Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy

Abstract

In this prospective randomized parallel group study, subjects with a pregnancy of less than 63 d were randomized to receive either (i) 200 mg oral mifepristone plus 400 μg misoprostol per vaginally concurrently (group A); (ii) or the administration of misoprostol after 48 h (group B). Transvaginal sonography was performed on the 14th day of misoprostol administration to confirm complete abortion. The primary outcome was to compare the rates of complete abortion in two groups. Secondary outcomes were to compare induction abortion interval, side effects and compliance. A total of 200 subjects included in the study were randomized into groups A and B (100 each). Both the groups were comparable for age, parity, gestational age and history of previous abortion. The complete expulsion rate in group A was 96% (95% confidence interval (CI) 95.1-98.2%) and group B was 95% (95% CI 93.0-96.8%) (p> 0.100). A gestational age of more than 56 d was found to predict failure of treatment in both groups. The adverse effect profile in the two groups was the same. Efficacy of concurrent mifepristone and misoprostol in combination is similar to that when misoprostol is given 48 h later (ctri.nic.in CTRI/2010/091/001422).

Medical termination for pregnancy in early first trimester (≤ 63 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review

“…Eight studies assessed different time intervals between mifepristone and misoprostol dosing in the combined regimen. These include comparisons between < 8 h vs. > 24 h [11,12], 24 h vs. 48 h [13,32,40], concurrent administration vs. 24 h [25,38] and < 8 h vs. 48 h [37] ( Table 2).…”

“…There may be little to no difference in rates of successful abortion between concurrent administration of misoprostol and a 24-h interval (RR 1.01 CI 95% 0.84-1.21, very low certainty of evidence) [25,38]. There was no significant difference between 24-h and 48-h interval in terms of ongoing pregnancy and successful abortion [13,32,40].…”

Simultaneous compared to interval administration of mifepristone and misoprostol for medical abortion up to 10+0weeks' gestation: a systematic review with meta-analyses

“…In two of the studies it was unclear whether allocation concealment was adequate,3 4 with the same concern being an issue for the randomisation method in one of those studies 4. Finally, one of the studies was at high risk of selective reporting bias with a number of stated outcomes not reported 4. All three studies were at low risk of attrition bias for all reported outcomes apart from patient satisfaction in the Creinin et al study, which was at high risk of attrition bias with data missing for 10% of the population in each intervention group 2…”

Medical termination for pregnancy in early first trimester (≤ 63 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review

“…Eight studies assessed different time intervals between mifepristone and misoprostol dosing in the combined regimen. These include comparisons between < 8 hours vs. > 24 hours [8,9], 24 hours vs. 48 hours [10,21,22], concurrent administration vs. 24 hours [23,24] and < 8 hours vs. 48 hours [25] (Table 2).…”

“…There may be little to no difference in rates of successful abortion between concurrent administration of misoprostol and a 24-hour interval (RR 1.01 CI 95% 0.84-1.21, very low certainty of evidence) [23,24]. There was no signi cant difference between 24-hour and 48-hour interval in terms of ongoing pregnancy and successful abortion [10,21,22].…”