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Raymond EG, Weaver MA, Shochet T. Effectiveness and safety of misoprostol-only for first-trimester medication abortion: An updated systematic review and meta-analysis. Contraception 2023; 127:110132. [PMID: 37517447 DOI: 10.1016/j.contraception.2023.110132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES This study aimed to update our 2019 systematic review of data on the effectiveness and safety of misoprostol-only for first-trimester abortion. STUDY DESIGN We searched PubMed on December 18, 2022, to find published articles describing the outcomes of treatment with misoprostol-only for abortion of viable intrauterine pregnancy at ≤91 days of gestation. From each article identified, two authors independently abstracted relevant data about each group of patients treated with a distinct regimen. We assessed the risk of bias using four defined indicators. We estimated the proportion of patients with treatment failure using meta-analytic methods as well as the proportion hospitalized or transfused after treatment. We examined associations between treatment failure and selected characteristics of the groups. RESULTS We identified 49 papers with 66 groups that collectively included 16,354 evaluable patients, of whom 2960 (meta-analytic estimate 15%, 95% CI 12%, 19%) had treatment failures. Of 9228 patients assessed for ongoing pregnancy after treatment, 521 (meta-analytic estimate 6%, 95% CI 5%, 8%) had that condition. Failure risk was significantly associated with misoprostol dose, the total allowed number of doses, the maximum duration of dosing, and certain indicators of risk of bias. Among 11,007 patients allowed to take at least three misoprostol doses, the first consisting of misoprostol 800 mcg administered vaginally, sublingually, or buccally, the meta-analytic estimate of the failure risk was 11% (95% CI 8%, 14%). At most, 0.2% of 15,679 evaluable patients were hospitalized or received transfusions. CONCLUSIONS Although some studies in this updated review were adjudicated to have a high risk of bias, the results continue to support the key conclusion of our 2019 analysis: misoprostol-only is effective and safe for the termination of first-trimester intrauterine pregnancy. IMPLICATIONS Misoprostol-only is a safe and effective option for medication abortion in the first trimester if mifepristone is unavailable or inaccessible.
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Affiliation(s)
| | - Mark A Weaver
- Elon University, Department of Mathematics and Statistics, Elon, NC, United States
| | - Tara Shochet
- Gynuity Health Projects, New York, NY, United States
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Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review. Obstet Gynecol 2019; 133:137-147. [PMID: 30531568 DOI: 10.1097/aog.0000000000003017] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize available data on the effectiveness and safety of single-agent misoprostol for medical abortion in the first trimester. DATA SOURCES We searched MEDLINE, CABI, Cochrane, EMBASE, LILACS, the Web of Science, and ClinicalTrials.gov for English-language studies that evaluated misoprostol alone for abortion of a viable pregnancy in the first trimester. METHODS OF STUDY SELECTION Our search yielded 1,562 citations, of which 38 included data from 53 trial groups that met our inclusion and exclusion criteria. TABULATION, INTEGRATION, AND RESULTS We abstracted data about each trial group, including study characteristics, treatment regimen, clinical protocol, number of women treated and followed, and numbers with outcomes of interest. We used meta-analytic methods and logistic regression to examine factors associated with surgical intervention after treatment. Among all 12,829 evaluable women, 2,536 (meta-analytic estimate 22.0%, 95% CI 18.8-25.5%) had surgical uterine evacuation. Multiple factors were significantly associated with this proportion, including misoprostol amount per dose and route of administration, loss to follow-up rate, publication date, geographic region, number of misoprostol doses, duration of dosing, and time between dosing and evaluation. Of 6,359 evaluable women, 384 (meta-analytic estimate 6.8%, 95% CI 5.3-8.5%) had ongoing pregnancies. At most 26 of 12,184 evaluable women (meta-analytic estimate 0.7%, 95% CI 0.4-1.0%) were transfused or hospitalized for abortion-related reasons. In trials that provided satisfaction data, most women were satisfied or very satisfied with the treatment (meta-analytic estimate 78%, 95% CI 71-85%). CONCLUSIONS Misoprostol alone is effective and safe and is a reasonable option for women seeking abortion in the first trimester. Research is indicated to further refine the regimen and to establish efficacy in the late first trimester. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42018083589.
