Is it time to move up? Feasibility of medical abortion between 9-13 weeks of gestation
Keywords:Mifepristone, Misoprostol, Medical abortion, Surgical abortion
Background: Medical termination of pregnancy act helps to reduce incidence of illegal abortion its dreaded complication like maternal mortality to analyze the safety, efficacy and acceptability of medical regimen in 9-13 weeks of pregnancy.
Methods: A prospective study was carried out for a period of two and half years. All patients between 9-13 weeks of pregnancy seeking medical termination of pregnancy were given either medical regimen or surgical abortion depending on patients’ preference. Medical regimen consisted of 200 mg of mifepristone followed by 600 mcg of misoprostol after 48 hours. If required 2nd and 3rd dose of misoprostol was repeated. Surgical abortion was done under sedation after cervical priming with misoprostol.
Results: Out of 353 cases of medical termination of pregnancy, 92 cases (26.1%) were between 9-13 weeks of pregnancy. Two cases were excluded as surgical abortion was indicated in them. Out of 90 cases, only 30 cases (33.3%) were willing to participate in randomized controlled trial if needed. Out of 90 cases, 50 (55.6%) preferred surgical abortion, while 40 (44.4%) cases preferred medical abortion. Out of 40 cases of medical abortion, 5% cases required surgical curettage, while 3.8% cases required repeat curettage in surgical group. Minor complication rate was comparable in both groups except for prolonged bleeding, which was significantly higher in medical abortion group. Major complication in the surgical group was uterine perforation (1.9%). After completion of procedure, both group satisfied with same procedure, 92% in medical abortion group and 89% in surgical abortion group.Conclusions: Medical abortion is a safe and effective alternative to surgical abortion between 9-13 weeks of gestation. It should be included routinely at these gestations, thus increasing women's choice. However randomized controlled trial for medical versus surgical abortion between 9-13 weeks will be difficult to initiate.
Newhall EP, Winikof B. Abortion with mifepristone and misoprostol: Regimens, efficacy, acceptability and future directions. Am J Obstet Gynecol. 2000;182:44-53.
El-Refaey H, Rajasekar D, Abdalla M, Calder L, Templeton A. Induction of abortion with mifepristone (RU 486) and oral or vaginal misoprostol. N Engl J Med. 1995;332:983-7.
World Health Organization. Medical Methods for Termination of Pregnancy. WHO Technical Report Series 871. World Health Organization, Geneva. 1997.
Webster D, Penney GC, Templeton A. A comparison of 600 and 200 mg mifepristone prior to second trimester abortion with the prostaglandin misoprostol. Br J Obstet Gynaecol. 1997;103:706-9.
UK Multicenter Study Group. Oral mifepristone 600 mg and vaginal gemeprost for mid-trimester induction of abortion. An open multicenter study. Contraception. 1997;56:361-6.
Tang OS, Thong KJ and Baird DT. Second trimester medical abortion with mifepristone and gemeprost: a review of 956 cases. Contraception. 2001;64:29-32.
Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States. N Engl J. 1998;338(18):1241-7.
Ashok PW, Kidd A, Flett GM, Fitzmaurice A, Graham W, Templeton A. A randomized comparison of medical abortion and surgical vacuum aspiration at 10-13 weeks gestation. Hum Reprod. 2002;17:92-8.
Schaff EA, Fielding SL, Eisinger SH. Low-dose mifepristone followed by vaginal misoprostol at 48 hours for abortion up to 63 days. Contraception. 2000;61:41-6.