Effect of the thyroid status in pregnant patients on the outcome in medical abortion

Nishi Sood, Shyam S. Sud


Background: Medical abortion has the potential to expand abortion services, where surgical services are limited, and to expand women’s choice of abortion method and experience. Objective of present study was to compare the outcome after medical abortion in euthyroid and hypothyroid pregnant patients.

Methods: A longitudinal study was carried out in pregnant patients before 9 weeks of pregnancy who wanted termination of pregnancy. Women were divided into two groups. Group I (n = 100) comprised euthyroid patients who acted as control group, whereas group II (n = 58) included patients having subclinical or overt hypothyroidism. All the patients were given 200 mg of mifepristone orally followed by 800 µg of misoprost vaginally 36 to 48 hours later. these patients were followed for 2 weeks. In all the patients, hemoglobin estimation and ultrasound were done during follow-up.

Results: Average hemoglobin in the study group was 9.5 gm%, whereas in control group it was 11.1 gm%, which was statistically significant. the fall in hemoglobin after 2 weeks of the drug intake was also significant in control as well as the study group. About 13.79% patients in the study group had to undergo emergency evacuation of uterus within 24 hours for complaints of severe bleeding. In control group, no emergency curettage was done within 24 hours, the difference being highly significant. Mean duration of bleeding was also more in the study group. About 28.57% patients in the study group revealed products of conception on ultrasound after 2 weeks in comparison with 11.57% in the control group, which was also statistically significant (p = 0.008). A total of 41% patients in the study group had to undergo uterine curettage, which was highly significant (p = 0.000).

Conclusions: Present study showed that patients having clinical or subclinical hypothyroidism have more failure rates, more chances of excessive bleeding, increased duration of bleeding, resulting in decrease in hemoglobin levels in already anemic patients. Also, the rate of operative intervention was unusually high in hypothyroid group.


Failure rate, Hypothyroidism, Medical abortion

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Sedgh G, Henshaw SK, Singh S, bankole A, Drescher J. legal abortion worldwide: incidence and recent trends. Int fam Plan Perspect. 2007 Sep;33(3):106-16.

Urquhart Dr, Templeton AA, Shinewi F, Chapman M, Hawkins K, McGarry J. The efficacy and tolerance of mifepristone and prostaglandin in termination of pregnancy of less than 63 days gestation: UK Multicentre Study—final results. Contraception. 1997 Jan;55(1):1-5.

United Kingdom Multicentre trial. the efficacy and tolerance of mifepristone and prostaglandin in first trimester termination of pregnancy. J Obstet Gynaecol. 1990 Jun;97(6):480-6.

Creinin MD. Oral methotrexate and vaginal misoprostol for early abortion. Contraception. 1996 Jul;54(1):15-8.

Bachelot A, Cludy l, Spira A. Conditions for chosing between drug-induced and surgical abortions. Contraception. 1992 Jun;45(6):547-59.

Minnisto T, Mendola P, Grewal J. thyroid diseases and adverse pregnancy outcomes in contemporary U.S cohort. J Clin Endocrinol Metab. 2013 Jul;98(7):2725-33.

nambiar V, Jagtap VS, Sarathi V, lila Ar, Kamalanathan S, Bandgar TR et al. Prevalence and impact of thyroid disorders on maternal outcome in Asian-Indian pregnant women. J Thyroid Res. 2011(2011):Article ID 429097.

Dhanwal DK, Prasad S, Agarwal AK. High prevalence of subclinical Hypothyroidism during first trimester in north India. Indian J Endocrinol Metab. 2013 Mar;17(2):281-4.

lebeau SO, Mandel SJ. thyroid disorders during pregnancy. Endocrinol Metab Clin North Am. 2006 Mar;35(1):117-36.

Van den Boogaard E, Vissenberg R, Land JA, Van Wely M, Van der Post JA, Goddijn M et al. Significance of subclinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17(5):605-19.

Das C, Sahana PK, Sengupta N, Giri D, Roy M, Mukhopadhyay P. Etiology of anemia in primary hypothyroid subjects in a tertiary care center in eastern India. Indian J endocrinol Metab. 2012 Dec;16(Suppl 2):S361-S3.

Benoist B, Mclean E, Egli I, Cogswell M. Global database on anemia. Geneva: WHO; 2008. Worldwide Prevalence Anemia. 1993-2005:1-2.1.

Erdogan M, Kosenli A, Sencer G, Kulaksizoglu M. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012;59(3):213-20.

Ashok PW, Penney GC, flett GM, Templeton A. An effective regimen for early medical abortion: a report of 2,000 consecutive cases. Hum Reprod. 1998 Oct;13(10):2962-5.

Spitz IM, Bardin CW, Benton l, Robbins A. early pregnancy termination with mifepristone and misoprostol in the United States. New Engl J Med. 1998 Apr;338:1241-7.

Weeks AD. Menorrhagia and hypothyroidism. evidence supports association between hypothyroidism and menorrhagia. BMJ. 2000 Mar;320(7235):649.

Royal college of Obstetricians and Gynaecologists. the care of women requesting induced abortion. london: RCOG Press; 2004.

Ngo TD, Park MH, Shakur H, Free C. comparative effectiveness, safety and acceptability of medical abortion at home and in clinic: a systematic review. Bull WHO. 2011;89:360-70.

Spitz IM, Bardin Bachelot A, Cludy l, Spira A. conditions for choosing between drug-induced and surgical abortions. Contraception. 1992 Jun;45(6):547-59.

Winikoff B, Sivin I, Coyaji KJ, Cabezas E, Xiao B, Gu S, Du MK et al. Safety, efficacy, and acceptability of medical abortion in china, cuba, and India: a comparative trial of mifepristone/misoprostol versus surgical abortion. Am J Obstet Gynecol. 1997 feb;176(2):431-7.

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 Apr;332(15):983-7.