Efficacy of Single Dose of Mifepristone Combined with Two Doses of Misoprostol in Early Medical Abortions

Objective To study the efficacy of single dose of mifepristone and two doses of misoprostol in women undergoing early medical abortion （EMA） up to 9 weeks of gestation. Methods An audit was performed on a retrospective data analysis of 162 women who underwent an early medical abortion in Southampton U.K. Relevant data on completeness of abortion and other details were analyzed. Results Majority of the women （67%） aged 20-30 years old, 22% were between 30 and 40 years old and 1% were above 40 years old when they came for abortion. About 94.5% women had complete abortion following the use of single dose mifepristone combined with two doses of misoprostol, 4.9% had an incomplete abortion and 0.6% had failure of the procedure. These figures had significantly improved over the results of similar audit in 2005 with single dose of misoprostol to women below 7 weeks of pregnancy. The results in this audit were 82.1% complete abortion, 7.2% incomplete abortion and O. 7% failed procedure. Conclusion Mifepristone in combination with two doses of misoprostol appears to be more effective in all cases of early medical abortion when compared with single dose of misoprostol for termination below 49 d （7 weeks） and two doses of misoprostol between 49 d and 63 d （7-9 weeks） of pregnancy.

Studies on Expression of IGF-II Gene in Deciduas Derived from Medical Abortion Patients

To determine the effect of insulin like growth factor Ⅱ(IGF Ⅱ) upon the maintenance of decidua in early pregnancy and its relationship with progesterone, as well as its role in medical abortion. Materials & Methods Decidua tissue was obtained from 28 women who undergoing surgical abortion and 39 for medical abortion respectively at 5~7 weeks of gestation. The extracted total RNA was reversely transcripted and amplified by PCR with specific primers (IGF Ⅱ and β actin). The products were semi quantitated by MIAS 300 system and qualitatively analyzed by southern blotting. Results The expression of IGF Ⅱ gene in decidua from surgical abortion was significantly higher than that from medical abortion (P<0.05). The average IGF Ⅱ gene transcription values were 1.54±0.79 and 0.72±0.39 respectively. The results of southern blotting proved qualitatively that the RT PCR products were IGF Ⅱ cDNA. Conclusion IGF Ⅱ plays a role in the maintenance of decidua in early pregnancy. It may act as a mediator of progestin. It's also involved in the molecular mechanism of mifepristone.

Clinical Effects of Lithospermum Ruderal on Medical Abortion by Mifepristone with Misoprostol

Early pregnancies(<42d)in 600 women were terminated respectively by mifepristone and Lithospermum Ruderal with misoprostol or mifepristone with misoprostol. The results showed that the rate of complete abortion(99.00%)of 300 women by mifepristone and Lithospermum Ruderal with misoprostol was significantly higher than that (92. 33%)of the other 300 women by mifepristone with misoprostol(P<0.01).The average length of time of embryo removal(54.01±7.55 h)and the rate of embryo removal (82.33%)within 6 hours after administration of misoprostol of the former were significantly shorter and higher than those(56.41±9.93 h and 72.67%) of the latter(P<0.05 respectively).The average length of the bleeding time of the former(7.01±3.11d)was significantly shorter than that(8.09±5.63d)of the latter(P<0.05).The recovery of the menstruation of both was not significantly different from each other(P>0.05).In all, the medical abortion by mifepristone and Lithospermum Ruderal with misoprostol was even more successful,with less bleeding time.Therefore it is essential to make researches on the auxiliary effects of Lithospermum Ruderal on the medical abortion by mifepristone with misoprostol.

