K. Joo Thong

Induction of abortion with mifepristone and misoprostol in early pregnancy

Objective To investigate the clinical efficacy of the combination of mifepristone and an orally active prostaglandin, misoprostol, for early medical termination.

Endocrinology: Randomized trial of misoprostol and cervagem in combination with a reduced dose of mifepristone for induction of abortion

Mifepristone (600 mg) in combination with a prostaglandin has been demonstrated to be a safe, acceptable alternative to vacuum aspiration for induction of abortion in the first 9 weeks of pregnancy. However, the efficacy and side-effects of different prostaglandins used in combination with mifepristone have not been assessed in a randomized trial. In this study, 800 women seeking an abortion at gestational age < or = 63 days amenorrhoea were randomized to receive either 0.5 mg gemeprost by vaginal pessary (group I) or 600 micrograms misoprostol (group II) by mouth approximately 48 h after taking 200 mg mifepristone by mouth. The side-effects and number of complete abortions were used as measures of efficacy. There was no significant difference in the rate of complete abortion between group I [96.7%; 95% confidence interval (CI) 94.9-98.5%, n = 391] and group II (94.6%; 95% CI 92.3-96.9, n = 386). It was not possible to assess the outcome with certainty in the remaining 23 women. However, there were significantly more ongoing pregnancies in the women who received misoprostol than in those who received gemeprost (nine versus one, P < 0.01) and in eight of these 10 women the gestation was > 49 days. Fewer women in group II required analgesia than in group I (48 versus 60%, P < 0.001) although the number requesting opiate was similar in each group (6.9 versus 5.2%, P > 0.4). The incidence of nausea and vomiting after misoprostol (47.8 and 21.9% respectively) was higher (P < 0.001) than after gemeprost (33.9 and 12% respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

What do women want during medical abortion

A questionnaire study was carried out to investigate the needs of women undergoing a medical abortion induced by mifepristone in combination with either gemeprost pessaries or oral misoprostol. One-hundred-and-eighty women undergoing medical abortion of pregnancy of up to 63 days amenorrhoea were randomised to treatment in the sitting-room (treatment room) or in the ward. Overall, 77% and 69% treated in the sitting-room and ward, respectively, would have preferred treatment in the sitting-room. Fifty-four per cent did not wish their partner or friend to be present and 76% would prefer to stay in hospital following administration of prostaglandin. Ninety-five per cent of the patients would recommend this method of abortion to their friends. Women who received misoprostol required significantly less analgesia than women who were given 1 mg gemeprost as a vaginal pessary. The requirement for opiate analgesia was not influenced by parity, gestation of pregnancy, history of dysmenorrhoea or the dose of mifepristone. Almost 100% of the patients were satisfied with this method of treatment. This study indicates that the majority of women undergoing medical abortion prefer to be treated in a group, a method which is highly cost-effective.

Effect of daily low dose mifepristone on the ovarian cycle and on dynamics of follicle growth.

BACKGROUND AND OBJECTIVE The antiprogestin mifepristone has been shown to disrupt folliculogenesis and endometrial maturation and, therefore, has the potential to be used as a novel form of contraception. The purpose of this study was to Investigate further the effects of daily administration of a low dose of mifeprlstone (2mg) on the ovarian cycle and on the dynamics of follicle growth. SUBJECTS Six healthy female voiunteers were given 2mg mifepristone dally for 30 days following an ovulatory control cycle.

Changes in the concentration of alpha-fetoprotein and placental hormones following two methods of medical abortion in early pregnancy

Objective Measurement of alpha‐fetoprotein (AFP) was used to investigate the occurrence of feto‐maternal haemorrhage in women undergoing medical abortion.

Dose and time dependent rise of plasma cortisol following administration of mifepristone in early pregnancy

Physicians compared data on plasma cortisol concentrations of 10 healthy pregnant women (amenorrhea or= 8 weeks) who received a single dose of 50 mg RU-486 with those of 10 healthy women also in the first trimester of pregnancy who received a single dose of 200 mg RU-486. The blood samples were drawn 9 hours before RU-486 administration and at 24 and 48 hours after its administration. After the last blood sample, the women received either 0.5 mg or 1 mg of a gemeprost vaginal pessary. All the women experienced a complete abortion. At 200 mg RU-486, plasma cortisol levels increased over time (178.8 nmol/l at 0 hours, 272.9 nmol/l at 24 hours, and 247.8 nmol/l at 48 hours; p 0.01). RU-486s antiglucocorticoid effect on the hypothalamic-pituitary-adrenal axis accounted for the increase in plasma cortisol. There was no time dependent increase of plasmal cortisol levels at 50 mg RU-486, however. There were no significant differences between the 2 dosage groups in serum estradiol, progesterone, and human chorionic gonadotropin. The manufacturers recommended dose for RU-486 (600 mg) is much higher than the 200 mg which evoked an increase in plasma cortisol. This recommended dose appears not to cause any adverse side effects. Since other data also indicates that 200 mg RU-486 is as effective as 600 mg RU-486 for early medical abortion and the increase in plasma cortisol is dose dependent, practitioners should administer the lowest effective dose of RU-486 for early medical abortion.

What Do Women Want During Medical Abortion

A questionnaire study was carried out to investigate the needs of women undergoing a medical abortion induced by mifepristone in combination with either gemeprost pessaries or oral misoprostol. One-hundred-and-eighty women undergoing medical abortion of pregnancy of up to 63 days amenorrhoea were randomised to treatment in the sitting-room (treatment room) or in the ward. Overall, 77% and 69% treated in the sitting-room and ward, respectively, would have preferred treatment in the sitting-room. Fifty-four per cent did not wish their partner or friend to be present and 76% would prefer to stay in hospital following administration of prostaglandin. Ninety-five per cent of the patients would recommend this method of abortion to their friends. Women who received misoprostol required significantly less analgesia than women who were given 1 mg gemeprost as a vaginal pessary. The requirement for opiate analgesia was not influenced by parity, gestation of pregnancy, history of dysmenorrhoea or the dose of mifepristone. Almost 100% of the patients were satisfied with this method of treatment. This study indicates that the majority of women undergoing medical abortion prefer to be treated in a group, a method which is highly cost-effective.