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Russian experience of medical abortion

This article discusses the Russian experience with medical abortions, including the use of mifepristone and prostaglandins. It covers the indications, contraindications, recommended check-ups, and the protocol and efficacy of induced abortion. The advantages of medically induced abortion are also highlighted.

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Russian experience of medical abortion

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  1. Russian experience of medical abortion T. Astakhova, A. Kuzemin, D. Jerdev Research Centerfor Obstetrics, Gynecology and Perinatology (Director – professor V.I. Kulakov) Moscow 2005

  2. Russian experience in medical abortions for pregnancy termination • 1975-80 yr. – synthetic analogues of PR 15 ме РgF2α, hemeprost, sulproston • 1982-90 yr. – syntheticsteroid drugs – antiprogestins RU-486 (mifepristone), mifegin • 1993-2005 yr.– antiprogestins + PG mifepristone, penkroftonmisoprostol

  3. MIFEPRISTONE MIR-PHARMA PENCROFTON PENCROFT-PHARMA Russian pharmacies

  4. Clinical research of mifepristone • Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia • Sechenov Medical Academy Clinic for Obstetric and Gynecology, Moscow • Military-medical Academy, St-Petersburg • V.N.Gorodkov’ Research Center for Mother and Child, Ivanovo • Professional Association of Gynecologists-oncologists, St-Petersburg • RepublicanMedical center «Family», Cheboksari

  5. State Pharmacologic Committee Public Health Servicehasapproved use of mifepristone (Reg. № 002340/0102003 от 07/04/2003 г.). and was recommended for clinical use.

  6. INDICATIONS • Request of patient • Uterine pregnancy (less than 6 weeks) confirmed by ultrasound • Women, who might have some difficulties when performing instrumental evacuation: -uterine malformation -pregnancy and intact uterine hymen

  7. CONTRAINDICATIONS • Ectopic pregnancy or suspicion on ectopic pregnancy • Adrenal insufficiency • Long-term corticosteroid therapy • Renal and hepatic insufficiency • Allergic reaction on mifepristoneand misoprostol • Blood diseases and anticoagulant therapy • Big size uterine myomas • STD in acute stage

  8. Recommended check-up • Counseling • Gynecologic exam • Ultrasound • Analysis for HIV, syphilis, Hepatitis B, C • Blood group, Rh • Vaginal specimen • Analysis for β-HCG • Coagulogramm • Blood clinical analysis

  9. Induced abortion: protocol and dynamic observation • Visit 1 Confirmed uterine pregnancy no more than 6 weeks (42 days of amenorrhea) Informed consent Mifepristone (600 mgper os) • Visit 2 After 36-48 hours Prostaglandins (misoprostol) 400 mgr per os • Visit 3 10-14 dayslater aftermifespristone administration Efficacy of induced abortion (clinical exam, ultrasound).

  10. I period - latent Characterized by absence of clinical manifestations of pregnancy termination during 24-48 hours(28,6±2.3) from the mifepriston administration IIperiod -main Characterized by menstrual-like reaction, appearing with mild to moderate bleeding which lasts for 5-18 days Clinical descriptionof induced abortion

  11. EFFICACY CRITERIA -Normal uterine size, absence of painful feelings, there may be mild blood spots - Absence of embryonal sac or its elements in uterine, confirming by ultrasound - Decrease of -HCG in blood sample

  12. Dynamic in decrease of the hormone’s levels

  13. Ultrasound examination before and 14 days laterafter mifepristoneadministration Before 14 days after

  14. Mifepristone concentrationin serum afterits using

  15. CLINICAL EFFICACYMEDICAL ABORTION (%) ACCORDING THE USED PROTOCOLSResearch Center for Obstetrics, Gynecology and Perinatology 100% 88% 98% 0 %

  16. SIDE-EFFECTS, % (n=2565)Research Center for Obstetrics, Gynecology and Perinatology

  17. Complications after instrumental andmedical abortion (%)Research Center for Obstetrics, Gynecology and Perinatology %

  18. Failure of medical abortion Progressive pregnancy or incomplete abortion Vacuum aspiration/ Surgical curettage

  19. ADVANTAGES OF MEDICALLY INDUCED ABORTION • High efficacy 98 %, safety andcomplience • Absence of complications vs instrumental abortion: mechanical damage of uterine anduterine vessels, cervix injury • Decreasesof possibility of ascending infection and complications dealing with it • No risk of anesthesia (no need) • Mifepristoneis the drug of choicein nulliparous • No psychogenic sequelae • High acceptability of method results

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