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
length.