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Ay SS, Aslan S, Önyay F, Kaya D, Koldaş E, Arslan S, Fındık M. Effect of oral misoprostol, alone or in combination with aglepristone, on mid-term pregnancy termination in cats. J Feline Med Surg 2019; 21:714-722. [PMID: 30230409 PMCID: PMC10814293 DOI: 10.1177/1098612x18797139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study aimed to determine the efficacy and safety of oral misoprostol (MIS) administration in the induction of mid-term pregnancy termination in cats. METHODS Twenty-eight cats that were pregnant for 30-40 days were allocated to four groups. The aglepristone (AGL) group (n = 7) received 10 mg/kg SC aglepristone q24h for two consecutive days. In the AGL+MIS group (n = 7), AGL (as administered in the AGL group) and MIS (200 µg/cat PO q12h until the start of abortion) were administered. The MIS200 (n = 7) and MIS400 groups (n = 7) received MIS (200 or 400 µg/cat misoprostol, respectively) alone PO q12h until the start of abortion. Blood samples were collected at the start of treatment (d0), 4 days after the start of treatment (d4) and on the day of complete abortion/end of administration (dA/d7). RESULTS The efficacy of the treatment was 71.4% in the AGL group, 100% in the AGL+MIS group, 0% in MIS200 group and 57.4% in MIS400 group (P = 0.004). No significance was found in relation to the interval from treatment to the start/end of abortion and the duration of abortion in all groups. The most observed side effect was vomiting in both groups administered MIS, particularly in the MIS400 group (56.7%). Progesterone (P4) concentrations were reduced during the abortion, but not to basal levels, in all groups. P4 concentrations were significantly lower at dA/d7 in the MIS400 group compared with the AGL and AGL+MIS groups (P = 0.002). CONCLUSIONS AND RELEVANCE The results obtained from this study showed that low doses of MIS do not induce abortions in cats but increase the effect of AGL. Although higher doses could terminate pregnancies, this also causes intense unwanted side effects. Therefore, the use of MIS alone as an abortifacient in cats is not recommended. For mid-term pregnancy termination in cats, the combination of misoprostol and aglepristone provides a more effective abortifacient than using either of them alone.
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Affiliation(s)
- Serhan Serhat Ay
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Selim Aslan
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Near East University, Nicosia-Turkish, Republic of Northern Cyprus
| | - Firdevs Önyay
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Duygu Kaya
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Kafkas University, Kars, Turkey
| | - Ece Koldaş
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Serhat Arslan
- Department of Biometry, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Murat Fındık
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD. Self-administered versus provider-administered medical abortion. Hippokratia 2018. [DOI: 10.1002/14651858.cd013181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Katherine Gambir
- Population Council; Poverty, Gender and Youth Program; One Dag Hammarskjöld Plaza New York New York USA 10017
| | - Caron Kim
- World Health Organization; Department of Reproductive Health and Research; 20 Avenue Appia Geneva Switzerland 1211
| | - Kelly Ann Necastro
- Massachusetts Institute of Technology; Cambridge Massachusetts USA 02139
| | - Bela Ganatra
- World Health Organization; Department of Reproductive Health and Research; 20 Avenue Appia Geneva Switzerland 1211
| | - Thoai D Ngo
- Population Council; Poverty, Gender and Youth Program; One Dag Hammarskjöld Plaza New York New York USA 10017
- Population Council; The GIRL Center; New York New York USA
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Frye LJ, Winikoff B, Meckstroth K. Claims of misoprostol use based on blood sampling should be viewed with skepticism. Int J Gynaecol Obstet 2014; 127:125-6. [PMID: 25220862 DOI: 10.1016/j.ijgo.2014.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Efforts to prosecute women for induced abortion have included allegations that misoprostol was found in body fluids. These claims, however, are questionable owing to the timing of specimen collection for accurate results, the scarcity and expense of validated assays, and the onerous lab procedures required to determine the presence of the substance. Adequate scrutiny should be applied each time such a claim is made.
