Clinical Applications of Mifepristone (RU486) and Other Antiprogestins Assessing the Science and Recommending a Research Agenda (1993) / Chapter Skim
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B5. Use of Antiprogestins Before 63 Days of Amenorrhea
B5. Use of Antiprogestins Before 63 Days of Amenorrhea
Pages 164-173
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From page 164... ...
It is secreted by the corpus luteum during the second part of the menstrual cycle and during early pregnancy, and by the placenta after the luteal placental shift, which occurs between six and eight weeks of pregnancy. It is essential for the nidation of the conceptus and is thought to inhibit myometrial contractility, thereby ensuring that the uterus is kept in a quiescent state throughout pregnancy.
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From page 165... ...
(1986) reported a complete abortion rate of 85 percent following treatment with up to 800 mg mifepristone for 2 to 4 days in women who were within 10 days of missed menses.
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From page 166... ...
The dose schedule recommended by the pharmaceutical company (Roussel-Uclaf, Paris) is a single dose of 600 mg mifepristone followed 36 to 48 hours later by 1.0 mg gemeprost.
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From page 167... ...
The frequency of hemostatic surgical procedures was between 0.4 and 1.0 in the two studies (Table B5.1~. Uterine pain is also common, especially during the first hours following prostaglandin treatment: 2 percent of the women reported severe pain after mifepristone administration, a frequency that increased to 21 percent two hours after gemeprost administration.
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From page 168... ...
Multicenter trials conducted under the auspices of the World Health Organization have shown that the same effectiveness observed with 600 mg can be achieved with either repeated small doses of mifepristone (five doses of 25 mg given at 12-hour intervals)
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From page 169... ...
This figure is considerably lower than that reported in the United Kingdom multicenter study in 1990 in which 28 percent of women required opiate analgesic and an additional 31 percent nonnarcotic analgesia following mifepristone and gemeprost. Although it is well known that the degree of pain and need for analgesic treatment vary considerably, it seems that the replacement of gemeprost by misoprostol will result in decreased pain.
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From page 170... ...
The report included 1,288 early pregnant women (duration of amenorrhea <50 days) who received 600 mg mifepristone followed two days later by a fixed dose of misoprostol (400 lug)
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From page 171... ...
CONCLUSIONS The need for a safe, noninvasive method of medical abortion was expressed by the World Health Organization in 1978, and the mifepristone-prostaglandin combination goes a long way towards fulfilling this
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From page 172... ...
Preliminary data indicate that side effects, mainly in terms of uterine pain, may be further reduced if treatment with mifepristone is combined with a lower dose of prostaglandin. In addition, the approach may be more convenient to use if ongoing trials confirm that oral administration of misoprostol is an effective alternative to gemeprost.
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From page 173... ...
World Health Organization (WHO) , Task Force on Postovulatory Methods for Fertility Regulation.
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