Efficacy of Mifepristone and Misoprostol combination in termination of early pregnancy

Background: Unplanned and unwanted pregnancies are common occurrences in all societies, regardless of the level of medical, economic, educational or religious development present within them. Despite wider availability of contraceptive methods, the incidence of induced abortion is increasing. Aim: To study the efficacy of Mifepristone 200 mg orally followed 48 hours later by Misoprostol 600 µg per vaginally in women undergoing medical termination of early pregnancy (up to 73 days of gestational age). Materials and methods: The present study included 50 pregnant women requesting termination of pregnancy in first trimester attending the department of Obstetrics and Gynecology. Women with gestational age up to 73 days from the first day of the last menstrual period with previous regular cycles were studied. Patients without medical or surgical contraindications to Mifepristone and Misoprostol were included. Women without prior caesarean section were studied. Results: Majority of the patients were of age group between 21-25 years. 92% of these women were married, 15% were nulliparous and 35% were multiparous. The period of gestation varied from 38-73 days. Majority of women were between 36-50 days of gestational age, constituting 50%. 94% of the patients had complete abortion and 4% had incomplete abortion. Success rate was not affected by the parity or gestational age, 72% of the patients expelled the products of conception within 10 hours, 84% in 15 hours and almost all the patients within 24 hours of prostaglandin administration. Most of the adverse effects reported were of the gastrointestinal system of which nausea was reported by 40%, abdominal pain by 70%, vomiting by 16% and diarrhoea by 4% of the cases. 6% of the patients reported excess bleeding at the time of abortion but none of them required hospitalization or blood transfusion. The mean duration of bleeding was 7.24 days. A significant fall in hemoglobin was not observed in any patient (less than 1 gm/dl). This combination has the advantage of high complete abortion rate with low frequency of side effects. Conclusion: The combination of RU 486 200mg orally and misoprostol 600 µg intravaginally appears to offer safe, efficient, acceptable, out-patient procedure and an alternative to surgical abortion in early termination of pregnancy (up to 73 days of gestation).