reproductive age women with pregnancies 57 to 70 days who presented requesting abortion. Medical abortions were managed with the current service delivery protocol (200 mg oral mifepristone followed in 24-48 h by 400 mcg sublingual misoprostol). Data on safety, efficacy and acceptability were collected. The main outcome measure was complete abortion without surgical intervention at any point.
  
  
  RESULTS
  A total of 703 cases were analyzable for efficacy. Success rates did not differ significantly in the two groups [57-63-day group: 94·8%; 64-70-day group: 91.9%; Relative Risk (RR): 0.79 (0.61-1.04)]. Ongoing pregnancy rates also did not differ significantly (57-63 days: 1.8%; 64-70 days: 2.2%; RR: 1.10 (0.65-1.87)].
  
  
  CONCLUSIONS
  A medical abortion regimen of 200 mg mifepristone followed in 24-48 h by 400 mcg sublingual misoprostol is effective through 70 days' gestation and may be offered within existing outpatient abortion services.
  
  
  CONCLUSIONS
  A regimen of 200 mg mifepristone followed in 24-48 h by 400 mcg sublingual misoprostol is effective up to 70 days' LMP. The findings have important implications for expanding access to outpatient medical abortion services in settings where the cost of misoprostol is of concern or a two-pill misoprostol regimen is the standard of care.
authors: Gynuity Health Projects, New York, NY 10010, USA. Electronic address: hbracken@gynuity.org.
authors: Hillary
authors: H
authors: Bracken
authors: Gynuity Health Projects, New York, NY 10010, USA.
authors: Rasha
authors: R
authors: Dabash
authors: Zhordania Institute of Human Reproduction, Tbilisi, Georgia.
authors: George
authors: G
authors: Tsertsvadze
authors: Central District Maternity House, Odessa, Ukraine.
authors: Svetlana
authors: S
authors: Posohova
authors: Naval Nursing Home, Solapur, India.
authors: Milind
authors: M
authors: Shah
authors: Reproductive Health Consultant, Tunis, Tunisia.
authors: Selma
authors: S
authors: Hajri
authors: Government Medical College, Nagpur, India.
authors: Shuchita
authors: S
authors: Mundle
authors: La Rabta Maternity Hospital, Tunis, Tunisia.
authors: Hela
authors: H
authors: Chelli
authors: Family Planning Center of Nabeul, Nabeul, Tunisia.
authors: Dhouha
authors: D
authors: Zeramdini
authors: Gynuity Health Projects, Tbilisi, Georgia.
authors: Tamar
authors: T
authors: Tsereteli
authors: Gynuity Health Projects, New York, NY 10010, USA.
authors: Ingrida
authors: I
authors: Platais
authors: Gynuity Health Projects, New York, NY 10010, USA.
authors: Beverly
authors: B
authors: Winikoff
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000028:Abortion, Induced / Q000379:methods*; D000286:Administration, Sublingual; D000553:Ambulatory Care; D005260:Female; D005846:Georgia (Republic); D005865:Gestational Age; D006801:Humans; D007194:India; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014416:Tunisia; D014455:Ukraine
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Mifepristone; Misoprostol; Termination of pregnancy