A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks

Objective To study the efficacy of repeated doses of vaginal misoprostol over 9 hours in a day care setting for terminating pregnancies up to eight weeks of gestation. Design An open, single arm prospective study conducted between January 2000 and December 2001. Setting Fertility Control Clinic, National University Hospital, Singapore. Population One hundred and fifty pregnant women with an unwanted pregnancy up to eight weeks of gestation requesting medical abortion. Methods The women were given an initial dose of 800 μg of vaginal misoprostol. A further dose of 400 μg was repeated every 3 hours for a maximum of three doses. Main outcome measures The complete abortion rate defined as successful cases that did not require vacuum aspiration. Results The complete abortion rate was 84.7% and 96.0% at 15 days and 43 days after initial administration of vaginal misoprostol. The mean interval between first dose of misoprostol and the onset of expulsion of products of conception (SD) was 8.1 hours (6.3). The mean and the median percentage changes in the serum β‐hCG levels at day 15 as compared with pre‐abortion levels were statistically significant (P < 0.001) and were a good predictor of the likely outcome of the medical abortion. The mean duration of bleeding (SD) was 11.7 days (4.7) and the mean duration between the onset of procedure and the return of normal menstruation (SD) was 35.5 days (5.7). There was no significant change in haemoglobin concentration. Lower abdominal pain, fever (>38.0°C) and diarrhoea were the most common side effects. Conclusions This regimen of repeated doses of vaginal misoprostol every 3 hours over a period of 9 hours, in keeping with the plasma level and pharmacokinetic of misoprostol administered vaginally, is an effective method of medical abortion that approaches the efficacy of surgical vacuum aspiration. The regimen would offer a suitable option for women requesting termination of pregnancy up to eight weeks of gestation in countries where mifespristone is and will never be made available.