Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval

Gómez, Olga; Borrás, Aina; Rabanal, Aintzane; Palacio, Montse; Carceller, Antonia; Coll, Oriol; Gratacós, Eduard

doi:10.1016/j.contraception.2009.10.001

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Volume 81, Issue 2 , Pages 97-101, February 2010

Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval

Olga Gómez
- Department of Maternal–Fetal Medicine, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), 08028 Barcelona, Spain
- Corresponding author. Department of Maternal–Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clínic, 08028 Barcelona, Spain. Tel.: +34 678451555; fax: +34 93 2275605.
Aina Borrás
- Department of Maternal–Fetal Medicine, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), 08028 Barcelona, Spain
Aintzane Rabanal
- Department of Maternal–Fetal Medicine, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), 08028 Barcelona, Spain
Montse Palacio
- Department of Maternal–Fetal Medicine, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), 08028 Barcelona, Spain
Antonia Carceller
- Department of Pharmacy, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), 08028 Barcelona, Spain
Oriol Coll
- Department of Maternal–Fetal Medicine, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), 08028 Barcelona, Spain
Eduard Gratacós
- Department of Maternal–Fetal Medicine, ICGON, Hospital Clínic, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBERER), 08028 Barcelona, Spain

Received 8 September 2009; received in revised form 19 September 2009; accepted 5 October 2009. published online 13 November 2009.

Abstract

Background

This study was conducted to explore the effect of gestational age (GA) on the induction-to-abortion interval of mifepristone–misoprostol midtrimester termination of pregnancy (TOP) regimen.

Study Design

This study involved a consecutive series of 270 pregnancies between 12.0 and 22.6 weeks that have undergone legal TOP from April 2006 to June 2009. All women received a single oral dose of 200 mg mifepristone and, 36–48 h later, a course of misoprostol (an initial vaginal dose of 800 mcg plus four oral doses of 400 mcg at 3-hourly intervals). Treatment was considered to be a failure if abortion did not occur within 24 h. The impact of GA, parity and maternal age on the induction-to-abortion interval was assessed by means of Cox regression.

Results

Overall, the mean GA at TOP was 18.0 weeks. The mean induction-to-abortion interval was 9.8 h (SD=8.2 h; range=1–50 h), and 246 women (91%) aborted successfully within 24 h. GA at TOP and parity were the only two variables independently associated with the induction-to-abortion interval. The mean induction-to-abortion interval was increased by about 50% in patients undergoing TOP between 20.0 and 22.6 weeks (12.9 h, SD=8.9), as compared with those at 16.0–19.6 weeks (7.8 h, SD=5.9) and 12.0–15.6 weeks (8.2 h, SD=8.3) (p<.001). The effect of parity on the induction-to-abortion interval was more modest, with a 20% increase in induction-to-abortion interval in nulliparous (10.1 h, SD=9.1), as compared with women with a previous live birth (8.1 h, SD=6.7).

Conclusions

The mean induction-to-abortion interval increases by 4 h after 20 weeks GA. This information may be relevant for counseling and planning of the procedure.

Keywords: Medical abortion, Mifepristone, Misoprostol