Timing of pain and bleeding after mifepristone-induced abortion

Previous studies of medical abortion with mifepristone and a prostaglandin have reported percentages of subjects who experience cramping and/or bleedi ng relative to prostaglandin use. This is the first analysis of cramping an d bleeding onset patterns in subjects treated with low-dose (200 mg) mifepr istone and 800 mug vaginal misoprostol at 24, 48, or 72 h after mifepriston e. We analyzed the cramping and bleeding onset patterns in subjects up to 8 weeks pregnant who used 800 mug vaginal misoprostol at 24, 48, or 72 h aft er 200 mg of oral mifepristone. We collected data from subjects' symptom di aries and divided symptom onset into 3 categories: before misoprostol use, 0-12 h following misoprostol, and more than 12 h after misoprostol. Of the 2,302 subjects, cramping and bleeding onset data were available for 2,030 ( 88%) and 2,123 (92%), respectively. Across all groups, 230 (11%) experience d cramping and 445 (21%) experienced bleeding before misoprostol use. There was a significantly higher percentage of subjects who experienced early cr amping and/or early bleeding between the three treatment groups, and this w as related to the interval between mifepristone and misoprostol. In the 12 h following misoprostol administration, cramping and bleeding patterns were similar in the three groups. The longer subjects waited to insert misopros tol, the more likely they were to experience early cramping and/or bleeding . After misoprostol insertion, cramping and bleeding patterns are similar r egardless of treatment group. Patients and providers cannot rely on symptom onset to predict treatment success. (C) 2001 Elsevier Science Inc. All rig hts reserved.