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Hum. Reprod. Advance Access originally published online on May 5, 2005
Human Reproduction 2005 20(8):2348-2354; doi:10.1093/humrep/dei037
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions{at}oupjournals.org

A randomized trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion at 13–20 weeks gestation

Haitham Hamoda1,2, Premila W. Ashok1, Gillian M.M. Flett1 and Allan Templeton1

1 Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Foresterhill, Aberdeen AB25 2ZD, UK

2 To whom correspondence should be addressed. Email: ogy262{at}abdn.ac.uk

BACKGROUND: Several studies have now reported the successful use of the sublingual administration of misoprostol for medical abortion in the first trimester. The objective of this study was to assess the acceptability to women, the efficacy of the regimen, as well as the acceptability to staff of sublingual versus vaginal administration of misoprostol following mifepristone for medical abortion at 13–20 weeks gestation. METHODS: Women were randomized by opening consecutive sealed envelopes generated using random number tables. Mifepristone (200 mg) was followed 36–48 h later by sublingual administration of misoprostol 600 µg or vaginal misoprostol 800 µg. This was followed by 3 hourly doses of misoprostol 400 µg administered sublingually or vaginally. RESULTS: A total of 76 women were randomized. Of women in the sublingual group, 24 (66.7%) expressed satisfaction with the route of misoprostol administration compared with 25 (62.5%) in the vaginal group. A higher proportion in the sublingual group used intramuscular opiates. There was no significant difference in the surgical evacuation rate between the sublingual (three out of 36 women, 8.3%) and vaginal groups (one out of 40, 2.5%), (P=0.26) and acceptability to staff was the same for both methods. CONCLUSIONS: Sublingual administration of misoprostol following mifepristone is an acceptable and effective alternative to vaginal administration for medical abortion at 13–20 weeks gestation. However, women should be advised about the greater likelihood of requiring stronger analgesia.

Key words: medical abortion/midtrimester/mifepristone/misoprostol/sublingual


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