Nonsurgical mid‐trimester termination of pregnancy: a review of 500 consecutive cases

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Abstract
Objective To assess the effectiveness of a regimen comprising mifepristone followed by a combination of the vaginal and oral administration of misoprostol for mid‐trimester medical termination of pregnancy. Design Retrospective analysis of prospectively collected data in women undergoing mid‐trimester medical termination of pregnancy. Setting Aberdeen Royal Infirmary, Scotland. Sample A consecutive series of 500 women with pregnancies of 13–21 weeks of amenorrhea undergoing legally induced abortion in one Scottish NHS hospital. Methods Each woman received a single oral dose of mifepristone 200 mg and 36–48 h later vaginal misoprosto1800 pg. Three hours following the first dose of misoprostol, 400 yg doses were administered orally at three hourly intervals, to a maximum of four doses. Success was defined as abortion occurring with five doses of prostaglandin, or within 15 h of administration of the first dose of prostaglandin. Results Ninety‐seven percent aborted successfully. The median dose of misoprostol required was 1200 yg and the median induction‐toabortion interval after first prostaglandin administration was 6.5 h. The median number of doses of misoprostol required to induce abortion, and the induction‐toabortion interval, was statistically significantly higher among women at gestations 17–21 weeks than among those at 13–16 weeks (P= 0–0001). A total of 9.4% required surgical evacuation of the uterus under general anaesthesia and 66.4% of the women were managed as day cases. Conclusions The combination of oral mifepristone 200 mg followed by vaginally and orally administered misoprostol provides a noninvasive and effective regimen for second trimester termination of pregnancy.