First-trimester Medical Abortion Research Articles

Administration of depot medroxyprogesterone acetate on the day of mifepristone for medical abortion: a pilot study

ObjectiveWe sought to evaluate satisfaction with timing of administration and continuation rates of depot medroxyprogesterone (DMPA) when given on the initial visit for first-trimester medical abortion. Study designIn this pilot study, we administered DMPA within 15 min of mifepristone administration. Participants were followed up in the clinic 7 days after enrollment and were contacted at 14 days, 28 days and 3, 6, 9 and 12 months by telephone. We assessed satisfaction with contraception timing, DMPA continuation, bleeding patterns and abortion completion. ResultsTwenty women were enrolled. At 7-day follow-up, 18 of 19 contacted participants (94.7%) were satisfied with timing of DMPA administration. Ten of 19 participants (52.6%) discontinued DMPA after the first injection. At 1 year, 3 participants out of 19 were continuing DMPA (15.7%). The median number of bleeding days after abortion was 19. Three participants had medical abortion failure. In the first year after abortion, there were four known repeat pregnancies. ConclusionsThe timing of initiation of DMPA on the initial visit for medical abortion is satisfactory to women, but its influence on medical abortion efficacy requires further study. Continuation rates for DMPA were low in our sample. ImplicationsThis pilot study provides groundwork for future larger studies to assess initiation of the injectable contraceptive DMPA on the day of mifepristone for medical abortion, but low continuation rates of DMPA in our sample emphasize the importance of access to intrauterine devices and implants after abortion.

First-trimester medical abortion versus surgical abortion: a comparison of efficacy and complications

First-trimester medical abortion versus surgical abortion: a comparison of efficacy and complications

Practice Bulletin No. 143

Over the past three decades, medical methods of abortion have been developed throughout the world and are now a standard method of providing abortion care in the United States. Medical abortion, which involves the use of medications rather than a surgical procedure to induce an abortion, is an option for women who wish to terminate a first-trimester pregnancy. Although the method is most commonly used up to 63 days of gestation (calculated from the first day of the last menstrual period), the treatment also is effective after 63 days of gestation. The Centers for Disease Control and Prevention estimates that 64% of abortions are performed before 63 days of gestation (1). Medical abortions currently comprise 16.5% of all abortions in the United States and 25.2% of all abortions at or before 9 weeks of gestation (1). Mifepristone, combined with misoprostol, is the most commonly used medical abortion regimen in the United States and Western Europe; however, in parts of the world, mifepristone remains unavailable. This document presents evidence of the effectiveness, benefits, and risks of first-trimester medical abortion and provides a framework for counseling women who are considering medical abortion.

Prophylactic Compared With Therapeutic Ibuprofen Analgesia in First-Trimester Medical Abortion

To compare the effectiveness of two oral analgesic regimens in first-trimester medical abortion. We randomly assigned 250 participants undergoing first-trimester abortion with mifepristone and misoprostol at three clinics to two ibuprofen regimens: therapeutic (800 mg every 4-6 hours as needed for pain) or prophylactic (800 mg starting 1 hour before the misoprostol dose, then every 4-6 hours for 48 hours regardless of pain, then as needed). We asked each participant to record her maximum pain on a scale of 0-10 daily thereafter. Of participants assigned to the prophylactic and therapeutic regimens, 111 of 123 (90%) and 117 of 127 (92%), respectively, provided follow-up data. More than 80% of the participants in each group complied with their assigned treatment. Participants in the prophylactic group used substantially more ibuprofen than those in the therapeutic group (median of nine and four tablets, respectively). The mean maximum pain score was 7.1 in the prophylactic group and 7.3 in the therapeutic group (standard deviations 2.5 and 2.2, respectively); the difference was not statistically significant (P=.87, adjusted for site). Duration of pain, verbal pain ratings reported at follow-up, and use of other analgesics did not differ significantly by group (all P>.05). No significant benefit of the prophylactic regimen was apparent in any population subgroup. Abortion failure and ibuprofen side effects in the two groups were similar. We found no evidence that prophylactic administration of ibuprofen reduces pain severity or duration in first-trimester medical abortion. The average pain severity experienced by participants using both regimens was high. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01457521. I.

Depot Medroxyprogesterone Acetate (DMPA) administration at the time of mifepristone for medical abortion: a pilot study

In a two-visit protocol for first-trimester medical abortion with mifepristone and misoprostol, injectable contraception is usually administered at the time of follow-up, after abortion is assessed to be complete. In this pilot study, we administered the DMPA injection at the time of mifepristone for medical abortion.

