Medical Termination Of Early Pregnancy Research Articles

Ultrasonographic features of the endometrium following successful medical termination of early pregnancy

ObjectiveUltrasonographic features of the endometrium are often assessed when deciding the necessity of surgical intervention following early medical abortion. Knowledge is therefore needed on the ultrasonographic appearance of the endometrium following successful medical abortion in order to avoid unnecessary surgical interventions. We aimed to assess endometrial thickness and echogenicity at multiple time points following successful early medical abortion. Study designWe conducted a retrospective study in the largest office-based abortion providing clinic in Denmark. Using archived ultrasonographic images, we assessed endometrial thickness and echogenicity following all early medical abortions that did not need surgical intervention or repeated medication for completion during the years 2014–2017. ResultsUltrasonographic endometrial features were assessed 1854 times following 1074 early medical abortions. Median endometrial thickness in the 1st week from induction was 13 milimeters (mm; lower-upper quartile 11–17 mm). For the 2nd, 3rd, 4th, and >4th week, the median endometrial thickness was found to be 11 mm (9–15 mm), 11 mm (8–14 mm), 12 mm (9–16 mm), and 11 mm (8–14 mm), respectively.Of the ultrasonographic examinations performed in the 1st week from medical induction, 24.7 % showed a heterogenous endometrium. For 2nd, 3rd, 4th, >4th week, the frequency of heterogeneity was 23.9 %, 16.3 %, 21.3 %, 18.9 %, respectively.A total of 151 abortions (14.1 %) were each examined three times, median time of examination being day 7, 15, and 26 following induction. Among these abortions, the three most common patterns of change in endometrial thickness were “decreasing” (37.7 %), “increasing-decreasing” (23.2 %), and “decreasing-increasing” (21.9 %). Further, 49.7 % of the 151 abortions showed a homogenous endometrium at all three examinations, 17.2 % showed a heterogenous endometrium at first examination and a homogenous endometrium the following two examinations, and 9.9 % showed a heterogenous endometrium at the first two examinations followed by a homogenous endometrium. ConclusionIn early medical abortions completed without secondary intervention, endometrial thickness and echogenicity varied clinically significantly for weeks following the medical induction. Every possible pattern of change in endometrial thickness and echogenicity was observed.

Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond

Author(s): Raymond, Elizabeth; Grossman, Daniel; Mark, Alice; Upadhyay, Ushma; Dean, Gillian; Creinin, Mitchell; Coplon, Leah; Perritt, Jamila; Atrio, Jessica; Taylor, DeShawn; Gold, Marji | Abstract: No abstract

Use of Combination of Mifepristone and Misoprostol to Terminate Early Pregnancy: Experience at a Tertiary Care Teaching Hospital

Background: Termination of pregnancy is well prescribed method all over the world to terminate the early pregnancy with the combination of mifepristone and misoprostol tablet orally.Objective: The purpose of this present study was to determine the efficacy of mifipristone (200 mg) for medical termination of early pregnancy with oral misoprostol 800 mcg 24 hours later.Methodology: This observational study was done in the Department of Gynaecology & Obstetrics at Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh among outdoor patients in 6 months period from July 2014 to December 2014. The patients with intrauterine pregnancy up to 9 weeks and blighted ovum were included. Incomplete abortion and extrauterine pregnancy were excluded. Mifepristone 200 mg followed by misoprostol 800 mg after 24 hours had been given.Result: Total 50 patients with 9 weeks of pregnancy were selected over the period of 6 months requesting termination of pregnancy. This study showed termination of early pregnancy up to 9 weeks with tablet mifepristone and tablet misoprostole which was effective as well as the expulsion rate of the product of conception was 92.0% cases and among them 32.0% patients were needed extended dose of misoprostol and 8.0% cases had incomplete abortion who needed surgical evacuation. Some patients had some complications like vomiting, fever, abdominal pain and excessive per vaginal bleeding which were managed accordingly.Conclusion: Mifepristone 200 mg followed by misoprostol 800 mcg orally is an effective method for termination early pregnancy with minimum side effects.Journal of Science Foundation 2017;15(1):9-13

The first comparative study on very early medical termination of pregnancy, with and without ultrasound confirmation of an intrauterine pregnancy.

