A Cross-sectional Analysis of Mifepristone, Misoprostol, and Combination Mifepristone-misoprostol Package Inserts Obtained in 20 Countries
Medical abortion pills may be obtained outside of the formal health system and in this case the package insert may be the only piece of information available to end-users. It is therefore imperative that these package inserts contain current, evidence-based information. Our review of medical abortion package inserts collected in LIMCs revealed a wide variety of information provided. The outdated clinical information suggests a lack of adequate revision of these documents as evidence changes. Read more on ourwebsite.
Sensitivity and Specificity of Placental Proteins for Gestational Age Screening:
An Exploratory Study
Knowledge of gestational age (GA) is a key component of pregnancy care and in most settings, clinicians use ultrasound to confirm GA. However, ultrasound is expensive and time-consuming, must be performed by a trained technician, and is usually available only in specialized medical facilities. We explored the possibility that a blood or urine test could be used for this purpose. After collecting urine and serum samples from 245 pregnant people across gestational ages, we identified two placental proteins that could reliably identify pregnancies with GA >70 days, the current US GA limit for medical abortion, and exclude most earlier pregnancies. Read more on our website.
A Non-inferiority Study of Outpatient Mifepristone-misoprostol Medical Abortion
at 64-70 Days and 71-77 Days of Gestation
Medical abortion with mifepristone and misoprostol is increasingly used as an outpatient alternative to aspiration, but it is not offered beyond 10 weeks of pregnancy in many clinics and facilities as a first trimester option due to limited evidence. We sought to bridge the evidence gap about outpatient medical abortion in the later first trimester. Better information about how well a common medical abortion regimen works in the 11th week of pregnancy would be beneficial for health providers and for people who prefer to avoid aspiration procedures. If effective, it could increase access to safe abortion care where providers trained in aspiration are scarce.
We conducted a multi-center study to evaluate the success of mifepristone 200mg followed 24-48 hours later by misoprostol 800mcg buccally (in the cheeks) among people with 10 and 11 week pregnancies who were seeking abortion. In addition to method success, we assessed whether study participants were prepared to manage the procedure at home. Our findings show a very good chance of success, regardless of pregnancy age. Successful abortion occurred in 92.3% of the 10th week pregnancies (which is consistent with other published studies) and in 86.7% of the 11th week pregnancies. The reason for the lower success rate in the 11th week was because nearly 9% of pregnancies continued after using the medication regimen. Pain, bleeding and acceptability measures did not differ by pregnancy age, and participants were able to manage their expulsions at home without making calls to the clinic. This regimen could be a reasonable option for medical abortion users with 11 week pregnancies, given high success and acceptability, but the significant increase in continuing pregnancies is concerning. Forthcoming evidence will shed light on the potential role of an additional dose of misoprostol at 10 and 11 weeks of pregnancy.Read more on ourwebsite.
Mifepristone Pretreatment Followed by Misoprostol 200mcg Buccal for the
Medical Management of Intrauterine Fetal Death at 14-28 Weeks:
Fetal death may be managed surgically with dilatation and evacuation (D&E) or medical induction. However, surgery is often expensive in some settings and more difficult for more advanced pregnancies. Medical induction can be provided at a lower level facility by mid-level providers and in settings where surgical evacuation techniques are not available. The primary goal of this study was to determine whether mifepristone-misoprostol or placebo-misoprostol would result in a higher rate of complete expulsion of the fetus and the placenta within 48 hours of the start of misoprostol administration without any additional surgical intervention or medication (e.g. additional misoprostol doses or oxytocin).
Mifepristone-misoprostol did not result in a higher rate of complete expulsion of the fetus and the placenta within 48 hours of the start of misoprostol administration without any additional surgical intervention or medication than placebo-misoprostol. However, pretreatment with mifepristone followed by misoprostol bucally resulted in a shorter treatment time for medical management of fetal death than treatment with misoprostol alone. Pre-treatment with mifepristone may be more acceptable to women and providers by both reducing the length of hospital stay and the amount of misoprostol required. Read more on ourwebsite.
