Medical abortion: public health and private lives

Article Abstract:

Mifepristone and misoprostol offer many women a safe alternative to surgical abortion. Methotrexate has also been used in the US, since mifepristone is not available in the US.

Usage, Abortifacients

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Mifepristone (RU 486) failure in an ovarian heterotopic pregnancy

Article Abstract:

Mifepristone, also known as RU 486, is a steroid drug that prevents the actions of the female hormone progesterone and the adrenal glucocorticoid hormones. This drug has been used to induce abortion in the first trimester of pregnancy. However, studies show that mifepristone is ineffective in eliminating tubal ectopic pregnancies, in which the fertilized egg implants in the fallopian tubes rather than the uterus. A case is described of a 27-year-old woman who was given 600 milligrams mifepristone and 50 micrograms of 15-methyl prostaglandin F2-alpha to induce first trimester abortion. Vaginal bleeding began two days after the first dose of mifepristone and decreased to light spotting within nine days. However, the levels of beta human chorionic gonadotropin (beta-hCG), a hormone produced during pregnancy, remained elevated despite the removal of residual fetal and related tissue by curettage. Ultrasonography, a diagnostic method in which sound waves are used to visualize internal structures, revealed a cyst or sac-like structure within the left ovary. The patient underwent laparoscopy, the examination of the abdomen using a tube-like device with an optical system called a laparoscope. A left ovarian pregnancy was identified and removed, and beta-hCG levels decreased to an undetectable value 21 days later. This case is the first report of simultaneous pregnancies occurring in the uterus and ovary in the same patient. In addition, this case shows that mifepristone and prostaglandin were ineffective in eliminating the ovarian pregnancy, which was successfully removed by laparoscopy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Pregnancy, Ectopic, Ectopic pregnancy

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Predictors of failed attempted abortion with the antiprogestin mifepristone (RU 486)

Article Abstract:

Mifepristone (RU 486) is an agent that blocks the action of progesterone, the hormone essential for a successful pregnancy. In France, RU 486 is being used by thousands of women as an alternative to surgical termination of unwanted pregnancies. Why RU 486 fails to induce an abortion in some women is unclear. The factors predicting a failed abortion attempt were studied among 271 women receiving RU 486 in an experimental protocol in the US. The factors that might influence the failure of RU 486 to achieve a complete abortion were the following: number of previous pregnancies, number of days without menstruation, the level of human chorionic gonadotropin hormone (hCG), the size of the gestational sac (containing the products of conception), patient's body weight and Quetelet's index (a ratio of weight to height). The two factors that influenced a failed RU 486 attempt the most were the type of treatment regimen used and the Quetelet index. Women who had a Quetelet index falling in the top 25th percentile were 2.9 times more likely to have a failed abortion attempt than the women falling within the bottom 25th percentile. As the level of hCG increased the chances of a failed attempt increased. Women with a hCG level of 19,800 milli-units per milliliter were 2.8 times more likely to have a failed abortion than women with a value less than 6,350. The results indicate that body weight influences the success of RU 486. Slender women with low hCG levels who were given the 600 milligram dose of RU 486 had the lowest abortion failure rate. Standard RU 486 treatment protocols may not be effective for women of all body types. (Consumer Summary produced by Reliance Medical Information, Inc.)

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