Early pregnancy termination with intravaginally administered sodium chloride solution-moistened misoprostol tablets: historical comparison with mifepristone and oral misoprostol

OBJECTIVE: The purpose of this study was to compare the abortifacient effect of intravaginally administered moistened misoprostol tablets with that of the combination regimen of mifepristone and oral misoprostol. STUDY DESIGN: One hundred women at 相似文献   

Second and third medical termination of pregnancy with misoprostol without mifepristone

BACKGROUND: Advances in prenatal diagnosis make it possible to detect many fetal pathologies for which a termination of pregnancy (TOP) is possible in France. In pregnancies which go beyond 3 months, the use of prostaglandins combined with mifepristone has simplified this procedure. Since mifepristone must be taken 48 h before using prostaglandins, we have used only misoprostol intravaginally. METHODS: Our report deals with a continuous series of terminated pregnancies in the second and third trimesters. The time period in question is January 1, 1996 through July 31, 2001. When this treatment was used within the first 30 weeks of gestation, four tablets (800 microg) of misoprostol were administered intravaginally. When there were no contractions, two additional tablets (400 microg) of misoprostol were given orally every 3 h, not exceeding 3 times. Beyond 30 weeks of amenorrhoea, because of the risk of uterine rupture, the initial dose was lower: 1/4 tablet (50 microg) of misoprostol intravaginally was increased to 100 microg (1/2 tablet) every 3 h until expulsion. RESULTS: In the second and third trimesters, 55 pregnancies were terminated medically; only 1 case was not successful. In the other 54 cases, the average time interval between administering misoprostol intravaginally and expulsion was 12.7 +/- 8 h. Side effects included nausea or vomiting for 12 patients (22%) and hyperthermia for 11 patients (20%). Thirty-three patients (60%) had no side effects at all. In 10 cases (18%), the fetus and the placenta were removed in one movement. In 11 cases (20%), the placenta had to be removed by artificial means. In 7 cases (13%), a curettage with a curette foam was done. In the long run perspective, only 1 patient needed a curettage to remove placental residue. CONCLUSION: Treatment by misoprostol without mifepristone during the second and third trimesters makes it possible to terminate a pregnancy easily and quickly without significant complications.     

Simultaneous use of mifepristone and misoprostol for early pregnancy termination

ObjectiveSimultaneous mifepristone 200 mg and vaginal misoprostol 800 μg produces a complete abortion rate of approximately 90% at up to 63 days of gestation. The aim of this study was to determine the effectiveness of concurrent administration of mifepristone 200 mg and vaginal misoprostol 600 μg with respect to early medical abortion.Materials and MethodsA total of 254 women with undesired pregnancies of less than 49 days of gestation were enrolled. All women received oral mifepristone 200 mg and vaginal misoprostol 600 μg concurrently. Follow-up assessment by transvaginal ultrasonography was performed 3 days and 2 weeks after treatment.ResultsEfficacy outcome was analyzed for 242 women (95.3%) after excluding 12 individuals lost to follow-up. The complete abortion rate was 92.6%. The mean induction to abortion interval was about 5.8 hours. The mean bleeding duration was about 12.6 days. The women indicated that the side effects were tolerable and 90% of them said that their experience was satisfactory.ConclusionConcurrent administration of oral mifepristone 200 mg and vaginal misoprostol 600 μg is an efficacious regimen for medical abortion of pregnancies up to 49 days of gestation.     

Early pregnancy termination with intravaginally administered sodium chloride solution–moistened misoprostol tablets: Historical comparison with mifepristone and oral misoprostol

Objective: The purpose of this study was to compare the abortifacient effect of intravaginally administered moistened misoprostol tablets with that of the combination regimen of mifepristone and oral misoprostol. Study Design: One hundred women at ≤56 days’ gestation received 800 μg misoprostol intravaginally in the form of sodium chloride solution–moistened tablets. The dose was repeated 24 hours later if a gestational sac persisted on ultrasonographic examination. These 100 subjects (group 1) were then matched with 100 subjects who had received 600 mg mifepristone followed by 400 μg misoprostol orally as part of a large multicenter American trial (group 2). Subjects were monitored for abortion success, adverse side effects, and bleeding characteristics. Abortion failure was defined as persistence of an intrauterine sac or the need to perform a surgical evacuation of the uterus for hemorrhage, for incomplete abortion, or at the subject’s request. Results: In 88 of the 100 women in group 1 and 94 of the 100 women in group 2, abortion occurred and a surgical procedure was not required. Abortion rates were not influenced by gestational age in either group. Prostaglandin-related side effects of fever and chills, vomiting, diarrhea, and uterine pain were all significantly higher in group 1. Excessive uterine bleeding was uncommon in both groups, and no subjects received blood transfusions. Conclusion: The abortion rate with intravaginally administered moistened misoprostol tablets is similar to that with the combination of mifepristone and oral misoprostol. However, intravaginal administration of misoprostol is associated with significantly more prostaglandin-related side effects. (Am J Obstet Gynecol 1999;181:1386-91.)     

