Micrograms Of Vaginal Misoprostol Research Articles

Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days

Background From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the United States provided medical abortions principally by a regimen of oral mifepristone, followed 24–48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and to employ additional measures to minimize subsequent serious uterine infections. In August 2006, we conducted an extensive audit of medical abortions with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen. Objectives We sought to evaluate the effectiveness of the buccal medical abortion regimen and to examine correlates of its success during routine service delivery. Methods In 2006, audits were conducted in 10 large urban service points to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted estimates of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from two sites. Results The effectiveness of the buccal misoprostol–mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol–mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%. Conclusion In conjunction with 200 mg of mifepristone, use of 800 mcg of buccal misoprostol up to 59 days of gestation is as effective as the use of 800 mcg of vaginal misoprostol up to 63 days of gestation.

Late second-trimester abortions induced with mifepristone, misoprostol and oxytocin: a report of 428 consecutive cases

BackgroundThe aim of the study was to assess efficacy and safety of administering 200 mg of mifepristone between 36 and 48 h before the insertion of 800 mcg of vaginal misoprostol to induce late second-trimester abortion between 19.1 and 25.6 weeks gestation. Study designA consecutive series of 428 women who requested a termination of their pregnancy between 19.1 and 25.6 weeks of gestation were analyzed. MethodsEach woman received 200 mg of mifepristone orally between 36 and 48 h before the vaginal administration of 800 mcg of misoprostol and the insertion of two Dilapan intracervical tents if the gynecologist deemed necessary. Four hours after misoprostol, amniorrhexis was performed and intravenous oxytocin infusion started. The variables for assessing efficacy were the number of complete abortion without dilation and evacuation (D&E) and the time elapsed since misoprostol administration until the abortion. ResultsComplete abortion without surgery occurred in 387/428 (90.4%) subjects, and the mean time for misoprostol to abortion was 6.9±3.1 (SD) h. In 32/428 (7.5%) patients, it was necessary to administer a second 600-mcg misoprostol dose. The mean total oxytocin used was 9.7±7.9 (SD) IU. In 41/428 (9.6%) women, the abortion process was completed by D&E. A uterine rupture occurred in one woman with a previous cesarean section. ConclusionThe method of abortion that combined mifepristone, misoprostol and oxytocin was effective for interrupting pregnancies between 19.1 and 25.6 weeks of gestation. It is advisable to be well trained in D&E technique in case of possible failures and/or abortion inductions that are excessively prolonged.

Second-trimester pregnancy termination with 600-μg vs. 400-μg vaginal misoprostol and systematic curettage postexpulsion: a randomized trial

Background This study was conducted to compare efficacy and safety of 600 mcg of misoprostol vaginally every 6 h up to four doses vs. 400 mcg of misoprostol vaginally every 4 h up to five doses, followed by systematic curettage of the uterine cavity, for pregnancy termination between 12 and 20 weeks' gestation. Study Design We used a randomized clinical trial conducted at Hospital Gineco-Obstétrico “Eusebio Hernández”, Havana, Cuba. Subjects were women requesting voluntary termination of pregnancies between 12 and 20 weeks' gestation. Two hundred ten women were randomly assigned to receive 600 mcg of vaginal misoprostol every 6 h up to four doses (Group I) vs. 400 mcg of vaginal misoprostol every 4 h up to five doses (Group II), followed by curettage 1 h after expulsion. The main outcomes measured were successful abortion rate and mean expulsion time. Results Successful abortion occurred in 103/105 women (98.1%) in Group I and in 99/105 (94.3%) in Group II [p=.279, relative risk (RR)=3.121 and 95% confidence interval for RR=0.615 to 15.833]. Fetus mean expulsion time was 10.7±1.3 (SD) h in Group I and 11.5±5.0 (SD) h in Group II (p=.209). Conclusions Six hundred micrograms of misoprostol administered vaginally every 6 h was as effective as 400 mcg of misoprostol every 4 h for second-trimester pregnancy termination.

O-40: Mifepristone and misoprostol together may offer improved treatment for early pregnancy failure: A pilot clinical trial

O-40: Mifepristone and misoprostol together may offer improved treatment for early pregnancy failure: A pilot clinical trial

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

To compare the efficacy, adverse effects and acceptability of the three most common misoprostol regimens used with mifepristone for medical abortion. Randomised nonblinded trial. Three clinics associated with major research universities in Canada; two in major urban areas and one in a periurban area. Women of reproductive age. 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. 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). 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. 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.

Vaginal misoprostol in termination of second trimester pregnancy.

To study the effectiveness and complications of 600 micrograms of intravaginal misoprostol for terminating second trimester pregnancies. One hundred and seventy-two patients undergoing termination of pregnancy between March 1997 and April 1999 were studied. Each patient received 600 micrograms of intravaginal misoprostol every 12 hours until abortion occurred. The mean induction to abortion time was 24.1 +/- 21.6 hours. The percentage of women aborting within 24 and 48 hours was 68.6 and 89.5 respectively. There was no significant difference in the mean induction to abortion time and the percentage of women aborted within 48 hours between nulliparous and multiparous women. The mean amount of misoprostol used was 1405.5 +/- 1084.6 micrograms. Incomplete abortion occurred in 23.3% of women. The most common complication was temperature of more than 38 degrees C occurred in 41% followed by diarrhoea (20%), nausea and vomiting (15%). Six hundred micrograms of vaginal misoprostol is effective, but whether the 48 hours abortion rate can be improved with a large dose or shortened the time interval between doses, requires further study.