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 misoprostol for mid-trimester medical termination of pregnancy.

Design Retrospective analysis of prospectively collected data in women undergoing 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 hospital.

Methods Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 mu g. Three hours following the first dose of misoprostol, 400 mu g doses were administered orally at three hourly intervals, to a maximum of four doses. Success was defined as abortion occurring 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 misoprostol required was 1200 mu g and the median induction-to-abortion interval after first prostaglandin administration was 6.5 h. The median number of doses of misoprostol required to induce abortion, and the induction-to-abortion interval, was statistically significantly higher among women at gestations 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 vaginally and orally administered misoprostol provides a noninvasive and effective regimen for second trimester termination of pregnancy.