TERMINATION OF PREGNANCY WITH REDUCED DOSES OF MIFEPRISTONE

Objectives-To compare the abortifacient efficacy and side effects of t hree doses of the antiprogestin mifepristone plus prostaglandin for te rmination of early pregnancy. Design-Randomised, double blind multicen tre trial. Setting-11 departments of obstetrics and gynaecology and of family planning, mostly in university hospitals, in seven countries. Subjects-1182 women with an early pregnancy (menstrual delay of 7-28 d ays) requesting abortion. Interventions-Single doses of 200 mg, 400 mg , or 600 mg mifepristone followed, 48 hours later, by vaginal pessary of 1 mg of the prostaglandin E1 analogue gemeprost. Main outcome measu res-Outcome of treatment; duration and subjective amount of menstrual bleeding; side effects and complications; and concentrations of haemog lobin. Results-Outcome was similar with the three doses of mifepriston e. Of the 1151 women with known outcome, 95.5% had a complete abortion (364 (93.8%) of those given 200 mg mifepristone, 368 (94.1%) of those given 400 mg, and 367 (94.3%) of those given 600 mg), 3.7% had an inc omplete abortion (14 (3.6%), 15 (3.8%), and 14 (3.6%)), 0.3% had a mis sed abortion (three (0.8%), one (0.3%), and none), and 0.4% had a cont inuing live pregnancy (two (0.5%), two (0.5%), and one (0.3%)). Of the 43 women who had incomplete abortion, 23 underwent emergency uterine curettage (usually for haemostatic purposes) and three of these women were given a blood transfusion. The numbers of reported complaints, bl eeding patterns, and changes in blood pressure and haemoglobin concent rations were similar with the three treatments. Conclusions-For termin ation of early pregnancy a single dose of 200 mg mifepristone is as ef fective as the currently recommended dose of 600 mg when used in combi nation with a vaginal pessary of 1 mg gemeprost.