Making unsafe abortion safe: medical method.

WHO reported 13.0% of maternal deaths are related to unsafe abortion in developing world. To improve this, medical method of abortion has been in clinical use for over a decade. The antiprogestogen mifepristone followed two days later by a prostaglandin analogue is registered as a medical alternative to surgical termination of early intra uterine pregnancy. Since registration of medical method, research has continued to improve the medical abortion. Multicentre trials have shown that 200 mg of mifepristone orally and 800 ug of misoprostol vaginally results in a higher complete abortion percentage (95.0%). The gold standard method at present is 200 mg mifepristone orally followed by 800 ug ofmisoprostol vaginally 48 hrs later gives 95.0 to 97.0% success rate. With much improvement and efficacy more women accept medical method for abortion with higher satisfaction and provide more privacy to women especially where social stigmas are attached to induced abortion. Use of drug is safe and non-invasive and training is simple and complications are minimal. This is important in developing world where limited trained personnels are available to perform surgical evacuation. The disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion and fear of uncertainty and side effects. The termination of pregnancy is legalised in Nepal now, these medicines could be made available in market.

Luteal phase contraception with mifepristone (RU 486) in the rhesus monkey.

Mifepristone (RU 486), an antiprogesterone, is a promising luteal phase contraceptive agent for human use. However, at present its use is limited by the practical constraint of determining the day of ovulation for an LH + 2 day administration of the drug as indicated from experimental and clinical studies. The aim of the present study was to identify the effective period of luteal phase (luteal phase window) when a single administration of mifepristone would induce antinidatory activity without disturbing menstrual cyclicity and ovulatory pattern in the rhesus monkey. RU 486 (2 mg/kg body weight in benzyl benzoate/olive oil, 1:3) was given to mated monkeys (n = 9) on cycle day 16 in the first treatment cycle (treatment group T1, n = 9), and in the following cycle on cycle day 20 (treatment group T2, n = 8). A single s.c. injection of this antiprogestin during early to midluteal phase (days 1-10 after ovulation, as determined from retrospective analysis of serum concentrations of estrogen and progesterone) provided a one hundred per cent protection against pregnancy, with no apparent side effects. There were no changes in cycle lengths (F = 3.5; P < 0.3), day of ovulation (F = 1.8; P < 0.7) and duration of menses (F = 3.5; P < 0.3) compared with the pre-treatment and post-treatment cycles. Pooled analyses of serum concentrations of estrogen and progesterone during luteal phases of T1 and T2 cycles also showed no variations with those in pre- and post-treatment cycles.(ABSTRACT TRUNCATED AT 250 WORDS)