ANALYSIS OF 369 ABORTIONS CONDUCTED BY MIFEPRISTONE (RU486) ASSOCIATED WITH SULPROSTONE IN A FRENCH FAMILY-PLANNING CENTER

Objective: To investigate the use of oral mifepristone (RU486; Roussel -Uclaf, Paris, France) associated with IM injection of sulprostone (Sc hering, Lys-Lez-Lannoy, France) for the induction of legal abortion (7 weeks of amenorrhea in France). Design: An uncontrolled observational study. Setting: A public family planning center in Paris. Patients: T hree hundred sixty-nine (369) pregnant women with up to 7 weeks amenor rhea undergoing legal abortion. Interventions: Six hundred milligrams (600 mg) of oral mifepristone followed 48 hours later by an IM injecti on of 250 mu g of sulprostone. Main Outcome Measures: Frequency of com plete abortion and the need for subsequent surgical evacuation, hospit alization, and blood transfusion. Measurement of the beta-hCG concentr ation before and 14 days after the oral administration of mifepristone . Results: There was complete abortion in 93.2% of the cases. Of the 2 5 failures, 8 were continued pregnancies, 6 terminated pregnancy but w ithout expulsion of the conceptus, and 11 were placenta retentions. Ei ght women required short hospitalization, but none needed blood transf usion. Among the 25 failures, 23 had a beta-hCG concentration > 500 IU /mL [sensitivity 92%, specificity 83%]. Conclusion: The sequential use of oral mifepristone and IM injection of sulprostone is effective in inducing abortion up to 7 weeks of amenorrhea. Nevertheless the risk o f maternal morbidity associated with sulprostone and also the risk of fetal malformations in cases of continued pregnancy indicate that this method should only be used in specialist centers.