A double‐blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14–21 weeks of pregnancy

Dabash, Rasha; Chelli, H.; Hajri, Selma; Shochet, Tara; Raghavan, Sheila; Winikoff, Beverly

doi:10.1016/j.ijgo.2015.02.023

Cited by 41 publications

(32 citation statements)

References 23 publications

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“…Modak et al [8] in a comparative study of sublingual and vaginal misoprostol in second trimester abortions reported a complete abortion at 24 h of 79.41 % (in sublingual group) and mean IAI of 12.28 h. Ngoc et al [9] in their double blind study reported the mean IAI was statistically shorter for mifepristone plus misoprostol group compared to misoprostol only group (8.1 h and 10.6 h, respectively, with a p value of \0.01). Rasha et al [10] in their study reported mean IAI of 10.4 ± 6.8 h in mifepristone group and 20.6 ± 9.7 h in misoprostol only group. Reduction in induction to abortion interval is likely to improve the acceptability of women [9].…”

Section: Discussionmentioning

confidence: 85%

A Comparative Study of Misoprostol Only and Mifepristone Plus Misoprostol in Second Trimester Termination of Pregnancy

Akkenapally

2016

J Obstet Gynecol India

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Objective To compare the effectiveness, success rate and induction to abortion interval between administration of misoprostol only and mifepristone with misoprostol in second trimester abortions (14-20 weeks). Materials and methods The study was conducted by dividing women approaching for second trimester termination, into two groups each consisting of 100 women.Group-I received only misoprostol; 600 mcg initial vaginal insertion followed by 400 mcg sublingually every 3 h until termination. Women in Group-II received mifepristone 200 mg and after 24 h started with 600 mcg misoprostol, per vaginal followed by 400 mcg sublingually till abortion was completed, up to a maximum of five doses in both groups. Results The success rate in Group-I was 89 %, whereas in Group-II it was 96 %. The mean induction abortion interval in Group-I was 10.67 ± 3.96 h compared to Group-II which was significantly less 6.19 ± 2.70 h (p value \ 0.01). The mean dose of misoprostol in Group-I was 1610 ± 511.18 mcg and in Group-II, it was lesser 1046 ± 392.71 mcg (p value \ 0.01). There was significant difference in the mean blood loss also, 97.20 ± 36.35 ml in Group-I and 52.55 ± 27.96 ml in Group-II. Also among the individual groups multigravidae and lower gestational age (\17 weeks), women had lesser IAI as well as lesser misoprostol dose was required. 123Conclusion Pretreatment with mifepristone significantly reduces the induction abortion interval and the misoprostol dose along with minimal blood loss.

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Section: Discussionmentioning

confidence: 85%

A Comparative Study of Misoprostol Only and Mifepristone Plus Misoprostol in Second Trimester Termination of Pregnancy

Akkenapally

2016

J Obstet Gynecol India

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“…Given recently published evidence, we have added alternative routes for taking misoprostol; in most cases, this has meant the addition of the buccal route, in which the tablets are placed in the cheek for 30 minutes after which any remnants are swallowed. This route has a similar pharmacokinetic profile to the vaginal route.…”

Section: Route Of Administrationmentioning

confidence: 99%

“…In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. In light of new evidence and through expert deliberation, this chart has now been revised and expanded (Fig. ).…”

Section: Introductionmentioning

confidence: 99%

FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics

Morris

Winikoff

Dabash

et al. 2017

Intl J Gynecology & Obste

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104

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In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. In light of new evidence 1-13 and through expert deliberation, this chart has now been revised and expanded (Fig. 1). Some areas were particularly challenging to develop given the limited, low-quality, or inconsistent evidence. The present commentary is intended to explain some of the changes and decisions made. | GENERAL CHANGESThe layout is now categorized vertically by gestation and horizontally by indication. Gestation is labelled and referred to as the number of weeks of gestation (<13 weeks, 13-26 weeks, and >26 weeks), with the final column being for postpartum use. However, in the case of incomplete abortion under 13 weeks, and inevitable abortion between 13-26 weeks, women should be treated on the basis of their uterine size rather than last menstrual period dating. Recommendations have been added for inevitable abortion and cervical preparation between 13 and 26 weeks, and for termination of pregnancy at more than 26 weeks. | NUMBER OF DOSESFor less than 13 weeks' gestation, we decided to recommend a fixed number of doses without specifying a maximum. This is because many early pregnancy regimens will be used on an outpatient basis, so it is useful for healthcare providers to know in advance how many doses to give the client; there is also sufficient evidence to support a fixed number of doses for use in pregnancies of less than 13 weeks' gestation, as well as evidence that it is safe to give further doses if they are required. [1][2][3][4]14 For 13-26 weeks' gestation, the notion of a maximum number of doses has been extrapolated from clinical research in which maximum doses are commonly noted not on the basis of patient safety issues or efficacy, 9 but rather as tangible endpoints. In clinical practice, however, they might not have great utility, and dosing should continue until expulsion, in the absence of rare complications. Suggesting that providers should discontinue dosing could actually increase risks, particularly when providers have few alternatives available if expulsion has not yet This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…In another study by Rasha et al, (2015) 8 the mean induction abortion interval in Group A was reported to be 10.46.8h while in Group B it was 20.6 9.7h. Thus, the reduction in the induction abortion interval also improves acceptability of the procedure in women ( Table 5).…”

Section: Induction-abortion-intervalmentioning

confidence: 90%

Study of the Efficacy and Success Rate of Single Dose Oral Mifepristone and Vaginal Misoprostol v/s Vaginal Misoprostol alone for Second Trimester Termination of Pregnancy

Khairnar

Patil

2019

mvpjms

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Background: Second trimester abortions constitute 10-15% of all induced abortions and are considered to be less safe than first trimester abortions. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Aim: To compare the efficacy and the success rate of single dose oral mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second trimester termination of pregnancy. Materials and Methods: A comparative study and was conducted in the Department of Obstetrics and Gynecology in a Tertiary Health Care Hospital. The study was carried out by dividing women into two groups (72 each). Group Areceived 200mg of oral Tablet Mifepristone and 400 of vaginal misoprostol (48 hours later) which was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Group B received 400 of vaginal misoprostol directly and the dose was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Results: The success rate in Group A was 98.6%, whereas in Group B was 84.7%. The mean induction abortion interval in Group A was lesser (6.2 hours) as compared to Group B (10.8 hours) (p value <0.00001). The mean dose of misoprostol in Group A was 613.88mcg compared to the Group B 1591.66mcg (p value <0.00001). Conclusion: Pretreatment with mifepristone significantly reduces the induction abortion interval (I-A-I) and the misoprostol dose.

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A double‐blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14–21 weeks of pregnancy

Abstract: Adding mifepristone before misoprostol can improve the quality of second-trimester abortion care by making the process faster.

Cited by 41 publications

References 23 publications

A Comparative Study of Misoprostol Only and Mifepristone Plus Misoprostol in Second Trimester Termination of Pregnancy

A Comparative Study of Misoprostol Only and Mifepristone Plus Misoprostol in Second Trimester Termination of Pregnancy

FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics

Study of the Efficacy and Success Rate of Single Dose Oral Mifepristone and Vaginal Misoprostol v/s Vaginal Misoprostol alone for Second Trimester Termination of Pregnancy

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