Mifepristone and misoprostol for cervical ripening in surgical abortion ă between 12 and 14 weeks of gestation: a randomized controlled trial

Objective: Misoprostol and mifepristone are the two substances ă recommended for cervical preparation during first -trimester surgical ă abortions to decrease intraoperative bleeding and complications. The ă objective of the study was to evaluate whether the combination of ă mifepristone and misoprostol for cervical preparation in an elective ă surgical abortion between 12 and 14 weeks of gestation can reduce blood ă loss in comparison to misoprostol or mifepristone alone. ă Study design: A randomized controlled trial was performed in Marseille, ă France between May 2013 and May 2014. Women requesting a surgical ă abortion under general anesthesia between 12 and 14 weeks of gestation ă were 198, randomized into three groups: one received 400 mu g oral ă misoprostol 3 h before surgery, one 200 mg oral mifepristone 36 h before ă surgery, and the other, both treatments. The main outcome was the ă quantity of intraoperative bleeding. The secondary outcomes were ă duration of intervention, ease of dilatation, and complications. ă Results: The quantity of intraoperative bleeding differed significantly ă between the groups (p = 0.001): 222 +/- 64 mL in the combination group, ă 329 +/- 129 mL in the misoprostol group, and 276 +/- 119 mL in the ă mifepristone group. The combination was associated with a shorter ă operative duration (p = 0.001): 5 +/- 2 min in the combination group, 7 ă +/- 5 min in the misoprostol group, and 7 +/- 3 min in the mifepristone ă group. A hemorrhage was observed for 5 of 55 women (9%) in the ă combination group, 13 of 51(25%) in the misoprostol group, and 9 of 56 ă (16%) in the mifepristone group (p = 0.08). No cervical laceration or ă uterine perforation was reported. ă Conclusions: The combination of mifepristone and misoprostol in cervical ă preparation for elective surgical abortions between 12 and 14 weeks of ă gestation significantly reduced blood loss in comparison to misoprostol ă or mifepristone alone. (C) 2016 Elsevier Ireland Ltd. All rights ă reserved.