Induction of second trimester abortion with mifepristone and gemeprost

Objective: To determine the efficacy of a new regimen of the antiprogestogen mifepristone and gemeprost for midtrimester abortion.

Design: Prospective study.

Setting: Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh.

Subjects: One hundred women undergoing midtrimester abortion.

Interventions: Women were pretreated with 200 mg mifepristone 36 h before prostaglandin; 1 mg gemeprost was administered every 6 h for the first 24 h. If abortion had not occurred, 1 mg gemeprost was administered 3 hourly over the next 12 h.

Measurement and main results: Ninety-six percent and 99% women aborted within 24 h and 48 h, respectively. The median prostaglandin-abortion interval was significantly shorter in multigravidae compared to primigravida (6.6 vs 8.2 h, P < 0.01). The median number of gemeprost pessaries to induce abortion was only two and 47% of women required one pessary. The incidence of vomiting and diarrhoea was 31% and 5%, respectively. Eighty-four percent of women required intramuscular diamorphine for analgesia. Thirty-three percent of women required an evacuation of the uterus following abortion.

Conclusions: The shortened induction-delivery interval following pretreatment with mifepristone makes it possible to conduct midtrimester abortion on a daycare basis.