TABLE B5.2 Clinical Management of Medical Abortion in Sweden

The clinical use of the combination of mifepristone and prostaglandin for termination of pregnancy is more regulated than most other medical procedures: (1) it may be prescribed only in centers registered for pregnancy termination (in Sweden by the National Board of Health and Welfare); (2) distribution of the drug is strictly controlled; and (3) each patient must sign a consent form indicating that she is aware that the method is not risk free and does not have a 100 percent success rate. The treatment includes four visits to the clinic (Table B5.2). The patient is seen by the physician at the initial visit and two weeks after the start of treatment to evaluate the outcome of the therapy. The nurse supervises the intake of mifepristone and the four- to six-hour observation period in the outpatient ward following prostaglandin therapy.

The ideal combination of mifepristone and prostaglandin remains to be established. Studies in both pregnant and nonpregnant women have shown that the pharmacokinetics of mifepristone are nonlinear and that oral administration of the drug in single doses greater than 100 mg results in serum concentrations that differ only minimally or not at all (for references, see Van Look and Bygdeman, 1989; Puri and Van Look, 1991). Multicenter trials conducted under the auspices of the World Health Organization have shown that the same effectiveness observed with 600 mg can be achieved with either repeated small doses of mifepristone (five doses of 25 mg given at 12-hour intervals) (WHO, 1991) or a single dose of 200 mg (WHO, to be published) if combined