Early Termination of Pregnancy with Mifepristone (RU 486) and the Orally Active Prostaglandin Misoprostol.

Peyron, Rémi; Aubeny, E.; Targosz, Veronique; Silvestre, Louise; Renault, Maguy; Elkik, F; Leclerc, Philippe; Ulmann, André; Baulieu, Étienne-Émile

doi:10.2307/2939197

Cited by 43 publications

(61 citation statements)

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“…[1][2][3][4][5][6] This regimen, with an efficacy of 92-98% for early termination of pregnancy (TOP), is effective outside clinical trial settings, 7-9 but is not registered and available in many countries where abortion is legal. The complexity of the original mifepristone-misoprostol regimen, requiring 600 mg mifepristone for pregnancies up to 49 days and three health facility visits, may limit its implementation in less developed countries.…”

Section: Introductionmentioning

confidence: 99%

Integrating medical abortion into safe abortion services: experience from three pilot sites in South Africa

Kawonga

Blanchard²,

Cooper³

et al. 2008

j fam plann reprod health care

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Background and methodology South Africa's Choice on Termination of Pregnancy Act of 1996 provides for safe termination of pregnancy (TOP) in designated facilities in the public and private health sectors. In 2001, mifepristone-misoprostol medical abortion was approved for TOP up to 56 days, but this method is not yet available in the public sector. Information on the operational requirements for integrating mifepristone-misoprostol medical abortion into South Africa's public sector safe abortion services is required to guide policy decisions. This study trained health workers to provide medical abortion to 290 women attending three TOP sites. Prospective data were collected to ascertain women's experience of the method, pregnancy outcome, women's and provider's acceptability of the method, and the operational requirements for providing medical abortion.Results Twenty-nine (10%) women were lost to follow-up; 261 (90%) women had a confirmed abortion outcome, of 159 ©FSRH J Fam Plann Reprod Health Care 2008: 34(3) IntroductionNumerous clinical studies in the literature report the efficacy of mifepristone-misoprostol medical abortion in both developed and developing countries. [1][2][3][4][5][6] This regimen, with an efficacy of 92-98% for early termination of pregnancy (TOP), is effective outside clinical trial settings, 7-9 but is not registered and available in many countries where abortion is legal. The complexity of the original mifepristone-misoprostol regimen, requiring 600 mg mifepristone for pregnancies up to 49 days and three health facility visits, may limit its implementation in less developed countries. 10 Correspondence to: Dr Mary Kawonga, School of Public Health, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, Gauteng 2193, South Africa. E-mail: mary.kawonga@wits.ac.za whom 93% had a complete abortion. Given the option, the vast majority of women opted to use misoprostol at home. No serious side effects were reported; pain (66%), and heavy bleeding (67%) were the most common side effects. Most (96%) women were very satisfied with the experience. Health providers were satisfied with providing medical abortion and recommended its introduction to complement existing surgical TOP services. Discussion and conclusionThis study demonstrates that integration of medical abortion into public sector services is feasible. The results of this study will guide policy decisions about integrating medical abortion into South Africa's public sector safe abortion services, within the context of the existing enabling legislative framework.Keywords medical abortion, mifepristone, misoprostol, public sector safe abortion services, South Africa efficacy. 4,11 Home use of misoprostol is safe, acceptable and feasible even in less developed contexts, 12-14 and a modified regimen extending the limit to 56 days achieves success rates of 92-97%. 10,13 Medical abortion in South AfricaSouth Africa's Choice on Termination of Pregnancy Act of 1996 allows TOP on request up to 12 weeks from the last mens...

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Section: Introductionmentioning

confidence: 99%

Integrating medical abortion into safe abortion services: experience from three pilot sites in South Africa

Kawonga

Blanchard²,

Cooper³

et al. 2008

j fam plann reprod health care

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show abstract

“…92-98% (8,9,17,18) and 600 mg i.e. 87-97% (19,20), demonstrating the potential efficacy of 100 mg mifepristone for medical abortion. Efficacy of low dose mifepristone was also reported by Jerbi et al (13).…”

Section: Discussionmentioning

confidence: 96%

Is mifepristone 100mg an effective alternative to standard dose for medical abortion

