Comparative study for efficacy of termination in first trimester pregnancy using Misoprostol and Mifepristone

Main Article Content

Georgi Stanulov
Xanthi Anthoulaki
Dorelia Deuteraiou
Anna Chalkidou
Grigorios Trypsianis
Werner Rath
Georgios Galazios
Panagiotis Tsikouras*

Abstract



Background: The best method for medical abortion depends fundamentally on pregnancy duration and the final result varies on medical stuff’s experience. The aim of this study pertained to investigate the effectiveness of medical abortion using misoprostol, mifepristone or the combination of them.


Patients and methods: During the period April 2007 to December 2017, 200 women with pregnancy until 49 days after LMP (last menstrual period) underwent medical termination by using 600 mg mifepristone (RU 486) (Mifegyn) Group A1 per os vs 800 mcg misoprostol (Cytotec) A2 and in other 200 pregnant women, duration between 49-63 days was administrated using 600 mg mifepristone followed 48 hours later 800 mcg misoprostol B1 vaginaly vs. only misoprostol B2. All participants were consistent with surgical abortion if deemed necessary and a transvaginal ultrasound was performed to confirm an intrauterine pregnancy before the medical administration. The indications for the abortion were as following: missed abortion, endometrial death, spontaneous and induced abortions.


Results: According to our study, there was not a case needed to undergo surgical abortion. Common side effects like nausea, vomiting, pain and moderate vaginal bleeding were noticed without the need of hospitalization. Bleeding was occurred earlier in Group A1 compared to Group A2. In addition, abortion started about 3.5 hours earlier in Group A1 compared to Group A2. Similarly, time between administration and abortion was 50% shorter in Group A1 compared to Group A2. The duration of bleeding in Group B1 in Group B2 was similar in the two groups. Analgesia was not necessary for any participant, while repeat administration was more than 7 times more frequent in Group B2 compared to Group B1.


Conclusion: The best method for medical abortion depends fundamentally on pregnancy duration and the final result varies on medical stuff’s experience. The aim of this study pertained to investigate the effectiveness of medical abortion using misoprostol, mifepristone or the combination of them.



Downloads

Download data is not yet available.

Article Details

Stanulov, G., Anthoulaki, X., Deuteraiou, D., Chalkidou, A., Trypsianis, G., Rath, W., Galazios, G., & Tsikouras, P. (2018). Comparative study for efficacy of termination in first trimester pregnancy using Misoprostol and Mifepristone. Archives of Community Medicine and Public Health, 4(2), 038–046. https://doi.org/10.17352/2455-5479.000037
Review Articles

Copyright (c) 2018 Stanulov G, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Licensing and protecting the author rights is the central aim and core of the publishing business. Peertechz dedicates itself in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. Peertechz licensing terms are formulated to facilitate reuse of the manuscripts published in journals to take maximum advantage of Open Access publication and for the purpose of disseminating knowledge.

We support 'libre' open access, which defines Open Access in true terms as free of charge online access along with usage rights. The usage rights are granted through the use of specific Creative Commons license.

Peertechz accomplice with- [CC BY 4.0]

Explanation

'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.

With this license, the authors are allowed that after publishing with Peertechz, they can share their research by posting a free draft copy of their article to any repository or website.
'CC BY' license observance:

License Name

Permission to read and download

Permission to display in a repository

Permission to translate

Commercial uses of manuscript

CC BY 4.0

Yes

Yes

Yes

Yes

The authors please note that Creative Commons license is focused on making creative works available for discovery and reuse. Creative Commons licenses provide an alternative to standard copyrights, allowing authors to specify ways that their works can be used without having to grant permission for each individual request. Others who want to reserve all of their rights under copyright law should not use CC licenses.

Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, et al. (2016) Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet 388: 258-267. Link: https://goo.gl/vkSkki

Chae S, Desai S, Crowell M, Sedgh G (2017) Reasons why women have induced abortions: a synthesis of findings from 14 countries. Contraception 96: 233-241. Link: https://goo.gl/eUYhtz

Sedgh G, Singh S, Shah IH, Ahman E, Henshaw SK, et al. (2012) Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet 379: 625-632. Link: https://goo.gl/gUdwbh

Sell SE, Santos EK, Velho MB, Erdmann AL, Rodriguez Mde J (2015) Reasons and meanings attributed by women who experienced induced abortion: an integrative review. Rev Esc Enferm USP 49: 502-508 Link: https://goo.gl/Q68MGR

Lim LM, Singh K (2014) Termination of pregnancy and unsafe abortion. Best Pract Res Clin Obstet Gynaecol 28: 859-869. Link: https://goo.gl/gMoRmd

Fawcus SR Maternal mortality and unsafe abortion. Best Pract Res Clin Obstet Gynaecol 22: 533-548. Link: https://goo.gl/7FPXXu

Levels M, Sluiter R, Need A (2014) A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010.Health Policy 118: 95-104. Link: https://goo.gl/Mzhmye

Pinter B, Aubeny E, Bartfai G, Loeber O, Ozalp S, et al. (2005) Accessibility and availability of abortion in six European countries. Eur J Contracept Reprod Health Care 10: 51-58. Link: https://goo.gl/98WPHr

David HP (2006) Born unwanted, 35 years later: the Prague study. Reprod Health Matters 14: 181-190. Link: https://goo.gl/b7Eebo

Trussell J (2009) Understanding contraceptive failure. Best Pract Res Clin Obstet Gynaecol 23: 199-209. Link: https://goo.gl/RxUfkN

Wiebe ER, Trussell J (2009) Contraceptive failure related to estimated cycle day of conception relative to the start of the last bleeding episode.Contraception 79: 178-181. Link: https://goo.gl/UpcyrZ

Shannon C, Wiebe E, Jacot F, Guilbert E, Dunn S, et al. (2006) Regimens of misoprostol with mifepristone for early medical abortion: a randomised trial. BJOG 113: 621-628. Link: https://goo.gl/2krXSr

American College of Obstetricians and Gynecologists Obstet Gynecol. Practice bulletin no. 143: medical management of first-trimester abortion. 123: 676-692. Link: https://goo.gl/2AFgTH

Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, et al. (2015) Reprod Health Matters. 22: 56-66. Link: https://goo.gl/e4tGt9

(2015) Medical methods for first trimester abortion. Cochrane Database Syst Rev 9: CD002855. Link: https://goo.gl/EPt7fo

Louie KS, Chong E, Tsereteli T, Avagyan G, Vardanyan S, et al. (2015) The introduction of first trimester medical abortion in Armenia. Reprod Health Matters 22: 56-66. Link: https://goo.gl/fR3Kj8

Lo SS, Ho PC (2015) First-trimester medical abortion service in Hong Kong. Hong Kong Med J 21: 462-467. Link: https://goo.gl/neXBEZ

Louie KS, Tsereteli T, Chong E, Aliyeva F, Rzayeva G, et al. (2014) Acceptability and feasibility of mifepristone medical abortion in the early first trimester in Azerbaijan. Eur J Contracept Reprod Health Care 19: 457-464. Link: https://goo.gl/jWEXpp

Nothnagle M, Taylor JS (2004) Medical methods for first-trimester abortion. Am Fam Physician 70: 81-83. Link: https://goo.gl/m1E9hn

Baird DT (2000) Mode of action of medical methods of abortion. J Am Med Womens Assoc 55: 121-126. Link: https://goo.gl/iGQ1kb

Child TJ, Thomas J, Rees M, MacKenzie IZ (2001) Morbidity of first trimester aspiration termination and the seniority of the surgeon. Hum Reprod 16: 875-878. Link: https://goo.gl/fcn1HV

Kapp N, Lohr PA, Ngo TD, Hayes JL (2010) Cervical preparation for first trimester surgical abortion. Cochrane Database Syst Rev 17: CD007207. Link: https://goo.gl/QUP2ai

Andersen LB, Dechend R, Karumanchi SA, Nielsen J, Joergensen JS, et al. (2016) Early pregnancy angiogenic markers and spontaneous abortion: an Odense Child Cohort study. Am J Obstet Gynecol 215: 594-594. Link: https://goo.gl/1dTi3X

Zeng LX, Yan H, Chen ZJ (2007) Study on the current status and risk factors of spontaneous abortion of women at reproductive age in rural areas of Xianyang district, Shaanxi province. Zhonghua Liu Xing Bing Xue Za Zhi 28: 19-23. Link: https://goo.gl/ZS9DzK