This first comparative study answers some questions about the provision of medical termination of pregnancy (TOP) when the location of the pregnancy is unknown (Bizjak et al, in this issue of BJOG) Note for typesetter: please update reference when assigned to an issue. . In current clinical practice many health professionals are reluctant to provide medical abortion if the pregnancy has not been confirmed by ultrasound to be inside the uterus. The major concern is the fear of missing an ectopic pregnancy but also the possibility of reduced efficacy of medical TOP (Goldstone P et al Contraception 2013;87(6):855-8.). This article is protected by copyright. All rights reserved.

Private midwives in Public Hospitals: Creating choice for birthing families in Victoria

To determine the outcome of early medical termination of pregnancy (TOP) among women who choose a “self assessment” follow up comprising a self-performed low sensitivity urine pregnancy test with instructions on signs/symptoms that mandate contacting the TOP service.A retrospective review of computer databases of 1726 women choosing self-assessment after early medical TOP (< 9 weeks) in the UK. The main outcome measures were (a) number of women choosing self-assessment, (b) contact rates with TOP service and (c) time to presentation with an ongoing pregnancy (failed TOP).Ninety-six percent of women having an early medical TOP and going home to expel the pregnancy chose self-assessment. Two percent of women made unscheduled visits to the TOP service. One hundred and eighty-eight women (11%) telephoned the service about concerns related to complications or the success of treatment. There were eight ongoing pregnancies (0.5%; 95% confidence interval 0.2–0.9%). Four were detected within 4 weeks of treatment; the remainder were not detected until one or more missed menses after the procedure.Most women having an early medical TOP, who go home to expel the pregnancy, choose self-assessment. Relatively few women make unscheduled visits or telephone the TOP service. Most ongoing pregnancies are recognized at an early stage, although late presentation (as with all methods of follow up) does still occur.If women are given clear instructions on how and when to conduct a urine pregnancy test and on signs/symptoms that mandate contacting the TOP service, then they can confirm the success of early medical TOP themselves. Late presentation due to failure to recognize an ongoing pregnancy is rare.

Efficacy and safety of very early medical termination of pregnancy: a cohort study.

To assess the efficacy and safety of medical termination of pregnancy (MTOP) when no intrauterine pregnancy (IUP) is confirmed on ultrasound. Retrospective case-note review. Two gynaecological clinics in Vienna, Austria, and Gothenburg, Sweden. All women with gestations of ≤49days undergoing an MTOP during 2004-14 (Vienna) and 2012-15 (Gothenburg). Two study cohorts were created: women with and women without a confirmed IUP. An IUP was defined as the intrauterine location of a yolk sac or fetal structure visible by ultrasound. Women with an IUP were selected randomly and included in the IUP cohort. Efficacy of MTOP, defined as no continuing pregnancy and with no need of surgery for incomplete TOP. After excluding 11 women diagnosed with an extra-uterine or molar pregnancy, 2643 cases were included in the final analysis; 1120 (98.2%) had a successful TOP in the no-IUP group, compared with 1458 (97.1%) in the IUP group, with a risk difference of 1.09% (95% confidence interval, 95%CI, -0.14, 2.32%; P=0.077). Significantly more women with confirmed IUP were diagnosed with incomplete TOP, and were treated with either surgery or additional medical treatment of misoprostol [64 (4.3%) versus 21 (1.8%); risk difference -2.42%; 95%CI -3.9, -1.1%; P<0.001]. There was no difference between the groups in efficacy of MTOP, whereas early treatment resulted in significantly fewer interventions for incomplete TOP. The risk of ectopic pregnancy needs to be considered if treatment is initiated before an IUP is confirmed, but with structured clinical protocols the possibility of the early detection of an ectopic pregnancy in an asymptomatic phase may increase. MTOP before confirmed intrauterine pregnancy is as effective as at later gestation with less incomplete TOP.

Can women determine the success of early medical termination of pregnancy themselves?