The combination of mifepristone and misoprostol for the termination of pregnancy

The combination of 200 mg of mifepristone followed by 25 μg to 800 μg (depending on gestational age) of misoprostol has been shown to be effective for the termination of pregnancy throughout gestation. The dose of misoprostol should be reduced as gestational age increases. Mifepristone is not indicated for induction of labor with a live fetus because there are no data to confirm that it does not have a possible deleterious fetal effect. The course of treatment and prerequisites for medical abortion and recommended mifepristone and misoprostol regimens for different gestational ages are described, along with the side effects, management of complications, and postabortion care. The use of the mifepristone-misoprostol combination regimen for induction of labor in cases of fetal death is also described.     

Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy

In this prospective randomized parallel group study, subjects with a pregnancy of less than 63 d were randomized to receive either (i) 200?mg oral mifepristone plus 400?μg misoprostol per vaginally concurrently (group A); (ii) or the administration of misoprostol after 48?h (group B). Transvaginal sonography was performed on the 14th day of misoprostol administration to confirm complete abortion. The primary outcome was to compare the rates of complete abortion in two groups. Secondary outcomes were to compare induction abortion interval, side effects and compliance. A total of 200 subjects included in the study were randomized into groups A and B (100 each). Both the groups were comparable for age, parity, gestational age and history of previous abortion. The complete expulsion rate in group A was 96% (95% confidence interval (CI) 95.1–98.2%) and group B was 95% (95% CI 93.0–96.8%) (p?>?0.100). A gestational age of more than 56 d was found to predict failure of treatment in both groups. The adverse effect profile in the two groups was the same. Efficacy of concurrent mifepristone and misoprostol in combination is similar to that when misoprostol is given 48?h later (ctri.nic.in CTRI/2010/091/001422).     

Self-administration of vaginal misoprostol after mifepristone for termination of pregnancy: patient acceptability.

This was a questionnaire survey involving women who self-administered vaginal misoprostol in the hospital setting following oral mifepristone for medical termination of pregnancy. The sample number was 89 with a median gestational age of 9 weeks; median dose of misoprostol used was 1600 mug and median induction abortion interval was 5.3 h. The success rate was 100% with the majority finding it easy to self-administer vaginal misoprostol and two-thirds did not mind doing this. Only one-third experienced adverse effects of the medication and 83% were satisfied with the procedure. Only one-third was willing to try it at home in future if necessary. Self-administration of vaginal misoprostol for termination of pregnancy in the hospital is safe and effective. Although women were comfortable in self administering the pessaries in the hospital, they do not appear to be keen to do it at home without any supervision. However, as this is the first study in the UK involving women expressing their views regarding this issue, added research in this area is required.     

Early medical termination pregnancy with methotrexate and misoprostol in lower segment cesarean section cases

AIM: The aim of the study was to investigate the efficacy of methotrexate and misoprostol for the medical termination of early pregnancy with previous cesarean section. METHODS: Sixty-six pregnant women of 60 days or less in duration with previous one or two cesarean sections were selected. Each woman received intramuscularly a dose of methotrexate (50mg). Two to 3 days later, 800 microg of misoprostol was administered intravaginally. Repeat doses were used if there was no significant bleeding. An ultrasonography was done in each case after seven days. Subjects with continuing pregnancies or excessive bleeding had a surgical abortion. A successful medical abortion was defined by vaginal bleeding without surgical intervention and a negative transvaginal ultrasound. Side-effects were noted. RESULTS: Complete abortion occurred in 87.9% cases after first dose of misoprostol, and 6.1% cases had complete abortion after second dose, so out of 66 cases 62 (94%) had a successful medical abortion. Four (6%) subjects required surgical intervention; one for continued pregnancies, one for missed abortion, and two for excessive bleeding. The complete abortion rate was higher for early gestations: 30/30 (100%) at < or = 45 days gestation, 28/30 (93.3%) at 46-50 days gestation, and 2/6 (33.3%) from 50 to 63 days gestation. Vaginal bleeding lasted 15 +/- 7 days. Gastrointestinal side-effects were uncommon, mild, and brief. There was no case of uterine rupture. CONCLUSION: Medical abortion using methotrexate with misoprostol is safe, cheap, and effective for early pregnancy termination through 8 weeks' gestation even with previous cesarean section.     

Termination of early pregnancy in the scarred uterus with mifepristone and misoprostol.

