An effective regimen for early medical abortion: a report of 2000 consecutive cases

Abstract

A combination of the anti-progesterone mifepristone and gemeprost provides an effective non-surgical method for the induction of abortion at gestations up to 63 days, achieving complete abortion rates of over 95%. We report our experience with an alternate regimen, comprising a reduced dose of mifepristone in combination with vaginal misoprostol. A consecutive series of 2000 women requesting early medical abortion at gestations up to 63 days was studied retrospectively. Each woman received mifepristone 200 mg orally, followed 36-48 h later by misoprostol 800 microg vaginally. Of the 2000 women, 39 (2.0%) aborted completely following administration of mifepristone alone and a further 1912 experienced complete abortion following administration of misoprostol (a complete abortion rate of 97.5%). Surgical intervention was required in 49 women (2.5%): for incomplete abortion in 27 (1.4%), for missed abortion in seven (0.4%), for continuing pregnancy in 11 (0.6%) and to exclude ectopic pregnancy in four (0.2%). The surgical intervention rate was significantly higher among women at gestations > or = 49 days than among those at < or = 49 days (3.3 versus 1.5%, P = 0.0193). The regimen appears as effective, in terms of high complete abortion rate and low continuing pregnancy rate, as any published alternative. This regimen has the benefit of being less costly as the dose of mifepristone is 67% lower and misoprostol is substantially less expensive than gemeprost. Additionally, misoprostol does not require special transport or storage requirements. As such, the combination of mifepristone and misoprostol may be preferable to mifepristone and gemeprost.