ObjectiveTo determine the outcome of early medical termination of pregnancy (TOP) among women who choose a “self assessment” follow up comprising a self-performed low sensitivity urine pregnancy test with instructions on signs/symptoms that mandate contacting the TOP service. Study designA retrospective review of computer databases of 1726 women choosing self-assessment after early medical TOP (<9 weeks) in the UK. The main outcome measures were (a) number of women choosing self-assessment, (b) contact rates with TOP service and (c) time to presentation with an ongoing pregnancy (failed TOP). ResultsNinety-six percent of women having an early medical TOP and going home to expel the pregnancy chose self-assessment. Two percent of women made unscheduled visits to the TOP service. One hundred and eighty-eight women (11%) telephoned the service about concerns related to complications or the success of treatment. There were eight ongoing pregnancies (0.5%; 95% confidence interval 0.2–0.9%). Four were detected within 4 weeks of treatment; the remainder were not detected until one or more missed menses after the procedure. ConclusionsMost women having an early medical TOP, who go home to expel the pregnancy, choose self-assessment. Relatively few women make unscheduled visits or telephone the TOP service. Most ongoing pregnancies are recognized at an early stage, although late presentation (as with all methods of follow up) does still occur. Implications statementIf women are given clear instructions on how and when to conduct a urine pregnancy test and on signs/symptoms that mandate contacting the TOP service, then they can confirm the success of early medical TOP themselves. Late presentation due to failure to recognize an ongoing pregnancy is rare.

The efficacy, safety and acceptability of medical termination of pregnancy provided by standard care by doctors or by nurse-midwives: a randomised controlled equivalence trial.

To assess nurse-midwife provision of early medical termination of pregnancy (TOP) in a high-resource setting where ultrasound examination for dating of pregnancy is part of the protocol. Randomised controlled equivalence trial. Out-patient family planning unit at a university hospital. Women seeking early medical TOP. A total of 1180 women were randomised, without any prior examination, to counselling, examination, and treatment by either nurse-midwife or gynaecologist. Ultrasound was performed in all cases by the allocated provider. The primary outcome was efficacy, defined as the successful completion of TOP without need for vacuum aspiration. Secondary outcomes were safety, defined as need for hospitalisation or blood transfusion, and acceptability, defined as preferred provider were the women to have a medical TOP in the future. A total of 481 women in the nurse-midwife group and 457 women in the doctor group were available for the final analysis. The effectiveness of provision of medical TOP by nurse-midwife providers was superior to that provided by doctors (risk difference 1.6%, 95% confidence interval 0.2-3.0%, which was within the set margin of equivalence). There were no significant differences in safety parameters. Women examined and counselled by a nurse-midwife were significantly more likely (P < 0.001, 95% confidence interval 0.308-0.394) to prefer seeing a nurse-midwife for the consultation were they to have another medical TOP in the future. These findings show that nurse-midwife provision of early medical TOP in a high-resource setting, where ultrasound is part of the protocol, is effective, and can be safely implemented with high acceptability among women.

A pilot study on the use of a 7-day course of letrozole followed by misoprostol for the termination of early pregnancy up to 63 days

BackgroundOur previous randomized controlled study showed that the complete abortion rate in termination of pregnancy up to 63 days with the combined use of letrozole for 3 days followed by vaginal misoprostol was significantly higher than that of misoprostol alone. A positive correlation was observed between the basal estradiol level and the failure rate. We performed this pilot study to assess if a longer course of letrozole followed by misoprostol would improve the estradiol suppression and the complete abortion rate of pregnancy up to 63 days. Study DesignTwenty subjects requesting legal termination of pregnancies up to 63 days were recruited. Medical abortion was offered with letrozole 10 mg daily for 7 days followed by vaginal misoprostol 800 mcg on the 7th day. ResultsMedian induction-to-abortion interval was 7.5 h (range, 4.75–10.75 h). Overall complete abortion rate was 95%. All subjects with gestation ≤49 days (12/12) as well as 87.5% of subjects with gestation between 50 and 63 days (7/8) had complete abortion. No major adverse event were reported and over 88% of women would like to have medical termination as an option should it be required in the future. ConclusionThis pilot study showed that a 7-day course of letrozole followed by vaginal misoprostol was associated with a very high complete abortion rate (95%) which is comparable to the standard regimen with sequential use of mifepristone and misoprostol in medical termination of early pregnancy up to 63 days.

A randomized controlled trial of different buccal misoprostol doses in mifepristone medical abortion

BackgroundAn 800-mcg dose of buccal misoprostol following mifepristone has been shown to be highly effective in terminating pregnancies through 63 days since the last menstrual period (LMP) (B. Winikoff, I.G. Dzuba, M.D. Creinin, et al., Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial. Obstet Gynecol 2008; 112: 1303–1310). However, a two 200-mcg misoprostol pill option would simplify administration, and potentially reduce costs and increase women's satisfaction. This study compares a 400-mcg dose (Group I) to an 800-mcg dose (Group II) of buccal misoprostol. Study DesignEligible and consenting women requesting medical termination of early pregnancy (n=1122) were randomized and instructed to take misoprostol 36 to 48 h after taking 200 mg mifepristone. Follow-up visits occurred 12 to 15 days after mifepristone administration. ResultsNinety-six percent of women in both groups had successful abortions. Women in Group I experienced significantly less vomiting and fever/chills than women in Group II. Ninety-six percent of women in both groups found the procedure very satisfactory or satisfactory. ConclusionsFour hundred micrograms of buccal misoprostol is as effective as the standard 800-mcg dose in terminating pregnancies up to 63 days LMP and reduces side effects.

