A two-pill sublingual misoprostol outpatient regimen following mifepristone for medical abortion through 70 days' LMP: a prospective comparative open-label trial

Bracken, Hillary; Dabash, Rasha; Tsertsvadze, George; Posohova, Svetlana; Shah, Milind; Hajri, Selma; Mundle, Shuchita; Chelli, H.; Zeramdini, Dhouha; Tsereteli, Tamar; Platais, Ingrida; Winikoff, Beverly

doi:10.1016/j.contraception.2013.10.018

Cited by 44 publications

(30 citation statements)

References 19 publications

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“…A study comparing the efficacy of two pill sublingual misoprostol outpatient regimen through 70 days GA reported the success rate of 94.8% in the 57-63 days group. 12 This two pill regimen opens up possibility of further research with low dose misoprostol in our set up as well. The lower success rate in our study could be because of smaller sample size.…”

Section: Safety Efficacy and Acceptability Of Early First Trimester mentioning

confidence: 85%

Safety, Efficacy and Acceptability of Early First Trimester Abortion using Oral Mifepristone and Sublingual Misoprostol

Shrestha

Aryal

Sharma

2018

J Nepal Health Res Council

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Background: With the legalization of medical abortion in Nepal, mifepristone-misoprostol combination via different routes has been widely used for early abortion. This study aims to evaluate the efficacy and acceptability of 200 milligrams mifepristone orally followed by 800 micrograms sublingual misoprostol in outpatient setting.Methods: It was an open-label prospective study conducted in outpatient department of a tertiary hospital over a period of 13 months. Clients upto nine weeks of pregnancy were enrolled. 200 milligrams of mifepristone orally followed by 800 micrograms of misoprostol sublingually 36 to 48 hours later were prescribed. They were followed up in 14 days sonologically or verbally through telephone. Side effects and satisfaction to the regimen were assessed through acceptability questionnaire. Mann-Whitney U test was used for analyzing categorical data.Results: A total of 47 clients were enrolled. The mean age and gestational age were 29.38 years (SD+5.914) and 6.2 weeks (SD+1.28) respectively. The commonest indications for termination were completed family and unwanted pregnancy (40.4% each). The average duration of bleeding was 5.76 days (SD +3.61). Abdominal cramping was the most common side effect (95.7%). The least acceptable parameter was the bleeding time (80.9%). For 97.9% clients, the adverse effects were acceptable. The overall success rate of the regimen was 87.2%.Conclusions: With a comparable success rate to vaginal use, home based sublingual use of misoprostol in low resource settings offers an acceptable and cost effective alternative for medical abortion upto nine weeks of pregnancy. Lesser gestational age is a useful predictor for successful abortion.

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Section: Safety Efficacy and Acceptability Of Early First Trimester mentioning

confidence: 85%

Safety, Efficacy and Acceptability of Early First Trimester Abortion using Oral Mifepristone and Sublingual Misoprostol

Shrestha

Aryal

Sharma

2018

J Nepal Health Res Council

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“…Increased availability of medical abortion is attributed to declines in mortality and morbidity of unsafe abortion [19]. Medical abortion with evidence-based mifepristone and misoprostol protocols is safe and effective for pregnancy termination up to 70 days gestation [20][21][22][23][24]. A 2015 retrospective cohort study including over 30,000 women undergoing early abortion found similar efficacy and low complication rates when comparing surgical abortion with medical abortion [25].…”

Section: Introductionmentioning

confidence: 93%

Update on Medical Abortion: Expanding Safe and Equitable, Patient-Centered Care

Whaley

Betstadt

2016

Curr Obstet Gynecol Rep

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Addressing disparities in abortion access and efforts to end the global problem of unsafe abortion are key public health and human rights priorities. Optimizing the role of various health workers in supporting safe medical abortion practices and working to remove unnecessary barriers to care are key strategies that address inequities in outcomes after abortion worldwide. Medical abortion using evidence-based protocols is effective through 70 days gestation and can safely be provided by non-physician providers in outpatient settings. Removing barriers of in-office administration of mifepristone and simplifying follow-up protocols are evidence-based approaches to expanding access to medical abortion, particularly in settings where access to surgical abortion is limited. Research supports expanding the role of women themselves, as well as task-shifting among health worker teams in providing safe abortion and postabortion care. Simplifying the process of medical abortion, including allowing prescription and home administration of mifepristone and utilizing telemedicine for follow-up protocols are safe and feasible, can optimize use of health resources and improve patient experience with medical abortion.

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“…111 A study from Gynuity Health involving 729 women undergoing termination of pregnancy showed efficacy of this regimen up to 70 days gestation. 112 Recent guidelines jointly distributed by ACOG and the Society of Family Planning claim that evidence-based protocols are superior to the FDA-approved regimen. 113 According to the guidelines, most women are candidates for medical abortion.…”

Section: Medical Abortionmentioning

confidence: 99%

State of Family Planning

Schreiber

Traxler²

2015

Clinical Obstetrics &Amp; Gynecology

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Family planning and reproductive health services are uniquely impacted by policy and politics in the United States. Recent years have witnessed an unprecedented number of abortion restrictions, and research funding has decreased in related areas. Despite this, both the science and the implementation of improved family planning and abortion methods have progressed in the past decade. This article reviews the current state of family planning, as well as technologies and patient care opportunities for the future.

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A two-pill sublingual misoprostol outpatient regimen following mifepristone for medical abortion through 70 days' LMP: a prospective comparative open-label trial

Cited by 44 publications

References 19 publications

Safety, Efficacy and Acceptability of Early First Trimester Abortion using Oral Mifepristone and Sublingual Misoprostol

Safety, Efficacy and Acceptability of Early First Trimester Abortion using Oral Mifepristone and Sublingual Misoprostol

Update on Medical Abortion: Expanding Safe and Equitable, Patient-Centered Care

State of Family Planning

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