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Hum. Reprod. Advance Access published online on July 29, 2005
Human Reproduction, doi:10.1093/humrep/dei216
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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.
Received April 22, 2005
Revised June 15, 2005
Accepted June 17, 2005

Article

The effect of non-steroidal anti-inflammatory drugs on medical abortion with mifepristone and misoprostol at 13-22 weeks gestation

C. Fiala 1*, M.L. Swahn 2, O. Stephansson 3, and K. Gemzell-Danielsson 4

1 Department of Woman and Child Health, Clinical Epidemiology Unit, Karolinska Institute, 171 76 Stockholm, Sweden; Department of Gynmed Ambulatorium, 1150 Vienna, Austria
2 Department of Clinical Sciences, Division for Obstetrics and Gynaecology, Clinical Epidemiology Unit, Karolinska Institute, 171 76 Stockholm, Sweden
3 Department of Woman and Child Health, Clinical Epidemiology Unit, Karolinska Institute, 171 76 Stockholm, Sweden; Department of Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, 171 76 Stockholm, Sweden
4 Department of Woman and Child Health, Clinical Epidemiology Unit, Karolinska Institute, 171 76 Stockholm, Sweden

* To whom correspondence should be addressed.
C. Fiala, E-mail: christian.fiala{at}aon.at


  Abstract

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins and concerns have been expressed that they might attenuate the effects of exogenous prostaglandins. This randomized study was conducted to evaluate whether NSAID given during medical abortion with mifepristone/misoprostol in the second trimester has a negative effect on the efficacy of the abortifacient by prolonging the induction-to-abortion interval. METHODS: Seventy-four women were treated with the anti-progesterone mifepristone, followed by repeated doses of misoprostol 36-48 h later. They were randomized to receive a prophylactic pain treatment of either paracetamol and codeine or diclofenac with the first dose of misoprostol. RESULTS: Cotreatment of NSAID with misoprostol did not attenuate the efficacy of mifepristone and misoprostol. There was no significant difference between the NSAID and the non-NSAID group in the induction-to-abortion interval (5.4 versus 6.5 h) or the total doses of misoprostol needed (2 versus 3). The frequency of surgical intervention was similar (55.6 versus 52.6%). Women in the group treated with NSAID required significantly less opiates (P = 0.042). CONCLUSION: Co-treatment with NSAID and misoprostol does not interfere with the action of mifepristone and/or misoprostol to induce uterine contractions and pregnancy expulsion in medical abortion. Prophylactic NSAID administration reduces the need for opiate injections.

Keywords: medical abortion/misoprostol/non-steroidal anti-inflammatory drug/pain relief/second trimester.
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