Comparison or oral versus vaginal misoprostol & continued use of misoprostol after mifepristone for early medical abortion.

BACKGROUND & OBJECTIVE: Medical abortion though legalized in India, is still not very popular. A disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion which may reduce acceptability. Due consideration needs to be given to the issues related to medical abortion for improving the reproductive health status of women suffering from consequences of unsafe and illegal surgical abortion. The present study compared the efficacy of oral and vaginal administration of misoprostol after a single dose of 200 mg of mifepristone and evaluated the influence of continuing misoprostol for one week on efficacy and side effects.

METHODS: A double-blind randomized controlled trial with 150 healthy pregnant women requesting medical abortion with < 63 days of amenorrhoea was conducted in the gynecological and family planning clinic at All India Institute of Medical Sciences, New Delhi. Mifepristone (200 mg) was administered orally on day one, followed by 0.8 mg misoprostol either orally or vaginally on day three. Women in the oral group and one of the two vaginal groups continued 0.4 mg of oral misoprostol twice daily for seven days.

RESULTS: Complete abortion rate in each of the groups was 96-100 per cent. The addition of misoprostol 0.4 mg twice a day from day 4-10 did not help in increasing successful outcome or shortening of duration or amount of bleeding.

INTERPRETATION & CONCLUSION: Medical abortion for pregnancy up to 63 days using misoprostol 0.8 mg vaginal/oral after pretreatment with mifepristone 200 mg is a safe and successful procedure. No differences in efficacy or duration of bleeding were observed with addition of oral misoprostol for 1 wk after abortion.