Scientific Paper Abstracts Originally Presented at the National Abortion Federation's Annual Meeting; April 23, 2007; Boston, Massachusetts

In This Article

Non-vaginal Routes of Misoprostol Administration for Pregnancy Termination up to 63 Days' LMP

Ilana Dzuba, MHS; Beverly Winikoff, MD, MPH; Linda Prine, MD; Michael Molaei, MD; E. Steve Lichtenberg, MD; Robert Hanson, MD; Alisa Goldberg, MD; Mitchell Creinin, MD; Thomas Britton, MD

Introduction: The practices surrounding medical abortion in the U.S. were altered after the documentation of five cases of rare fatal infection following medical abortion. Some providers have opted not to offer vaginal misoprostol. Since no published studies of mifepristone followed by non-vaginal misoprostol achieved acceptable success rates in the ninth week of gestation, in some sites medical abortion is restricted to women with pregnancies through 56 days' LMP. Our multi-site randomized study attempts to determine whether misoprostol 800 mcg taken orally and buccally 24-36 hours following mifepristone 200 mg are safe, effective, and acceptable regimens for terminating pregnancy through 63 days' LMP.

Data-Collection Methods: Women seeking abortions at seven sites, meeting inclusion and exclusion criteria, and providing informed consent were randomized to take either buccal or oral misoprostol 800 mcg 24-36 hours following mifepristone 200 mg. Participants returned 7-14 days after their initial visit to determine the status of their abortions. Each woman completed a diary of bleeding, side effects, and medications used during the first 15 days, and a satisfaction questionnaire was administered prior to exit from the study.

Summary of Results: Preliminary results follow. Approximately 960 women were enrolled in the study: about 480 randomized to oral and 480 to buccal administration. Success among women who took oral and buccal misoprostol was approximately 91% and 96%, respectively (p=0.005). Ongoing pregnancy occurred in approximately 4.0% of women who took oral misoprostol compared with around 1.5% of women in the buccal group (p=0.02). Through 49 days' gestation, the oral and buccal regimens performed similarly. Success with oral misoprostol decreases as pregnancy advance. In pregnancies of 57-63 days' gestation, success with oral misoprostol falls below 90% while that with buccal remains high (oral 84%, buccal 94%, p=0.03). The side effect profiles of the methods were similar, except that fever and chills were reported more often among women who took buccal misoprostol. Satisfaction and acceptability were high for both methods.

Conclusions: Buccal administration of misoprostol 800 mcg through 63 days' LMP appears to be a feasible, effective, and acceptable option in medical abortion. Oral administration of 800 mcg misoprostol is an additional alternative for termination of pregnancies, although success rates diminish with increasing gestational age. Side effects reported after use of either route are generally mild and tolerable. Some women who previously would not have been able to have a medical abortion beyond 56 days' LMP will now have an acceptable option through 63 days' LMP.

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