Clinical Applications of Mifepristone (RU486) and Other Antiprogestins Assessing the Science and Recommending a Research Agenda (1993) / Chapter Skim
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Uses of Antiprogestins: The Reproductive Cycle (Part II)
Uses of Antiprogestins: The Reproductive Cycle (Part II)
Pages 26-35
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From page 26... ...
First, the frequency of successful complete abortion using mifepristone decreased with advancing age of the fetus, with approximately a 60 to 70 percent incidence of complete abortion up to eight weeks. Second, there appeared to be no relationship between the success rate and the treatment regime employed for women at the same stage of gestation.
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From page 27... ...
Uterine pain is common, especially in the first few hours following prostaglandin treatment, with approximately 30 percent of women requiring an analgesic and another 30 percent requiring a narcotic. In a large study in France, serious cardiovascular side effects following prostaglandin administration (sulprostone injection)
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From page 28... ...
In addition, uterine cramping or discomfort was reported to be far less than that experienced with injectable or vaginal prostaglandins, with only 16 percent of patients requiring analgesia and 0.1 percent requiring narcotics. A recent dose-finding study using 200, 400, and 600 mg of mifepristone suggests that doses as low as 200 mg are equally efficacious in inducing f~rst-trimester abortion (Van Look et al., in press)
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From page 29... ...
However, the United States has a very different health care system in which access to reproductive health care is a major problem. Research can help clarify how to increase access to a medical program for terminating pregnancy, as well as provide benefit-cost analyses comparing the medical procedure to surgical termination of pregnancy.
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From page 30... ...
has found widespread patient acceptability in Europe (David, 1992; Winikoff et al., 1992) , the committee suggests additional studies to determine appropriate protocols for this country, which may vary from those used elsewhere.
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From page 31... ...
The alternative surgical procedure of D&E, although widely used, requires highly skilled technical ability, which may not be available in all clinical settings. A series of clinical trials has been performed to study the efficacy of mifepristone treatment before prostaglandin administration for second-trimester pregnancy termination to determine whether smaller doses of prostaglandin following mifepristone are as effective as larger doses of prostaglandin alone.
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From page 32... ...
Several studies documenting the ability of antiprogestins to induce cervical maturation and ripening before vacuum aspiration have shown a significant effect 24 to 48 hours after mifepristone administration (Ulmann and Silvestre, Appendix By. A dosefinding Canadian study using placebo or 100, 200, 400, or 600 mg of mifepristone as a single dose, administered 24 or 48 hours before cervical calibration, showed a significant increase in cervical diameter that was linearly related to dose up to 400 mg (Lefebvre et al., 1990~.
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From page 33... ...
IABOR INDUCTION IN IATE PREGNANCY In addition to its possible use in cervical ripening in preparation for labor induction, mifepristone may also be useful in inducing labor, for instance in cases of intrauterine fetal demise and during late pregnancy when the medical complications require prompt delivery. Fetal Demise Fetal demise is an unfortunate occurrence in both second- and third-trimester pregnancies, and requires evacuation of the uterus.
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From page 34... ...
. The application of mifepristone for cervical ripening at term, and for labor induction in late pregnancy when medical complications require it, has been tested and shows promise.
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From page 35... ...
Effet d'un steroide antiprogestine chez la femme interruption du cycle menstrual et de la grossesse au debut. Comptes Rendus Hebdomadaires des Seances de l'Academie des Sciences (Paris)
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