Evidence for shortening the time interval of prostaglandin after mifepristone for medical abortion

Abstract 

Objectives

The aim of this study was to compare regimens that shorten the interval between mifepristone and the prostaglandin misoprostol or gemeprost for medical abortion.

Methods

The Cochrane Controlled Trials Register and MEDLINE were systematically searched for the words mifepristone and abortion. Only randomized controlled trials comparing different mifepristone regimens with either misoprostol or gemeprost were included. The outcome was a complete abortion not requiring surgical evacuation.

Results

Five randomized trials were identified and all were published since 1999. Four were from the United States and three had enrollments of >1000. The route of administration of the prostaglandin was used vaginally, except in one study where misoprostol was divided in two doses 2 h apart. Four studies provided information about a 1-day interval and two trials provided information about an interval of 6–8 h evaluating mifepristone 200 mg and misoprostol 800 μg vaginally. There were no significant differences noted between the current 2-day interval compared with the 1-day interval. There was one study suggesting no difference with an interval of 6–8 h.

Conclusions

The interval between mifepristone and misoprostol 800 μg vaginally can be decreased from 48 to 6–8 h without loss of efficacy.

Keywords: Medical abortion, Mifepristone, Misoprostol, Time interval