Webber K, Grivell RM (2015) Cervical ripening before first trimester surgical evacuation for non-viable pregnancy. Cochrane Database Syst Rev 10: CD009954. Link: https://goo.gl/J4iwbt

Kulier R, Gülmezoglu AM, Hofmeyr GJ, Cheng LN, Campana A (2004) Medical methods for first trimester abortion. Cochrane Database Syst Rev 2: CD002855. Link: https://goo.gl/m1E9hn

Say L, Kulier R, Gülmezoglu M, Campana A (2005) Medical versus surgical methods for first trimester termination of pregnancy. Cochrane Database Syst Rev 25: CD003037. Link: https://goo.gl/2bwp6e

Bouschbacher L, Maatouk A, Collin P, Welter E, Morel O, et al. (2014) Association of mifepristone and misoprostol for the medical management of early pregnancy failure. Gynecol Obstet Fertil 42: 832-837. Link: https://goo.gl/aUXmWv

Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L (2018) Misoprostol treatment vs expectant management in women with early non-viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial. Ultrasound Obstet Gynecol 51: 24-32. Link: https://goo.gl/iMtwqa

Kapp N, Baldwin MK, Rodriguez MI (2018) Efficacy of medical abortion prior to 6 gestational weeks: a systematic review. Contraception 97: 90-99. Link: https://goo.gl/8pzMzQ

Winikoff B, Dzuba IG, Creinin MD, Crowden WA, Goldberg AB (2008) Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial. Obstet Gynecol 112: 1303-1310. Link: https://goo.gl/oKXicX

Ghosh A, Chaudhuri P (2013) Misoprostol for cervical ripening prior to gynecological transcervical procedures. Arch Gynecol Obstet 287: 967-973. Link: https://goo.gl/UsqhFa

Khan RU, El-Refaey H, Sharma S, Sooranna D, Stafford M (2004) Oral, rectal, and vaginal pharmacokinetics of misoprostol. Obstet Gynecol 103: 866-870. Link: https://goo.gl/gtTzAC

Im A, Appleman LJ (2010) Mifepristone: pharmacology and clinical impact in reproductive medicine, endocrinology and oncology. Expert Opin Pharmacother 11: 481-488. Link: https://goo.gl/k8TjsA

Hamoda H, Ashok PW, Flett GM, Templeton A (2005) A randomised controlled trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion up to 13 weeks of gestation. BJOG 112: 1102-1108. Link: https://goo.gl/AEpQhK

Raymond EG, Shannon C, Weaver MA, Winikoff B (2013) First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Contraception 87: 26-37. Link: https://goo.gl/GZSvhv

Mishell DR, Jain JK, Byrne JD, Lacarra MD (1998) A medical method of early pregnancy termination using tamoxifen and misoprostol. Contraception 58: 1-6. Link: https://goo.gl/bS9JPY

Jain JK, Meckstroth KR, Park M, Mishell DR Jr (2000) A comparison of tamoxifen and misoprostol to misoprostol alone for early pregnancy termination. Contraception 60: 353-356. Link: https://goo.gl/zSEnQe

Creinin MD (2000) Medical abortion regimens: historical context and overview. Am J Obstet Gynecol 183: 3-9. Link: https://goo.gl/NEhbTu

Bos-Thompson MA, Hillaire-Buys D, Roux C, Faillie JL, Amram D (2008) Möbius syndrome in a neonate after mifepristone and misoprostol elective abortion failure. Ann Pharmacother 42: 888-892. Link: https://goo.gl/ENWmxL

Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, et al. (2006) Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet 368: 1248-1253. Link: https://tinyurl.com/y74n6d3j

Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, et al. (2018) Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. Link: https://tinyurl.com/y8y4yyxs

Kulier R, Gülmezoglu AM, Hofmeyr GJ, Cheng LN, Campana A (2004) Medical methods for first trimester abortion. Cochrane Database Syst Rev. Link: https://tinyurl.com/y7kochk7

Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, et al. (2011) Medical methods for first trimester abortion. Cochrane Database Syst Rev. Link: https://tinyurl.com/ycfzbyb7

Pymar HC, Creinin MD, Schwartz JL (2001) Mifepristone followed on the same day by vaginal misoprostol for early abortion. Contraception 64: 87-92. Link: https://tinyurl.com/y7gt95lk

