EARLY ABORTION INDUCTION BY A COMBINATION OF MIFEPRISTONE AND ORAL MISOPROSTOL - A COMPARISON BETWEEN 2 DOSE REGIMENS OF MISOPROSTOL AND THEIR EFFECT ON BLOOD-PRESSURE

Objectives 1. To investigate the efficacy of 800 mu g misoprostol (a P GE(1) analogue) when administered to women pretreated with mifepriston e for early pregnancy termination. 2. To establish means of minimising gastrointestinal side effects by comparing two different misoprostol regimens. The impact of these regimens on blood pressure was investiga ted in a subgroup of patients. Design A randomised study of 150 women of 56 days gestation, or less, allocated to receive oral misoprostol e ither in a single dose of 800 mu g or as two doses of 400 mu g adminis tered sequentially 2 h apart; in each case misoprostol was administere d 36 to 48 h after receiving mifepristone 200 mg orally. Main outcomes Complete abortion rates, the frequency and severity (patients' percep tion) of gastrointestinal side effects, and blood pressure changes in response to prostaglandin administration. Results The overall success rate was 93 %. Seventy-one (95 %) women who received a single dose of misoprostol and sixty-nine (92 %) who received the sequential dose abo rted completely. There were two ongoing pregnancies in the first group (2.5 %) and three (4 %) in the second. The overall ongoing pregnancy rate was 3 %. The incidence of diarrhoea was significantly lower for w omen receiving the sequential dose, and no significant differences wer e found in the incidence of the other gastrointestinal side effects. T he only noted significant change in blood pressure was in diastolic pr essure 4 h after the administration of the higher dose of prostaglandi n, but this was slight. Conclusions The combination of mifepristone an d oral misoprostol provides an alternative method to inducing abortion of pregnancies of up to eight weeks gestation. Patients receiving the single dose of 800 mu g were more troubled by diarrhoea than those on the sequential regimen. The ongoing pregnancy rate was higher than pr eviously reported with vaginal or parenteral administration of prostag landin.