Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost

doi:10.1016/S0010-7824(00)00187-6

Contraception

Volume 62, Issue 6, December 2000, Pages 297-303

https://doi.org/10.1016/S0010-7824(00)00187-6 Get rights and content

Abstract

The antiprogesterone mifepristone in combination with a suitable prostaglandin provides an effective method for induction of abortion in early pregnancy up to 63 days of gestation. The combination of 600 mg mifepristone followed by 1 mg of gemeprost vaginal pessary 48 h later is one of the standard regimens in practice, which is registered in several countries in Europe. In 1995, we reduced the doses for both mifepristone and gemeprost to 200 mg and 0.5 mg respectively, as this was shown to decrease significantly the incidence of side effects whilst maintaining a high efficacy. In this article, we report our experience with this regimen in routine clinical practice by analysing 3161 consecutive medical abortions retrospectively. Twelve case notes (0.4%) were not available, and for 310 (9.8%) women, the outcome was not known with certainty as they did not return for their follow up visit. Of the remaining 2839 women, 2732 (96.2%) had a complete abortion following their treatment. One-hundred-two (3.6%) women required an evacuation of the uterus: for incomplete abortion in 63 (2.2%) and ongoing pregnancy in 39 (1.4%). Three women had to undergo surgery for ectopic pregnancies. The surgical intervention rate was significantly higher at gestation of >49 days compared to ≤49 days (5.7% vs. 2.6%, p = 0.002) and at >56 days than among those at ≤56 days (6.7% vs. 3.1%; p <0.001). However, for incomplete abortion a significant increase was only seen at gestation >49 days compared to ≤49 days (3% vs. 1.6%, p = 0.017). The incidence of ongoing pregnancies increased significantly only after 56 days of gestation compared to ≤56 days (3.8% vs. 0.9%; p <0.001). Parity was related to the outcome with parous women having significantly more incomplete/ongoing abortions compared to nulliparous women (5.4% vs. 2.0%; p <0.001), although parous women did present earlier in pregnancy for termination than nulliparous women (p = 0.01). The incidence of complications was low: 165 (5.8%) women were given antibiotics for presumed genital infection and severe haemorrhage occurred in 11 (0.4%) women, of whom only two required blood transfusion. In summary, the recommended regimen with the reduced doses of mifepristone and gemeprost is highly effective, meeting the anticipated efficacy with a complete abortion rate of >95%. We have concluded from the data that gestation and parity are strong predictors for clinicians to anticipate the probability of a successful medical termination of pregnancy.

Introduction

It is now established that abortion can be induced safely and effectively with an antigestagen and a prostaglandin. A combination of 600 mg mifepristone by mouth followed 48 h later by a suitable prostaglandin (1 mg gemeprost pessary or 400 μg oral misoprostol) is licensed in a number of European countries as an alternative to vacuum aspiration for termination of pregnancy. Experience in clinical practice in France and UK has shown that the majority of women prefer the medical method when given the choice [1], [2]. Several studies have demonstrated that the dose of mifepristone can be reduced to 200 mg without loss of efficacy [3], [4], [5]. However, the common side effects of pain, vomiting, and diarrhea are related to the effects of the prostaglandin on smooth muscle. We have previously demonstrated that side effects are much reduced when one-half rather than a whole 1 mg gemeprost pessary is used while still maintaining a complete abortion rate of >95% [5], [6]. Since 1995, we have used the regimen of 200 mg of mifepristone in combination with 0.5 mg of gemeprost as the routine method for induction of medical abortion in early pregnancy (<9 weeks).

To our knowledge, only one report has been published so far that has looked at the effectiveness of medical terminations in early pregnancy in routine clinical practice, in this case for mifepristone in combination with vaginal misoprostol [7]. However, no such report has been conducted for the most widely registered combination of mifepristone and gemeprost. In this paper we report our experience with over 3000 women who requested abortion in early pregnancy and were treated with 200 mg mifepristone and 0.5 mg vaginal gemeprost consecutively over a 4-year period.

Section snippets

Methods

Between July 1995 and August 1999, a total of 3500 women were treated in the Medical Abortion Unit, Royal Infirmary of Edinburgh, for medical abortion. All women were referred by the local family planning clinics or their local general practitioners to a gynecologist in the Royal Infirmary for consideration of termination of pregnancy under the conditions of the 1967 Abortion Act (UK).

