background
Jill Durocher

A repeat dose of misoprostol 800mcg following mifepristone for outpatient medical abortion at 64-70 and 71-77 days of gestation: A retrospective chart review

Published
May 28th, 2020
Type
Staff Publication
Topic
Medical Abortion
Authors
Dzuba, I., Bousiéguez, M., Castillo, P.W., Lugo Hernández, E.M., Castañeda Vivar, J.J., Sanhueza Smith, P.

Contraception; May 28, 2020; doi:https://doi.org/10.1016/j.contraception.2020.05.012

Objective: To compare the effectiveness of outpatient medical abortion with mifepristone 200mg and two misoprostol 800mcg doses at 64-70 and 71-77 days of gestation.Study DesignWe conducted a retrospective chart review of medical abortion outcomes among clients with 64-77 day gestations at a Mexico City public clinic between February 2014 and November 2016 who took mifepristone 200mg followed 24-48 hours later by two doses of misoprostol 800mcg four hours apart (first dose buccally, second dose sublingually). The primary outcome was successful medical abortion, defined as pregnancy expulsion without surgical intervention. We also assessed additional management and visits to other facilities. We compared outcomes by gestational age (64-70 vs 71-77 days).

Results: Of 602 charts reviewed, we analyzed 232 and 218 in the respective groups for effectiveness; nearly 25% of clients were lost to follow up. Treatment success occurred in 231 (99.6%, 95% CI 97.6-100%) clients at 64-70 days and 213 (97.7%, 95% CI 94.7-99.3%) clients at 71-77 days (p=0.11). Ongoing pregnancy occurred in 1 (0.4%, 95% CI 0-2.4%) and 3 (1.4%, 95% CI 0.3-4.0%) clients, respectively (p=0.36). Two charts from the 71-77 days group documented visits to other facilities: one bleeding concern prior to scheduled follow up and a hemorrhage during an aspiration intervention.

Conclusions: Regimen effectiveness was high at 64-70 and 71-77 days among clients who attended follow up. However, with 25% attrition, it is difficult to draw definitive conclusions about effectiveness and associated safety.

Implications: Mifepristone 200mg followed by two doses of misoprostol 800mcg four hours apart is a promising medical abortion regimen to improve efficacy in pregnancies from 64-77 days of gestation as compared to regimens with an initial single misoprostol dose. Prospective research is recommended to achieve more robust efficacy estimates.