Feasibility, efficacy, safety, and acceptability of mifepristone-misoprostol for medical abortion in the Democratic People's Republic of Korea

Objective

To examine the feasibility, efficacy, safety, and acceptability of medical abortion among rural and urban women up to 56 days of pregnancy in the Democratic People's Republic of Korea.

Method

A total of 199 women (rural n = 95, urban n = 104) recruited from 2 rural and 2 urban reproductive health clinics received 200 mg of oral mifepristone followed 2 days later by 400 μg of sublingual misoprostol. The women's abortion status and satisfaction level were determined 2 weeks later.

Results

Overall complete abortion occurred in 96.0% of the women; there was no statistically significant difference between the groups (rural 95.8%, 95% confidence interval [CI], 89.6-98.8; urban 96.2%, 95% CI, 90.4-98.9). The 2 groups reported similar adverse effects. In total, 90.5% of rural and 88.5% of urban participants were satisfied or very satisfied with the method.

Conclusion

The high efficacy and acceptability of medical abortion among rural and urban women suggest that medical abortion is a safe alternative to surgical abortion and can be scaled up to other reproductive health clinics in both rural and urban areas of the Democratic People's Republic of Korea, provided that there is appropriate training and supervision.     

Misoprostol administration in medical abortion. A comparison of three regimens

OBJECTIVE: To determine the best regimen for using misoprostol after methotrexate in medical abortion with respect to outcome and side effects. STUDY DESIGN: In a cohort study, we compared vaginal misoprostol in one cohort of 134 women who used 800 micrograms dry tablets with 99 women who used 600 micrograms wet and 197 women who used 800 micrograms wet. These cohorts were compared with respect to outcome and side effects. RESULTS: The "dry" group had fewer completed abortions by day 8 (55.2% as compared to 69.7% and 71.1%, P = .008) but similar surgery rates. The dry group also had fewer side effects, especially fever and chills (4.5% as compared to 25.3% and 40.6%, P = .0001) and vomiting (8.2% as compared to 16.2% and 20.3%, P = .01). CONCLUSION: Of the three methods, the one consisting of 600 micrograms of wet misoprostol is the most effective for early completion of abortion and has the fewest side effects.     

Alternatives to mifepristone for early medical abortion.

OBJECTIVE: To review published reports of first-trimester medical abortion regimens that do not include mifepristone. METHODS: Reports listed in Pubmed and Medline on prospective and controlled trials of the efficacy of misoprostol, alone or associated with methotrexate, for first-trimester abortion were analyzed if they included more than 100 participants and were published since 1990. RESULTS: The efficacy of regimens using misoprostol alone ranged from 84% to 96%, and when misoprostol was used with methotrexate the efficacy ranged from 70% to 97%. Efficacy rates were influenced by follow-up interval. Treatment for infection, bleeding, and incomplete abortion were infrequent with both methods (0.3%-5%). CONCLUSION: Alone or in combination with methotrexate, misoprostol is an efficacious alternative to mifepristone for the medical termination of pregnancy.     

Home administration of misoprostol for early medical abortion in India

Objective

To assess the efficacy and acceptability of home administration of misoprostol for early medical abortion in Indian family planning clinics.

Methods

In this prospective cohort study, consenting pregnant women (n = 599) with amenorrhea of 8 weeks or less seeking termination of pregnancy received 200 mg of oral mifepristone followed 48 hours later with 400 µg of oral misoprostol, administered either at home or at the clinic.

Results

Almost all women (88.4%) chose to take misoprostol home. There was no statistical difference in success rates between home and clinic users (89.0% vs 92.4%, Pearson χ² = 0.7; P = 0.395). Most women in both the home (90.7%) and clinic (92.3%) groups were satisfied or very satisfied with the procedure.

Conclusion

Home administration of misoprostol is safe and feasible for introduction into medical abortion services in India.     

