Setting up a one-stop mifepristonemisoprostol medical termination of pregnancy service for all gestations from 5 to 23 weeksa review of 482 cases

Abstract

Mifepristone - misoprostol combination is increasingly being utilised for medical termination of pregnancy on account of its reported efficacy, safety and lower cost. Experience with this modality of effecting termination of pregnancy from 9 to 13 weeks' gestation is scanty. At the Scunthorpe General Hospital in the United Kingdom, we established a nurse-led, one-stop medical termination of pregnancy service using mifepristone and misoprostol for all gestations from 5 to 23 weeks. A review of the case records of 482 women who had medical termination of pregnancy at all gestations from 5 to 23 weeks from December 1997 to May 1999 was undertaken in order to assess the effectiveness and complications associated with the mifepristone - misoprostol protocol. Complete abortion was achieved in 406 (84%) women. Surgical evacuation was required to complete the abortion in 74 (16%) women. The complete abortion rate was similar across the spectrum, i.e. 87% in the 5- 8-weeks group; 79% in the 9-13 weeks group; and 87% in those of S 14 weeks. Two failures occurred: one of them proceeded to surgical evacuation after three courses of misoprostol, while the other continued with her pregnancy after one course. Three women (0·6%) required blood transfusion for haemorrhage, while two others were treated for infection. Oral mifepristone with or without vaginal misoprostol in an effective and safe regimen for termination of all pregnancies from 5 to 23 weeks' gestation.