Goel¹,

Mittal²,

Taneja³

et al. 2010

J Turkish German Gynecol Assoc

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“…In France, where the use of mifepristone was described first, the standard regimen involves the use of mifepristone 600 mg followed by misoprostol 400 µg orally in a single dose. 38,39 Two large French trials assessed the regimen and reported success rates of 95-97% at 49 days' gestation. 38,39 The second French study 39 included women up to 63 days' gestation.…”

Section: Dosementioning

confidence: 99%

“…38,39 Two large French trials assessed the regimen and reported success rates of 95-97% at 49 days' gestation. 38,39 The second French study 39 included women up to 63 days' gestation. The standard regimen was followed by an additional dose of misoprostol 200 µg for women who did not abort within 3 h of the initial dose.…”

Section: Dosementioning

confidence: 99%

“…38,39 El-Refaey et al 43 reported a randomised trial that compared vaginal to oral administration of misoprostol 800 µg following mifepristone 600 mg in the context of medical abortion up to 63 days' gestation and showed superior efficacy and lower side effects with the vaginal route of administration. Zieman et al 44 reported on the absorption kinetics of misoprostol with oral and vaginal administration.…”

Section: Route Of Misoprostol Administrationmentioning

confidence: 99%

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Medical termination of pregnancy in the early first trimester

Hamoda

Flett²

2005

j fam plann reprod health care

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Surgical abortion using vacuum aspiration or dilatation and curettage has been the method of choice for termination of pregnancy up to 63 days' gestation since the 1960s. Over the last three decades many studies have explored the use of medical methods for inducing abortion at these gestations. Earlier regimens assessed the systemic and intrauterine injection of prostaglandins. This was followed in the 1980s by the introduction of the antiprogesterone, mifepristone. Since its introduction, the uptake of medical abortion has been steadily increasing in countries where it has been available for routine use. Most current clinical protocols require the use of prostaglandins in combination with anti-progesterones or antimetabolites. The safety, efficacy and acceptability of the medical regimen are now well established at all gestations of pregnancy. Provision of medical abortion increases the choice available to women, in particular those wishing to avoid surgery. q The provision of medical abortion offers additional choice to women, in particular those wishing to avoid surgery.q Follow-up provides the opportunity to confirm successful abortion and identify possible complications. This is particularly essential for women who do not expel recognisable products of conception, to exclude risk of failed treatment and continuing pregnancy. 10 J Fam Plann Reprod Health Care 2005: 31(1) Historical backgroundOver three decades ago, it was shown that the systemic or intrauterine injection of prostaglandins would induce abortion in over 90% of women in early pregnancy. 3,4 In 1980, the scientists at Roussel-Uclaf (Romainville, France) discovered a C19 derivative of norethisterone with a modification at the 11-beta position. This was found to have high affinity for the progesterone receptor. The company's code for this drug was RU38486 (later shortened to RU486) and the generic name, mifepristone. This discovery began a new era in fertility control and has shaped much of our current practice. In 1982, the potential abortifacient effect of mifepristone was demonstrated and the compound was reported to interrupt the menstrual cycle and early pregnancy. 5 This provoked a wave of publicity and protest from anti-abortion organisations, which has continued to this day. Methods used for medical abortionThe three main categories of medical abortion are described in the following paragraphs. Uterotonic compounds (prostaglandins)Prostaglandins are naturally occurring fatty acids that are produced by many tissues in the body. Prostaglandins cause uterine contractions and result in softening and dilatation of the cervix. 7,8 PGF2α and PGE2 were first investigated for medical abortion in the 1970s. 9 Both cause powerful contractions of the smooth muscle in the myometrium at all stages of pregnancy. This contrasts with the relative uterine insensitivity to oxytocin in early pregnancy. 7,10 Prostaglandins, however, also cause contractions in other areas of smooth muscle in the body (e.g. the intestinal wall) and hence may be associat...

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Early Termination of Pregnancy with Mifepristone (RU 486) and the Orally Active Prostaglandin Misoprostol.

Cited by 43 publications

References 0 publications

Integrating medical abortion into safe abortion services: experience from three pilot sites in South Africa

Integrating medical abortion into safe abortion services: experience from three pilot sites in South Africa

Is mifepristone 100mg an effective alternative to standard dose for medical abortion

Medical termination of pregnancy in the early first trimester

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