Browsing by Subject "Medical Abortion"

Introduction: Little is known concerning the optimal misoprostol loading dose following mifepristone pretreatment in late first trimester medical abortion. We examined the efficacy, total dose of misoprostol needed, length of hospital stay, need for analgesia, and complications of two misoprostol loading doses (400 vs. 800 mcg) in late first trimester medical abortion. Materials and methods: This retrospective sequential cohort study compared misoprostol loading doses of 400 mcg and 800 mcg among women requesting medical abortion at 9–12 weeks of gestation in Helsinki University Hospital, Finland. Results: Altogether, 413 women received the 400-mcg and 287 women the 800-mcg loading dose of misoprostol. The median fetal expulsion time was 357 minutes (IQR 285–475) following the 400-mcg and 311 minutes (210–419) following the 800-mcg loading dose (p<0.01). The median length of hospital stay was 515 min vs. 520 min (p = 0.79). The total amount of misoprostol administered was 1200 mcg vs.1600 mcg (p < 0.01), respectively. Fewer women in the 400-mcg misoprostol group needed analgesia using strong opioids (150 [36.5%] vs. 133 [46.3%], p < 0.01) than women in the 800-mcg misoprostol group. The need for surgical evacuation was lower in the 400-mcg than the 800-mcg group (51 [12.4%] vs. 53 [18.5%], p = 0.03). Conclusions: A misoprostol loading dose of 800 mcg associates with a shorter fetal expulsion time compared to a loading dose of 400 mcg. However, a higher loading dose increases the need for strong opioids and the risk of surgical evacuation.