Low dose Mifepristone (100 mg) for medical termination of pregnancy

BackgroundAbortion is the most common entity in the practice of obstetrics and gynaecology. Different methods and modes have been opted for until now to find an effective regimen with the least complications. We have tried the minimal dose (100 mg) of Mifepristone (PO) instead of the presently recommended 200 mg for medical abortion in early first trimester cases.ObjectivesThe objective of the study was to determine the efficacy of low dose (100 mg) Mifepristone for medical termination of early pregnancy with oral Misoprostol 800 μg, 24 hours later.DesignA prospective analytical study was conducted on a population of 82 early-pregnant patients who have requested medical abortions.MethodPregnant women of less than 56 days gestation age from their last menstrual period, requesting medical abortion were selected over a period of 14 months from January 2007 to March 2008. They were given 100 mg Mifepristone orally on Day-1, followed by 800 μg Misoprostol orally 24 hours later on Day-2, keeping the patient in the ward for at least 6 hours.Abortion interval, success rate, post-abortion bleeding and side-effects were noted. Success was defined as complete uterine evacuation without the need for surgical intervention.ResultsThe total success rate of this minimal dose Mifepristone regimen was 96.25%. Pain and nausea were the predominant side-effects noted. In total 72 (90%) women had completely aborted within 5 hours of taking Misoprostol. Three (3.75%) women only required suction aspiration, hence termed as failed medical abortion. The abortion interval increased with the gestation age. All three failures were of the more-than-42-day gestational age group. The overall mean abortion interval was 4.68 ± 5.32 hours.ConclusionMifepristone 100 mg, followed 24 hours later by Misoprostol 800 μg orally, is a safe and effective regimen for medical abortion.

Misoprostol With or Without Letrozole Pretreatment for Termination of Pregnancy

To compare the success rate and side effects of letrozole and misoprostol versus misoprostol alone for medical termination of early pregnancy. Patients requesting termination of pregnancy up to 63 days of gestation were randomized into two groups. The letrozole group received letrozole 10 mg daily for 3 days followed by 800 micrograms of vaginal misoprostol, while the placebo group received placebo for 3 days followed by the same dosage of misoprostol. The complete abortion rate and the side effects profiles of the two groups were compared. The primary outcome measure was the complete abortion rate. A total of 168 women were recruited. The complete abortion rate of the letrozole group was significantly higher than that of the placebo group (86.9% compared with 72.6%, relative risk [RR] 1.20, 95% confidence interval [CI] 1.03-1.40). The complete abortion rate in gestations up to 49 days was significantly higher in the letrozole group than in the placebo group (93.3% compared with 78.7%, RR 1.19, 95% CI 1.002-1.40), while the corresponding rates for gestation between 50 and 63 days were not significantly different between the two groups. There were significantly fewer women complaining of vomiting in the letrozole group than those in the placebo group (8.3% compared with 19.0%, P=.043, RR 2.29, 95% CI 1.005-5.27). The use of letrozole and misoprostol is associated with a higher complete abortion rate. HKClinicalTrials.com, http://www.hkclinicaltrials.com, HKCTR-349. I.

Medical Termination of Early Pregnancy

Medical Termination of Early Pregnancy

First trimester medical termination of pregnancy: The Nottingham experience

SummaryThis is a retrospective study of 614 women undergoing first trimester medical termination of pregnancy (TOP) from 1 January to 31 December 2006, at Nottingham Contraception and Sexual Health service. All women were in the gestational age of 6–9 weeks. The results showed that three women had blood loss of more than 500 ml and had to be transfused. All patients requiring blood transfusion were over 8 weeks' gestation. A total of 84 (13.8%) patients returned as planned to the unit for follow-up scan because of uncertainty over completeness of abortion. All patients (1.13%) who needed surgical intervention were more than 8 weeks' gestation. A total of 27 patients (4.3%) required admission overnight, the main indication being lack of support at home. Early medical TOP was successful in over 98% of women and allowed them to avoid the risks of surgical instrumentation and anaesthesia. Early medical abortion is a safe and effective procedure and deserves to be more widely available and utilised.