Administration of the etonogestrel contraceptive implant on the day of mifepristone for medical abortion: a pilot study

ObjectiveWe sought to determine satisfaction and continuation rates of the contraceptive implant when placed on the initial visit for first-trimester medical abortion. Study DesignIn this pilot study, we placed the implant within 15 min of mifepristone administration. We assessed satisfaction with implant placement timing, 1-year implant continuation and abortion completion. ResultsWe enrolled 20 participants. Sixteen (80%) returned for follow-up, and all had complete abortion. At 1 year, of 16 participants contacted, 14 (87.5%) were satisfied with implant insertion timing, and 14 (87.5%) continued the implant. ConclusionsInitiation of the contraceptive implant on the initial visit for medical abortion resulted in high satisfaction and continuation rates. ImplicationsThis pilot study provides important groundwork for future larger studies to assess initiation of the contraceptive implant on the day of mifepristone for medical abortion.

I081 DOES ROUTE MATTER? WHAT WE KNOW ABOUT FIRST TRIMESTER MEDICAL ABORTION OUTCOMES WITH REGIMENS USING VARIOUS ROUTES OF MISOPROSTOL ADMINISTRATION

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S180-S180 Invited presentations and presentations by organisations and societies I081 DOES ROUTE MATTER? WHAT WE KNOW ABOUT FIRST TRIMESTER MEDICAL ABORTION OUTCOMES WITH REGIMENS USING VARIOUS ROUTES OF MISOPROSTOL ADMINISTRATION R. Dabash, R. DabashSearch for more papers by this author R. Dabash, R. DabashSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60111-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S180-S180 RelatedInformation

Etonogestrel implant at the time of mifepristone for medical abortion

This pilot study sought to determine the feasibility and acceptability of insertion of the etonogestrel contraceptive implant (Implanon) at the time of mifepristone use for first-trimester medical abortion. Secondary outcomes included failure rate of medical abortion with this protocol, bleeding patterns, and continuation of Implanon at 3, 6, 9 and 12 months.

Comparing the World Health Organization-versus China-recommended protocol for first-trimester medical abortion: a retrospective analysis.

ObjectiveTo compare the effectiveness, in terms of complete abortion, of the World Health Organization (WHO)- and the China-recommended protocol for first-trimester medical abortion.MethodsA retrospective analysis of clinical data from women presenting for first trimester medical abortion between January 2009 and August 2010 at reproductive health clinics in Qingdao, Xi’an, Nanjing, Nanning, and Zhengzhou was conducted. One clinic in Qingdao administered the WHO-recommended protocol (200 mg mifepristone orally followed by 0.8 mg misoprostol buccally 36–48 hours later). Four clinics in the other locations provided the China-recommended procedure (Day 1: 50 mg of mifepristone in the morning, 25 mg in the afternoon; Day 2: 50 mg of mifepristone in the morning, 25 mg in the afternoon; Day 3: 0.6 mg oral misoprostol). Data on reproductive and demographic characteristics were extracted from clinic records, and complete termination was determined on day 14 (post-mifepristone administration).ResultsA total of 337 women underwent early medical abortion (167 WHO- and 170 China-recommended procedures). Complete abortion was significantly higher among women who had the WHO protocol than those who received the China protocol (91.0% vs 77.7%, respectively; P < 0.001). Women using the China-recommended protocol were three times more likely to require an additional dose of misoprostol than women using the WHO protocol (21.8% vs 7.8%, respectively; P < 0.001), and had significantly more bleeding on the day of misoprostol administration (12.5 mL vs 18.5 mL; P < 0.001).ConclusionThis clinical audit provides preliminary evidence suggesting the WHO-recommended protocol may be more effective than the China-recommended protocol for early medical abortion. A larger scale study is necessary to compare the methods’ effectiveness and acceptability.

Medical abortion: the Australian experience

The provision of medical abortion has been the subject of considerable political controversy in Australia over the past two decades. Specifically, use of the drug mifepristone (RU486) was virtually prohibited in the country in the years 1996–2006. Synthetic prostaglandins (in particular gemeprost and misoprostol) have been widely available and used for late (second and third trimester) termination of pregnancy since the late 1980s, usually for indications of fetal abnormality or serious maternal medical conditions, and there are numerous reports of the Australian use of these drugs in the literature. However, first-trimester medical abortion using mifepristone with misoprostol, a procedure which gained increasing acceptance overseas in the years following 1990, was unavailable to Australian women until 2006. The political and legal aspects of medical abortion are integral to an account of the experience of medical abortion in Australia, and will therefore be discussed in this article together with all asp...

