The use of mifepristone (RU 486) for cervical preparation in first trimester pregnancy termination by vacuum aspiration

Article Abstract:

Termination of pregnancy can be achieved by mechanically dilating the cervix (the opening to the uterus) and using vacuum aspiration to remove the uterine contents. There is a risk of tearing the cervical tissue and perforating the wall of the uterus when surgical instruments are used. Furthermore, if the opening of the cervix is not adequate, hemorrhage and incomplete abortion can result. If the cervix can be prepared before mechanical manipulation, the risk of these complications can be reduced. Two types of cervical 'ripening' agents are currently used. Prostaglandins, which relax smooth muscle and help induce labor, can be inserted in the vagina to soften and dilate the cervical opening. The other agents, such as Laminaria, slowly dilate the cervix over time. The drug mifepristone (RU 486) inhibits the action of progesterone (a hormone required to maintain pregnancy) and is used in some countries in pill form to induce abortion. Mifepristone can also be used to prepare the cervix for surgical termination of pregnancy. To determine whether mifepristone is useful in ripening the cervix, 230 women were given 0, 25, 50 or 100 milligrams (mg) of mifepristone prior to surgical terminations; those given 0 mg of the drug received an inert placebo instead. Mifepristone was useful in achieving cervical dilation (women given the drug were 0.9 to 1.2 millimeters more dilated than women given placebo) prior to termination, but the amount of dilation was not related to the dose. The resistance of the inserted catheter was judged by the surgeon based on whether the dilator was spontaneously expelled. The women who did not receive mifepristone had smaller cervical diameters and had a higher catheter resistance than the women receiving the drug. The dilation was judged to be easier in the mifepristone-prepared women, and greater dilation was reported with the higher doses. Only two out of 54 women receiving 100 mg mifepristone experienced bleeding prior to the procedure. Overall, no side-effects were experienced by the women who received mifepristone. The amount, duration, and character of postoperative bleeding and the time until the next menstrual period were the same in the treated and placebo groups. Although mifepristone appears to be useful as a cervical ripening agent prior to surgical termination of pregnancy, the safety and efficacy must be compared with that of conventional cervical ripening agents before mifepristone can be considered for routine use. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Cervix uteri, World Health Organization, Incompetent cervix

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Psychiatric morbidity and acceptability following medical and surgical methods of induced abortion

Article Abstract:

The incidence of psychiatric problems following the voluntary termination of a pregnancy is low; while women commonly feel guilt, a sense of loss, and decreased self-esteem, such feelings tend to be transient and mild. Research indicates that few women in Britain and the US consider abortion a negative experience, and few regret having undergone the procedure. However, those who fear more liberalized abortion laws often cite the possibility of serious emotional and psychological effects. It is likely that the recent development of a medical approach to pregnancy termination, which relies on the administration of mifepristone and prostaglandin, will influence women's perceptions of abortion. To evaluate the risk factors that might predispose women to psychiatric illness after pregnancy termination, a study was carried out of 91 women who underwent either medical (54 subjects) or surgical (37) abortion. Feelings of anxiety and depression were assessed by means of a standard questionnaire administered before, one week after, and four weeks after pregnancy termination. The incidence of psychiatric problems for women undergoing either procedure fell from 60 percent before the abortion to less than 10 percent afterwards. No difference was seen between the groups in the incidence of psychiatric problems. Although both medical and surgical methods of abortion were considered acceptable, only 75 percent of the medically-treated patients and 94 percent of the surgically-treated patients said they would have the same procedure if necessary in the future. Ten of 13 women who had undergone both methods of abortion preferred the medical approach. The findings show that termination of pregnancy with mifepristone and prostaglandins is acceptable to most women and is associated with a low rate of psychiatric complications, as is surgical abortion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, United Kingdom, Great Britain, Abortion, Therapeutic, Therapeutic abortion

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Pre-operative cervical preparation before first trimester vacuum aspiration: a randomized controlled comparison between gemeprost and mifepristone (RU 486)

Article Abstract:

Before a vacuum aspiration abortion is performed, the cervix is usually primed, or treated with an agent to soften and dilate it. This controlled, randomized study compares mifepristone (RU 486) with gemeprost, a commonly used priming agent. Ninety women were randomly assigned to take either mifepristone or a placebo (inactive) drug 36 hours before surgery, or to receive a gemeprost one-milligram vaginal pessary a few hours before surgery. Subjects' symptoms were evaluated when the drugs were given and just before surgery began. Postoperative complications were noted. More women in the gemeprost group than either the placebo or the mifepristone group experienced abdominal pain, and fewer women in that group remained without symptoms. Mifepristone produced the greatest baseline cervical dilatation and resulted in the need for the least amount of force to dilate the cervix further. However, this difference when compared with gemeprost was not statistically significant. Both drug groups had less blood loss than the placebo group. No differences between the gemeprost and mifepristone groups were seen in the extent of postoperative complications. Mifepristone, an oral preparation, had few side effects. Further studies of its effectiveness in cervical priming should be carried out. (Consumer Summary produced by Reliance Medical Information, Inc.)

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