Comparison of women seeking early and late abortion

The differential characteristics of 697 women desiring induced abortion were studied according to when in pregnancy they presented. Age, marriage, and level of formal education were inversely related, those with greatest delay tending to be young, unmarried, and minimally educated. Religion was relevant, but generally was not. Nulliparity was only a weak correlate of delay. Contributory factors of denial, ambivalence, fear, and preceding menstrual irregularity accounted for two thirds of cases; they were uniformly distributed over the range of gestational age, but constituted the greatest proportion of reasons among those delaying decision longest. Physician delay and laboratory error accounted for all but one tenth of the remainder; they were concentrated particularly among gravidas presenting for care in the early part of the midtrimester. Fear characterized the young, poorly informed noncontraceptors, and had the greatest relative impact in protracted delays; denial was more likely to be found among older and ostensibly better informed women.     

Study supports the introduction of early medical abortion in Turkey

In Turkey, there is an unmet need for induced abortion services provided by the public health services, especially in rural and semi-urban areas. The objective of this clinical study was to show that early medical abortion could be introduced safely in Turkey to improve women's access to services. In the study, women aged 18-49 up to 56 days of pregnancy were offered a choice between medical abortion with 200 mg mifepristone followed by 400 mcg oral misoprostol and MVA with local anaesthesia. 209 chose medical and 149 surgical abortion. Data from an additional 112 women were collected to obtain a similar number of surgical abortion cases. Women's preference for and satisfaction with the chosen method, side effects and complications up to the 14-day follow-up visit were recorded. 75% of women who chose medical abortion opted for home use of misoprostol. Pain with medical abortion on average lasted 3.6 +/- 3.0 days and with surgical abortion 3.7 +/- 2.9 days. 90% of women who had medical abortion said they would prefer it again compared to 70% of those having surgical abortion. There were 1.4% ongoing pregnancies in the medical abortion group and none in the surgical group. Provider training and familiarity with medical abortion are crucial. The high incomplete abortion rate indicates that the dose and regimen of misoprostol should be reconsidered. The findings support the introduction of early medical abortion in Turkey.     

Regimens of misoprostol with mifepristone for early medical abortion: a randomised trial

OBJECTIVE: To compare the efficacy, adverse effects and acceptability of the three most common misoprostol regimens used with mifepristone for medical abortion. DESIGN: Randomised nonblinded trial. SETTING: Three clinics associated with major research universities in Canada; two in major urban areas and one in a periurban area. POPULATION: Women of reproductive age. METHODS: Consenting women presenting for abortion services with gestations less than 56 days and who met inclusion criteria were given 200 mg mifepristone orally and then randomised into three misoprostol study groups: (group I) 400 micrograms of oral misoprostol, (group II) 600 micrograms of oral misoprostol, and (group III) 800 micrograms of vaginal misoprostol. Misoprostol was self-administered at home 24-48 hours following mifepristone, and participants were instructed to take a second similar misoprostol dose at 24 hours after the initial dose if bleeding was less than a normal menstrual period. MAIN OUTCOME MEASURES: Successful abortion without surgery was 94.1%, with no significant differences across the three study groups (94.7% in group I, 93.4% in group II, and 94.3% in group III; P= 0.975). RESULTS: Efficacy and adverse effects did not differ significantly across the three study groups. Pain increased significantly across the study and the gestational age groups and was associated with lower acceptability. CONCLUSIONS: There appears to be a range of safe and effective options for early medical abortion with mifepristone including a choice between oral and vaginal administration of misoprostol.     

Support for provision of early medical abortion by mid-level providers in Bihar and Jharkhand,India

Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India.     

One- and 2-day mifepristone-misoprostol intervals are both effective in medical termination of second-trimester pregnancy

Termination of pregnancy because of fetal anomaly requires the utmost clinical sensitivity and individualized patient care. This study compared the efficacy of a 1-day mifepristone and misoprostol interval in medical termination of second-trimester pregnancy performed because of fetal anomaly with that of the standard 2-day interval among the first 100 women in each group. A 200 mg dose of mifepristone was used; 0.4 mg of misoprostol was administered vaginally at 3-h intervals until abortion occurred. When calculated from ingestion of mifepristone, the time to abortion was 28 h 25 min (28:25 h) [23:10-50:40 h; median (range)] and 52:43 h (45:55-83:15 h) (P < 0.0001) in the 1- and 2-day mifepristone-misoprostol groups respectively. However, following initiation of misoprostol administration, the time to abortion [7:25 h (1:00-23:15 h)] was longer (P < 0.05) in the 1-day interval group than in the 2-day interval group [6:20 h (0:45-36:30 h)]; by 12 h, 82 and 87% (n.s.) respectively of the subjects had aborted. The proportions of cases undergoing surgical evacuation of the uterus were 64 and 45% (P < 0.001), in the 1- and 2-day interval groups respectively. Thus both 1- and 2-day mifepristone-misoprostol intervals are valuable in termination of second-trimester pregnancy.     

