Vaginal misoprostol administered at home after mifepristone (RU486) for abortion

Area of Science:

• Reproductive Health
• Pharmacology
• Clinical Trials

Background:

• No prior US studies assessed home vaginal misoprostol following oral mifepristone for early abortion.
• Effectiveness, safety, bleeding time, and acceptability of this regimen were unevaluated.

Purpose of the Study:

• To evaluate the effectiveness, safety, bleeding patterns, and patient acceptability of home vaginal misoprostol administration after mifepristone for early abortion (up to 8 weeks pregnant).

Main Methods:

• A prospective trial involved 166 women up to 8 weeks pregnant undergoing medical abortion.
• Participants received oral mifepristone, followed by self-administered vaginal misoprostol at home two days later.
• A repeat in-office misoprostol dose was given if ultrasound confirmed retained products of conception within 7 days.

Main Results:

• A complete medical abortion occurred in 98% (163/166) of subjects.
• Vaginal bleeding commenced approximately 3.5 hours after misoprostol administration.
• 96% of subjects found the procedure went well, and 90% deemed home misoprostol administration acceptable.

Conclusions:

• Vaginal misoprostol administered at home two days after mifepristone is safe, highly effective, and acceptable for early abortion.
• The regimen shows promise as an alternative to surgical abortion.
• Further research is needed to draw conclusions regarding the necessity of repeat misoprostol doses.