Mifepristone – misoprostol sequential oral administration is safe & effective method for termination of pregnancy up to what gestational age?
Correct Answer: 7 weeks
Description: Ans. D 7 weeks . (Ref. Text book of Obstetrics by DC Dutta 7th/pg. 174; KDT 6th/pg. 310) MIFEPRISTONE (RU 486) # It is a steroid with an affinity for progesterone receptors. # Single dose 600 mg or 25 mg bd for 4 days if amenorrhea is of > 48 hours. # Mifepristone (RU 486/progesterone receptor antagonist) is effective in inducing therapeutic abortion upto 63 days of gestation, but is most effective when used within 49 days of gestation. # It does not prevent fertilization, but by blocking action of progesterone on endomertium, causes sloughing and shedding of deciduas and brings about abortion. # However, emptying is incomplete and surgical evacuation is needed. # Adding PG (Misoprostol) on last day improves the rate of complete abortion Uses of Mifepristone (anti-progestin): A Postcoital contraceptive Mifepristone 600 mg given within 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 misoprostol. 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 ripening 24-30 hrs before attempting surgical abortion or induction of labour, mifepristone 600 mg results in softening of cervix. D. Once a month contraceptive A single 200 mg dose of mifepristone given 2 days after the midcycle each month prevents conception on most occasions. E. Induction of labour By 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 syndrome Mifepristone has palliative effect due to glucocorticoid receptor blocking property. May be used for inoperable cases.
Category:
Gynaecology & Obstetrics
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