Contraception
Volume 80, Issue 1 , Pages 95-100 , July 2009

Meta-analysis of 200 or 600 mg mifepristone in association with two prostaglandins for termination of early pregnancy

  • Michel Lièvre

      Affiliations

    • Department of Pharmacology, Université Lyon 1, UMR5558, Hospices Civils de Lyon, F-69003 France
    • Corresponding Author InformationCorresponding author. Service de Pharmacologie Clinique, Faculté de médecine RTH Laennec, 69372 Lyon Cedex 08, France. Tel.: +33 0 478785759; fax: +33 0 478776917.
  • ,
  • Regine Sitruk-Ware

      Affiliations

    • Population Council and Rockefeller University, New York, NY 10065, USA

Received 24 April 2008 ,Revised 26 January 2009 ,Accepted 26 January 2009.

References 

  1. WHO . Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th ed.. Geneva: World Health Organization; 2004;Available from: http://www.who.int/reproductive-health/publications/unsafeabortion_2003/ua_estimates03.pdf
  2. WHO . Model list of essential medicines. 15th ed. Geneva: World Health Organization; 2007;Available from: http://www.who.int/medicines/publications/EssMedList15.pdf
  3. Sitruk-Ware R. Mifepristone and misoprostol sequential regimen: side effects, complications and safety. Contraception. 2006;74:48–55
  4. Ulmann A, Silvestre L, Chemama L, et al. Medical termination of early pregnancy with mifepristone (RU 486) followed by a prostaglandin analogue. Acta Obstet Gynecol Scand. 1992;71:278–283
  5. Aubeny E, Peyron R, Turpin CL, et al. Termination of early pregnancy (up to 63 days of amenorrhea) with mifepristone and increasing doses of misoprostol. Int J Fertil Menopausal Stud. 1995;40(Suppl 2):85–91
  6. Spitz IM, Bardin CW, Benton L, Robbins A. Early termination of pregnancy with mifepristone (RU 486) and the orally active prostaglandin misoprostol. N Eng J Med. 1998;21:1509–1513
  7. WHO Task Force on Post-Ovulatory Methods for Fertility Regulation . Lowering the doses of mifepristone and gemeprost for early abortion: a randomised controlled trial. BJOG. 2001;108:738–742
  8. Schaff EA, Fielding SL, Westhoff C. Randomized trial of oral versus vaginal misoprostol 2 days after mifepristone 200 mg for abortion up to 63 days of pregnancy. Contraception. 2002;66:247–250
  9. von Hertzen H, Honkanen H, Piaggio G, et al. WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion. I: efficacy. BJOG. 2003;110:808–818
  10. von Hertzen H. Research on regimens for early medical abortion. J Am Med Womens Assoc 2000;55(3 Suppl):133-6, 150.
  11. Ashok PW, Penney GC, Flett GM, Templeton A. An effective regimen for early medical abortion: a report of 2000 consecutive cases. Hum Reprod. 1998;13:2962–2965
  12. Schaff EA, Fielding SL, Eisinger SH, Stadalius LS, Fuller L. Low-dose mifepristone followed by vaginal misoprostol at 48 hours for abortion up to 63 days. Contraception. 2000;61:41–46
  13. Schaff EA, Fielding SL, Westhoff C, et al. Vaginal misoprostol administered 1, 2, or 3 days after mifepristone for early medical abortion. A randomized trial. JAMA. 2000;284:1948–1953[Erratum in: JAMA;284:2597]
  14. Bartley J, Brown A, Elton R, Baird DT. A double blind randomized control trial between vaginal gemeprost and misoprostol in combination with mifepristone for induction of abortion in early pregnancy. Hum Reprod. 2001;16:2098–2102
  15. Ashok PW, Templeton A, Wagaarachchi PT, Flett GM. Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases. BJOG. 2002;109:1281–1289
  16. Kulier R, Gulmezoglu AM, Hofmeyr GJ, Cheng LN, Campana A. Medical methods for first trimester abortion. Cochrane Database Syst Rev. 2004;(1):CD002855
  17. Agence Nationale d'Accréditation et d'Evaluation en Santé (ANAES) . Prise en charge de l'interruption volontaire de grossesse jusqu'à 14 semaines. Paris: Agence Nationale D'accréditation et D'évaluation en Santé; 2001;
  18. National Abortion Federation (NAF) . Early medical abortion with mifepristone and other agents: overview and protocol recommendations. Washington (DC): National Abortion Federation; 2002;
  19. WHO . Safe abortion: technical and policy guidance for health systems. Geneva: World Health Organization; 2003;
  20. Royal College of Obstetricians and Gynaecologists (RCOG) . The care of women requesting induced abortion. Evidence-based clinical guideline N° 7. London: RCOG Press; 2004;
  21. WHO Task Force on Post-Ovulatory Methods for Fertility Regulation . Termination of pregnancy with reduced doses of mifepristone. Br Med J. 1993;307:532–537
  22. Peyron R, Aubény E, Targosz V, et al. Early termination of pregnancy with mifepristone (RU486) and the orally active prostaglandin misoprostol. N England J Med. 1993;328:1509–1513
  23. McKinley C, Thong KJ, Baird DT. The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol. Hum Reprod. 1993;8:1502–1505
  24. WHO Task Force on Post-Ovulatory Methods for Fertility Regulation . Comparison of two doses of mifepristone in combination with misoprostol for early medical abortion: a randomised trial. BJOG. 2000;107:524–530
  25. Sitruk-Ware R, Davey A, Sakiz E. Fetal malformation and failed medical termination of pregnancy. Lancet. 1998;352:323
  26. Aronoff DM, Hao Y, Chung J, et al. Misoprostol impairs female reproductive tract innate immunity against Clostridium sordellii. J Immunol. 2008;180(12):8222–8230
  27. Aronsson A, Fiala C, Stephansson O, et al. Pharmacokinetic profiles up to 12 h after administration of vaginal, sublingual and slow-release oral misoprostol. Hum Reprod. 2007;22:1912–1918
  28. Winikoff B, Dzuba IG, Creinin MD, et al. Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial. Obstet Gynecol. 2008;112:1303–1310
  29. El-Refaey H, Templeton A. Early induction of abortion by a combination of oral mifepristone and misoprostol administered by the vaginal route: a comparison between two dose regimens of misoprostol and their effect on blood pressure. Br J Obstet Gynaecol. 1994;101:792–796
  30. El-Refaey H, Rajasekar D, Abdalla M, et al. Induction of abortion with mifepristone (RU 486) and oral or vaginal misoprostol. N Engl J Med. 1995;332:983–987

 Exelgyn SA, a marketer of mifepristone, funded this study.

☆☆ M.L.'s institution has received a grant from Exelgyn for the meta-analysis. R.S.-W. was previously Director of Research at Exelgyn.

 The content of this article reflects the personal views of R.S.-W. and not necessarily that of the organizations to which she is affiliated.

PII: S0010-7824(09)00032-8

doi: 10.1016/j.contraception.2009.01.011

Contraception
Volume 80, Issue 1 , Pages 95-100 , July 2009