OBJECTIVE: To analyze the safety and possibility of terminating early pregnancy up to 49 days gestation after cesarean section with mifepristone and misoprostol. METHODS: One-hundred and ninety-two early pregnant women were recruited, of which, 35 cases with uterine cicatrix and 157 cases were no-uterine cicatrix as control group. All of them took 25 mg of mifepristone, b.i.d. for 3 days and 600 microg of misoprostol on the 4th day. RESULTS: Of the 35 cases with uterine cicatrix, 33 achieved complete abortion after medical abortion. The complete abortion rate was 94.29% (95% CI 81-99%) in the cicatrix group and 89.81% (95% CI 75-91%) in the control group. There were no obvious complications detected in the cicatrix group. CONCLUSION: For the termination of early pregnancy in scarred uterus, administration of mifepristone and misoprostol is safe and effective, and a further large series study needs be done to confirm its acceptability as a routine medication in such situations.     

Simultaneous administration of mifepristone and misoprostol for early termination of pregnancy: a randomized controlled trial

Aim  

To compare the efficacy of different intervals of misoprostol administration (simultaneously vis-à-vis 24 h), after mifepristone, in women undergoing medical termination of pregnancy up to gestation of 49 days.     

Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services

Women on Web is a service that uses telemedicine to help women access mifepristone and misoprostol in countries with no safe care for termination of pregnancy (TOP). This study reviews the telemedicine service. After an online consultation, women with an unwanted pregnancy of up to 9 weeks are referred to a doctor. If there are no contraindications, a medical TOP is conducted by mail. After maximising the follow up from 54.8 to 77.6%, 12.6% decided not to do the TOP and 6.8% of the women who did the medical TOP at home needed a vacuum aspiration. Telemedicine can provide an alternative to unsafe TOP. Outcomes of care are in the same range as TOP provided in outpatient settings.     

Comparison of two doses and two routes of administration of misoprostol after pre-treatment with mifepristone for early pregnancy termination

Background  

It is not known whether a 400 μg dose of misoprostol has a similar efficacy as an 800 μg dose when administered sublingually or vaginally 24 hours after 200 mg mifepristone.     

米非司酮配伍米索前列醇终止8～16周妊娠有效性及安全性的临床研究

目的：探讨米非司酮配伍不同用药途径（口服或阴道给药）的米索前列醇终止8~16周妊娠的有效性和安全性。方法采用随机、开放、多中心研究,于2011年1月至2012年10月间对复旦大学附属妇产科医院等11个研究中心纳入的625例观察对象进入数据分析,口服组417例,其中孕8~9周198例、孕10~16周219例;阴道组208例,其中孕8~9周99例、孕10~16周109例。第1、2天分别顿服米非司酮100 mg,距首次口服米非司酮36~48 h后,口服组予米索前列醇400μg口服,间隔3 h重复给药400μg,最多4次;阴道组予米索前列醇600μg阴道放置,间隔6 h重复给药400μg,最多4次。主要评价指标为流产有效率,其他评价指标包括胚胎或胎儿排出时间、阴道流血情况、月经复潮时间及安全性等。结果（1）流产有效率阴道组[98.1%（202/206）]优于口服组[94.0%（390/415）],两组比较,差异有统计学意义（P=0.023）。按孕周分层,孕8~9周流产有效率口服组为95.9%（189/197）,阴道组99.0%（96/97）;孕10~16周流产有效率口服组为92.2%（201/218）,阴道组97.2%（106/109）;两组分别比较,差异均无统计学意义（P=0.156、0.073）。（2）胚胎或胎儿排出时间按孕周分层,孕8~9周口服组为（4.3±7.9）h,阴道组（3.8±2.5）h;孕10~16周口服组为（6.2±4.8）h,阴道组（5.5±3.8）h;两组分别比较,差异均无统计学意义（P=0.238、0.273）;孕8~9周平均为（4.1±6.6）h,孕10~16周平均为（6.0±4.5）h。（3）孕8~9周观察对象胎盘娩出2 h内阴道流血量口服组平均为（63±46）ml,多于阴道组的（55±45）ml,两组比较,差异有统计学意义（P=0.047）;孕10~16周胎盘娩出2 h内阴道流血量口服组为（76±52）ml,与阴道组的（76±61）ml比较,差异无统计学意义（P=0.507）。（4）月经复潮时间两组均在37 d左右。（5）研究期间发生5例严重不良事件,其中2例与药物相关;其他不良事件均为轻中度;口服组胃肠道症状恶心、呕吐的发生率分别为57.2%（239/417）、36.3%（151/417）,高于阴道组的45.4%（94/208）、26.1%（54/208）,两组比较,差异均有统计学意义（P=0.005、0.011）。结论米非司酮配伍米索前列醇终止8~16周妊娠,无论口服还是阴道给药均安全有效,这种非侵入性终止妊娠的方法值得临床推广应用。