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Affiliation(s)
| | | | - Karen Meckstroth
- Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, CA, USA
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Clark W, Shannon C, Winikoff B. Misoprostol for uterine evacuation in induced abortion and pregnancy failure. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.1.67] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rodriguez MI, Seuc A, Kapp N, von Hertzen H, Huong NTM, Wojdyla D, Mittal S, Arustamyan K, Shah R. Acceptability of misoprostol-only medical termination of pregnancy compared with vacuum aspiration: an international, multicentre trial. BJOG 2012; 119:817-23. [DOI: 10.1111/j.1471-0528.2012.03310.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baggaley RF, Burgin J, Campbell OMR. The potential of medical abortion to reduce maternal mortality in Africa: what benefits for Tanzania and Ethiopia? PLoS One 2010; 5:e13260. [PMID: 20948995 PMCID: PMC2952582 DOI: 10.1371/journal.pone.0013260] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 09/15/2010] [Indexed: 01/23/2023] Open
Abstract
Background Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative. Methods By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios) and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term. Results Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia). Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates. Conclusions This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention.
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Affiliation(s)
- Rebecca F Baggaley
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
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Pharmacy worker practices related to use of misoprostol for abortion in one Mexican state. Contraception 2009; 79:445-51. [DOI: 10.1016/j.contraception.2008.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 12/23/2008] [Accepted: 12/23/2008] [Indexed: 11/19/2022]
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High-Dose Misoprostol as An Alternative Therapy After Failed Medical Abortion. Taiwan J Obstet Gynecol 2008; 47:408-11. [DOI: 10.1016/s1028-4559(09)60007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Moreno-Ruiz NL, Borgatta L, Yanow S, Kapp N, Wiebe ER, Winikoff B. Alternatives to mifepristone for early medical abortion. Int J Gynaecol Obstet 2007; 96:212-8. [PMID: 17280669 DOI: 10.1016/j.ijgo.2006.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 08/17/2006] [Accepted: 09/11/2006] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- N L Moreno-Ruiz
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA.
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Li YT, Chen TH, Kuo TC. Vaginal misoprostol for salvage therapy after failed medical abortion. Int J Gynaecol Obstet 2006; 96:52-3. [PMID: 17188691 DOI: 10.1016/j.ijgo.2006.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 10/19/2006] [Accepted: 10/25/2006] [Indexed: 11/30/2022]
Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan
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Blanchard K, Shochet T, Coyaji K, Thi Nhu Ngoc N, Winikoff B. Misoprostol alone for early abortion: an evaluation of seven potential regimens. Contraception 2006; 72:91-7. [PMID: 16022846 DOI: 10.1016/j.contraception.2005.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Revised: 02/25/2005] [Accepted: 02/26/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION A growing body of literature has shown that misoprostol alone could be effective for early medical abortion. We evaluated seven potential regimens in women up to 56 days of gestation in order to potentially identify an optimal regimen. METHODS In phase I of the study, women requesting early abortion were randomized to one of three misoprostol regimens (4x400 microg po every 3 h, 2x800 microg po every 6 h, 1x600 pv microg); in phase II, women were randomized to one of two regimens (2x800 microg po every 3 h, 1x800 pv microg). In phase III, we consecutively tested two regimens (800 microg pv wetted with saline repeated after 24 h if intact gestational sac, 2x800 microg pv wetted with saline) to validate previously published results. RESULTS Although most women experienced some side effects, all regimens were tolerable and acceptable. Five of the seven regimens resulted in complete abortion rates of 60% or less. Only repeated doses of 800 microg pv misoprostol resulted in efficacy exceeding 60%. DISCUSSION Misoprostol-alone abortion regimens using oral misoprostol are too ineffective for clinical use or further investigation. Regimens with repeated dosing of misoprostol 800 microg pv warrant further study to find the optimal treatment protocol.
