Evaluation Of The Effectiveness Of Mifepristone Concomitant With Misoprostol For Medical Abortion

OBJECTIVES: To evaluate the effectiveness of mifepristone concomitant with misoprostol for the first trimester medical abortion,which investigated effectiveness of medical abortion compared with two different mifepristone regimens(multi- dosageVS. single-dosage),two different dosage of misoprostol (1200μg VS. 600μg )and two different routes of misoprostol ( vaginalVS.oral,sublingualVS. oral ).METHODS: Twelve databases were electronically searched(1982—2008),The Cochrane Central Register of Controlled Trials,Embase,Medline,Pumed,EBSCO,ELSEVISER,OVID,WHO/RHL,CBMdiSC,CNKI,CMCC,VIP database. Ten journals were searched by hand search. Only randomized control trials(RCTs) and clinical control trials (CCTs) were included. At least two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data from the eligible studies,with confirmation of cross-check.Different opinions would be decided by the third party.Meta-analysis was done by Revman5.0.16. After heterogeneity test was done,data without heterogeneity could be pooled using fixed effect model,and those with heterogeneity could be solved by sensitivity analysis or randomized effect model.RESULTS: Six original trials (n=1615) were included in comparing with two different mifepristone regimens. Four original trials(n=1843) were included in comparing with two different dosage of misoprostol. Nine original trials ( n= 3896 ) were included in comparing with two different routes of misoprostol ( vaginalVS.oral ). Seven original trials ( n= 1152 ) were included in comparing with two different routes of misoprostol (sublingualVS.oral ).There was significant differences observed in the rate of complete,incomplete,abortion failed,mean bleeding time and time of recovering menses between the two different mifepristone regimens (multi-dosageVS. single dosage). Effectiveness of single dosage of mifepristone was better than that of multi-dosage of mifepristone ; There was significant differences observed in the rate of complete,incomplete and abortion failed between the two different dosage of misoprostol (1200μg VS.600μg). Effectiveness of 1200μg of misoprostol was better than that of 600μg of misoprostol,and would not increasing the mean bleeding time and time of recovering menses;Misoprostol administered orally is less effective(less complete,more incomplete and failures ) than that of the vaginal route and the sublingual route.CONCLUSIONS:Effectiveness of single dosage of mifepristone might be better than that of multi-dosage of mifepristone,and the single dosage of mifepristone might be more convenient. The dosage of 1200μg of misoprostol might be more effective than the dosage of 600μg. It might be possible to improve the effectiveness by increasing dosages of misoprostol without increasing the mean bleeding time and the time of recovering menses;Misoprostol administered orally might be less effective(more incomplete and failures) than that of the vaginal route or sublingual route.