Search

A medical abortion can be safely done in the late first trimester, according to a study of 483 women whose pregnancy was between 64 and 91 days. Ninety-five percent of the women had a successful abortion when they took mifepristone followed by misoprostol 36 to 48 hours later. The average time to abortion was 5.5 hours.

Mifepristone can soften the cervix, making surgical abortion easier. This as the conclusion of a study of 90 women who were given oral mifepristone 24 to 48 hours before surgery or vaginal misoprostol 2 to 4 hours before surgery.

Many women may prefer taking mifepristone and misoprostol to induce abortion rather than receiving suction curettage and vacuum aspiration. This was the conclusion of a study of 152 women who took the drugs and 174 women who received the surgical treatment.

Mifepristone combined with methotrexate appears to be more effective in inducing abortion in ectopic pregnancies than methotrexate alone. During an ectopic pregnancy, the developing embryo implants in the Fallopian tubes instead of the uterus. Researchers compared the outcome of 30 pregnant women who received mifepristone and methotrexate for an ectopic pregnancy with the outcome of 42 who receive methotrexate alone. Abortion was induced in all but one of the women who received both drugs and all but 11 of the women who received methotrexate alone.

Drug-induced abortion with mifepristone-misoprostol may be safe and well accepted by women in developing countries. Researchers in China, Cuba, and India allowed 1373 women pregnant less than 56 days to choose between surgical abortion or medical abortion. Medical abortion was accomplished using 600 mg of mifepristone followed two days later by 400 micrograms of misoprostol. Failure rates for medical abortion were 8.6% in China, 16% in Cuba, and 5.2% in India, and exceeded failure rates for surgical abortion. More women preferred medical abortion even though they experienced more bleeding.

Before a pregnancy is terminated, the cervix may be dilated with fatty acid compounds called prostaglandins or by special medical devices called intracervical tents. However, prostaglandins may cause pain in the pelvis, bleeding, and gastrointestinal complications, while cervical tents can cause pain and are difficult to use. Mifepristone, or RU 486, is a drug that counteracts the actions of the hormone progesterone, and may be capable of dilating the cervix. The effect of mifepristone on the cervix was assessed in 80 women in their first pregnancy. Mifepristone was given in one dose of 600 milligrams 30 hours before the termination of pregnancy in the first three months. The women were older than 18 years of age and were to undergo termination of pregnancy between 7 and 13 weeks of pregnancy. Treatment with mifepristone reduced the force needed to dilate the cervix from 4 to 10 millimeters. The required amount of force was decreased from 84.3 newtons (N) in untreated patients to 46.0 N in mifepristone-treated patients. Mifepristone treatment caused a greater incidence of pelvic pain and vaginal bleeding before the operation but less pain after surgery. These findings show that the antiprogesterone mifepristone reduces the resistance of the cervix in the first three months of pregnancy and causes few adverse side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Currently, in the United Kingdom, elective abortions are performed by removing the products of conception by vacuum aspiration. Although the complication rate is low, it is a surgical procedure generally performed under general anesthesia and requiring a good deal of technical expertise. Mifepristone (RU 486) is a drug that induces abortion by blocking the action of progesterone, a hormone essential in maintaining pregnancy. Studies have shown that mifepristone works 88 percent of the time but may be associated with heavy bleeding. However, when this nonsurgical method is used in combination with prostaglandin, a hormone-like substance that effects the smooth muscle of the uterus, it's efficacy is improved. The efficacy of mifepristone in combination with prostaglandin (gemeprost) for the termination of early pregnancy was studied among 588 women who were less than nine weeks pregnant attending one of 13 participating centers in England. The women received a single 600 milligram dose of mifepristone orally. A vaginal pessary (a device inserted into the vagina) containing prostaglandin was inserted 48 hours later. Complete termination of pregnancy occurred in 94 percent of the patients. None of the 46 women who were less than 6.5 weeks pregnant required surgical termination due to failed mifepristone attempt. A surgical termination was needed in 70 (6.5 percent) of the remaining women. In five women, a procedure to scrape the lining of the uterus, curettage, was needed to complete the abortion. These women also required a blood transfusion. A small percentage of women (one percent) had a significant reduction in hemoglobin, the iron-containing pigment of red blood cells. The women who had had children were less likely to need pain medication than women who had never had children (13 percent versus 37 percent). Vomiting occurred in 26 percent of the women and 13 percent of the women experienced diarrhea. Early termination of pregnancy (before the ninth week of pregnancy) is easily achieved with mifepristone combined with gemeprost. Side effects such as pain and bleeding can be managed effectively when women are hospitalized for a few hours after the insertion of the pessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mifepristone (RU 486) is an agent that blocks the action of progesterone, the hormone essential for a successful pregnancy. In France, RU 486 is being used by thousands of women as an alternative to surgical termination of unwanted pregnancies. Why RU 486 fails to induce an abortion in some women is unclear. The factors predicting a failed abortion attempt were studied among 271 women receiving RU 486 in an experimental protocol in the US. The factors that might influence the failure of RU 486 to achieve a complete abortion were the following: number of previous pregnancies, number of days without menstruation, the level of human chorionic gonadotropin hormone (hCG), the size of the gestational sac (containing the products of conception), patient's body weight and Quetelet's index (a ratio of weight to height). The two factors that influenced a failed RU 486 attempt the most were the type of treatment regimen used and the Quetelet index. Women who had a Quetelet index falling in the top 25th percentile were 2.9 times more likely to have a failed abortion attempt than the women falling within the bottom 25th percentile. As the level of hCG increased the chances of a failed attempt increased. Women with a hCG level of 19,800 milli-units per milliliter were 2.8 times more likely to have a failed abortion than women with a value less than 6,350. The results indicate that body weight influences the success of RU 486. Slender women with low hCG levels who were given the 600 milligram dose of RU 486 had the lowest abortion failure rate. Standard RU 486 treatment protocols may not be effective for women of all body types. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vacuum aspiration is a popular technique used in England and Wales to terminate unwanted pregnancies. Although the surgical procedure is relatively safe, some complications do arise. RU 38,486 is a drug given orally that blocks receptors on cells of the uterus which have a particular affinity for progesterone, the hormone necessary to maintain a pregnancy. When prostaglandin, a hormone-like substance that causes uterine contractions, is given in combination with RU 38,486, the expulsion of the fetus is enhanced. A pessary (a device inserted into the vagina) containing prostaglandins was inserted 48 hours after RU 38,486 had been administered to 100 pregnant women. Pregnancies were terminated in all patients, 95 complete and four incomplete (where some of the products of conception were retained). Nausea was experienced by 25 percent of the women and 15 percent vomited after RU 38,486 was administered. The prostaglandins given afterwards caused 13 percent of the women to vomit, 10 percent to have diarrhea and 23 percent to have pain requiring a pain killer. A pelvic infection was noted in one patient. Of the 40 women asked about the character of the blood loss with the termination, 16 (40 percent) reported a normal blood flow, eight (20 percent) reported a lighter than normal blood flow and 16 (40 percent) reported a heavier than normal blood flow. When asked if they would repeat the procedure a second time, 88 percent stated they would, while nine percent stated they definitely would not. Most of the women who would not repeat the procedure had incomplete terminations (three percent) or painful termination (six percent). A nonsurgical method of pregnancy termination has many advantages. The high success rate with minimal complications make RU 38,486 an attractive alternative to current surgical methods of abortion. (Consumer Summary produced by Reliance Medical Information, Inc.)

