Early versus late misoprostol administration after mifepristone for medical abortion.
OBJECTIVE
To evaluate the successful medical termination of pregnancy comparing two regimens: misoprostol 2 or 48 h after mifepristone administration.


METHODS
Prospective randomized study.


METHODS
Department of Obstetrics and Gynecology.


METHODS
One hundred pregnant women admitted for medical termination of pregnancy were enrolled; no pregnancies were over 55 days gestational age.


METHODS
All subjects were randomly assigned for misoprostol administration either 2 or 48 h after mifepristone. All participants underwent transvaginal ultrasound examination for uterine contents 48 h and 3 weeks after mifepristone.


METHODS
Procedure failure, defined as the presence of fetal heart activity, presence of a gestational sac, or a need for uterine curettage after misoprostol administration.


RESULTS
Each group consisted of 50 women. Fetal heart activity was significantly more frequent after 48 h in the 2-h interval group (10/50) than in the 48-h interval group (0/50) (p = 0.002). Three weeks after misoprostol administration, fetal heart activity was present in 4/50 (8 %) in the 2-h interval group (p = 0.118) and none of the 48-h interval group. At 48 h residual tissue was present in 13/50 (26 %) and 5/50 (10 %) in the 2 and 48-h interval groups, respectively (p = 0.031); this was reduced to 12/50 (24 %) compared to 5/50 (10 %) in the two groups, respectively (p = 0.054) after 3 weeks.


CONCLUSIONS
Successful medical termination of pregnancy can be achieved using misoprostol administration 2 h after mifepristone in 76 % of cases. However, this regimen is not recommended as it is significantly inferior to the traditional 48-h interval regimen.
Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, 22100, Nahariya, Israel.|Galilee Faculty of Medicine, Bar Ilan University, Safed, Israel.
Rene
R
Tendler
Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, 22100, Nahariya, Israel.|Galilee Faculty of Medicine, Bar Ilan University, Safed, Israel.
Jacob
J
Bornstein
Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, 22100, Nahariya, Israel.
Mohamad
M
Kais
Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, 22100, Nahariya, Israel.
Irina
I
Masri
Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, 22100, Nahariya, Israel. marwan20@bezeqint.net.|Galilee Faculty of Medicine, Bar Ilan University, Safed, Israel. marwan20@bezeqint.net.
Marwan
M
Odeh
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D005324:Fetal Movement; D005865:Gestational Age; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011446:Prospective Studies; D014599:Uterus
D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone
Failed medical termination of pregnancy; Mifepristone; Misoprostol; Regimen; Termination pregnancy