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 abortion be promoted as a family planning 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 – Mifepristone 200 mg oral – 36 – 48hr later Æ Misoprostol 400 mcg vaginal • 8- 10 weeks – Mifepristone 200 mg oral – 36 – 48 hrs later ÆMisoprostol 800 mcg vaginal – Surgical protocol: • Vacuum aspiration 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 medical abortion 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 No statistical differences Patch differences between 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.