Misoprostol Alone or In Combination with Mifepristone: The Search for a Safe and Economical Option
Journal Title: Journal of Medical Science And clinical Research - Year 2014, Vol 2, Issue 12
Abstract
Background: Medical abortion provides women with a safe, less invasive method for termination of pregnancy. Regimens with mifepristone and misoprostol are expensive and not freely available throughout the world. Aims and objectives: The objective of this study was to confirm the effectiveness, safety and cost efficacy of medical abortion up to 7 weeks (up to 49 days) using 2 different regimes. Materials and methods: Hundred and twenty prospective patients attending our OPD for termination of pregnancy who fulfilled the inclusion criteria were included in the study after informed consent. The patients were randomly allotted to one of the following two groups: (1) group 1- mifepristone 200mg orally with 800mcg misoprostol vaginally after 48 hours; (2) group 2- 3 doses of vaginal misoprostol 1000mcg 24 hourly. Outcomes measured were (1) successful abortion (complete abortion without requiring additional procedure), (2) side effects, (3) mean time of onset of cramping, (4) mean time of onset of bleeding, (5) mean duration of bleeding, (6) mean decrease in haemoglobin and (7) mean time of menstruation returning. Results: Medical abortion was successful in 55 of 60 (91.67%) patients in group 1 and in 54 of 60 (90%) patients in group 2 (p=1.00). The mean change in haemoglobin was 0.70+0.5g/dl in group 1 and 0.7+0.4g/dl in group 2 (p=0.713). Cramping began at 4.1 + 1.6 hours and lasted 5.2 + 3.7 hours in group 1. Cramping began at 5.1 + 3.4 hours and lasted 3.7 + 1.9 hours in group 2. Vaginal bleeding started at 3.43+1.2 hours after administration of misoprostol in group 1 and 6.46+ 1.6 hours after first dose of misoprostol in group 2. Mean duration of bleeding in group 1 was 6.23+5.3 days and 7.0+4.6 days in group 2. Time to return of menstruation was 36.9 +97.1 days in group 1 and 37 + 7.1 days in group 2. Conclusions: The present study suggests that 1000mcg misoprostol administered vaginally at 24 hour intervals could be a more economical and viable option in situations where financial constraints restrict the use of mifepristone. Moreover the 24 hour interval improves patient compliance and allows out patient management.
Authors and Affiliations
Dr Shail Kaur
Keywords
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