Using Mifepristone, therapeutic abortion can be effectively induced until______ weeks of gestation?
Correct Answer: 9 weeks
Description: Ans. d. 9 weeks. (Ref Gynaecology by Dutta 5th/pg. 511, Dutta obstetrics 6th/pg. 175&550; Shaw Gynecology 15th/pg. 317; Ref KDT 6th/pg. 310).Text book of Obstetrics by DC Dutta 7th/pg. 174...........Mifepristone (RU 486/progesterone receptor antagonist) is effective in inducing therapeutic abortion upto 63 days of gestation, but is most effective when used with 49 days of gestation.Uses of Mifepristone (RU-486)(anti-progestin):APostcoital contraceptiveMifepristone 600 mg given 72 hrs of intercourse interferes with implantation and is highly effective method of emergency contraception. The menstrual cycle is however disturbed.B.Termination of pregnancy# Up to 7 weeks: 600 mg as single dose causes complete abortion in 60-85% cases. # To improve the success rate, current recommendation is to follow up 48 hrs later by a single 400 mg oral dose of misoprotol. This achieves > 90% success rate and is the accepted nonsurgical method of early first trimester abortion.# In place of oral Misoprostol, a 1 mg geneprost pessary can be inserted intravaginally. Mifepristone administered within 10 days of missed period results in an apparent late heavy period in upto 90% cases.# Anorexia, nausea, tiredness, abdominal discomfort, uterine crapms, loose motions are the side effects, apart from problems like prolonged bleeding and failed abortion in some cases.C.Cervical ripening24-30 hrs before attempteing surgical abortion or induction of labour, mifepristone 600 mg results in softening of cervix.D.Once a month contraceptiveA single 200 mg dose of mifepristone given 2 days after the midcycle each month prevents conception on most occasions.E.Induction of labourBy blocking the relaxant action of progesterone on uterus of late pregnancy, mifepristone can induce labour. It may be tried in cases with IUD and to deliver abnormal fetuses.F.Cushing's syndromeMifepristone has palliative effect due to glucocorticoid receptor blocking property. May be used for inoperable cases.Note: Other recently developed antiprogestins are Onapristone (a pure antagonist ) and Gestinone (most efficacious in endometriosis).Gossypol is nonsteroidal compound obtained from cotton seeds. Its effective orally-causes suppression of spermatogenesis in 99% men and reduces sperm motility.
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Gynaecology & Obstetrics
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