Introduction of early medical abortion in New Zealand: An audit of the first 67 cases

In New Zealand, mifepristone became available in 2001, but because of uncertainty about the law, the first 67 cases were carried out under a very strict protocol. Once the prostaglandin had been administered it was necessary that the woman remain in the unit until the products of conception (POC) had been passed and, if this had not occurred within 8 h, she underwent suction curettage. To demonstrate that an early medical termination of pregnancy (EMTOP) service could be offered as a safe option for women, despite the constraints of the law. An audit of patient notes was carried out on the first 67 patients undergoing an EMTOP at the Level J Unit (LJU), Wellington Hospital. Data collected included age, ethnicity, parity, previous abortions, gestational age, length of time between the administration of mifepristone and misoprostol, length of time after administration of misoprostol to the completion of abortion, whether a fetal sac was seen, analgesia required, extent of heavy bleeding and any adverse effects. Patient characteristics were compared with those of the 3052 women who underwent surgical termination during the same time period. Data were analysed using EpiInfo 2000 (Centers for Disease Control and Prevention, Atlanta, GA) and Chi square tests for significance. Successful completion of EMTOP occurred in 63 of 67 cases (94%). Only four cases (6%) required completion by suction curettage and this was performed for legal and financial reasons, rather than for medical reasons. Clinical events requiring management, mainly bleeding problems, occurred in 11 patients (16%). EMTOP with mifepristone and misoprostol was successfully introduced and the experience provides useful data for others contemplating a similar service.

A Fatal Case of Clostridium sordellii Septic Shock Syndrome Associated With Medical Abortion

Clostridia bacteria are infrequent human pathogens. In the obstetric and gynecologic literature, Clostridium sordellii infections have been very rarely reported. This is a case of infection following medical termination of early pregnancy with mifepristone and misoprostol. A 27-year-old woman presented for termination of pregnancy at 5.5 weeks from her last menstrual period. She received mifepristone 200 mg orally followed by 800 microg vaginal misoprostol. Three days after administration of misoprostol, she complained of dizziness, pelvic pain, and bleeding. The next day, she experienced worsening of symptoms and was hospitalized. She developed pulmonary edema, ascites, and heart failure. Despite supportive measures, antibiotics, and hysterectomy, she died 3 days later. The post mortem examinations indicated that death was caused by shock secondary to C sordellii infection. The frequency of infection following medical abortion is low. The rapid and fatal course of this infection is similar to other obstetric and gynecologic cases reported in the literature. Although providers should remain vigilant to the possibility of infection following medical abortion, the overall proven safety of medical abortion remains the same.

Randomized, double-blind, controlled trial of mifepristone in capsule versus tablet form followed by misoprostol for early medical abortion

Objective: To compare the efficacy and side-effects of mifepristone 75 mg in capsule form versus 150 mg in tablet form followed by misoprostol for medical termination of early pregnancy. Study design: In a prospective randomized, double-blind, placebo-controlled trial, a total of 480 women who were 49 days or less pregnant were randomized by means of a random number table to receive either two tablets in the morning and one tablet 12 h later for 2 days (group A) or three capsules orally twice daily for 2 days, the first dose being double all subsequent doses (group B). After a further 48 h, 600 μg misoprostol was given orally. Successful abortion was defined as complete abortion with no need for surgical aspiration. Results: There were no significant differences between the two study groups in the rates of complete abortion (95.4% in group A versus 96.3% in group B), incomplete abortion (3.8% in group A, 3.3% in group B) and continued pregnancy (0.8% in group A, 0.4% in group B). No significant difference in the duration and amount of vaginal bleeding was observed. The incidence of side-effects, such as vomiting, nausea, headache, diarrhea and lower abdominal pain was similar in the two groups. Conclusions: Our results indicate that 75 mg mifepristone in capsule form combined with 600 μg misoprostol is as effective and safe as 150 mg mifepristone in tablet form for the termination of pregnancy up to 49 days.

Differential kinetics of serum and cervical insulin-like growth factor-binding protein-1 during mifepristone-misoprostol-induced medical termination of early pregnancy.

