Obstet Gynecol Sci.  2017 Sep;60(5):427-432. 10.5468/ogs.2017.60.5.427.

Serum β-hCG concentration is a predictive factor for successful early medical abortion with vaginal misoprostol within 24 hours

• Kim JI
• Park IY
• Yim JM
• Cheon JY
• Yun HG
• Kwon JY

• KMID: 2393841
• DOI: http://doi.org/10.5468/ogs.2017.60.5.427

Abstract

OBJECTIVE
To evaluate the predictive factors associated with the success of medical abortion by misoprostol monotherapy within 24 hours in the first trimester of pregnancy.
METHODS
The records of 228 women with miscarriage up to 11 weeks of gestational age who underwent medical abortion by intravaginal misoprostol monotherapy were reviewed. Success of abortion was defined as complete expulsion of the conceptus without the need for surgical intervention. Outcomes of interest were success of abortion within 24 hours following administration of misoprostol.
RESULTS
Among 222 women who continued the process of medical abortion for 24 hours, 209 (94.1%) had a successfully completed abortion. Multivariate logistic regression showed that serum β-human chorionic gonadotropin (β-hCG) above 40,000 mIU/mL is significantly associated with failed medical abortion within 24 hours (odds ratio [OR], 7.13; 95% confidence interval [CI], 1.60-37.32; P=0.011). The area under the receiver operating characteristic curve of β-hCG level associated with successful abortion within 24 hours was 0.705 (95% CI, 0.63-0.77; P=0.007). Previous vaginal delivery seems to be significantly associated with successful abortion within 24 hours on univariate analysis (P=0.037), but the association was lost in multivariate analysis.
CONCLUSION
Misoprostol monotherapy has a high success rate for first trimester abortion. Women with serum β-hCG less than 40,000 mIU/mL are likely to achieve a successful abortion within 24 hours after intravaginal administration of misoprostol.

Keyword

Chorionic gonadotropin; Beta subunit, human; Medical abortion; Abortion; Pregnancy trimester, first

MeSH Terms

Abortion, Spontaneous
Administration, Intravaginal
Chorionic Gonadotropin
Female
Gestational Age
Humans
Logistic Models
Misoprostol*
Multivariate Analysis
Pregnancy
Pregnancy Trimester, First
ROC Curve
Chorionic Gonadotropin
Misoprostol

Reference

1. Chen MJ, Creinin MD. Mifepristone with buccal misoprostol for medical abortion: a systematic review. Obstet Gynecol. 2015; 126:12–21. PMID: 26241251.

2. Raymond EG, Shannon C, Weaver MA, Winikoff B. First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Contraception. 2013; 87:26–37. PMID: 22898359.

3. American College of Obstetricians and Gynecologists. Practice bulletin no. 143: medical management of first-trimester abortion. Obstet Gynecol. 2014; 123:676–692. PMID: 24553166.

4. Blum J, Raghavan S, Dabash R, Ngoc Nt, Chelli H, Hajri S, et al. Comparison of misoprostol-only and combined mifepristone-misoprostol regimens for home-based early medical abortion in Tunisia and Vietnam. Int J Gynaecol Obstet. 2012; 118:166–171. PMID: 22682768.

5. Jain JK, Dutton C, Harwood B, Meckstroth KR, Mishell DR Jr. A prospective randomized, double-blinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy. Hum Reprod. 2002; 17:1477–1482. PMID: 12042265.

6. von Hertzen H, Piaggio G, Huong NT, Arustamyan K, Cabezas E, Gomez M, et al. Efficacy of two intervals and two routes of administration of misoprostol for termination of early pregnancy: a randomised controlled equivalence trial. Lancet. 2007; 369:1938–1946. PMID: 17560446.

7. Henshaw RC, Naji SA, Russell IT, Templeton AA. Comparison of medical abortion with surgical vacuum aspiration: women's preferences and acceptability of treatment. BMJ. 1993; 307:714–717. PMID: 8401094.

8. Creinin MD. Randomized comparison of efficacy, acceptability and cost of medical versus surgical abortion. Contraception. 2000; 62:117–124. PMID: 11124358.

9. Teal SB, Dempsey-Fanning A, Westhoff C. Predictors of acceptability of medication abortion. Contraception. 2007; 75:224–229. PMID: 17303494.

10. Lavecchia M, Abenhaim HA. Effect of menstrual age on failure of medical management in women with early pregnancy loss. J Obstet Gynaecol Can. 2015; 37:617–623. PMID: 26366818.

11. Creinin MD, Spitz IM. Use of various ultrasonographic criteria to evaluate the efficacy of mifepristone and misoprostol for medical abortion. Am J Obstet Gynecol. 1999; 181:1419–1424. PMID: 10601923.

12. Schreiber CA, Ratcliffe SJ, Quinley KE, Miller C, Sammel MD. Serum biomarkers may help predict successful misoprostol management of early pregnancy failure. Reprod Biol. 2015; 15:79–85. PMID: 26051455.

13. Chien LW, Liu WM, Tzeng CR, Au HK. Effect of previous live birth and prior route of delivery on the outcome of early medical abortion. Obstet Gynecol. 2009; 113:669–674. PMID: 19300333.

14. Bartley J, Tong S, Everington D, Baird DT. Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost. Contraception. 2000; 62:297–303. PMID: 11239616.