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Schaff E. Evidence for shortening the time interval of prostaglandin after mifepristone for medical abortion. Contraception 2006; 74:42-4. [PMID: 16781259 DOI: 10.1016/j.contraception.2006.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 03/03/2006] [Accepted: 03/10/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to compare regimens that shorten the interval between mifepristone and the prostaglandin misoprostol or gemeprost for medical abortion. METHODS The Cochrane Controlled Trials Register and MEDLINE were systematically searched for the words mifepristone and abortion. Only randomized controlled trials comparing different mifepristone regimens with either misoprostol or gemeprost were included. The outcome was a complete abortion not requiring surgical evacuation. RESULTS Five randomized trials were identified and all were published since 1999. Four were from the United States and three had enrollments of >1000. The route of administration of the prostaglandin was used vaginally, except in one study where misoprostol was divided in two doses 2 h apart. Four studies provided information about a 1-day interval and two trials provided information about an interval of 6-8 h evaluating mifepristone 200 mg and misoprostol 800 microg vaginally. There were no significant differences noted between the current 2-day interval compared with the 1-day interval. There was one study suggesting no difference with an interval of 6-8 h. CONCLUSIONS The interval between mifepristone and misoprostol 800 microg vaginally can be decreased from 48 to 6-8 h without loss of efficacy.
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Affiliation(s)
- Eric Schaff
- Department of Family Medicine, University at Buffalo, New York, USA.
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Cohen J, Ortiz O, Llaguno SE, Goodyear L, Billings D, Martinez I. Reaching women with instructions on misoprostol use in a Latin American country. REPRODUCTIVE HEALTH MATTERS 2006; 13:84-92. [PMID: 16291489 DOI: 10.1016/s0968-8080(05)26202-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In Latin America, where restrictive laws limit women's access to safe abortion services, misoprostol is being used to induce abortions, often without correct information on dosage or regimens. This study in an unnamed Latin American country aimed to identify appropriate channels through which instructions on misoprostol use could be disseminated to women. In-depth interviews were carried out with physicians, pharmacy staff, women who had had safe abortions and women from the community, as well as focus group discussions with advocates of safe abortion. Participants considered physicians to be the most appropriate source of information and for ensuring confidentiality for both women and provider. Participants considered midwives, pharmacists and women's groups as appropriate referral points, but not providers of information. Legal restrictions and professional risk were the primary reasons why pharmacists rejected this role, though many are selling misoprostol. There was a general lack of information about misoprostol for medical abortion among both health professionals and women. Accurate information about misoprostol use for a wide range of gynaecologic and obstetric purposes, including induced abortion, could be incorporated into training and educational materials for physicians, midwives and other appropriate mid-level providers, as well as pharmacists. Without these alternative information channels, access to information would be severely restricted, especially in rural areas.
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Billings DL. Misoprostol Alone for Early Medical Abortion in a Latin American Clinic Setting. REPRODUCTIVE HEALTH MATTERS 2005; 12:57-64. [PMID: 15938158 DOI: 10.1016/s0968-8080(04)24010-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Misoprostol is being used widely by women throughout Latin America, often based on instructions passed along through friends, acquaintances or professionals who may have little information about safe and effective use. This paper presents the experience of a Latin American clinic working in a legally restrictive setting that offers misoprostol as one option to women seeking early pregnancy termination. Between February 2001 and June 2002, 3225 women who attended the clinic chose to use misoprostol rather than vacuum aspiration. 89.9% returned for follow-up, of whom 76.4% had had a complete abortion within 72 hours, using one, two or three doses of 800 micrograms of misoprostol administered by the woman herself vaginally every 24 hours. The first 78 women who returned for follow-up at 72 hours responded to a questionnaire regarding their experiences. Satisfaction with the abortion process was high, despite some pain, chills, diarrhoea and/or nausea. Seventy-two of the 78 women said they would use misoprostol again if they needed to terminate another pregnancy and would recommend it to a friend. Having a clinic where staff are knowledgeable and experienced in misoprostol use is particularly important in settings where abortion is stigmatised, unsafe abortion common and access to safe services limited.