After counseling and determining that there are grounds for abortion, a careful assessment of gestation is

Results

A total of 3500 women had a medical termination of pregnancy in the period from July 1995 to August 1999. Women (n = 399) who were recruited for a double blind clinical research study, which began in August 1998, were not included in the analysis. Twelve case records were not available, leaving a total of 3149 cases for the retrospective study. Women (n = 310) were excluded because they did not attend their follow up appointment, i.e., the outcome in their cases was not certain, although in the

Discussion

This study, presenting the experience from 3161 consecutive abortions in early pregnancy, represents, to our knowledge, the largest existing series and is the second report evaluating the effectiveness of a single regimen in routine clinical practice. The first large report for the combination of mifepristone with a vaginal prostaglandin, the WHO Multicentre Study [3], involved 1182 women and compared different doses for mifepristone in combination with 1 mg of gemeprost. This was followed by a

Acknowledgements

We are grateful to the medical and nursing staff of the Medical Abortion Unit at the Royal Infirmary of Edinburgh for their help in managing the patients and collecting data and to Margaret Harper for typing the manuscript.

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The frequencies of preeclampsia, fetal growth restriction, fetal demise, and low birthweight are lower in subsequent pregnancies. Enhanced maternal cardiovascular adaptation, shorter first and second stages of labor, and more robust lactation also have been observed in subsequent as compared with first pregnancies. We sought to investigate the cellular and molecular bases for better outcomes in subsequent pregnancies. Based on the knowledge that specialized immune cells at the maternal–fetal interface, decidual natural killer cells, promote development of the placental bed and conversion of the spiral arteries by secreting a myriad of angiogenic and growth factors, we asked whether decidual natural killer cells differ in subsequent as compared with first pregnancies. This idea stemmed from recent studies suggesting that natural killer cells, although part of the innate immune system, possess some features of adaptive immunity, including a certain type of immune cell memory, termed trained immunity. We found that decidual natural killer cells from parous women “remember pregnancy” and differ from decidual natural killer cells of primigravidae. Compared with the decidual natural killer cells of first pregnancy, these cells, that we termed pregnancy-trained decidual natural killer cells, express greater levels of the natural killer receptors NKG2C and leukocyte immunoglobulin-like receptor B1, which interact with ligands expressed on invasive trophoblasts. Furthermore, they secrete greater levels of several growth factors, including vascular endothelial growth factor α as well as interferon-γ, augmenting remodeling of the placental bed. We propose that this pregnancy-trained memory dwells in the epigenome, where memory of stimuli is known to persist even when the stimulus is no longer present. This epigenetic memory apparently resides in endometrial natural killer cells between pregnancies. We suggest that this trained memory, which we coined pregnancy-trained decidual natural killer cells, may be the missing link in the immune basis for enhanced subsequent pregnancy. Epigenetic memory (chromatin modification) also may afford a global explanation for additional findings of enhanced maternal cardiovascular adaptation, shorter first and second stages of labor, and more robust lactation. Understanding the molecular and cellular bases of improved outcomes of subsequent pregnancy may lead to the development of treatment modalities designed for women at high risk for pregnancy disorders originating at the maternal–fetal interface.
Risk factors for surgical intervention of early medical abortion
2019, American Journal of Obstetrics and Gynecology
By being noninvasive, medical termination of pregnancy has increased worldwide access to abortion and improved safety of unsafe abortion. However, secondary surgical intervention is the most frequent complication to medical abortion.
We aimed to identify and quantify risk factors for surgical intervention in women undergoing medically induced termination of pregnancy before 9 completed weeks of gestation.
We conducted a nationwide cohort study, including all pregnancies terminated before 63 gestational days in women aged 15–49 years during the period 2005–2015. Induction regimen was 200 mg mifepristone followed 24–48 hours later by 0.8 mg vaginal misoprostol. All included pregnancies were followed up for 8 weeks from mifepristone administration. Data were retrieved from national health registers. Multiple logistic regression provided adjusted odds ratios of surgical intervention with 95% confidence intervals. The discriminative ability of the risk factors in identifying surgical intervention was assessed by cross-validated area under the receiver operating characteristic curve.
