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

Abstract

Background: A wide range of drugs have been studied for first trimester medical abortion. Studies evaluating different regimens, including combination mifepristone and misoprostol and misoprostol alone regimens, show varying results related to safety, efficacy and other outcomes. Thus, the objectives of this systematic review were to compare the safety, effectiveness and acceptability of medical abortion and to compare medical with surgical methods of abortion ≤63 days of gestation. Methods: Pubmed and EMBASE were systematically searched from database inception through January 2019 using a combination of MeSH, keywords and text words. Randomized controlled trials on induced abortion at ≤63 days that compared different regimens of medical abortion using mifepristone and/or misoprostol and trials that compared medical with surgical methods of abortion were included. We extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses where possible. The primary outcomes were ongoing pregnancy and successful abortion. Results: Thirty-three studies composed of 22,275 participants were included in this review. Combined regimens using mifepristone and misoprostol had lower rates of ongoing pregnancy, higher rates of successful abortion and satisfaction compared to misoprostol only regimens. In combined regimens, misoprostol 800 μg was more effective than 400 μg. There was no significant difference in dosing intervals between mifepristone and misoprostol and routes of misoprostol administration in combination or misoprostol alone regimens. The rate of serious adverse events was generally low.

Effect of misoprostol on type 3 transformation zone of the cervix among Cameroonian women

“…A major difference is that our study was a retrospective cohort reporting our preliminary experience with clinical implementation while the described studies were RCTs. The 600 mcg of misoprostol, although consistent with clinically approved doses ( Abubeker et al, 2020 ), was higher than the doses used in prior trials. We anticipated higher conversion rates but since more women who received 600 mcg were FSWs who elected to return the next day rather than wait for same-day re-screenings, we are unable to tease the effect of dose from duration of misoprostol placement using our data.…”

“…Misoprostol is a prostaglandin E1 analogue that causes ripening of the cervix with softening and dilation. It is commonly used in obstetrics to induce labor or treat missed/incomplete first trimester miscarriage ( Abubeker et al, 2020 , Wu et al, 2017 .) Thus, misoprostol has to be used with caution among women of reproductive age and pregnancy has to be adequately ruled out.…”

Comparison of mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion: A systematic review and meta-analysis

“…Whereas earlier primary studies provided evidence of success for terminating early pregnancy applying either options (52,53), reviews compared the clinical effectiveness of combined mifepristone and misoprostol against misoprostol alone for medical abortion (26,27,54). Although these reviews considered studies designed through RCTs, variations in the study population characteristics and outcomes evaluated make it difficult to draw linear conclusions across all settings.…”

A trans-national examination of the impact of the COVID-19 pandemic on abortion requests through a telemedicine service

“…6 Medical abortion with mifepristone and misoprostol is 95%-98% effective in terminating pregnancies in the early first trimester. 7 Multiple studies confirm the safety and acceptability of medical abortion, also when provided through telemedicine. [8][9][10][11][12] The World Health Organization (WHO) also recommends self-management of medical abortion with the use of mifepristone and misoprostol.…”