One or two day mifepristone–misoprostol interval for second trimester abortion

Nilas, Lisbeth; Glavind‐Kristensen, Marianne; Vejborg, Thomas S; Knudsen, Ulla Breth

doi:10.1080/00016340701505002

Cited by 31 publications

(21 citation statements)

References 26 publications

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“…All published studies reported no increase in adverse events, which is in agreement with our findings [13,14,15,16,17]. We report one uterine rupture in a woman with previous caesarean section; no cases have been reported in cohorts with mifepristone-to-misoprostol intervals of <36 h. However, in the context of a small cohort, it is inappropriate to extrapolate the significance of rare adverse events to the mifepristone-misoprostol regimen used.…”

Section: Discussionsupporting

confidence: 81%

“…Four RCTs reported percentage expulsion at 12 h post-misoprostol for mifepristone-to-misoprostol intervals <36 h, ranging from 73 to 82% compared to 36.3% in our short regimen cohort [12,13,14,16], although again the mifepristone-to-misoprostol intervals were greater than in our short regimen. Information regarding expulsion at 24 h was provided by 5 of the 6 studies examined and ranged from 91 to 98% [12,14,15,16,17], compared to 80% in our short and 91% in our standard regimen cohorts, respectively. …”

Section: Discussionmentioning

confidence: 99%

“…There are currently 4 randomised controlled trials (RCTs) and 2 observational studies (1 retrospective cohort study and 1 retrospective case series) assessing the effects of mifepristone-to-misoprostol dosing intervals <36 h for second-trimester termination of pregnancy in the context of fetal abnormality [12,13,14,15,16,17]. However, the retrospective case series also included 28 cases of intrauterine death, which were analysed as a subgroup [15].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Short versus Standard Mifepristone and Misoprostol Regimen for Second- and Third-Trimester Termination of Pregnancy for Fetal Anomaly

Sharp

Navaratnam²,

Abreu³

et al. 2015

Fetal Diagn Ther

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Background: Termination of pregnancy requires a 48-hour ‘window' between mifepristone and misoprostol. Shorter durations have been used in first-trimester termination, but there are few data available in later termination for fetal anomaly. Material and Methods: We reviewed all terminations for fetal anomaly at ≥13 weeks from May 2013 to May 2014. Cases were managed using a short (≤12 h) or standard (≥36 h) mifepristone-to-misoprostol interval. Results: Two hundred and twenty women underwent a termination of pregnancy for fetal anomaly during the study period, of which 119 were included for analysis. Sixty-six (55%) women were managed according to the short regimen and 53 (45%) women with the standard regimen. The short regimen resulted in a shorter mifepristone-to-delivery interval but was less likely to result in delivery within 12 h of misoprostol. Delivery rates at 24 h were equivocal. There was no difference in blood loss, vaginal delivery rates, complications or bed nights. The short regimen did require more doses of misoprostol. Feticide or previous uterine scar had no effect on outcomes. Discussion: There was no significant difference in clinical outcome for women managed with a short (≤12 h) or a standard (≥36 h) regimen for medical termination of pregnancy for fetal anomaly, suggesting that either regimen could be offered.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Short versus Standard Mifepristone and Misoprostol Regimen for Second- and Third-Trimester Termination of Pregnancy for Fetal Anomaly

Sharp

Navaratnam²,

Abreu³

et al. 2015

Fetal Diagn Ther

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“…However, another randomized trial found that simultaneous use of mifepristone and misoprostol for second trimester medical abortion was not as effective as the 36 to 38-hour dosing interval [4]. In addition, two studies compared the effects of 1-day and 2-day intervals for second trimester pregnancy termination [5,6]. Successful abortion rates were similar between the groups, but the time between misoprostol administration and fetal expulsion was longer in the 1-day group compared with in the 2-day group.…”

Section: Introductionmentioning

confidence: 97%

One- and two-day mifepristone-misoprostol intervals for second trimester termination of pregnancy between 13 and 16 weeks of gestation

Hou

Zhang

Chen

et al. 2010

International Journal of Gynecology & Obstetrics

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“…of receiving misoprostol. [8] Increasing gestational age is also correlated with increased induction time when using mifepristone and misoprostol from 12 to 20 weeks. In our study too women with gestational age <16 weeks had a lower (8.5±.8hrs.)…”

Section: Discussionmentioning

confidence: 99%

A Study on the Use of a Combination of Mifeprin and Misoprostol for Second Trimester Termination of Pregnancy

Rao¹,

Aruna²,

K³

2015

jemds

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The significant need to conduct second trimester abortions safely is being addressed by the use of a combination of mifepristone and misoprostol, though their dosage regimen continue to be debated. The present study was conducted on 50 selected women in the Department of Gynecology and Obstetrics, Andhra Medical College, Visakhapatnam, from April 2014 to October 2015 to determine the safety and efficacy of 200mg of mifepristone orally followed 24hrs. later by 400mcg of misoprostol administered vaginally every 6hrs. upto a maximum of 5 doses, which is the regimen recommended by FOGSI and the results were analysed. The mean induction abortion interval (IAI) was 10.08±2.9hrs. and 76% of cases had IAI of ≤12hrs. The side effects were few and manageable. Hence, the above regimen should be used for safe and effective termination of a second trimester pregnancy. KEYWORDSAbortion, Mifepristone, Misoprostol, Second trimester. HOW TO CITE THIS ARTICLE: INTRODUCTIONAbortion is the single most common procedure performed for women worldwide. Second trimester abortions constitute 10-15% of all induced abortions worldwide, but are responsible for two-thirds of all major abortion-related complications. Medical abortion, the termination of pregnancy through the use of a drug or a combination of drugs has the potential to reduce complications. Though the medical abortions upto nine weeks of gestation were approved in some countries by 1992, the approval for the use of the above drugs for second trimester abortion was obtained in these countries only in 1999-2000. The optimal method of second trimester abortion continues to be debated. Advantage of medical abortion in second trimester includes the scope for examination of the fetus in abortions done for fetal anomalies to further evaluate the subsequent risk of recurrence and provide information to help in counseling of these patients, which is not possible if dilatation and evacuation is the method chosen. [1] The most commonly used combination is mifepristone taken first and misoprostol administered 24-48 hours later. Mifepristone an antiprogesterone leads to cervical softening, increased uterine sensitivity to prostaglandins and conversion of the quiet pregnant uterus into an organ of spontaneous activity with maximal effect at 36-48 hours. [2] Misoprostol a synthetic PGE-1 analogue induces cervical ripening as well as strong uterine contractions and leads to expulsion of a pregnancy. The oral tablet is effective in different routes of administration and the dose of prostaglandin can be easily adjusted according to need.

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One or two day mifepristone–misoprostol interval for second trimester abortion

Abstract: The combined regimen of mifepristone and misoprostol is effective in the second trimester, and the interval between the drugs can be reduced allowing individualised patient care.

Cited by 31 publications

References 26 publications

Short versus Standard Mifepristone and Misoprostol Regimen for Second- and Third-Trimester Termination of Pregnancy for Fetal Anomaly

Short versus Standard Mifepristone and Misoprostol Regimen for Second- and Third-Trimester Termination of Pregnancy for Fetal Anomaly

One- and two-day mifepristone-misoprostol intervals for second trimester termination of pregnancy between 13 and 16 weeks of gestation

A Study on the Use of a Combination of Mifeprin and Misoprostol for Second Trimester Termination of Pregnancy

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