Of 86,437 early medical abortions, 5320 (6.2%) underwent a surgical intervention within 8 weeks after induction. The proportion of surgical interventions increased from 3.5% in the 5th to 6th gestational week to 10.3% in week 9, odds ratio, 3.2 (95% confidence interval, 2.9–3.6). Compared with women aged 15–19 years, the risk of surgical intervention increased with increasing maternal age until the age of 30–34 years, odds ratio, 1.7 (95% confidence interval, 1.5–1.9), where after the risk decreased to an odds ratio for age group 40–49 of 1.2 (95% confidence interval, 1.0–1.4). Compared with nulliparous women, a history of only vaginal deliveries with spontaneous delivery of placenta implied an odds ratio of 1.1 (95% confidence interval, 1.0–1.2), women with a history of at least 1 cesarean delivery, an odds ratio of 1.5 (95% confidence interval, 1.3–1.6), and women having experienced a manual removal of placenta after a vaginal birth, an odds ratio of 2.0 (95% confidence interval, 1.7–2.4). Previous medically induced abortion decreased the risk of surgical intervention, odds ratio 0.84 (95% confidence interval, 0.78–0.91), whereas previous early (before 56 days of gestation) surgically induced abortion implied a 53% (95% confidence interval, 1.4–1.7) increased risk of surgical intervention. Previous surgical abortion after 55 days of gestation increased the risk by 17% (95% confidence interval, 1.1–1.3). The area under the receiver operating characteristic curve of the model including all quantified risk factors was 63% (95% confidence interval, 62-64%).
Gestational age, maternal age, previous deliveries, and history of medically and surgically induced abortions all had a significant influence on the risk of surgical intervention of early medical abortion. However, inclusion of all quantified risk factors still left most interventions unpredictable.
Medical induced abortion
2016, Journal de Gynecologie Obstetrique et Biologie de la Reproduction
Recommandations de pratiques cliniques dans l’interruption volontaire de grossesse (IVG) médicamenteuse du premier trimestre.
Une revue systématique de la littérature en langue française et anglaise, concernant la prise en charge des patientes en demande d’IVG médicamenteuse, a été réalisée sur PubMed, Cochrane Library et sur les recommandations des sociétés savantes internationales.
L’efficacité de la méthode médicamenteuse est supérieure à 95 % lorsque les protocoles sont adaptés en fonction de l’âge gestationnel (NP1). Le misoprostol seul est moins efficace qu’une association mifépristone–misoprostol (NP1). Le géméprost est moins efficace que le misoprostol (NP2). La dose de 200 mg de mifépristone doit être préférée à la dose de 600 mg quel que soit le terme (NP1, grade A). La mifépristone peut être prise à domicile (accord professionnel). L’intervalle libre entre mifépristone et misoprostol doit être entre 24 à 48 heures (NP1, grade A). Avant 7 SA, le misoprostol doit être donné par voie orale à la dose de 400 μg (NP1, grade A) éventuellement renouvelé après 3 heures en l’absence de métrorragies. Entre 7 et 14 SA, pour une efficacité optimale, il ne faut pas raccourcir le délai entre mifépristone et misoprostol en dessous de 8 heures (grade A). Un délai de 24 à 48 heures n’a aucune incidence sur l’efficacité de la technique médicamenteuse à condition que la dose de misoprostol soit suffisante à 800 μg (NP1). Les voies d’administration du misoprostol vaginale, sublinguale ou buccale sont plus efficaces et mieux tolérées que la voie orale qui devrait être abandonnée (NP1). La dose de 800 μg de misoprostol administrée par voie sublinguale ou buccale a la même efficacité que celle administrée par voie vaginale mais est moins bien tolérée sur le plan digestif (NP1, grade A). Entre 7 et 9 SA, il ne semble pas nécessaire de répéter les doses alors qu’il faut les répéter au-delà de 9 SA (grade B). Entre 9 et 14 SA, après la première dose, 400 μg doivent être administrées toutes les 3 heures par voie vaginale, buccale ou sublinguale et répétées si nécessaire (jusqu’à 5 doses supplémentaires) (NP2, grade B). Il n’existe pas de preuve suffisante pour recommander une antibioprophylaxie systématique dans le cadre d’une IVG médicamenteuse (accord professionnel). Les contre-indications sont rares mais doivent être respectées (allergie aux produits, anémie profonde, troubles de la coagulation, traitement anticoagulant, porphyrie, GEU confirmée ou suspectée) ainsi que les précautions d’emploi (pathologies graves, traitement corticostéroïdes). En l’absence de facteurs de risque et de symptômes, une grossesse de localisation indéterminée (GLI) à l’échographie endovaginale associée à un taux d’hCG plasmatique généralement choisi inférieur à 1500 UI, (ou 2500 UI si échographie