OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

Moreira, M.; Martins, R.; Bombas, T.; Fernandes,T.; Moura, P. G.R. Fetal Maternal Medicine Department Coimbra University Hospital Pitorra, M.; Almeida, M. Bissaya Barreto’s Maternity Coimbra Hospital Center

PORTUGAL

8th Conference FIAPAC Berlin, 2008/10/25 OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

AbortionAbortion • In no case should be promoted as a method

• Women should have access to quality services for the management of complications arising from abortion WHO, Cairo OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage AbortionAbortion inin PortugalPortugal

• Since 16th of July of 2007, abortion is legal by women request before 10 weeks. • The protocols (Surgical / Medical) used have been done by Health Minister according to WHO recommendations. – Medical Protocol: • Before 8 w – 200 mg oral – 36 – 48hr later Æ 400 mcg vaginal • 8- 10 weeks – Mifepristone 200 mg oral – 36 – 48 hrs later ÆMisoprostol 800 mcg vaginal – Surgical protocol: •

OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

AbortionAbortion inin PortugalPortugal • 1st Appointment – clinical history – ultrasound

• ≥3 days reflection

• 2nd Appointment – Therapeutic Regimen

• 3rd Appointment (2 or 3 weeks later) – Ultrasound – Contraception

OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

MaterialMaterial andand MethodsMethods • Retrospective analysis of 600 women who made a in ambulatory during oneone yearyear ofof experience.experience.

• Comparison of twotwo groups:groups GroupGroup 1–1 under 8 weeks GroupGroup 2–2 between 8 and 10 weeks

• During Data analysed using SPSSSPSS version 14.0

OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

MaterialMaterial andand MethodsMethods

•• GroupGroup 11 Before 8 weeks – 450 women

•• GroupGroup 22 8 – 10 weeks – 150 women

OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

DemographicDemographic DataData

• Mean Maternal Age – 28.2 ±7.6 ys – Adolescents: 11,8%

• 90% Portuguese nationality – European Economic Countries : 4% – African countries : 4% – Others : 2% No statistical differences between two groups • 50% married

(n=600) • 90% 1st abortion

OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage ContraceptionContraception UseUse • No Contraceptive Method : 30%

• Under Contraceptive use : 70% (n=600)

Others No statistical Nodifferences statistical differencesbetween Patch between two groups two groups Vaginal Ring

IUD

Oral Contr.

Condom

0 1020304050% OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

ContraceptionContraception UseUse

70 % users of contraceptive methods (n=420) Reasons for faillure : 11% 35%

27%

No statistical 27% differences between "Faillure" of method two groups Wrong use Non protected sexual intercourse Interference with other drugs OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

No statistical ReasonsReasons forfor abortionabortion differences between two groups

3% 18% 37%

20% (n=600) 22%

Economical Family Reason Ocasional Intercourse Professional Maternal Disability OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

ClinicalClinical DataData

Group 1 ComplicationsComplications Group 2 p (n= 450; <8 weeks) (n= 150; 8-10 weeks)

95 % NO 86 % NS

5 % YES 14 % NS OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

ComplicationsComplications duedue toto thethe procedureprocedure

• 7,2 % overall (group 1 and 2)

(n= 43)

% 2,5

2

1,5

1

0,5

0 Persistent Faillure of therapy Infections metrorrhagia Group 1 Group 2 OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

LevelLevel ofof satisfactionsatisfaction withwith protocolprotocol

(n=600)

No statistical Low differences between two groups Medium

High

0 20406080% OutOut PatientPatient UseUse ofof MifepristoneMifepristone andand MisoprostolMisoprostol beforebefore andand afterafter 88 weeksweeks gestacionalgestacional ageage

ConclusionsConclusions

• The use of medical abortion in out patient regimen was safe.

• The complications had no statistical significance.

• When questioned, patients expressed a high level of satisfaction with this protocol. ThankThank youyou!! Marisa Moreira