von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial. Lancet 2002; 360:1803-1810. * PRACTICE [...]

### FORSYTHE, CLARKE D. A COUPLE of years ago promoters of RU-486 hired a PR firm to 'sell' the drug to the American public. They had four talking points: it [...]

Intrauterine death of the fetus is a common and serious complication of pregnancy, which causes psychological distress and adverse physiological effects as well. Hence, clinicians try to expel the fetus from the uterus by inducing labor with prostaglandins. However, these naturally occurring substances have adverse side effects and cannot be used under certain conditions. Mifepristone, also known as RU 486, is a steroid drug that prevents the actions of the female hormone progesterone and the adrenal glucocorticoid hormones. This drug has been used to induce abortion in the first trimester of pregnancy, and can induce labor after fetal death. The effectiveness of and tolerance to mifepristone in inducing labor was assessed in patients with intrauterine fetal deaths; 46 women were given mifepristone and 48 women (controls) were given an inert placebo. The drug was considered effective if the fetus was expelled from the uterus within 72 hours after starting treatment with mifepristone at a dose of 600 milligrams per day for two days. Treatment with mifepristone was effective in 29 of 46 patients (63 percent), whereas spontaneous labor occurred in only eight of 48 patients (17 percent) given a placebo. Mifepristone was well tolerated. One woman who was given a placebo developed widespread coagulation (clotting) within the blood vessels. These findings show that mifepristone may be a useful alternative to prostaglandins in the management of intrauterine fetal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

2002 AUG 8 - (NewsRx.com & NewsRx.net) -- RU-486 appears to hasten cure of women's fibroids and endometriosis, according to recent research. The fibroid research was conducted by Dr. Steven [...]

Over the weekend an old and dear friend sent me a sheaf of quotes attributed to CBS newsman and curmudgeon Andy Rooney. They are in the form of 'I've learned....' [...]

While American providers have just begun to use mifepristone for early medical abortion, researchers are looking at the drug's possible use in emergency contraception. Investigators coordinated by the Geneva-based World [...]

WASHINGTON--The U.S. Food and Drug Administration (FDA) has approved marketing of the abortion-inducing pill, RU 486 or mifepristone. The drug will be distributed under the name of Mifeprex by Danco [...]

Women have been using mifepristone, aka the abortion pill, for more than a decade. But lately, anti-abortion groups have ratcheted up their scare tactics--saying it causes breast cancer, infertility, and [...]

The principle of 'emptying the uterus as quickly and safely as possible' remains the cornerstone of management in inevitable or incomplete spontaneous abortion.[1] Surgical curettage has been used since the [...]

Mifepristone, also known as RU 486, is a steroid drug that prevents the actions of the female hormone progesterone and the adrenal glucocorticoid hormones. This drug has been used to induce abortion in the first trimester of pregnancy. However, studies show that mifepristone is ineffective in eliminating tubal ectopic pregnancies, in which the fertilized egg implants in the fallopian tubes rather than the uterus. A case is described of a 27-year-old woman who was given 600 milligrams mifepristone and 50 micrograms of 15-methyl prostaglandin F2-alpha to induce first trimester abortion. Vaginal bleeding began two days after the first dose of mifepristone and decreased to light spotting within nine days. However, the levels of beta human chorionic gonadotropin (beta-hCG), a hormone produced during pregnancy, remained elevated despite the removal of residual fetal and related tissue by curettage. Ultrasonography, a diagnostic method in which sound waves are used to visualize internal structures, revealed a cyst or sac-like structure within the left ovary. The patient underwent laparoscopy, the examination of the abdomen using a tube-like device with an optical system called a laparoscope. A left ovarian pregnancy was identified and removed, and beta-hCG levels decreased to an undetectable value 21 days later. This case is the first report of simultaneous pregnancies occurring in the uterus and ovary in the same patient. In addition, this case shows that mifepristone and prostaglandin were ineffective in eliminating the ovarian pregnancy, which was successfully removed by laparoscopy. (Consumer Summary produced by Reliance Medical Information, Inc.)