sus-pubienne) ne contre-indique pas l’IVG médicamenteuse. Il est recommandé d’informer les femmes du risque de non-diagnostic de GEU et des signes qui doivent les alerter. Un suivi plus précoce par dosage des hCG plasmatiques est recommandé afin de s’assurer de leur décroissance. Allaitement, obésité, grossesse gémellaire et utérus cicatriciel ne sont pas des contre-indications à l’avortement médicamenteux du premier trimestre. Les effets indésirables (troubles digestifs et ceux de la thermorégulation) au cours de l’avortement médicamenteux sont le plus souvent peu intenses et de courte durée. Un traitement anti-émétique devrait être proposé en prophylactique (accord professionnel). La douleur augmente avec l’âge gestationnel de la patiente (NP1). L’ibuprofène est le traitement antalgique à privilégier (NP1). La prescription systématique ou à la demande de l’ibuprofène se fera selon les habitudes des équipes (accord professionnel). À la suite d’un avortement médicamenteux, un suivi est recommandé pour s’assurer du succès de la méthode (NP2, grade B). Les modalités de surveillance, échographique et/ou par hCG combinés à l’histoire clinique sont des méthodes fiables et sont laissées au choix des équipes (grade B). Une baisse supérieure à 80 % du dosage sanguin initial d’hCG, 15 jours après l’IVG médicamenteuse est en faveur d’une réussite de celle-ci (grade B).
L’IVG médicamenteuse est une méthode sûre et efficace jusqu’à 14 SA à condition de respecter des protocoles qui différent selon l’âge gestationnel. Les femmes doivent être informées des avantages et inconvénients des méthodes en fonction du terme et des effets secondaires ce qui leur permettra de choisir la méthode qui leur convient le mieux.
Updated clinical recommendations for medical induced abortion procedure.
A systematic review of French and English literature, reviewing the evidence relating to the provision of medical induced abortion was carried out on PubMed, Cochrane Library and international scientific societies recommendations.
The effectiveness of medical abortion is higher than 95% when the protocols are adjusted to gestational age (EL1). Misoprostol alone is less effective than a combination of mifepristone and misoprostol (EL1). Gemeprost is less effective than misoprostol (EL2). The dose of 200 mg of mifepristone should be preferred to 600 mg (NP1, Rank A). Mifepristone can be taken at home (professional agreement). The optimum interval between mifepristone and misoprostol intake should be 24 to 48 hours (EL1, grade A). Before 7 weeks LMP, the dose of 400 μg misoprostol should be given orally (EL1, grade A) eventually repeated after 3 hours if no bleeding occurs. For optimal effectiveness between 7 and 14 LMP, the interval between mifepristone and misoprostol should not be shortened to less than 8 hours (grade 1). An interval of 24 to 48 hours will not affect the effectiveness of the method provided misoprostol dosage is 800 μg (EL1). Vaginal, sublingual or buccal routes of administration are more effective and better tolerated than the oral route, which should be abandoned (EL1). An amount of 800 μg sublingual or buccal misoprostol route has the same effectiveness than the vaginal route but more gastrointestinal side effects (EL1, grade A). Between 7 and 9 LMP, it does not seem necessary to repeat misoprostol dose whereas it should be repeated beyond 9 SA (grade B). Between 9 and 14 LMP, the dose of 400 μg misoprostol given either vaginally, buccally or sublingually should be repeated every 3 hours if needed (with a maximum of 5 doses) (EL2, grade B). There is no strong evidence supporting routine antibiotic prophylaxis for medical abortion (professional agreement). Rare contraindications should be respected (known hypersensitivity to misoprostol or mifepristone, inherited porphyria, severe anemia, hemorrhagic disorders or current anticoagulation therapy, suspected or confirmed ectopic pregnancy) as well as precautions of use (severe disease or on-going corticosteroid therapy). With no risk factors or symptoms, a pregnancy of unknown location (PUL) at the endovaginal ultrasound associated with a level of hCG usually chosen at less than 1500 IU (or 2500 IU with an abdominal probe) is not a contraindication of medical abortion as long as the woman is informed of the risk of undiagnosed ectopic pregnancy and knows how and when to seek emergency attention. An earlier than usual follow-up of the decrease of hCG levels is highly recommended. Breastfeeding, obesity, twin pregnancy and scared uterus are not contraindications for first trimester medical abortion. Side effects (gastro intestinal and thermoregulation disorders) during the procedure are generally of low intensity and short duration. A prophylactic treatment for nausea should be proposed (professional agreement). The pain increases with gestational age of the pregnancy (EL1). Ibuprofen is the first choice of painkiller (EL1). Ibuprofen will be systematically proposed or given on demand according to the practice of each facility (professional agreement). After a medical abortion, a follow-up assessment to confirm completion of the abortion is recommended (EL2, grade B). Clinical history combined with ultrasound and/or hCG blood level are both reliable methods and can be left with the choice of each facility (grade B). A fall of more than 80% of the initial blood level of hCG, fifteen days after the procedure is in favor of the success of the method (grade B).