Clinical Observation on Termination of Early Pregnancy of 213 Cases after Caesarian Section with Repeated Use of Mifepristone and Misoprostol

Objective To investigate the efficacy and safety in women after caesarian section for termination of early pregnancies by treatment, or repeated treatment with mifepristone and misoprostol. Subjects and Methods A total of 213 pregnant women with amenorrhea of 34~69 d after caesarian section who asked for medical abortion were recruited, including 63 cases undergoing their second medical abortion. A total amount of mifeprisstone of 150 mg given in separate doses (25 mg×4 and 50 mg at the first time) was administered orally within 3 d, followed by misoprostol of 0.6 mg orally in the morning of d 3. Results The complete abortion rate was 92.5%, incomplete abortion was 4.7% and failure was 2.8%. Conclusion The sequential use of mifepristone and misoprostol could be successfully and repeatedly used for induced abortion in those women with a caesarian section history. Its efficacy was similar to that for ordinary population. Its safety and effectiveness were satisfactory.

Safety of Mifepristone in Medical Abortion in Hyperthyroidism Pregnant Mice

Objective:To study the safety of mifepristone on thyroid hormone level by using hyperthyroidism pregnant model in mouse to simulate the process of medical abortion and observe the changes of thyroid hormone during abortion.Methods:A total of 60 female Institute of Cancer Research(ICR)mice aged 6-8 weeks were divided into control group,control group with 0 mgRU486 group(control-0 mgRU486),control group with 2 mgRU486 group(control-2 mgRU486),hyperthyroid pregnant mice with 0 mgRU486 group(hyper-0 mgRU486),hyperthyroid pregnant mice with 2 mgRU486 group(hyper-2 mgRU486),and hyperthyroid pregnant mice with 20 mgRU486 group(hyper-20 mgRU486).In the hyperthyroidism groups,L-thyroxine sodium was intraperitoneally injected every day at 30μg·kg^(−1)·day^(−1) until the end of the experiment.On the 7^(th) day of the experiment,free triiodothyronine(FT3),free tetraiodothyroxine(FT4),thyroxine(TT4),and thyroid-stimulating hormone(TSH)levels were tested.The mice in the control groups and those in the experimental groups were paired with the male mice(2:1)on the 10^(th) day of the experiment,and the caging was recorded.On the 8^(th) day of pregnancy(day 8),pregnant mice were subcutaneously injected with mifepristone in different doses and were sacrificed 6 h later.Pregnancy rate and the number of embryos were recorded.Thyroid tissues were observed by hematoxylin and eosin(HE)staining.Serum TSH level was determined by radioimmunoassay.Results:Six hours after injection with mifepristone,serum FT3,FT4,and TT4 levels of pregnant mice were all increased.The increased levels in the mice under hyperthyroidism were different from those in the control groups(P<0.05).There was no difference in the embryo number and pregnancy rate between the experimental and the control groups;HE staining indicated that there was no significant change in microscopic features before and after mifepristone administration.Conclusion:Serum thyroid hormone level of mice under hyperthyroidism was significantly increased after mifepristone administration.Therefore,mifepristone should be avoided when hyperthyroidism has not been controlled.

Mifepristone in Combination with Misoprostol for the Termination of Pregnancy at 8-16 Weeks' Gestational Age: A Multicentre Randomized Controlled Trial

Objective To compare the efficacy and safety of medical abortion of different regimens for termination of pregnancy at 8-16 weeks of gestation. Methods Healthy pregnant women requesting medical abortion at 8-16 weeks＇ gestation within 12 hospitals in Shanghai were randomly allocated to four treatment groups. Three intervention groups were given mifepristone 200 mg as a single dose then 24 h later misoprostol 600 #g at 3 h intervals vaginally, orally or vaginally followed by orally, respectively. Control group was given mifepristone 100 mg for 2 d, followed at 48 h by initiation of misoprostol 600 μg vaginally every 12 h. The primary outcome measures were the successful abortion rate, the induction-to-abortion interval, vaginal bleeding and side effects. Results Efficacy outcomes were analyzed for 1 112 women （92.67%）, excluding 88 protocol violations. Termination successful rates were similar among the four groups from 97.1% to 97.8%. The average dose of misoprostol and the incidence of side effects in control group were lower than those in three intervention groups. Stratified analysis showed that the interval of induction-to-abortion at gestation of 1116 weeks was decreased in control group. Conclusion The four regimens have the similar termination successful rates in spite of different administration intervals or routes. Control group was recommended for the advantages of reduced dose of misoprostol and fewer side effects.