Abstract
Objectives
To assess the efficacy, side effects, and acceptability of medical abortion using oral mifepristone (200 mg) followed 24 h later by oral or sublingual misoprostol (400 μg).
Materials and methods
A total of 93 women with pregnancies up to 56 days of gestational age were assigned to two groups according to the different misoprostol regimen (group I 400 μg orally and group II 400 μg sublingually). The principle outcome measure was complete abortion defined as a complete expulsion of intrauterine contents without a need for surgical intervention 7 days after the procedure.
Results
Successful abortion occurred in 87.5% of patients in group 1 and 95.5% patients in group 2 (p = 0.166, 95% CI −0.194, 0.033). The patient acceptability and satisfaction rates were similar in both the groups.
Conclusion
It is concluded that 400 μg of sublingual misoprostol is as effective as oral misoprostol 24 h after mifepristone for medical abortion of ≤56 days.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Saxena P, Salhan S, Sarda N (2004) Comparison between the sublingual and oral route of misoprostol for pre-abortion cervical priming in first trimester abortions. Hum Reprod 1(1):77–80
World Health Organization Task Force on Postovulatory Methods of Fertility Regulation (2000) Comparison of two doses of mifepristone in combination with misoprostol for early medical abortion: a randomized trial. Br J Obstet Gynaecol 107:524–530
Tang OS, Chan C, Ng E, Lee S, Ho P (2003) A prospective, randomized, placebo-controlled trial on the use of mifepristone with sublingual or vaginal misoprostol for medical abortions of less than 9 weeks gestation. Hum Reprod 18(11):2315–2318
Schaff EA, Fielding SL, Westhoff C, Ellertson C, Eisinger SH, Stadalius LS (2000) Vaginal misoprostol administered 1, 2, or 3 days after mifepristone for early medical abortion. JAMA 284:1948–1953
von Hertzen H, Piaggio G, Marions L (2008) Comparison of two doses and two routes of administration of misoprostol after pre-treatment with mifepristone for early pregnancy termination. Reprod Health 5(2). doi:10.1186/1742-4755-5-2
Vimala N, Mittal S, Kumar S (2004) Sublingual misoprostol before first trimester abortion: a comparative study using two dose regimens. Indian J Med Sci 58:54–61
Spitz IM, Bardin CW, Benton L, Robbins A (1998) Early pregnancy termination with mifepristone and misoprostol in the United States. N Engl J Med 338:1241–1247
Tang OS, Schweer H, Seyberth HW, Lee SW, Ho PC (2002) Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod 17:332–336
Tang OS, Xu J, Cheng L, Lee SWH, Ho PC (2002) Pilot study on the use of sublingual misoprostol with mifepristone in termination of first trimester pregnancy up to 9 weeks of gestation. Hum Reprod 17:1738–1740
Hamoda H, Ashok PW, Flett GM, Templeton A (2005) A randomised controlled trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion up to 13 weeks of gestation. BJOG 112:1102–1108
Creinin MD, Fox MC, Teal S, Chen A, Schaff EA, Meyn LA, MOD Study Trial Group (2004) A randomized comparison of misoprostol 6 to 8 hours versus 24 hours after mifepristone for abortion. Obstet Gynecol 103(51):851–859
Von Hertzen H, Honkanen H, Piaggio G, Bartfai G, Erdenetungalag R, Gemzell-Danielsson K (2003) WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion. I: Efficacy. BJOG 110(9):808–818
Guest J, Chien PFW, Thomson MAR, Kosseim ML (2007) Randomized controlled trial comparing the efficacy of same-day administration of mifepristone and misoprostol for termination of pregnancy with the standard 36 to 48 hour protocol. BJOG 114(2):207–215
Winikoff B, Dzuba IG, Creinin MD, Crowden WA, Goldberg AB, Gonzales J (2008) Two distinct routes of administration of misoprostol in mifepristone medical abortion: a randomized controlled trial. Obstet Gynecol 112(6):1303–1310
Schaff EA, Eisinger SH, Stadalius LS, Franks P, Gore BZ, Poppema S (1999) Low-dose mifepristone, 200 mg, and vaginal misoprostol for induced abortion. Contraception 59:1–6
Raghavan S, Comendant R, Digol I, Ungureanu S, Friptu V, Bracken H, Winikoff B (2009) Two pill regimens of misoprostol after mifepristone medical abortion through 63 days’ gestational age: a randomized controlled trial of sublingual and oral misoprostol. Contraception 7(2):84–90
Akin A, Dabash R, Dilbaz B, Aktun H, Dursun P, Kiran S, Aksan G, Dogan B, Winikoff B (2009) Increasing women’s choices in medical abortion: a study of misoprostol 400 μg swallowed immediately or held sublingually following 200 mg mifepristone. Eur J Contracept Reprod Health Care 14(3):169–175
Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V (2009) Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days. Contraception 80(3):282–286
Faucher P, Baunot N, Madelenat P (2005) The efficacy and acceptability of mifepristone medical abortion with home administration misoprostol provided by private providers linked with the hospital: a prospective study of 433 patients. Gynecol Obstet Fertil 33(4):220–227
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dahiya, K., Mann, S. & Nanda, S. Randomized trial of oral versus sublingual misoprostol 24 h after mifepristone for medical abortion. Arch Gynecol Obstet 284, 59–63 (2011). https://doi.org/10.1007/s00404-010-1590-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-010-1590-2