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Affiliation(s)
- Deborah L Billings
- Senior Associate, Research and Evaluation, Ipas Mexico, Mexico City, Mexico.
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Shannon C, Brothers LP, Philip NM, Winikoff B. Infection after medical abortion: A review of the literature. Contraception 2004; 70:183-90. [PMID: 15325886 DOI: 10.1016/j.contraception.2004.04.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2004] [Revised: 04/30/2004] [Accepted: 04/30/2004] [Indexed: 10/26/2022]
Abstract
Medical abortion regimens have become widely used, but the frequency of infection after medical abortion is not well documented. This systematic review provides data on infectious complications after medical abortion. We searched Medline for articles written before July 2003 to determine the frequency of infection after medical abortion up to 26 weeks of gestation. We reviewed all articles and extracted data on the frequency of infection from 65 studies. The frequency of diagnosed and/or treated infection after medical abortion was very low (0.92%, N = 46,421) and varied among regimens. Results of this review confirm that, with respect to infectious complications, medical abortion is a safe and effective option for first- and second-trimester pregnancy termination. After accounting for regional variations in diagnosis, there is little difference in frequency of infection among the regimens reviewed. Future studies should report clear diagnosis and treatment standards for infection so that more precise information becomes available.
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Affiliation(s)
- Caitlin Shannon
- Gynuity Health Projects, 15 East 26th Street, Suite 1609, New York, NY 10010, USA
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Borgatta L, Mullally B, Vragovic O, Gittinger E, Chen A. Misoprostol as the primary agent for medical abortion in a low-income urban setting. Contraception 2004; 70:121-6. [PMID: 15288216 DOI: 10.1016/j.contraception.2004.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Revised: 01/10/2004] [Accepted: 03/04/2004] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to assess the outcomes of early medical abortion in an inner-city hospital abortion service, using misoprostol as the primary agent. This was a retrospective chart review from July 2001 through December 2002. Women were eligible if they had a viable pregnancy with gestational age 8 weeks or less by transvaginal ultrasound and no medical contraindications. Two doses of 800 microg misoprostol were administered vaginally, 24 h apart. Initial follow-up was scheduled 2-3 days later. Of the 440 women who underwent medical abortion, 373 (90.8%, 95% confidence interval (CI) 88-94%) completed abortion medically, 38 (9.2%) had uterine aspiration and the remainder had incomplete or no follow-up. Of uterine aspirations, 11 were medically indicated, giving a rate of indicated aspiration of 2.7%. Gestational age, age, gravidity, parity, past abortion history, ethnic group and payer did not significantly correlate with overall rate of aspiration or rate of follow-up, but gestational age was correlated with medically indicated aspiration. Among 57 women who reported a time of tissue passage, the mean time from initial misoprostol dose was 8.5 h (95% CI 6.5-13 h).
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Affiliation(s)
- Lynn Borgatta
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118, USA.
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Abstract
OBJECTIVE Medical abortion regimens have become more widely used to terminate early pregnancies. Medical abortion providers are concerned to diagnose and exclude women with ectopic pregnancy before initiating treatment, as with any early pregnancy termination. Yet, there is little information about whether the various pretreatment screening methods used are adequate. We reviewed published literature to determine the overall success of screening for ectopic pregnancy before medical abortion treatment. DATA SOURCES We searched MEDLINE for articles on medical abortion regimens published before July 2003. METHODS OF STUDY SELECTION We selected English language articles of studies of medical abortion with sample sizes greater than 100, which reported on ectopic pregnancy diagnosed after medical abortion treatment. Fifty-seven of 85 prospective studies and randomized trials (69%) met these inclusion criteria. We also included data from 2 unpublished studies because they were large and well-controlled and because they included serious adverse events known to us, which we did not deem fair to exclude from our analysis. TABULATION, INTEGRATION, AND RESULTS Each article was reviewed by one author. Data from selected studies were compiled, and the frequency of ectopic pregnancy diagnosed after medical abortion treatment was calculated. Ectopic pregnancy was diagnosed very infrequently following medical abortion procedures, occurring in only 10 of 44,789 (0.02%) women. CONCLUSION The very low frequency of ectopic pregnancies diagnosed after medical abortion treatment demonstrates that the various pretreatment screening methods that providers use to exclude patients with ectopic pregnancies are successful. Further, there is no evidence to suggest that medical abortion treatment leads to unusual complications for women with ectopic pregnancies.