Ngo TD, Park MH, Shakur H, Free C (2011) Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review. Bull World Health Organ 89: 360-370. Link: https://tinyurl.com/ycax6gt2

Spitz IM, Robbins A (1998) Mechanism of action and clinical effects of antiprogestins on the non-pregnant uterus.Hum Reprod Update 4: 584-593. Review. Link: https://tinyurl.com/yahs29fq

Anjum ZK (2000) Termination of early pregnancy with a reduced oral dose of mifepristone and vaginal misoprostol. S Afr Med J 90: 889-891. Link:

Tang OS, Chan CC, Ng EH, Lee SW, Ho PC (2003) A prospective, randomized, placebo-controlled trial on the use of mifepristone with sublingual or vaginal misoprostol for medical abortions of less than 9 weeks gestation.Hum Reprod 18: 2315-2318. Link: https://tinyurl.com/yd3b4bu3

Grossman D, White K, Harris L, Reeves M, Blumenthal PD, et al. (2015) Continuing pregnancy after mifepristone and reversal of first-trimester medical abortion: a systematic review. Contraception 92: 206-211. Link: https://tinyurl.com/y7zrur7n

Song LP, Tang SY, Li CL, Zhou LJ, Mo XT (2018) Early medical abortion with self-administered low-dose mifepristone in combination with misoprostol. J Obstet Gynaecol Res. Link: https://tinyurl.com/ycmn2m4m

Fleseriu M, Biller BM, Findling JW, Molitch ME, Schteingart DE, et al. (2012) SEISMIC Study Investigators. J Clin Endocrinol Meta 97: 2039-4209. Link: https://tinyurl.com/ybhefug4

Shen J, Che Y, Showell E, Chen K, Cheng L (2017) Interventions for emergency contraception. Cochrane Database Syst Rev 8. Link: https://tinyurl.com/y8s9vamv

Spitz IM, Bardin CW, Benton L, Robbins A (1998) N Engl J Med. Early pregnancy termination with mifepristone and misoprostol in the United States 338: 1241-1247 Link: https://tinyurl.com/ycpzg43t

Sparrow M, Shand C, Macdonald J (2006) Atypical presentation of serious pelvic inflammatory disease following mifepristone-induced medical abortion 74: 352-353 Link: https://tinyurl.com/y85o4btq

de Costa CM (2011) Use of mifepristone for medical abortion in Australia, 2006-2009. Med J Aust 194: 206-207. Link: https://tinyurl.com/y9cfjt7g

Lim LM, Singh K (2014) Termination of pregnancy and unsafe abortion. Best Pract Res Clin Obstet Gynaecol 28: 859-869. Link: https://tinyurl.com/yanndykh

Renner RM, Brahmi D, Kapp N (2013) Who can provide effective and safe termination of pregnancy care? A systematic review*. BJOG 120: 23-31. Link: https://tinyurl.com/y9gd4g3e

Blumenthal PD (1992) Abortion: epidemiology, safety, and technique. Curr Opin Obstet Gynecol 4: 506-512. Link: https://tinyurl.com/y7pbskoo

Blanchard K, Winikoff B, Ellertson C (1999) Misoprostol used alone for the termination of early pregnancy. A review of the evidence. Contraception 59: 209-217. Link: https://tinyurl.com/yarur2nk

Carbonell JL, Varela L, Velazco A, Fernández C (1997) The use of misoprostol for termination of early pregnancy. Contraception 55: 165-168. Link: https://tinyurl.com/ybkvqmbz

Chawdhary R, Rana A, Pradhan N (2009) Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial.J Obstet Gynaecol Res 35: 78-85. Link: https://tinyurl.com/ycfk28g2

Glasier A, Thong KJ, Dewar M, Mackie M, Baird DT (1992) Mifepristone (RU 486) compared with high-dose estrogen and progestogen for emergency postcoital contraception. N Engl J Med 327: 1041-1044 Link: https://tinyurl.com/y7qetl37

Kahn JG, Becker BJ, MacIsaa L, Amory JK, Neuhaus J, et al. (2000) The efficacy of medical abortion: a meta-analysis. Contraception 61: 29-40. Link: https://tinyurl.com/y7wahlos