The kinetics of cervical and circulating phosphoisoforms of insulin-like growth factor-binding protein-1 (IGFBP-1) in normal and pathological early pregnancy are not well known. We investigated the profiles of IGFBP-1 in serum and in cervical secretion during medical termination of early pregnancy. Sixteen women requesting termination of pregnancy, with <63 days of amenorrhoea, received 200 mg of mifepristone on day 0, followed by either oral or vaginal administration of 0.8 mg of misoprostol on day 2. Serum and cervical swab samples, collected up to 6 weeks following the beginning of the treatment, were analysed for IGFBP-1 using two immunoenzymometric assays recognizing different patterns of IGFBP-1 phosphoisoforms. Serum mifepristone was also assayed. In the cervical samples, IGFBP-1 concentration, measured with both assays, increased substantially 2 days following administration of mifepristone. At 3 h after administration of misoprostol, IGFBP-1 had further increased several-fold in the cervix, but the increase was more pronounced as measured by the assay with preference for the amniotic fluid isoforms of IGFBP-1. A strong negative correlation was found between the time to abortion and the increase in cervical IGFBP-1 after administration of misoprostol, as measured by the assay preferring the phosphorylated isoforms of IGFBP-1. At 6 weeks, IGFBP-1 in the cervix had decreased to lower than pre-treatment levels, as measured by both assays. In serum, both assays showed a significant increase in IGFBP-1 concentrations after administration of mifepristone, and the highest values were measured on day 2, already before misoprostol administration. Thus, the kinetics of circulating and cervical IGFBP-1 differed from each other, indicating different sources and regulation of serum and cervical IGFBP-1.

Early medical termination pregnancy with methotrexate and misoprostol in lower segment cesarean section cases.

The aim of the study was to investigate the efficacy of methotrexate and misoprostol for the medical termination of early pregnancy with previous cesarean section. Sixty-six pregnant women of 60 days or less in duration with previous one or two cesarean sections were selected. Each woman received intramuscularly a dose of methotrexate (50mg). Two to 3 days later, 800 microg of misoprostol was administered intravaginally. Repeat doses were used if there was no significant bleeding. An ultrasonography was done in each case after seven days. Subjects with continuing pregnancies or excessive bleeding had a surgical abortion. A successful medical abortion was defined by vaginal bleeding without surgical intervention and a negative transvaginal ultrasound. Side-effects were noted. Complete abortion occurred in 87.9% cases after first dose of misoprostol, and 6.1% cases had complete abortion after second dose, so out of 66 cases 62 (94%) had a successful medical abortion. Four (6%) subjects required surgical intervention; one for continued pregnancies, one for missed abortion, and two for excessive bleeding. The complete abortion rate was higher for early gestations: 30/30 (100%) at < or = 45 days gestation, 28/30 (93.3%) at 46-50 days gestation, and 2/6 (33.3%) from 50 to 63 days gestation. Vaginal bleeding lasted 15 +/- 7 days. Gastrointestinal side-effects were uncommon, mild, and brief. There was no case of uterine rupture. Medical abortion using methotrexate with misoprostol is safe, cheap, and effective for early pregnancy termination through 8 weeks' gestation even with previous cesarean section.

The kinetics of serum hCG and progesterone in response to oral and vaginal administration of misoprostol during medical termination of early pregnancy.

Misoprostol is widely used in combination with mifepristone for medical termination of pregnancy. We studied the endocrine parameters of trophoblast function during medical termination of early pregnancy using mifepristone in combination with oral or vaginal misoprostol. The effect of prolonged misoprostol administration was also examined. Thirty-four women, requesting termination of pregnancy and with <or=63 days of amenorrhoea, received 200 mg of mifepristone on day 0, followed by either oral (n = 13) or vaginal (n = 21) administration of 0.8 mg of misoprostol on day 2. In 23 cases misoprostol administration was continued orally for an additional 7 days. Serum samples, collected up to 14 days following the beginning of the treatment, were analysed for hCG, progesterone and mifepristone. hCG and progesterone concentrations continued to increase until day 2. Following misoprostol, hCG and progesterone levels declined by 70.5 +/- 8.8% and 61.3 +/- 16.3% (mean +/- SD) respectively, in 24 h. The percentage decline in hCG correlated inversely (P < 0.05) with the time taken to abort. The peak level of mifepristone measured on day 2 did not correlate with the decline in serum hCG or progesterone. The kinetics of hCG, progesterone and mifepristone were similar in the different treatment groups. The route and duration of misoprostol administration have no effect on the kinetics of serum hCG or progesterone during medical termination of early pregnancy.