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Abstract
Misoprostol is a prostaglandin E1 analog originally intended for use to prevent NSAID-induced gastric ulcers. However, because of its cervical ripening and uterotonic property, misoprostol has become one of the most useful drugs in obstetrics and gynecology. Misoprostol has proven to be a very convenient and flexible drug because of its formulation as a tablet that is stable and that can be administered orally, rectally, vaginally and by the sublingual route. Beginning with its abuse for illegal abortion in the late 1980s, misoprostol has quickly become established as one of the most effective drugs for terminating pregnancies in the first and second trimesters, as well as for inducing labor in the third trimester. Its use for routine prevention of postpartum hemorrhage has not been so successful, partly as the high doses required for this indication often result in troublesome side effects. Despite the large body of medical evidence about its efficacy and relative safety, the use of misoprostol in pregnant women remained off-label until the spring of 2002.
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Affiliation(s)
- Yap-Seng Chong
- Department of Obstetrics & Gynaecology, National University of Singapore, Singapore
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Abstract
Since the 1980s, when mifepristone combined with a prostaglandin was found to be safe and effective for early abortion, many studies have refined the regimens and investigated alternatives such as methotrexate plus misoprostol, and misoprostol alone. Evidence now demonstrates that more than 200 mg of mifepristone provides no additional benefit, that vaginal misoprostol is superior to oral, especially between 7 and 9 weeks' gestation, and that misoprostol may be safely self-administered at home. Buccal and sublingual routes of administration of misoprostol also are promising. Absolute contraindications to medical abortion arise infrequently. Gastrointestinal and other side-effects occur in about one-third of women, primarily after administration of the prostaglandin. Careful assessment before and after medical abortion is essential and can be accomplished in various ways, depending on the skills of the clinician.
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Affiliation(s)
- Karen R Meckstroth
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco General Hospital, San Francisco, CA 94110, USA.
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Carbonell JLL, Rodríguez J, Velazco A, Tanda R, Sánchez C, Barambio S, Chami S, Valero F, Marí J, de Vargas F, Salvador I. Oral and vaginal misoprostol 800 microg every 8 h for early abortion. Contraception 2003; 67:457-62. [PMID: 12814814 DOI: 10.1016/s0010-7824(03)00043-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of the study was to evaluate the efficacy and safety of 800 microg misoprostol (Cytotec) every 8 h for 24 h for pharmacological abortion; the treatment was repeated if abortion did not occur in the first 24-h interval. The first misoprostol doses were always self-administered into the vagina; the second and third doses could be administered orally or vaginally depending on the amount of bleeding. Four-hundred and fifty-two women with gestations between 36 and 63 days were recruited into the study. The main outcomes assessed were: successful abortion (complete abortion without surgery), side effects, mean drop in hemoglobin, vaginal bleeding and mean time of return of menstruation. Complete abortion occurred in 409/452 (90.5%; 95% confidence interval [CI] 87%, 93%) patients. Medication to relieve symptoms was administered to all women before the first misoprostol dose. Vaginal bleeding lasted 15.9 +/- 4.4 days. The mean drop in hemoglobin, measured 14 days after abortion, was statistically significant (p = 0.0001) but without clinical relevance. According to the results obtained, 800 microg of misoprostol administered every 8 h for 24 h could be a valid method for abortion for up to 9 weeks of gestation.
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Affiliation(s)
- J L L Carbonell
- Clínica Mediterrania Medica, C/ Salvador Guinot 14, 46017, Castelló, Valencia, Spain.
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