During recent years, new medical methods have been developed as an alternative to vacuum aspiration for termination of early pregnancy upto 63 days of amenorrhoea.

The compounds mainly used for medical abortion are prostaglandin analogues, misoprostol and gemeprost, methotrexate alone or in combination with misoprostol and mifepristone in combination with a suitable prostaglandin analogue. However, only the last method has been registered for routine clinical use. The treatment mainly used is mifepristone 200 to 600 mg followed 36 to 48 hours later by oral misoprostol 0.4 to 0.6 mg in pregnancies up to 49 days and vaginal misoprostol 0.8 mg or gemeprost 1.0 mg if the treatment period is extended to 63 days of amenorrhea.

Since misoprostol is available in a large number of countries, is stable at room temperature and significantly cheaper than the other drugs, treatment with this prostaglandin analogue alone has attracted significant interest. So far, however, the best treatment schedule has not been agreed upon. Misoprostol is administered either vaginally or sublingually. Generally a dose of 0.8 mg repeated 3 to 5 times with intervalsfrom 3 to 24 hours is used. Available data indicate that misoprostol alone is slightly less effective and the treatment is associated with a higher frequency of
temperature-elevation and gastrointestinal side-effects, than if misoprostol is combined with mifepristone.

With methotrexate, it takes a long time for the women to abort. Methotrexate in combination with misoprostol does not seem more effective than misoprostol alone.

It seems adequate to state that the combination of mifepristone and misoprostol is equally effective, or almost equally effective, as vacuum aspiration. Duration of bleeding and amount of blood loss is greater following the medical procedure. Also, the frequency of uterine pain is higher. On the other hand, the frequency of major complications such as abundant bleeding, blood transfusion and pelvic infection does not seem to differ between the two procedures. Surgical complications, for example, uterine perforation and cervical tears are obviously not a risk associated with
medical abortion.

It can be concluded that medical termination of early pregnancy will not replace, but is an alternative, to vacuum aspiration and, ideally, both methods should be available to give women a choice.

(Dr. Marc Bygdeman could not make it to the meeting due to certain unavoidable circumstances, but had sent his abstract earlier).