Nonsurgical mid-trimester termination of pregnancy: a review of 500 consecutive cases

Objective To assess the effectiveness of a regimen comprising mifepristone followed by a combination of the vaginal and oral administration of misopro stol for mid-trimester medical termination of pregnancy. Design Retrospective analysis of prospectively collected data in women unde rgoing mid-trimester medical termination of pregnancy. Setting Aberdeen Royal Infirmary, Scotland. Sample A consecutive series of 500 women with pregnancies of 13-21 weeks of amenorrhea undergoing legally induced abortion in one Scottish NHS hospita l. Methods Each woman received a single oral dose of mifepristone 200 mg and 3 6-48 h later vaginal misoprostol 800 mu g. Three hours following the first dose of misoprostol, 400 mu g doses were administered orally at three hourl y intervals, to a maximum of four doses. Success was defined as abortion oc curring with five doses of prostaglandin, or within 15 h of administration of the first dose of prostaglandin. Results Ninety-seven percent aborted successfully. The median dose of misop rostol required was 1200 mu g and the median induction-to-abortion interval after first prostaglandin administration was 6.5 h. The median number of d oses of misoprostol required to induce abortion, and the induction-to-abort ion interval, was statistically significantly higher among women at gestati ons 17-21 weeks than among those at 13-16 weeks (P = 0.0001). A total of 9. 4% required surgical evacuation of the uterus under general anaesthesia and 66.4% of the women were managed as day cases. Conclusions The combination of oral mifepristone 200 mg followed by vaginal ly and orally administered misoprostol provides a noninvasive and effective regimen for second trimester termination of pregnancy.