Medical abortion is a safe and efficient abortion method up to 14 weeks LMP. To be effective, the drug regimen should be adapted to gestational age. Women should be informed of advantages and disadvantages of the method according to the gestational age and side effects so she can choose the method that fits her best.
Potential predictors for successful misoprostol treatment for early pregnancy failure: Clinical and color Doppler imaging study
2015, Middle East Fertility Society Journal
To identify the clinical characteristics and features of color Doppler imaging related to successful misoprostol treatment for early pregnancy failure.
Prospective observational study.
Factors related to successful misoprostol treatment for early pregnancy failure.
Four groups of women with early pregnancy failure (missed, anembryonic and incomplete miscarriage) were included in the study. The first group included 159 cases, 73 were presenting with active vaginal bleeding and/or localized abdominal colic in the 24 h preceding misoprostol administration and 86 cases were not presenting with these symptoms. The parity of all participants was ⩾2. The second group included 143 cases that did not present with vaginal bleeding and/or abdominal colic. The parity was 0–1 in 66 cases and ⩾2 in 77 cases. The third group included 34 cases of missed miscarriage and 22 cases of anembryonic pregnancy presenting with active vaginal bleeding and/or localized abdominal colic and the parity was 0–1.The fourth group included 172 women, blood flow was detected by color Doppler imaging in the trophoblastic tissue in 90 cases and was absent in 82 cases. All participants in this group did not present with vaginal bleeding and/or localized abdominal colic and their parity was ⩾2. All participants in the four groups were given 800 μg vaginal misoprostol on day 1 of treatment. If the miscarriage was not complete on day 3 the same dose was repeated. On day 8 they were submitted to dilatation and evacuation if miscarriage was not complete. Miscarriage was considered complete when no gestation sac was detected in the uterine cavity on transvaginal ultrasonography.
First group: the success rate of the two doses of misoprostol, when active vaginal bleeding and/or localized abdominal colic were present, was 94.52% (69 out of 73 cases). In absence of these symptoms the success rate was 75.58% (65 out of 86 cases). The difference was statistically (p = 0.0241) significant.
Second group: the success rate of the two doses of misoprostol, when parity was 0–1, was 98.48% (65 cases out of 66). When parity was ⩾2 the success rate was 85.71% (60 cases out of 77). The difference was statistically (p = 0.0442) significant. Third group: the success rate of the first dose of misoprostol for missed miscarriage was 97.05%, 33 cases out of 34 cases and 100% for anembryonic miscarriage, 22 out of 22 cases. One case of missed miscarriage needed a second dose of misoprostol to complete the miscarriage.
Fourth group: the success rate of the two doses of misoprostol, when blood flow was detected in the IVS of missed miscarriage and anembryonic pregnancy, was 100.0% (62 out of 62 cases). When blood flow was not detected in the IVS the success rate was 83.92% (47 out of 56 cases). The difference was statistically (p = 0.0422) significant.
When blood flow (vascularity) was detected in the trophoblastic tissue of incomplete miscarriage the success rate was 75.0% (21 out of 28 cases) but when no blood flow (vascularity) was detected the success rate was 100% (26 out of 26 cases). The difference was statistically (p = 0.0331) significant.
The potential predictors for successful misoprostol treatment for early pregnancy failure may be one or more of the following:
- 1.
  Active vaginal bleeding and/or localized abdominal colic in the 24 h preceding misoprostol administration.
- 2.
  Nulliparity or low parity not more than 1.
- 3.
  Blood flow in the presumed IVS of missed miscarriage or anembryonic pregnancy and absence of blood flow (vascularity) in trophoblastic tissue of incomplete miscarriage.
- Women, with early pregnancy failure, presenting with a combination of active vaginal bleeding and/or abdominal colic and parity 0–1, the success rate of the first-dose of vaginal misoprostol (800 μg) may reach >97% in missed miscarriage and 100% with anembryonic pregnancy.
Clinical outcomes from a prospective study evaluating the role of ambulation during medical termination of pregnancy
2012, Contraception
