One- and 2-day mifepristone–misoprostol intervals are both effective in medical termination of second-trimester pregnancy

Abstract

Termination of pregnancy because of fetal anomaly requires the utmost clinical sensitivity and individualized patient care. This study compared the efficacy of a 1-day mifepristone and misoprostol interval in medical termination of second-trimester pregnancy performed because of fetal anomaly with that of the standard 2-day interval among the first 100 women in each group. A 200 mg dose of mifepristone was used; 0.4 mg of misoprostol was administered vaginally at 3-h intervals until abortion occurred. When calculated from ingestion of mifepristone, the time to abortion was 28 h 25 min (28:25 h) [23:10-50:40 h; median (range)] and 52:43 h (45:55-83:15 h) (P < 0.0001) in the 1- and 2-day mifepristone-misoprostol groups respectively. However, following initiation of misoprostol administration, the time to abortion [7:25 h (1:00-23:15 h)] was longer (P < 0.05) in the 1-day interval group than in the 2-day interval group [6:20 h (0:45-36:30 h)]; by 12 h, 82 and 87% (n.s.) respectively of the subjects had aborted. The proportions of cases undergoing surgical evacuation of the uterus were 64 and 45% (P < 0.001), in the 1- and 2-day interval groups respectively. Thus both 1- and 2-day mifepristone-misoprostol intervals are valuable in termination of second-trimester pregnancy.

Short versus Standard Mifepristone and Misoprostol Regimen for Second- and Third-Trimester Termination of Pregnancy for Fetal Anomaly

“…All published studies reported no increase in adverse events, which is in agreement with our findings [13,14,15,16,17]. We report one uterine rupture in a woman with previous caesarean section; no cases have been reported in cohorts with mifepristone-to-misoprostol intervals of <36 h. However, in the context of a small cohort, it is inappropriate to extrapolate the significance of rare adverse events to the mifepristone-misoprostol regimen used.…”

“…These intervals are similar to our standard regimen but are significantly shorter than the 16 h in our short regimen cohort, although the mifepristone-to-misoprostol interval of 12 h in the short regimen cohort is considerably less than that in the existing literature. Four RCTs reported percentage expulsion at 12 h post-misoprostol for mifepristone-to-misoprostol intervals <36 h, ranging from 73 to 82% compared to 36.3% in our short regimen cohort [12,13,14,16], although again the mifepristone-to-misoprostol intervals were greater than in our short regimen. Information regarding expulsion at 24 h was provided by 5 of the 6 studies examined and ranged from 91 to 98% [12,14,15,16,17], compared to 80% in our short and 91% in our standard regimen cohorts, respectively.…”

“…There are currently 4 randomised controlled trials (RCTs) and 2 observational studies (1 retrospective cohort study and 1 retrospective case series) assessing the effects of mifepristone-to-misoprostol dosing intervals <36 h for second-trimester termination of pregnancy in the context of fetal abnormality [12,13,14,15,16,17]. However, the retrospective case series also included 28 cases of intrauterine death, which were analysed as a subgroup [15].…”

“…Most studies used oral 200 mg mifepristone and vaginal 400 μg misoprostol [12,13,14,15,16], whilst 1 used oral misoprostol [15], broadly in line with our regimes (Appendix). Doses were halved for women with a previous caesarean.…”

Two mifepristone doses and two intervals of misoprostol administration for termination of early pregnancy: a randomised factorial controlled equivalence trial*

“…We used one single dose of 800 micrograms of misoprostol vaginally. This high dose of misoprostol may have masked the effect of 16 in which the time until abortion occurred was significantly longer (P < 0.0001) in the 1-day interval group compared with 2-day interval between 200 mg of mifepristone and the start of administration of vaginal misoprostol (400 micrograms at 3-hour intervals). Consequently, the total dose of misoprostol given to women was higher in the 1-day interval group.…”