Misoprostol a viable abortion pill option

Misoprostol alone appears to be safe and effective for termination of first trimester pregnancy and can be used if mifepristone is unavailable or inaccessible, according to a study.

Researchers conducted a systematic review and meta-analysis including studies that described outcomes of treatment with misoprostol-only for abortion of viable intrauterine pregnancy at ≤91 days of gestation.

Data about each group of patients treated with a distinct regimen were collected. Risk of bias was evaluated using four defined indicators. Meta-analytic methods were used to estimate the proportion of patients with treatment failure and the proportion hospitalized or transfused after treatment. The associations between treatment failure and selected characteristics of the groups were also evaluated.

A total of 49 papers with 66 groups that comprised 16,354 evaluable patients met the eligibility criteria and were included in the meta-analysis. Of these patients, 2,960 (meta-analytic estimate, 15 percent, 95 percent confidence interval [CI], 12–19) had treatment failures.

Of the 9,228 patients evaluated for ongoing pregnancy after treatment, 521 had treatment failure (meta-analytic estimate, 6 percent, 95 percent CI, 5–8). The risk of treatment failure was significantly associated with misoprostol dose, the total allowed number of doses, the maximum duration of dosing, and certain indicators of risk of bias.

Among 11,007 patients who were allowed to take at least three misoprostol doses—with the first dose consisting of misoprostol 800 mcg administered vaginally, sublingually, or buccally—treatment failure occurred in 11 percent of patients (95 percent CI, 8–14).