Preoperative effects of mifepristone on dilation and evacuation: mifepristone versus osmotic dilators after 19 weeks' gestation

Abstract

800-mcg buccal misoprostol. Enrollment was stratified into two gestational cohorts, less than 49 days and 49-63 days, to ensure gestational variability. Serum quantitative hCG values were collected on day 1 (day of mifepristone), day 3, day 5 and days 7-14. The percentage of hCG decline was calculated from day 1 to each repeat measure using repeated measure ANOVA. Trends were evaluated based on initial serum hCG level and gestation. Results: Sixty-six women were recruited, of which 59 were protocol adherent and included in the analysis. Mean gestation on day 1 was 49 days, and median baseline hCG was 51,761 IU. Fifty-seven subjects (97%) had a complete medication abortion without further intervention. The least square means of serum hCG decline among subjects with complete medication abortion was 70% (95% CI, 68.2-71.8%; range, 36.9-98.6%) on day 3, 91.5% (95% CI, 89.5-93.4%; range, 68.4-97.7%) on day 5 and 98.2% (95% CI, 96.3-100.1%; range, 86.7-99.5%) on days 7-14. There was no difference in the percentage of hCG decline stratified by initial hCG or gestation. Conclusions: Serum hCG declines rapidly and predictably as soon as 5 days after complete medication abortion. The rate of hCG decline is not affected by initial hCG or gestational duration.