Comparative study of early (24 hours) versus late (48 hours) misoprostol administration after mifepristone for termination of early pregnancy

Abstract

Background: Medical method of abortion – a combination of Mifepristone followed by prostaglandin analogue such as Misoprostol has been used up to 9 completed weeks since last menstrual period. Misoprostol is the prostaglandin of choice for most settings since it is cheap and does not require refrigeration.The availability of safe and effective medical methods for inducing abortion remains limited at present. However, rapid development and ongoing research may lead to their wider introduction in the near future.Objectives: The aim of the present study is to compare the efficacy of Mifepristone followed after 24 hours by Misoprostol with the standard protocol (Mifepristone followed by Misoprostol after 48 hours).Materials and Methods: This prospective case control study was conducted in 120 patients up to 63 days period of gestation who was diagnosed with early pregnancy failure & suitable for medical abortion from a period of November 2018-July 2019.•Subjects in study arm was given 200 mg oral Mifepristone followed by 800 mcg vaginal Misoprostol after 24 hours, whereas those in control arm was given 200 mg oral Mifepristone followed by 800 mcg of vaginal Misoprostol after 48 hours.•Women who did not have bleeding in the first 8 hrs following 800 mcg Misoprostol were given subsequent 200 mcg of vaginal Misoprostol. Doses were repeated at 4th hourly interval to a maximum Misoprostol dose of 1200mcg.•Sequential allocation was done in the ratio of 1:1.Statistical analysis: It was done by using Student t test & chi-square test. Descriptive and inferential statistical analysis has been carried out in the present study.Summary of Results: Out of 135 patients screened 15 patients were excluded as per exclusion criteria and 120 patients were taken for study. Mean induction to abortion interval in study group was in the range of 5-6 hrs versus 6-7 hrs in control group with P value of 0.772. The success rate in study group versus control group is 78.3 % versus 81.6% with P value of 0.29. 11/58 patients required curettage in study group compared to 6/55 in control group. Side effect profile between 24 vs 48 hour regimen was statistically insignificant.Conclusion: Vaginal Misoprostol can be safely administered 24 hours following Mifepristone compared to 48 hours regimen with equal efficacy.