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ORAL REGIMEN RELIABLY TERMINATES EARLY PREGNANCY.

In 1982 it was reported that a progesterone antagonist -- mifepristone, or RU 486 -- could be given orally to terminate early pregnancy. After careful study, these investigators report the experience of 2040 women in France who used a single dose of RU 486 within 49 days of amenorrhea. This dose was followed 36 to 48 hours later by one of two prostaglandin analogues in different regimens.

Pregnancy was terminated in 96 percent of cases without major complication. Of the cases remaining, pregnancy persisted in 1 percent, incomplete expulsion of fetus and placenta (requiring vacuum aspiration) occurred in 2 percent, and 1 percent had significant bleeding requiring hemostatic procedures. Most women had abdominal pain; 34 percent, 15 percent, and 8 percent had nausea, vomiting, and diarrhea, respectively; none of the latter symptoms was severe enough to warrant treatment.

The combination of RU 486 and prostaglandins was more effective in terminating pregnancy than RU 486 alone, and the doses of prostaglandins required were much lower than those required when prostaglandins have been used alone. Though this combined regimen is widely used in France, it is unlikely to be available soon in the U.S., given FDA requirements for approval, and the politics involved.

— ALK

Published in Journal Watch General Medicine March 16, 1990

Citation(s):

Silvestre L et al. Voluntary interruption of pregnancy with mifepristone (RU 486) and a prostaglandin analogue: a large-scale French experience. N Engl J Med 1990 Mar 8 322 645-648.

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