Medical abortion- Up to what gestational age?

Medical abortion- Up to what gestational age?

K. Gemzell Danielsson

Department of Woman and Child Health, Division for Obstetrics

&.Gynecology, Karolinska University Hospital/ Karolinska Institutet,

Stockholm, Sweden

Medical abortion with a combined regimen of mifepristone and a

prostaglandin analogue was first approved in France in 1988. Today medical

abortion is available in around 30 countries. Except for the UK, Sweden and

Norway where the method is approved up to 63 days, other approvals are limited

to 49 days.

Since the introduction of the method research has focused mainly

on the following issues: To find the optimal dose of mifepristone, the optimal

type, dose and route of administration of prostaglandin, to increase

acceptability of the method and to define the duration of pregnancy for which it

can be used.

During this time it has been shown that the dose of mifepristone

can be reduced without affecting its priming effect on the myometrium and

cervix. Misoprostol, has emerged as the most optimal prostaglandin analogue with

its effect being dependent on the duration of pregnancy, and on the dose and the

route of administration.

With the introduction of mifepristone the non-surgical,

non-invasive methods for 2nd trimester abortion could be dramatically improved

and has become the recommended method in many centres. The induction-to-abortion

interval is on average 6,5 hours and more than 70% of women are treated as day

care patients.

After 24 weeks of pregnancy the dose of misoprostol has to be

reduced. This continues gradually until term.

More recently medical abortion has also become increasingly used

in 10 to 13 weeks. In this interval the comparison between medical and surgical

abortion has shown more side-effects in the group using medical termination

while there is no difference in major complications. The high level of

acceptance and the 94-95 per cent effectiveness let to the conclusion of

medicinal termination as being an alternative for women also between 10 to 13

weeks of pregnancy,

In conclusion the combined treatment with 200 mg mifepristone

and misoprostol is a highly effective and safe method to terminate pregnancy

provided that the dose and route of misoprostol is adjusted to the pregnancy


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