Acceptability and feasibility of mifepristone medical abortion in the early first trimester in Azerbaijan

Abstract

Objective To examine the acceptability and feasibility of early medical abortion using mifepristone and misoprostol in Azerbaijan.

Methods A total of 863 women in Baku and two regions of Azerbaijan who sought termination of gestations up to 63 days were enrolled in the study. In the capital, women swallowed 200 mg mifepristone in the clinic and were given the option of taking 800 μg misoprostol buccally either at the clinic or at home 24–48 hours later. In the regions, women were given the option of taking both drugs at home. Follow-up visits were to take place two weeks after mifepristone administration to determine abortion status.

Results Seventy-four percent of women in the regions chose home administration of mifepristone, and 92% of women from all locations selected misoprostol home administration. Ninety-seven percent of women had complete abortions, and 97% were satisfied or very satisfied with the method. The vast majority of participants preferred medical abortion for a future procedure (96%). Nearly all women (98%) would recommend medical abortion for pregnancy termination to a friend.

Conclusion Mifepristone-misoprostol medical abortion with the option of home administration of both drugs is an acceptable and feasible option for women in Azerbaijan.

Chinese Abstract

摘要 目的 研究阿塞拜疆妇女对应用米非司酮米索前列醇进行早期妊娠药物流产的可接受性及可行性。

方法 研究选取在阿塞拜疆首都巴库以及两个地区的要求终止63天内妊娠的863名妇女。在巴库,流产妇女在门诊口服200mg的米非司酮,24-48小时后她们可以选择在门诊或在家舌下含服800ug的米索前列醇。在阿塞拜疆的两个地区这两种药物妇女都可以选择在家服用。服用米非司酮后两周进行随访,以判断流产的状况。

结果 阿塞拜疆两个地区的74%的妇女选择在家服用米非司酮,所有入选妇女的92%都选择了在家服用米索前列醇。所有药物流产中,完全流产率为97%。97%的妇女对这种流产方法表示满意或非常满意,绝大部分的妇女（96%）表示以后会优先选择这种方法,几乎所有的妇女（98%）愿意把这种流产的方法介绍给她们的朋友。

结论 在阿塞拜疆,让妇女选择在家里使用米非司酮-米索前列醇进行药物流产是可以接受的也是可行的。     

Risk factors for repeat abortion and implications for addressing unintended pregnancy in Vietnam

Objective

To determine predictors of repeat abortion in 3 provinces in Vietnam.

Methods

In a cross-sectional study between August and December 2011, women who underwent abortion were interviewed after the procedure in 62 public health facilities in Hanoi, Khanh Hoa, and Ho Chi Minh City (HCMC). Information on sociodemographic factors, contraceptive and reproductive history and intentions, and opinions and experience of abortion services was collected. The primary outcome was repeat (≥ 2) abortions.

Results

Overall, 1224 women were interviewed: 534 from Hanoi, 163 from Khanh Hoa, and 527 from HCMC. The mean age and parity of the respondents were 29 years and 1.8, respectively, and 79.6% were married. Approximately half of the respondents were not using contraception before pregnancy. The prevalence of repeat abortion was 31.7%. In multivariate models, significant predictors of repeat abortion included living in Hanoi, higher parity, age 35 years or older, and having 2 or more daughters (versus 1) or no sons (versus 1) after controlling for parity (all P < 0.05).

Conclusion

Repeat abortion remains high in Vietnam, fueled partly by inadequate contraceptive use. Son preference seems to be an important predictor of repeat abortion. Strengthening post-abortion contraceptive counseling and promoting long-acting contraceptive methods are essential to reduce repeat abortion.