Are Two Doses of Misoprostol After Mifepristone for Early Abortion Better Than One?

BJOG; 2007 Mar; 114(3):271-8; doi:10.1111/j.1471-0528.2006.01208.x

Objective: The objective of this study was to determine if a repeat dose of misoprostol following mifepristone or a single dose of misoprostol increases the efficacy of medical termination of pregnancy.

Design: Randomised, placebo controlled trial.

Setting: K.E.M. Hospital, Pune, India, and the Health Centre, Larsen and Toubro Limited, Mumbai, India.

Sample: A total of 300 women seeking an abortion with amenorrhoea of 8 weeks or less.

Methods: Women were randomised to receive one or two doses of 400 microgram oral misoprostol at the clinic 48 hours after administration of 200 mg mifepristone.

Main outcome measure: Complete abortion without surgical intervention.

Results: The repeat administration of misoprostol 400 microgram improved the complete abortion rate from 86 to 92% and significantly reduced the rate of continuing pregnancy from 7 to 1%. Almost all the women who were administered the additional dose of misoprostol were either very satisfied (58%) or satisfied (37%) with the method.

Conclusion: While an additional oral dose of 400 microgram misoprostol did not significantly increase the rate of complete abortion without surgical intervention, the additional dose did significantly reduce the rate of continuing pregnancies without compromising the acceptability and ease of use of the method.