Can midlevel health-care providers administer early medical abortion as safely and effectively as doctors? A randomised controlled equivalence trial in Nepal

Medical abortion is under-used in developing countries. We assessed whether early fi rst-trimester medical abortion provided by midlevel providers (government-trained, certified nurses and auxiliary nurse midwives) was as safe and effective as that provided by doctors in Nepal. This multicentre randomised controlled equivalence trial was done in fi ve rural district hospitals in Nepal. Women were eligible for medical abortion if their pregnancy was of less than 9 weeks (63 days) and if they resided less than 90 min journey away from the study clinic. Women were ineligible if they had any contraindication to medical abortion. We used a computer-generated randomisation scheme stratified by study centre with a block size of six. Women were randomly assigned to a doctor or a midlevel provider for oral administration of 200 mg mifepristone followed by 800 μg misoprostol vaginally 2 days later, and followed up 10-4 days later. The primary endpoint was complete abortion without manual vacuum aspiration within 30 days of treatment. The study was not masked. Abortions were recorded as complete, incomplete, or failed (continuing pregnancy). Analyses for primary and secondary endpoints were by intention to treat, supplemented by per-protocol analysis of the primary endpoint. This trial is registered with ClinicalTrials.gov, NCT01186302. Of 1295 women screened, 535 were randomly assigned to a doctor and 542 to a midlevel provider. 514 and 518, respectively, were included in the analyses of the primary endpoint. Abortions were judged complete in 504 (97.3%) women assigned to midlevel providers and in 494 (96.1%) assigned to physicians. The risk difference for complete abortion was 1.24% (95% CI -0.53 to 3.02), which falls within the predefined equivalence range (-5% to 5%). Five cases (1%) were recorded as failed abortion in the doctor cohort and none in the midlevel provider cohort; the remaining cases were recorded as incomplete abortions. No serious complications were noted. The provision of medical abortion up to 9 weeks’ gestation by midlevel providers and doctors was similar in safety and effectiveness. Where permitted by law, appropriately trained midlevel health-care providers can provide safe, low-technology medical abortion services for women independently from doctors. UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization.

Intrauterine device insertion after medical abortion

Background Studies comparing immediate intrauterine device (IUD) insertion after first-trimester surgical abortion with interval insertion show similar efficacy and expulsion rates. However, women randomized to interval insertion of an IUD are less likely to return for device placement. An ideal time to insert intrauterine contraception may be the day a woman presents for verification of a completed medical abortion. We examined immediate insertion of IUDs after completed first-trimester medical abortion. Study Design This is a prospective, observational clinical study to determine expulsion rates of intrauterine contraception placed immediately after confirmed, completed first-trimester medical abortion. Results Of 118 subjects, 78 women had levonorgestrel IUDs placed, whereas 41 women received copper IUDs. Of 97 subjects who completed the study, there were 4 clinical expulsions (4.1%) during 3 months of follow-up. There were no diagnosed pelvic infections, pregnancies, or uterine perforations. The continuation rate at 3 months was 80%. Conclusion Intrauterine devices inserted at the time of completed, confirmed first-trimester medical abortion have low rates of expulsion.

Cervical priming with misoprostol before manual vacuum aspiration versus electric vacuum aspiration for first-trimester surgical abortion

Objective To compare the efficacy of manual vacuum aspiration (MVA) with electric vacuum aspiration (EVA) and to evaluate whether cervical priming with misoprostol facilitates cervical dilation and reduces complications associated with first-trimester medical abortion performed up to 10 weeks of pregnancy. Methods A total of 600 women who requested termination of pregnancy were randomized into 4 groups (150 women in each group). Group I and II received a vaginal placebo 3 hours before MVA or EVA, respectively. Group III and IV received 400 μg of vaginal misoprostol 3 hours before MVA or EVA, respectively. Results Complete abortion rates after MVA and EVA were both 97.9%; after cervical priming with misoprostol complete abortion rates were 98.6% versus 97.3% after cervical priming with placebo ( P > 0.05). Administration of misoprostol into the vagina before MVA resulted in 99.3% complete abortions ( P = 0.40), and the least operative blood loss, operating time, and need for cervical dilation ( P < 0.05). Overall complications and adverse effects were similar in all groups ( P > 0.05). Conclusion For surgical evacuation, EVA and MVA did not differ in efficacy. Cervical priming 3 hours before MVA for termination of pregnancy significantly reduced the need for cervical dilation and the operative time, and improved the efficacy of the procedure. Pretreatment with vaginal misoprostol before MVA is a safe and effective method for terminating pregnancies of up to 10 weeks of gestation. Clinical Trials Registry: CTRI/2009/091/000008

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.

