Comparison of two doses of oral misoprostol with one, after mifepristone in early abortion

Abstract

A prospective randomised controlled study was conducted at RG Kar Medical College and hospital to compare the efficacy and side-effects of two doses of oral misoprostol, with one dose following mifepristone in early abortion. Two randomly allocated groups of seventy-five women each were formed, which were comparable in all respects and also conformed to the inclusion and exclusion criteria laid down in this study. Both groups received 200 mg of mifepristone on day one. After 48 hours, both groups received 400 microg of misoprostol and 3 hours later one group received 3 tablets of 200 microg misoprostol and the other group received 3 tablets of placebo. The women were then followed up to note the time of expulsion, completeness of the process, amount of bleeding encountered, side-effects if any or any other observation. The most important parameter, i.e., the completeness of the expulsion when compared showed no statistically significant difference between the two groups (p-value = 0.1025).

Comment: Although the WHO recommends the use of a mifepristone/misoprostol combination for safe abortion, there is no consensus yet about the interval between the two drugs and the need to continue. This article shows that the recommended regimen is sufficient for a complete expulsion, and that with patience a follow-up dosage of misoprostol is not needed. Mifepristone/misoprostol regimen:
200 mg mifepristone, orally, after (24 or) 48 hours followed by:
4 x 200 µg misoprostol, vaginally or sublingually.