A randomised controlled trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion up to 13 weeks of gestation

Abstract

Objective To assess women's acceptability, the efficacy and side effects of sublingual versus vaginal administration of misoprostol in combination with mifepristone for medical abortion up to 13 weeks of gestation. Design Randomised controlled trial.Setting Aberdeen Royal Infirmary.Population Women undergoing medical abortion under the terms of the 1967 Abortion Act.Methods Mifepristone (200 mg) was given orally followed 36 -48 hours later by misoprostol administration (sublingual: 600 Ag; vaginal: 800 Ag). A second dose of misoprostol 400 Ag was given 3 hours later (sublingually or vaginally). Women between 9 and 13 weeks of gestation received a further (third) dose of misoprostol 400 Ag (sublingually or vaginally), 3 hours later if abortion had not occurred. Main outcome measures Women's acceptability, efficacy of the regimen and side effects experienced.Results A total of 340 women were recruited (171 sublingual and 169 vaginal). A total of 70% of women in the sublingual group expressed satisfaction with the route of misoprostol administration; 18% answered 'Don't know' while 12% were dissatisfied, compared with 68%, 28% and 4%, respectively, in the vaginal group (P ¼ 0.02). There was no significant difference in the need for surgical evacuation for women in the sublingual (3/158, 1.9%) and vaginal groups (4/156, 2.6%) (P ¼ 0.70). Women receiving misoprostol sublingually were more likely to experience diarrhoea (P < 0.01), shivering (P < 0.01) and unpleasant mouth taste (P < 0.01). Conclusions Sublingual administration of misoprostol is an effective alternative to vaginal administration for medical abortion up to 13 weeks of gestation. The prevalence of prostaglandin-related side effects, however, was higher with this route of administration.

A Simple Procedure for Termination of Pregnancy in the Late First Trimester with Mifeprostone and Misoprostol

“…When judged by the efficacy of medical termination in the early part of the first trimester our results are comparable with previous publications [6] [17] [18]. When compared with previous studies of late first semester medical TOPs, the overall complete abortion rate was close to the success rates reported in previous studies [13] [14] [19].…”

Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone-misoprostol

“…Studies have explored the effectiveness of medical termination of pregnancy after 10 weeks from LMP, and have demonstrated the efficacy and acceptability of regimens of mifepristone and misoprostol. [5][6][7][8][9] Most protocols used for gestational ages above 63 days from LMP require 800 lg vaginal misoprostol in an in-clinic setting, 24-48 hours after the administration of 200 mg mifepristone, with an additional 400 lg vaginal, oral or sublingual misoprostol administered every 3 hours. As clinical research shows, the effectiveness of termination of pregnancy with mifepristone-misoprostol does not suddenly cease at 64 days of pregnancy.…”

“…Termination of pregnancy with mifepristonemisoprostol is also used in the late first trimester (10)(11)(12) weeks from LMP) with documented success rates after 9 weeks from LMP being comparable with those achieved at earlier gestations, with some modifications in the protocol. [5][6][7][8][9][10] Previous research has indicated a high correlation between pregnancy dating determined by clinician (based on bimanual examination and history) and that determined by sonography. 11 Women who have a clear idea of the date of their LMP tend, on average, to believe that their pregnancies are slightly more advanced than they are.…”

Use of Oral Misoprostol for Cervical Priming before Hysteroscopy: A Randomized Comparison of Two Dosages

“…Cochrane review considers that use of misoprostol will reduce the need for mechanical dilatation to between 14 and 39% [1]. Sublingual misoprostol was able to achieve the highest serum peak concentration compared to the oral and vaginal routes, and it is more comfortable for those wishing to avoid vaginal administration [11,12]. …”