Termination of second trimester pregnancy with mifepristone and gemeprost

Background. Earlier controlled clinical trials have demonstrated that combined treatment with the antiprogestagen, mifepristone and a suitable prostaglandin reduce the induction to abortion time in second trimester abortion. The aim of this study was to describe the results of the 197 consecutive second trimester terminations performed in routine clinical practice at our Department from 1996 to 1998. Methods. The report is based on 197 consecutive second trimester abortions including live pregnancies and missed abortions, carried out in 192 women. The women were treated with 600 mg mifepristone followed 24 to 48 hours later by 1 mg gemeprost administered every 6 hours four times. If abortion had not occurred, 1 mg gemeprost was administered every 3 hours for the next 12 hours. After expulsion of the fetus a surgical evacuation of the uterus was routinely performed up to 18 weeks gestation and thereafter when needed. The induction to abortion time was defined as the interval between the insertion of the first gemeprost pessary and expulsion of the fetus. Results. The median abortion time was 9.0 (1.4–40.5) hours for primigravidae and 7.2 (0–152.5) hours for multigravidae. The medium number of gemeprost pessaries to induce abortion was two and all except seven women aborted within 24 hours. Significantly more abortions occurred before 6, 7 and 8 hours in multigravidae than among primigravidae. The induction to abortion interval was also significantly shorter for nulliparous than for parous women. Except for one case of heavy bleeding, no serious complications occurred. Conclusion. The study confirms the efficacy and safety of mifepristone, together with gemeprost, for termination of second trimester pregnancy when routinely used in the clinic.