An effective regimen for early medical abortion: a report of 2000 consecutive cases

A combination of the anti-progesterone mifepristone and gemeprost provides an effective non-surgical method for the induction of abortion at gestation s up to 63 days, achieving complete abortion rates of over 95%. We report o ur experience with an alternate regimen, comprising a reduced dose of mifep ristone in combination with vaginal misoprostol, A consecutive series of 20 00 women requesting early medical abortion at gestations up to 63 days was studied retrospectively, Each woman received mifepristone 200 mg orally, fo llowed 36-48 h later by misoprostol 800 mu g vaginally. Of the 2000 women, 39 (2.0%) aborted completely following administration of mifepristone alone and a further 1912 experienced complete abortion following administration of misoprostol (a complete abortion rate of 97.5%), Surgical intervention w as required in 49 women (2.5%): for incomplete abortion in 27 (1.4%), for m issed abortion in seven (0.4%), for continuing pregnancy in 11 (0.6%) and t o exclude ectopic pregnancy in four (0.2%), The surgical intervention rate was significantly higher among women at gestations greater than or equal to 49 days than among those at less than or equal to 49 days (3.3 versus 1.5% , P = 0.0193), The regimen appears as effective, in terms of high complete abortion rate and low continuing pregnancy rate, as any published alternati ve. This regimen has the benefit of being less costly as the dose of mifepr istone is 67% lower and misoprostol is substantially less expensive than ge meprost, Additionally, misoprostol does not require special transport or st orage requirements. As such, the combination of mifepristone and misoprosto l may be preferable to mifepristone and gemeprost.