Prospective study to compare the efficacy of vaginal misoprostol for first trimester MTP before six weeks and up to 9 weeks

Paresh N. Sheth


Background: Misoprostol is prostaglandin E1 analogue that has been used for medical abortion. MTP has been legalized in India since 1971. Medical abortion refers for early pregnancy termination performed without any primary surgical interventions, usually before 9 weeks (63 days) gestational age. This prospective study was conducted to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <6 weeks (42 days) and in woman up to 9 weeks (63 days) gestational age.

Methods: This is a prospective study of total 130 women seeking medical termination of pregnancy up to 9 weeks (63 days) gestational age at obstetrics and gynecology department, at a tertiary care hospital Gujarat, India, from May 2018 to May 2019.

Results: In result study the overall complete abortion rate was 91.54% In Group A (<6 weeks) complete abortion occurred in 93.3% women. Whereas in Group B (6 to 9 weeks) complete abortion occurred in 90% of women. The two groups did not differ significantly with respect to side effects. Overall, 91.3% women were satisfied with this method and will choose it again if required.

Conclusions: This study shows that vaginal misoprostol alone regimen is highly effective and well tolerated method in Indian women requiring MTP up to 63 days gestational age. However better efficacy maybe achieved at gestational age < 6 weeks (42 days).



MTP, Abortion, Misoprostol

Full Text:



Borgatta L, Burnhill MS, Tyson J, Leonhardt KK, Hausknecht RU, Haskell S. Early medical abortion with methotrexate and misoprostol. Obstet. Gynecol. 2001;97:11-16.

Norman JE, Thong KJ, Baird DT. Uterine contractility and induction of abortion in early pregnancy by misoprostol and mifepristone. Lancet. 1991;338:1233-236.

Barbosa RM, Arilha M. The Brazilian experience with Cytotec. Stud Fam Plann. 1993;24:236-40.

Coelho HL, Teixeira AC, Santos AP, Forte EB, Morais SM, La Vecchia C et al. (1993) Misoprostol and illegal abortion in Fortalezza, Brazil. Lancet. 1993;341:1261-263.

Costa SH, Vessey MP. Misoprostol and illegal abortion in Rio de Janeiro, Brazil. Lancet, 1993;341:1258-261.

Carbonell JLL, Varela L, Velazco A, Fernandez C, Sanchez C. The use of misoprostol for abortion of 9 weeks gestation. Eur. J. Contracept. Reprod Health Care. 1997;2:181-5.

Blanchard K, Winikoff B, Ellertson C. Misoprostol used alone for the termination of pregnancy. A review of the evidence. Contraception. 1999;59:209-217.

Jain JK, Harwood B, Meckstroth KR, Mishell D.R. Jr. Early pregnancy termination with vaginal misoprostol combined with loperamide and acetaminophen prophylaxis. Contraception. 2001;63:217-21.

Use of RU - 486 with Misoprostol for early abortions in India. Guidelines for Medical Officers, WHOCCR in Human Reproduction. All India Institute of Medical Sciences, Ministry of Health and Family Welfare, Government of India and India Council of Medical Research 2003.

Handbook on medical methods of abortion. Available at MMAReference%20Manual.pdf. Accessed on 3 June 2020.

Ashok PW, Flet GM, Templeton A. Mefipristone verses vaginaly administered misoprostol for cervical priming before first trimester termination of pregnancy, A randemised, controlled study. Americal J Og Obstetric Gynecol. 2000;183(4):998-1002.

Goldstein SR Embryonic ultrasonographic measurements: crown– rump length revisited. Am. J. Obstet. Gynecol. 1991;165:497-501.

Refresher course of medical abortion services Available at Publications/REFMAINDE09.ASHX. Accessed on 3 June 2020.

El-Rafey 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. 1997;332:983-87.

World Health Organization Task Force on Post-ovulatory Methods of Fertility Regulation. Termination of pregnancy with reduced doses of mifepristone. Br Med Assoc. 1993;307,532-37.

Anonymous. The efficacy and tolerance of mifepristone and prostaglandin in termination of pregnancy of less than 63 days gestation: UK Multicenter study|final results. Contraception. 1997;55:1-5.

Bugalho A, Mocumbi S, Faundes A, David E. Termination of pregnancies of 6 weeks gestation with a single dose of 800 µg of vaginal misoprostol. Contraception. 2000;61:47-50.

Silvestre L, Dubois C, Renault M, Rezvani Y, Baulieu EE, Ulmann, A. Voluntary interruption of pregnancy with mifepristone (RU 486) and a prostaglandin analogue. A large-scale French experience. N Engl J Med. 1990;322:645-48.