Second trimester medical abortion with mifepristone followed by unlimited dosing of buccal misoprostol in Armenia

Abstract

Objectives: The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia.

Methods: Women seeking to terminate 13–22 week pregnancies were enrolled in the study. Participants swallowed 200 mg mifepristone in the clinic and were instructed to return to the hospital for induction 24–48 h later. During induction, women were given 400 μg buccal misoprostol every 3 h until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery.

Results: A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24 h after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3 h (range 4–17.4) with a mean of 9.5 ± 2.5 h. A median of four misoprostol doses (range 2–6) with a mean of 4 ± 1 misoprostol doses were administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers.

Conclusion: The medical abortion regimen of 200 mg mifepristone followed 24 h later by induction with 400 μg buccal misoprostol administered every 3 h, with no limit on the number of doses used for the termination of pregnancies of 13–22 weeks’ gestation is an effective and acceptable option for women.

Chinese abstract

目的：本研究的目的是评估在亚美尼亚采用米非司酮配伍无剂量限制的米索前列醇进行中期妊娠引产的有效性和可接受性。

方法：本研究招募了需在13-22周中止妊娠的女性。参与者在门诊口服200 mg 米非司酮, 并被告知24-48h后返回医院引产。引产期间, 参与者每 3h 口服给予400μg 米索前列醇直至胎儿和胎盘娩出。当无需催产素或手术使子宫完全排空时, 则认为引产完成。

结果：孕龄中位数为18周的120名女性参与了本研究。所有女性在服用米非司酮约24h后采用米索前列醇引产。119名（99.2%）女性达到完全子宫排空。引产-流产的平均时间间隔为10.3h (范围4-17.4) , 均值为9.5 ± 2.5 h。给予米索前列醇4种剂量（范围2-6）平均值4 ± 1。引产-流产时间间隔, 米索前列醇剂量, 疼痛评分和痛觉缺失随着孕龄的增加而增加。医生和患者对此方法的可接受性较高。

结论：药物引产采用200 mg 米非司酮, 24h后每3h 经口给予400μg米索前列醇引产, 且不限制应用剂量, 对于13-22周终止妊娠的患者是以一种有效且可接受的选择。

Keywords:

• Armenia
• medical abortion
• mifepristone
• misoprostol
• second trimester

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper. This study was supported by an anonymous donor.