The efficacy and tolerance of mifepristone and prostaglandin in the first trimester termination of pregnancy

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.)