Although induced abortion is one of the most commonly performed gynecological procedures in Great Britain and medical termination of pregnancy is being used more frequently, very little is known about the role of ambulation during the procedure. We sought to compare ambulatory and non-ambulatory groups of patients undergoing medical termination in the hospital setting and determine whether ambulation impacted clinical outcomes.
This was a prospective patient-preference study carried out among 130 women with pregnancies up to 63 days of gestation fulfilling the requirements of the 1967 Abortion Act and undergoing medical termination of pregnancy. The objective was to evaluate the effect of ambulation during medical termination of pregnancy. The women were given the choice to be ambulatory or non-ambulatory throughout the process of medical termination of pregnancy. They received 200 mg oral mifepristone and 800 mcg vaginal misoprostol for the termination procedure. Outcomes measured included time taken to pass the products of conception, first feeling of abdominal cramps, estimated blood loss, time to discharge from the hospital, pain scores and need for analgesia.
In both ambulatory and non-ambulatory groups, the mean time taken to pass the products of conception was similar: 230.7 min (118–343.4) and 233.0 min (134.5–331.5) for ambulatory and non-ambulatory patients, respectively. Time to onset of cramps was 75.6 min (29.4–121.8) for ambulatory and 91.7 min (22.2–161.2) for non-ambulatory patients, from administration of misoprostol. Mean estimated blood loss (assessed by weighing the pads as well as blood in bed pan) was less than 100 mL in both groups, and overall, approximately 85% of patients ranked their pain score as 3 or less (on a scale of 0–5). There were no statistically significant differences in the ambulatory versus non-ambulatory groups with regard to clinical outcomes.
Ambulation during medical termination of pregnancy neither appears to influence the amount of bleeding or pain nor hasten the process of medical termination of pregnancy.
Alternatives to ultrasound for follow-up after medication abortion: A systematic review
2011, Contraception
Citation Excerpt :
Routine follow-up visits after medication abortion are recommended or required by most medication abortion protocols, primarily to diagnose ongoing pregnancies [1–6]. While ongoing pregnancy is relatively rare following early medication abortion, occurring in approximately 0.4%–3% of women with the mifepristone–misoprostol regimen [7–9] and in 5% with the misoprostol-alone regimen [10], several studies have shown that the incidence of ongoing pregnancy increases with increasing gestational age [7,9,11,12]. Ongoing pregnancy is typically identified during a follow-up visit via ultrasound or clinician's exam, and although pelvic ultrasonography is not required by the FDA-approved mifepristone label [13], many US facilities employ it to detect ongoing pregnancy [14].
Requiring a follow-up visit with ultrasound evaluation to confirm completion after medication abortion can be a barrier to providing the service.
The PubMed (including MEDLINE), Cochrane Central Register of Controlled Trials and POPLINE databases were systematically searched in October and November 2009 for studies related to alternative follow-up modalities after first-trimester medication abortion to diagnose ongoing pregnancy or retained gestational sac. We calculated the sensitivity, specificity, positive predictive value and negative predictive value compared with ultrasound or clinician's exam. We also calculated the proportion of cases in each study with a positive screening test.
Our search identified eight articles. The most promising modalities included serum human chorionic gonadotropin measurements, standardized assessment of women's symptoms combined with low-sensitivity urine pregnancy testing and telephone consultation. These follow-up modalities had sensitivities ≥90%, negative predictive values ≥99% and proportions of “screen-positives” ≤33%.
Alternatives to routine in-person follow-up visits after medication abortion are accurate at diagnosing ongoing pregnancy. Additional research is needed to demonstrate the accuracy, acceptability and feasibility of alternative follow-up modalities in practice, particularly of home-based urine testing combined with self-assessment and/or clinician-assisted assessment.

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Original research articleParity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Contraception

Contraception

Contraception

Am J Obstet Gynecol

Lancet

Lancet

Impact of the introduction of new medical methods on therapeutic abortions at the Royal Infirmary of Edinburgh

Br J Obstet Gynaecol

Termination of pregnancy with reduced doses of mifepristone

Br Med J

The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol

Human Reprod

Original research article
Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost