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Abstracts on Medical Abortion

Section 2. Abortion technologies.

2-3. Articles on medical abortion in Journal of the American Medical Women's Association (JAMWA) 2000;55(3): Supplement

(only the name of the first author is shown)

  • 1. Baird DT. Mode of action of medical methods of abortion.

    J Am Med Wom Assoc 2000;55:121-6.

    Several pharmacologic agents capable of inducing abortion have become available in the last 20 years. Prostaglandins cause powerful contractions of the uterus that lead eventually to expulsion of the fetal or embryonic tissue, but their effects on smooth muscle elsewhere in the body lead to such troublesome side effects as vomiting and diarrhea. Antimetabolites such as methotrexate inhibit DNA synthesis in rapidly dividing cells such as the trophoblast, resulting in release of prostaglandins and cytokines, extravasation of blood into the decidua, uterine contractions, and expulsion of embryonic or fetal tissue.

    Drugs that inhibit the synthesis of progesterone (epostane) or block its receptor (mifepristone) reverse the dominant influence of progesterone during pregnancy. As a result, a cascade of events is initiated, including influx of leukocytes and red blood cells into the decidua, release of prostaglandins and cytokines, and uterine contractions. Addition of uterotonic agents such as prostaglandins results in powerful uterine contractions, which supplement those induced by the withdrawal of progesterone. Because these methods reproduce many of the same physiological changes, clinical management of medical abortion is similar to that of spontaneous abortion. These methods provide a useful alternative to surgical abortion in early pregnancy.
    (Abortifacient Agents, Nonsteroidal); (Cytokines); (Prostaglandins); 57-83-0 (Progesterone); 59-05-2 Methotrexate); 9007-49-2 (DNA);

  • 2. Blanchard K.

    Misoprostol alone--a new method of medical abortion?

    J Am Med Wom Assoc 2000;55:189-90.

    Misoprostol shows promise for early termination of pregnancy. The drug is widely available, inexpensive, and easy to administer. Current evidence on the efficacy of potential regimens for early abortion, though, is hard to decipher and often contradictory. Research on a safe, effective, acceptable regimen of misoprostol alone for early abortion is underway. Available data show a wide range in efficacy of various regimens, and additional research is needed to understand this variability.

    A framework for additional research on misoprostol alone for medical abortion is presented with a focus on the need to evaluate benefits and risks of new regimens in the context of women's options for termination of pregnancy. We discuss the potential usefulness of a regimen with less efficacy than approved medical abortifacients. Research is needed as well on women's ability to self-diagnose incomplete abortion or ongoing pregnancy and the potential for misoprostol to be used as treatment for incomplete abortion in order to evaluate the benefits and risks of misoprostol-alone regimens.
    0 (Abortifacient Agents, Nonsteroidal); 59122-46-2 (Misoprostol);

    3. Borgatta L.

    Instituting medical abortion services: changes in outcome and acceptability related to provider experience.

    J Am Med Wom Assoc 2000;55:173-6.

    A prospective case series carried out at 34 Planned Parenthood sites studied the safety, efficacy, and acceptability of medical abortion with methotrexate and misoprostol in 1973 women. Women with pregnancies of 26 to 49 gestational days were given methotrexate followed by vaginal misoprostol. Eighty-one percent of women had documented complete medical abortions; abortion was not confirmed by examination in 6%, and 13% had documented suction curettage. The rate of suction curettage decreased with site experience, from 17% during the first 20 procedures to 10% at sites that had performed more than 50.

    Sites that had previous experience with either methotrexate or mifepristone medical abortion had a rate of 9% after they had performed at least 50 procedures. Exit interviews with 755 of the 902 women having abortions in the first year inquired about the level of comfort with the abortion and its overall acceptability. Women's satisfaction with the side effects did not directly correlate with site experience. Overall satisfaction with the abortion experience was related to whether the women had complete medical abortions or suction curettage.
    (Abortifacient Agents, Nonsteroidal); 59-05-2 (Methotrexate); 59122-46-2 (Misoprostol);

  • 4. Breitbart V.

    The counseling component of medical abortion.

    J Am Med Wom Assoc 2000;55:164-6.

    OBJECTIVE: To investigate the specifics of counseling for medical abortion. METHODS: We used both self-administered surveys and semi-structured interviews to collect information from 77 medical abortion providers working in 56 sites. Providers were asked about staff training needs, the essential factors to be stressed in counseling, the time involved, and how counseling for medical abortion compares to counseling for surgical.

    RESULTS: Providers reported that counseling for medical abortion took longer than for surgical and that the time medical abortion takes to complete was the most important element to convey. The majority of respondents considered direct experience with patients to be the most effective form of training. CONCLUSION: This article presents some practical information and strategies for providers and clinic administrators interested in adding medical abortion to their services.
    ;Abortion, Induced/methods; Adult; Counseling; Female; Health Care Surveys; Human; Male; Physician's Role; Physician-Patient Relations; Pregnancy; Time Factors;

  • 5. Bygdeman M.

    Medical termination of early pregnancy: the Swedish experience.

    J Am Med Wom Assoc 2000;55:195-6

    Abortion has been legal up to the 22nd week of gestation in Sweden since 1975. Most women terminate their pregnancies early; 96% before the 12th week and 75% in less than 63 days. Termination of early pregnancy (up to 63 days' gestation) using mifepristone followed by gemeprost was approved in Sweden in 1992. Use of the medical method has slowly but steadily increased since then. Currently about 40% of the women eligible for the procedure choose it. Both the surgical (vacuum aspiration) and the medical methods are regarded as effective and safe. The medical method will not replace vacuum aspiration, but be an alternative to it.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 64318-79-2 (gemeprost); 745-65-3 (Alprostadil); 84371-65-3 (Mifepristone);

  • 6. Clark S.

    Is medical abortion acceptable to all American women: the impact of sociodemographic characteristics on the acceptability of mifepristone-misoprostol abortion.

    J Am Med Wom Assoc 2000;55:177-82.

    OBJECTIVE: To determine whether mifepristone-misoprostol medical abortion is more acceptable to some American women than to others. METHODS: Using previously reported acceptability data from a large US multicenter study (n = 2121), we conducted a more detailed analysis to test whether characteristics such as race/ethnicity, education, age, gestational age, and geographic location affect acceptability. RESULTS: In the United States, Asian women were more than twice as likely as other women to choose this method because they believed it was safer, while white women were twice as likely to select it because they considered it more natural. More educated women were likely to select this method to show support for greater choice and were more pleased about being able to avoid surgery.

    Particular features of the protocol also appealed to different women. White and African-American women as well as women with more education would feel significantly more comfortable taking one or both of the drugs at home than they would in the clinic. Nearly all groups of women were equally satisfied with this method and found it highly acceptable. The data showed surprisingly few differences among women's overall satisfaction level, their willingness to choose the method again, or to recommend it to others. CONCLUSION: Mifepristone-misoprostol medical abortion has widespread appeal to a broad range of women, but different women choose and prefer this method for different reasons.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 59122-46-2 (Misoprostol); 84371-65-3 (Mifepristone);

  • 7. Coyaji K.

    Early medical abortion in India: three studies and their implications for abortion services.

    J Am Med Wom Assoc 2000;55:191-4.

    Although legal in India, abortion is frequently performed under unsafe or undesirable conditions. Moreover, the advancements required to make surgical abortion safe in India appear insurmountable in the near future. Because it requires a less extensive infrastructure than surgical abortion, medical abortion offers great potential for improving abortion access and safety now. To examine the feasibility of introducing medical abortion and to assess its potential as an alternative to surgical abortion, we conducted three separate studies on the use of 600 mg mifepristone and 400 micrograms oral misoprostol for medical abortion.

    Study 1 focused on the safety, efficacy, and feasibility of the standard French, three-visit protocol and was conducted in urban research centers in China, Cuba, and India. Study 2 liberalized the protocol to collect information from women using the method under more "real life" conditions in urban family planning clinics in India. Lastly, study 3 extended the trial to rural Indian villages to examine feasibility in settings typical of where the majority of the population resides.

    In all three settings in India mifepristone-misoprostol proved to be not only feasible, but safe and acceptable as well. With some changes to current protocols, medical abortion could now be safely phased into the existing health care infrastructure in India. Yet, medical abortion will bring its own set of service delivery challenges to address.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 59122-46-2 (Misoprostol); 84371-65-3 ifepristone);

  • 8. Creinin MD.

    Medical abortion alternatives to mifepristone.

    J Am Med Wom Assoc 2000;55:127-32

    Social and political constraints have prohibited the use of mifepristone in most countries. As a result, researchers, clinicians, and women throughout the world have pushed for the development of alternative medical abortion regimens. Methotrexate (both oral and intramuscular) combined with misoprostol has been under investigation since 1993, with complete abortion rates similar to mifepristone regimens for pregnancies up to 49 days' gestation. Thousands of women have had safe medical abortions in their own homes using these medications. The overall abortion process using methotrexate and misoprostol takes longer, however, with 20% to 30% of women waiting up to five weeks for the abortion to occur.

    More recently, misoprostol-only regimens have been proposed for medical termination of pregnancy. The efficacy of these misoprostol regimens has been reported in the same range as those combining mifepristone or methotrexate with misoprostol, although other investigators have been unable to confirm these results. Additionally, a few small studies have tested tamoxifen combined with misoprostol, with mixed results. Continued research is necessary to ensure that reported efficacy rates for all proven medical abortion regimens are true for various populations of women.
    (Abortifacient Agents, Nonsteroidal); 59-05-2 (Methotrexate); 59122-46-2 (Misoprostol);

  • 9. Davis A.

    Bleeding patterns after early abortion with mifepristone and misoprostol or manual vacuum aspiration.

    J Am Med Wom Assoc 2000;55:141-4.

    OBJECTIVE: To prospectively determine patterns and predictors of bleeding after early abortion with mifepristone and misoprostol or manual vacuum aspiration (MVA). METHODS: Women fewer than 63 days from the last menstrual period and desiring termination of pregnancy were offered medical abortion with 200 mg oral mifepristone and 800 micrograms oral misoprostol or MVA under local anesthesia. Women completed a bleeding diary during the six weeks after abortion. Telephone calls were used to encourage diary completion and determine contraception use.

    RESULTS: 212 women were enrolled, 80% of whom completed diaries. Mean days of bleeding was higher in the medical (14 days) than MVA (9 days) group, but days of spotting (about 10) was similar in both groups. Increasing gestational age predicted more bleeding or spotting days after medical, but not MVA, abortion. Prolonged bleeding was not rare and was more common in the medical than the surgical abortion group. Combined oral contraceptive (COC) users and non-COC users had similar bleeding patterns after medical or surgical abortion.

    CONCLUSION: Bleeding after early medical abortion persists longer than after MVA and continues longer than previously appreciated regardless of method. Oral contraceptive use does not decrease bleeding after early medical or surgical abortion.
    59122-46-2 (Misoprostol); 84371-65-3 (Mifepristone);

  • 10. Elul B.

    In-depth interviews with medical abortion clients: thoughts on the method and home administration of misoprostol.

    J Am Med Wom Assoc 2000;55:169-72.

    OBJECTIVE: To document women's experiences with a home-use mifepristone-misoprostol medical abortion regimen. METHODS: We conducted in-depth interviews (n = 22) with women who received abortions in the New York City clinic of the ongoing Abortion Rights Mobilization clinical trial. Women received 200 micrograms mifepristone in the clinic and were randomized to self-administer 800 micrograms misoprostol vaginally at home either 24, 48, or 72 hours later. One week later, after their follow-up visits, women were asked to describe their experiences in their own words.

    RESULTS: The overwhelming majority of women found the home-use regimen acceptable. Nearly all said that they would not have preferred to return to the clinic for misoprostol, and many stated that the home-use option was the principal appeal of medical abortion. Women described the medical procedure as "natural," private, and noninvasive, and, when describing their physical experiences, noted that the side effects were more tolerable in the comfort of their homes with someone familiar nearby for support. Additionally, most women felt prepared for the experience they encountered and competent in assessing any problems that arose.

    CONCLUSION: Home use of misoprostol affords women more flexibility, privacy, and control in their abortions, ultimately allowing them to seek their own comfort level.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 59122-46-2 (Misoprostol); 84371-65-3 (Mifepristone);

  • 11. Harvey SM.

    Experiences and satisfaction with providing methotrexate-induced abortions among US providers.

    J Am Med Wom Assoc 2000;55:161-3.

    OBJECTIVE: This study examined the acceptability of and experiences with methotrexate as an abortifacient among health care providers in the United States. METHODS: Seventy-six telephone interviews were conducted with providers (28% physicians, 13% midlevel providers, 29% administrators, and 30% counselors/other medical staff) of methotrexate-induced abortions during May and June of 1997. We examined provider satisfaction and several key operational issues relative to medical abortion, including: time spent with patients and staffing, training, and space needs.

    RESULTS: The majority of providers agreed that overall, more time was spent with methotrexate than with surgical abortion patients. Most agreed that the number of staff needed was the same for both methods, and that methotrexate required less office space. There were differing views on whether methotrexate required more, an equal amount of, or less training than surgical. Overall, providers were satisfied with methotrexate as an abortifacient. CONCLUSION: These data suggest that as knowledge of the method spreads, more providers will add this technique to their services.
    (Abortifacient Agents, Nonsteroidal); 59-05-2 (Methotrexate);

  • 12. Joffe C.

    Medical abortion and the potential for new abortion providers: a cautionary tale.

    J Am Med Wom Assoc 2000;55:151-4.

    The prochoice movement has expressed much hope that medical abortion will increase the pool of abortion providers because it does not require surgical training and does not need to be performed in specialized settings. By offering a detailed case study of the events surrounding a methotrexate abortion in a rural community health center by a family practice physician who had not previously performed surgical abortion, this article suggests that the diffusion of medical abortion to new providers and new settings may be more complex than some have suggested.

    The article illustrates that abortion is not only a medical procedure, but also a social process involving relations with large, often unfriendly bureaucracies as well as with the local community in which the abortion takes place. While still retaining optimism that medical abortion will ultimately increase the number of providers and hence increase access to abortion, the author believes that such a change will be considerably more gradual than commonly thought.
    (Abortifacient Agents, Nonsteroidal); 59-05-2 (Methotrexate);

  • 13. Jones BS. Providing medical abortion: legal issues of relevance to providers.

    J Am Med Wom Assoc 2000;55:145-50.

    As early medical abortion becomes more widely used and available in the United States, providers of women's health care are questioning whether, and in what way, existing abortion restrictions apply to medical abortion. Many of these laws, virtually all of which were written before early medical abortion was widely used in this country, make little sense in the context of medical abortion. Nonetheless, most abortion restrictions are broadly written and could be interpreted by state officials to apply to providers of medical abortion.

    This paper identifies and briefly describes common types of abortion restrictions, including physician-only laws, targeted regulation of abortion providers, fetal tissue examination and disposal laws, parental involvement requirements, and mandatory waiting periods, and explains the extent to which these types of requirements may be enforced against providers of medical abortion. In addition, because some abortion restrictions are irrational or impose significant and unwarranted burdens on women's access when applied to medical abortion, they may be vulnerable to legal challenge. We also review possible legal efforts to invalidate these laws, as well as legislative or regulatory changes that can be sought in order to make medical abortion truly accessible to women in this country.
    Abortion, Induced/methods; Abortion, Legal; Female; Fetus; Health Services Accessibility; Human; Informed Consent; Physician's Role; Pregnancy; Third-Party Consent; Women's Health;

  • 14. Koenig JD.

    Are US health professionals likely to prescribe mifepristone or methotrexate?

    J Am Med Wom Assoc 2000;55:155-60.

    OBJECTIVE: To determine US health professionals' knowledge, attitudes, and practices regarding mifepristone and methotrexate as abortifacients. METHODS: In 1997, we conducted a nationally representative telephone survey of US obstetrician/gynecologists (OBs), family practice physicians (FPs), nurse practitioners (NPs), and physician assistants (PAs).

    RESULTS: Most health professionals surveyed considered themselves at least "somewhat familiar" with mifepristone or methotrexate, but few reported being "very familiar" with the methods. OBs were most likely to report being familiar with mifepristone (79%), followed by NPs/PAs (73%), and FPs (62%). FPs and NPs/PAs reported being less familiar with methotrexate than with mifepristone. If mifepristone were approved by the Food Drug Administration (FDA), 54% of OBs said they would be "very" or "somewhat" likely to prescribe the drug for abortion, including 35% of OBs who do not perform surgical abortions currently. About half of FPs and NPs/PAs were interested in offering mifepristone if approved by the FDA. Few health professionals reported ever having prescribed methotrexate for abortion.

    CONCLUSION: The providers most likely to express interest in offering medical alternatives were OBs who reported they "ever perform surgical abortions." Many health professionals who said they do not perform surgical abortions also said they would be interested in prescribing mifepristone, indicating a potential expansion of the number of health professionals who will provide abortion services. Medical protocol and legal issues may inhibit or slow expansion of the pool of providers offering medical abortion.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 59-05-2 (Methotrexate); 84371-65-3 (Mifepristone);

  • 15. Koonin LM.
    Abortion reporting in the era of medical procedures: why is it important?

    J Am Med Wom Assoc 2000;55:203-4.

    Food and Drug Administration approval of mifepristone and the subsequent widespread use of medical abortion will change the patterns and practice of abortion services in this country. Accurate monitoring of new, nonsurgical abortion techniques will be critical as this change takes place. Providers will want to know which women will be the predominant users of medical versus surgical methods. If medical procedures are used widely, the national trend in gestational age at the time of abortion is likely to change because medical procedures are usually performed early (at less than eight weeks' gestation).

    New and existing abortion providers must be informed about the reporting statutes and requirements in their areas.

    Information and instructions for reporting abortions are available from the vital statistics offices in each state health department and the health departments of New York City and the District of Columbia. Ongoing comprehensive monitoring of legal induced abortion is needed in all states to determine the number of procedures performed, the characteristics of women who obtain them, and the evolving trends in procedures.
    (Abortifacient Agents, Steroidal); 84371-65-3 (Mifepristone);

  • 16. Kruse B.

    Advanced practice clinicians and medical abortion: increasing access to care.

    J Am Med Wom Assoc 2000;55:167-8.

    Early abortion is one of the safest and most common surgical procedures in the United States, yet it carries a significant stigma for both women and health care providers. Due to a number of factors, including political maneuvering and antichoice violence, the availability of physicians trained and willing to provide abortion has decreased dramatically over the past decades, thereby compounding the obstacles to early termination of pregnancy. At the same time, roles for nurse-midwives, nurse practitioners, and physician assistants have expanded in primary care as well as in specialty practice.

    Medical abortion is generating renewed interest in abortion care and is potentially more accessible to providers of primary care, women's health, and family planning services. Its provision by qualified advanced practice clinicians working with their physician colleagues promises to significantly improve the delivery of abortion services to women.
    Abortion, Induced/methods; Female; Health Services Accessibility; Human; Interprofessional Relations; Nurse Midwives; Nurse Practitioners; Physician Assistants; Pregnancy; Primary Health Care; United States; Women's Health;

  • 17. Pollack AE.

    Opening a door to safe abortion: international perspectives on medical abortifacient use.

    J Am Med Wom Assoc 2000;55:186-8.

    International experience compels us to revisit how we define and assess the safety and efficacy of medical abortifacients such as misoprostol. In some countries where safe abortion is neither accessible nor legal, even unsupervised, off-protocol use of misoprostol can provide women with a means to safely terminate pregnancy.

    This is due primarily to misoprostol-induced uterine contractions that cause bleeding, which in turn provides access to existing reasonable quality health services that would otherwise be unavailable. Several studies have suggested that an increase in the underground use of misoprostol in Brazil has already reduced serious complications from unsafe abortion. Thus, the availability of medical abortifacients combined with strengthened postabortion care services can legitimately be considered a public health success in countries in which safe abortion services do not exist and law reform is unlikely.
    (Abortifacient Agents, Nonsteroidal); 59122-46-2 (Misoprostol);

  • 18. Rosing MA.

    The knowledge, acceptability, and use of misoprostol for self-induced medical abortion in an urban US population.

    J Am Med Wom Assoc 2000;55:183-5.

    4 OBJECTIVE: To assess the knowledge, acceptability, and use of misoprostol as an abortifacient in a primarily Latina population in the United States. METHODS: This was a cross-sectional study of 610 women who used one of three obstetrics/gynecology clinics in New York City. Participants answered a self-administered questionnaire about their demographic and obstetrical characteristics; patterns of contraceptive use, including emergency contraception; general acceptability of abortion; perceptions of accessibility to abortion; prevalence of misoprostol use; and knowledge, attitudes, and availability of misoprostol.

    RESULTS: A substantial proportion (37%) of respondents admitted familiarity with the use of misoprostol as an abortifacient. The proportion of women who reported personal use of misoprostol (5%, 29/610) exceeded that reported in a large Brazilian prenatal care population (2.2%, 133/6102). Those who had taken misoprostol were more likely to have had abortions (p < 0.01), to be foreign born (p < 0.01), and to have known someone else who had used the drug (p < 0.01). Although the majority of women surveyed (73%) were Medicaid recipients, only half were aware that Medicaid covers abortion in New York State.

    CONCLUSION: The results of this descriptive study indicate a need to increase awareness of pre- and post-conception family planning methods and to remove barriers to access to these methods. Further research is essential to elucidate the knowledge and unsupervised use of misoprostol in other US populations.
    (Abortifacient Agents, Nonsteroidal); 59122-46-2 (Misoprostol);

  • 19. Schaff EA.

    A comparison of the Abortion Rights Mobilization and Population Council trials.

    J Am Med Wom Assoc 2000;55:137-40.

    We compared the published results of the 1994-1995 Population Council (PC) trial to those from the 1996-1997 Abortion Rights Mobilization (ARM) trial to determine whether 200 mg mifepristone with 800 micrograms vaginal misoprostol is more effective and has fewer side effects than 600 mg mifepristone with 400 micrograms oral misoprostol. The complete medical abortion rate was lower in the PC trial than the ARM trial: 92% compared with 97% up to 49 days LMP (p < 0.05) and 83% versus 96% from 50 to 56 days LMP (p < 0.05). Nausea and vomiting were reported more frequently in the PC trial.

    The overall acceptability of the procedure was lower in the PC trial (88%) than in the ARM trial (94%), (p < 0.05). Mifepristone can be reduced from 600 to 200 mg when followed by vaginal misoprostol without loss of efficacy. Vaginal misoprostol extends the efficacy to 56 days LMP and is associated with less nausea and vomiting. Home use of misoprostol is safe and acceptable to women and decreases the number of required visits from three to two in most cases.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 59122-46-2 (Misoprostol); 84371-65-3 (Mifepristone);

  • 20. Stewart F.

    Improving early options for abortion: it's time to stop waiting. J Am Med Wom Assoc 2000;55:115-6.

    Abortion, Induced/methods/trends; Female; Human; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Research/trends; Women's Health;

  • 21. von Hertzen H.

    Research on regimens for early medical abortion. J Am Med Wom Assoc 2000;55:133-6 150.

    Until recently the medical abortion regimen of mifepristone followed by a suitable prostaglandin analogue two days later has been available in only a few countries. Limited access to the drug has hampered research and forced investigators without access to seek alternatives. Where mifepristone has not been available, investigators have tested repeated doses of the prostaglandin misoprostol alone or in combination with methotrexate. However, these regimens cannot compete in efficacy, safety, and convenience with the mifepristone-prostaglandin regimen. The development of the mifepristone-prostaglandin regimen has continued since approval, and a more effective and better tolerated medical method than was available ten years ago can now be offered to women.

    Several randomized double-blind studies have demonstrated that the dose of mifepristone can be lowered to 200 mg, one-third of the original dose, without compromising efficacy. Misoprostol has now largely replaced other prostaglandin analogues in the regimen, and this has made medical abortion simpler and more cost effective. Although women prefer oral administration of drugs, recent evidence suggests that to achieve sufficient efficacy, misoprostol has to be administered vaginally in women beyond 49 days' gestation. This medical abortion regimen has proved to be acceptable to women and safe when provided under proper conditions.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 0

    (Prostaglandins); 59-05-2 (Methotrexate); 59122-46-2 (Misoprostol); 84371-65-3 (Mifepristone);

  • 22. Wu S.

    Medical abortion in China.

    J Am Med Wom Assoc 2000;55:197-9 204.

    This paper reviews the literature on early medical abortion in China. Mifepristone was approved for termination of pregnancy up to 49 days' gestation in China in 1986. The commonly accepted regimens are 150 mg mifepristone administered in several small doses or a single 200 mg dose followed by 0.6 mg oral misoprostol. Complete abortion rates are 90% to 97%. Ultrasound is strongly recommended to rule out ectopic pregnancy. Patients remain in the clinic for four to six hours after misoprostol. If the fetal sac is not expelled during the four-hour observation, the second dose of 0.4 mg misoprostol is given in many of the clinics.

    Rates of emergency curettage ranged from less than 1% to 4%, and rates of blood transfusion were less than 1%. The major complication of concern is undiagnosed ectopic pregnancy. The Chinese experience has shown that medical abortion is well accepted as an alternative to surgical intervention when provided under medical supervision and administrative monitoring.
    (Abortifacient Agents, Nonsteroidal); 0 (Abortifacient Agents, Steroidal); 59122-46-2 (Misoprostol); 84371-65-3 (Mifepristone);

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