Misoprostol (alone) in second trimester terminations of pregnancy: as effective as Gemeprost
? J Obstet Gynaecol 2006; 6: 9-546.
A randomised controlled trial comparing two intravaginal misoprostol regimens and gemeprost
for mid-trimester termination of pregnancy.
A 43-year-old primigravida underwent pregnancy termination with gemeprost
at the 13th gestational week.
The review included studies of regimens using mifepristone with gemeprost
, mifepristone with oral misoprostol, mifepristone with vaginal misoprostol, methotrexate with vaginal misoprostol, and vaginal misoprostol only.
The approved regimens in Great Britain and Sweden provide that the prostaglandin gemeprost
be administered vaginally.
Two prostaglandins used early on in conjunction with RU486 in France, gemeprost
and sulprostone, were largely abandoned after one of the four women suffering heart attacks died in 1992.
Benedetti and others suggested that there are safer alternatives to misoprostol for cervical ripening and/or labor induction, including dinoprostone, gemeprost
, and oxytocin, although some of these agents cost $90 per dose.
The results of the French study, which analyzed the effectiveness of RU 486/oral misoprostol in 488 women (study 1), confirmed that the ongoing pregnancy rate with 400 ug oral misoprostol is four times higher (four women, 0.8%) than that found in Britain using gemeprost
(1 woman, 0.2%).
She returns to the clinic 48 hours later and is given a second drug, a prostaglandin (in France, an oral version called misopristol is used; in Great Britain and Sweden, a vaginal suppository called gemeprost
Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost
. Contraception 2000;62(6):297-303.
The frequency of infection was highest among those who received mifepristone followed by gemeprost
(1.6%) but much lower amongst those treated with mifepristone and oral misoprostol (0.2%).