On Efficacy and Acceptability of Early Medical Abortion by Mifepristone With Oral or Vaginal Misoprostol

Abstract

BACKGROUNDUnsafe abortion is a major public health problem. Globally, 20 million unsafe abortions take place each year and account for 13% of all maternal deaths. According to WHO, 56% of abortions in developing countries are still unsafe even though medical abortion methods have been in use for more than a decade.The main objective of the present study is to compare the efficacy, acceptability, side effects and factors affecting outcome of early medical abortion with oral and vaginal misoprostol after oral mifepristone in inducing early medical abortion up to 49 days. MATERIALS AND METHODSIt was an interventional study (non-RCT) conducted on women requesting termination of early pregnancy at the outpatient department of family planning unit with ultrasound confirmed intrauterine gestation of  49 days allocated into two groups. Mifepristone 200 mg was administered on Day 1 followed by 400 mg of oral misoprostol for Group I and 800 mg of vaginal misoprostol for Group II. They were reviewed on Day 14 by ultrasound for completion of abortion and Hb. If abortion was incomplete or bleeding was excessive, curettage was done. RESULTSThe two groups were comparable with respect to age, parity and gestational age, socio-economic status and level of education. There was no significant difference in the complete abortion rates for oral (91.1%) and vaginal (92.0%). Mean induction abortion interval was 4.29 hours for oral and 3.5 hours for vaginal (p= 0.023). History of previous abortion was found to be a strong predictor of failure of early medical abortion (p= 0.007). Nausea (24%), vomiting (13%) and fatigue (50%) were more in the oral group. Mean duration of bleeding was 9.4 days in oral and 8.2 days in vaginal group (p= 0.000). Method satisfaction was more among oral group (92.2%) compared to 85.1% in vaginal, but not statistically significant (p > 0.05). CONCLUSIONMedical abortion with 200 mg of mifepristone in combination with 400 mg misoprostol orally or 800 mg vaginally after 48 hours was found to be safe, simple, effective, non-invasive and acceptable method. BACKGROUND Unsafe abortion is a major public health problem in developing countries. Globally, 20 million unsafe abortions take place each year and account for 13% of all maternal deaths. (1) The incidence of induced abortions is not definitely known, because estimates of illegal abortions are generally unreliable. This has led to the liberalisation of abortion laws and search for newer methods. KEYWORDSMedical abortion offers great potential for improving abortion access and safety. The drugs used were mainly mifepristone (RU 486), a potent antiprogestin in combination with prostaglandin E1 analogue misoprostol.

Outcome of First Trimester Induced Abortions Using Misoprostol by Buccal and Vaginal Routes

“…Similar results were observed in the study conducted by Nath and Kumar. 8 In our study, no statistically significant differences were noted among side effects, except for altered taste in a buccal group. The findings were consistent with studies conducted by Khan et al 6 and Nath and Kumar.…”

“…Similar results were noted in studies conducted by Khan et al, 6 Raj and Pradhan 7 and Nath and Kumar. 8 In our study, the satisfaction rate was 89% in the vaginal group and 92% in a buccal group. The difference is not significant.…”

“…The results are comparable to the study conducted by Raj and Pradhan 7 and Nath and Kumar. 8 The mean induction-abortion interval was 3.72 hours in the vaginal group and 4.02 hours in the buccal group. The difference was statistically not significant.…”

“…The findings were consistent with studies conducted by Khan et al 6 and Nath and Kumar. 8 The rate of complete abortion was 92.7% in the vaginal group and 91% in a buccal group (p-value = 0.72) showing both routes were equally effective. Similar results were noted in studies conducted by Khan et al, 6 Raj and Pradhan 7 and Nath and Kumar.…”