Dosing interval between mifepristone and misoprostol in second and third trimester termination
- 31 Downloads
To compare several strategies for second trimester labor induction for termination of pregnancy (TOP) using misoprostol and mifepristone and to determine which one is more effective in accelerating the time to delivery.
This was a retrospective study in which pregnancies that underwent second and third trimester TOP due to fetal anomalies between 2007 and 2017 were classified into a group that received misoprostol alone, a group that received mifepristone followed by misoprostol on the same day, one where misoprostol was given 1 day after mifepristone and one where the medications were administered 2 days apart. The primary outcome measure was the induction to delivery interval.
481 pregnancies fulfilled the inclusion criteria. In 140 cases, mifepristone was not administered. 341 women received mifepristone prior to induction, which was administered on the day of induction in 85 cases, and 1 or 2 days prior to induction in 140 and 19 cases. Median time interval between first induction and delivery was 15.0 (IQR 10.0–24.1) h in case no mifepristone was given and 13.2 (9.7–18.2) h if mifepristone was given on the same day and 9.3 (6.6–14.9) and 10.5 (7.2–22.3) h, if mifepristone was given 1 or 2 days prior to induction. After 24 h, the proportion of terminated pregnancies in each of the four groups was 75.0, 83.5, 93.2 and 78.9%.
A 1 day interval between mifepristone and misoprostol is more effective in second and third trimester TOP compared to other strategies in terms of reducing the induction to abortion interval.
KeywordsMifepristone Misoprostol Induction Termination of pregnancy
NP: data collection, manuscript writing and editing. JB: data collection. MH: data collection, manuscript writing and editing. HA: manuscript writing and editing. PW: manuscript writing and editing. KOK: conceptualization, project development, formal analysis, manuscript writing and editing.
Compliance with ethical standards
Conflict of interest
All authors declare that there is no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This is a retrospective study that was approved by the local ethical committee (530/2018BO2).
- 3.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. https://doi.org/10.1016/j.contraception.2017.06.014 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.ACOG Practice Bulletin No. 135 (2013) Second-trimester abortion. Obstet Gynecol 121:1394–1406. https://doi.org/10.1097/01.aog.0000431056.79334.cc CrossRefGoogle Scholar
- 8.World Health Organization (2014) Clinical practice handbook for safe abortion. http://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf;jsessionid=F3CA17048D0BF0E570DD6C8C1665AAC1?sequence=1. Accessed 01 Oct 2018
- 11.Guest J, Chien P, Thomson M, Kosseim ML (2007) Randomised controlled trial comparing the efficacy of same-day administration of mifepristone and misoprostol for termination of pregnancy with the standard 36 to 48 hour protocol. BJOG Int J Obstet Gynaecol 114:207–215. https://doi.org/10.1111/j.1471-0528.2006.01179.x CrossRefGoogle Scholar
- 14.Wedisinghe L, Elsandabesee D (2010) Flexible mifepristone and misoprostol administration interval for first-trimester medical termination. Contraception 81:269–274. https://doi.org/10.1016/j.contraception.2009.09.007 CrossRefPubMedGoogle Scholar
- 15.Schaff E (2006) Evidence for shortening the time interval of prostaglandin after mifepristone for medical abortion. Contraception 74:42–44. https://doi.org/10.1016/j.contraception.2006.03.014 CrossRefPubMedGoogle Scholar
- 19.World Health Organization (2017) The selection and use of essential medicines: report of the WHO Expert Committee, 2017. http://apps.who.int/iris/bitstream/handle/10665/259481/9789241210157-eng.pdf?. Accessed 01 Oct 2018
- 20.Baev OR, Rumyantseva VP, Tysyachnyu OV et al (2017) Outcomes of mifepristone usage for cervical ripening and induction of labour in full-term pregnancy. Randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 217:144–149. https://doi.org/10.1016/j.ejogrb.2017.08.038 CrossRefPubMedGoogle Scholar