Second trimester medical abortion with mifepristone followed by unlimited dosing of buccal misoprostol in Armenia

 

by Karmen S Louie, Erica Chong, Tamar Tsereteli, Gayane Avagyan, Ruzanna Abrahamyan, Beverly Winikoff

European Journal of Contraception & Reproductive Health Care 2017;22(1)

DOI: http://dx.doi.org/10.1080/13625187.2016.1258461  Not open access / Abstract also in Chinese

Abstract

Objectives: The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia.

Methods: Women seeking to terminate 13-22 week pregnancies were enrolled in the study. Participants swallowed 200 mg mifepristone in the clinic and were instructed to return to the hospital for induction 24-48 hours later. During induction, women were given 400 mcg buccal misoprostol every 3 hours until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery. 

Results: A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24 hours after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3 hours (range 4–17.4) with a mean of 9.5 ± 2.5 hours. A median of four misoprostol doses (range 2–6) with a mean of 4 ± 1 misoprostol doses was administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers. 

Conclusion: The medical abortion regimen of 200 mg mifepristone followed 24 hours later by induction with 400 μg buccal misoprostol administered every 3 hours, with no limit on the number of doses used for the termination of pregnancies of 13–22 weeks’ gestation is an effective and acceptable option for women.

Regimen:

200 mg mifepristone orally followed 24 hours later by

400 mcg buccal misoprostol every 3 hours until expulsion of

the fetus and placenta. A median of four doses was needed

and no woman needed more than six doses to evacuate

the uterus completely –- without any observed or reported

serious adverse effects. Analgesia is also required.