Patient satisfaction with the use of nuvaring after surgical or medical abortion

Introduction: This pilot study was conducted to determine if the use of a vaginal combined hormonal contraceptive ring (NuvaRing) is an acceptable method of hormonal contraception when used in the immediate postabortion period following a first-trimester surgical or medical abortion.Materials and Methods: Study participants were recruited from the Planned Parenthood of Houston and Southeast Texas, Inc. Participants were instructed to insert NuvaRing within 5 days of a first-trimester surgical abortion or within 7 days of a medical abortion. Participants were followed for 3 months to determine the acceptability and safety of NuvaRing inserted vaginally postabortion. Each participant finishing the study completed a NuvaRing satisfaction questionnaire. Safety was measured by the absence of signs of infection or serious adverse events related to the use of NuvaRing.Results: Sixty-eight participants (84%) completed the first-month follow-up visit and 54% (67%) completed the 3-month follow-up visit. Of the participants who completed the study, 48 (88.9%) continued the use of NuvaRing as their birth control method. There were no serious adverse events reported by the participants. The follow-up examinations showed no signs of infection related to the use of NuvaRing.Discussion: The results of this pilot study suggest that the use of NuvaRing is not only safe but also highly acceptable to women immediately following first-trimester medical or surgical abortion. Such use could potentially reduce contraceptive noncompliance and subsequent unintended pregnancy.Conclusion: NuvaRing is acceptable and safe when used in the immediate postabortion period following a first-trimester surgical or medical abortion. Introduction: This pilot study was conducted to determine if the use of a vaginal combined hormonal contraceptive ring (NuvaRing) is an acceptable method of hormonal contraception when used in the immediate postabortion period following a first-trimester surgical or medical abortion. Materials and Methods: Study participants were recruited from the Planned Parenthood of Houston and Southeast Texas, Inc. Participants were instructed to insert NuvaRing within 5 days of a first-trimester surgical abortion or within 7 days of a medical abortion. Participants were followed for 3 months to determine the acceptability and safety of NuvaRing inserted vaginally postabortion. Each participant finishing the study completed a NuvaRing satisfaction questionnaire. Safety was measured by the absence of signs of infection or serious adverse events related to the use of NuvaRing. Results: Sixty-eight participants (84%) completed the first-month follow-up visit and 54% (67%) completed the 3-month follow-up visit. Of the participants who completed the study, 48 (88.9%) continued the use of NuvaRing as their birth control method. There were no serious adverse events reported by the participants. The follow-up examinations showed no signs of infection related to the use of NuvaRing. Discussion: The results of this pilot study suggest that the use of NuvaRing is not only safe but also highly acceptable to women immediately following first-trimester medical or surgical abortion. Such use could potentially reduce contraceptive noncompliance and subsequent unintended pregnancy. Conclusion: NuvaRing is acceptable and safe when used in the immediate postabortion period following a first-trimester surgical or medical abortion.

An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 |ag for first-trimester legal medical abortion

An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 |ag for first-trimester legal medical abortion

Home use of two doses of misoprostol after mifepristone for medical abortion: A pilot study in Sweden and France

Objective To test the feasibility, safety, and efficacy of home use of two doses of misoprostol for medical abortion (MA) in European settings.Methods One hundred thirty women (100 in Sweden, 30 in France) presenting for first-trimester MA were administered oral mifepristone in the clinic and sent home with two 400 μg doses of misoprostol, along with instructions to take the misoprostol at 24 h intervals. Women were also asked to complete a daily symptom diary. Outcomes of interest included effectiveness, side-effects, and adherence to and acceptability of the home-use regimen.Results Three women (all in France) were lost to follow-up. Of the remaining 127 women, 124 (98%) had a successful MA. All women adhered successfully to the home-use regimen, and satisfaction with home use was high (98%). Most women experienced noticeable, if transitory, side effects after both the first and second doses of misoprostol (97% and 94%, respectively).Conclusions Misoprostol may successfully and satisfactorily be used at home as part of a MA regimen in European settings as it has been for years in the US. Further research to determine if two doses of misoprostol are more effective than a single dose would be useful.

Clinical uses of mifepristone: an update for women’s health practitioners

In September 2000, the U.S. Food and Drug Administration (FDA) approved the use of mifepristone for the provision of medical abortion. Although mifepristone was developed and marketed because of its potential to effect early first-trimester medical abortion, it has additional applications to health care, including the treatment of gynecologic conditions, cancer, and Cushing’s disease. The controversial nature of abortion has dominated the publicity about mifepristone. The evidence for the safety and efficacy of mifepristone in medical abortion has been overshadowed, and many clinicians are unaware of the other potential uses of the drug. This article provides a discussion of background information on the pharmacology, development of, and research on mifepristone and an update on current and potential uses in health care today. Information on the FDA-approved regimen and alternative protocols for management of mifepristone in its use in abortion care are presented.