title: Mifepristone and misoprostol for cervical ripening in surgical abortion between 12 and 14 weeks of gestation: a randomized controlled trial.
abstract: OBJECTIVE
  Misoprostol and mifepristone are the two substances recommended for cervical preparation during first-trimester surgical abortions to decrease intraoperative bleeding and complications. The objective of the study was to evaluate whether the combination of mifepristone and misoprostol for cervical preparation in an elective surgical abortion between 12 and 14 weeks of gestation can reduce blood loss in comparison to misoprostol or mifepristone alone.
  
  
  METHODS
  A randomized controlled trial was performed in Marseille, France between May 2013 and May 2014. Women requesting a surgical abortion under general anesthesia between 12 and 14 weeks of gestation were 198, randomized into three groups: one received 400μg oral misoprostol 3h before surgery, one 200mg oral mifepristone 36h before surgery, and the other, both treatments. The main outcome was the quantity of intraoperative bleeding. The secondary outcomes were duration of intervention, ease of dilatation, and complications.
  
  
  RESULTS
  The quantity of intraoperative bleeding differed significantly between the groups (p=0.001): 222±64mL in the combination group, 329±129mL in the misoprostol group, and 276±119mL in the mifepristone group. The combination was associated with a shorter operative duration (p=0.001): 5±2min in the combination group, 7±5min in the misoprostol group, and 7±3min in the mifepristone group. A hemorrhage was observed for 5 of 55 women (9%) in the combination group, 13 of 51 (25%) in the misoprostol group, and 9 of 56 (16%) in the mifepristone group (p=0.08). No cervical laceration or uterine perforation was reported.
  
  
  CONCLUSIONS
  The combination of mifepristone and misoprostol in cervical preparation for elective surgical abortions between 12 and 14 weeks of gestation significantly reduced blood loss in comparison to misoprostol or mifepristone alone.
authors.affiliation: Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ohannessian
authors.affiliation: Department of Public Health, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 boulevard Jean Moulin, 13005 Marseille, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Baumstarck
authors.affiliation: Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Maruani
authors.affiliation: Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cohen-Solal
authors.affiliation: Department of Public Health, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 boulevard Jean Moulin, 13005 Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.affiliation: Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France. Electronic address: aubert.agostini@ap-hm.fr.
authors.forename: Aubert
authors.initials: A
authors.lastname: Agostini
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D020070:Cervical Ripening / Q000187:drug effects*; D005260:Female; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone
keywords: Abortion; Cervical priming; Mifepristone; Misoprostol; Termination of pregnancy