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Mifepristone-Misoprostol Use for Second- and Third-Trimester Medical Termination of Pregnancy in a Canadian Tertiary Care Centre

Published:January 31, 2022DOI:https://doi.org/10.1016/j.jogc.2021.12.010

      Abstract

      Objective

      This study aims to evaluate the impact of the implementation a mifepristone-misoprostol protocol (MIFE/MISO) on the induction-to-expulsion interval in the context of second- and third-trimester pregnancy termination or intrauterine fetal death (IUFD) compared with misoprostol alone (MISO), and to share the experience of a Canadian tertiary hospital concerning the feasibility and safety of such a protocol.

      Methods

      This is a single-centre retrospective pre–post cohort study carried out at the Centre Hospitalier Universitaire (CHU) Sainte-Justine between 2017 and 2019. Women in the MIFE/MISO group were instructed to take mifepristone 24-48 hours before induction. Induction in the MIFE/MISO group was performed with misoprostol dosages adjusted to gestational age and the presence of previous uterine scars, while, in the MISO group, all patients received 400 μg of misoprostol vaginally every 4 hours.

      Results

      Ninety-four patients were included in the MIFE/MISO group and 103 patients, in the MISO group. Median time to expulsion was significantly lower in the MIFE/MISO group than the MISO group (13.5 and 19.5 h respectively; P < 0.001). The total dose of misoprostol administered was significantly lower in the MIFE/MISO group than the MISO group, and adverse effects were reported in 60% and 82% of patient records, respectively (P < 0.001). Complication rates were similar between the 2 groups.

      Conclusion

      The MIFE/MISO protocol is highly effective for second- and third-trimester induction for pregnancy termination or IUFD, without increasing complication rates and with fewer reported adverse effects. Its implementation is safe and feasible in a tertiary medical centre.

      Résumé

      Objectif

      Cette étude cherche à évaluer l’effet de la mise en œuvre d’un protocole mifépristone-misoprostol (MIFE-MISO) sur le délai déclenchement-expulsion en contexte d’interruption de grossesse ou de mort fœtale intra-utérine (MFIU) au deuxième ou troisième trimestre par comparaison au misoprostol seul (MISO). L’étude vise aussi à diffuser l’expérience d’un hôpital de soins tertiaires canadien en ce qui concerne la faisabilité et l’innocuité d’un tel protocole.

      Méthodologie

      Il s’agit d’une étude de cohorte rétrospective monocentrique menée au Centre hospitalier universitaire (CHU) Sainte-Justine de 2017 à 2019. Les patientes du groupe MIFE-MISO ont reçu l’instruction de prendre la mifépristone 24 à 48 heures avant le déclenchement du travail. Le déclenchement du travail pour ce groupe a été effectué en utilisant une dose de misoprostol adaptée en fonction de l’âge gestationnel et de la présence de cicatrices utérines préexistantes. Dans le groupe MISO, toutes les patientes ont reçu 400 mcg de misoprostol par voie vaginale toutes les 4 heures.

      Résultats

      Le groupe MIFE-MISO comptait 94 patientes; le groupe MISO en comptait 103. Le délai déclenchement-expulsion médian était significativement plus court dans le groupe MIFE-MISO que dans le groupe MISO (13,5 et 19,5 h respectivement; p < 0,001). La dose totale de misoprostol était significativement plus faible dans le groupe MIFE-MISO, et des effets indésirables ont été rapportés dans 60 % (MIFE-MISO) et 82 % (MISO) des dossiers de patientes (p < 0,001). Le taux de complications était comparable entre les deux groupes.

      Conclusion

      Le protocole MIFE-MISO est très efficace pour le déclenchement du travail en cas d’interruption de grossesse ou de MFIU au deuxième ou troisième trimestre, sans augmenter le taux de complications tout en ayant moins d’effets indésirables rapportés. La mise en œuvre de ce protocole est sécuritaire et réalisable dans un centre de soins tertiaires.

      Keywords

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