Evaluation of the Effectiveness of Mifepristone Concomitant with Misoprostol for Medical Abortion_Chinese Journal of Evidence-Based Medicine

Authors：

ZOU Yan ¹ , LI Youping ² , GAN Changping ³ , WU Lan ³ , TONG Lin ³ , LIANG Yan ⁴ , LI Tao ³ , TANG Ying ³ , MEI Ling ³ , YANG Jing ³ , LIU Yiwen ³

1. National Research Institute for Family Planning; Beijing 100081; China2. Chinese Evidence-Based Medicine Center; West China Hospital; Sichuan University; Chengdu 6100413. West China School of Clinical Medicine; Sichuan Universtiy4. Changzheng Hospital of the Second Millitary Medical University; Shanghai 200043;

Corresponding author：

Keywords：

Mifepristone; Misoprostol; Medical abortion; Effectiveness

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Objective 　To evaluate the effectiveness of mifepristone concomitant with misoprostol for medical abortion.
Methods 　We searched the related original studies worldwide, and controlled prospective studies and systematic reviews based on randomized controlled trials （RCTs）. Nine electronic databases were searched. Ten journals and reference lists of eligible studies were handsearched. Two reviewers independently screened the studies for eligibility, evaluated the quality, and extracted the data from eligible studies, with confirmation by cross checking. Any disputes were decided by a third person. Meta-analysis was conducted using statistical software RevMan 4.2. After heterogeneity test was done （α=0.05 ） , data without heterogeneity were pooled using a fixed effect model, and those with heterogeneity could be solved by sensitivity＂ analysis, subgroup analysis or random effect model.
Results 　We found eight original trials （n = 3 348 ） that compared medical abortion with surgical abortion, nine trials （n =6 116） that investigating the effect of gestational ages on medical abortion, five trials （n = 1 934） on the use of mifepristone and two trials （n =2381 ） on intervals of administration of mifepristone and misoprostol were located. Quality of foreign studies was better than that of Chinese studies. Therate of complete abortion was higher in surgical abortion group than that in medical abortion group with odds ratio （OR） 0. 18 and 95% confidence interval （CI） 0. 11 to 0.27. The rate of incomplete abortion and abortion failure was higher in medical abortion group with OR 3.32, and 95% CI 1.79 to 6.17, OR 7.36, 95% CI 4. 17 to 12.98, respectively. The rate of complete abortion in the group with gestational age over 49 days was lower than that with gestational age under 49 days with OR 0.51 and 95% CI 0.43 to 0.61. The rate of incomplete abortion and abortion failure was higher in the group with gestational age over 49 days with OR 1.66, 95% CI 1.32 to 2.09 and OR 3.37, 95% CI 2.30 to 4. 94.There were no significant differences observed in the rates of complete abortion, incomplete abortion, abortion failed, time of expelling pregnant sac and time of menses recovery between the single and multi-dosage of mifepristone. Except for the rate of complete abortion, which was higher in 〈48h group, there was a comparable effectiveness for different intervals of mifepristone and ntisoprostol.
Conclusions 　This review showes that it is important to improve the quality of Chinese original studies. Although the effectiveness is better in the surgical abortion group, the rate of complete abortion of medical abortion achieved is 91.6% （1 648/1 800）. This is acceptable for clinicians and women who do not want to be pregnance. The rate of complete abortion is lower in the gestation over 49 days, which had a statistically difference, but little clinical significance. It is necessary to consider increasing the gestational age of medical abortion, especially for those women who have contradictions of surgical abortion or are afraid of operation. Effectiveness of single dosage of mifeprostone is similar to that ofmulti-dosage, but single dosage might be more convenient. This review suggests that shortening the interval ofmifepristone and misoprostol administration should be considered and the best and shortest interval time need to be identified with better evidence.

Citation： ZOU Yan,LI Youping,GAN Changping,WU Lan,TONG Lin,LIANG Yan,LI Tao,TANG Ying,MEI Ling,YANG Jing,LIU Yiwen. Evaluation of the Effectiveness of Mifepristone Concomitant with Misoprostol for Medical Abortion. Chinese Journal of Evidence-Based Medicine, 2005, 05(8): 619-631. doi: Copy

1.	叶寒.紧急避孕的研究现状与发展方向[J].中国妇幼保健, 2001; 16(2): 119～211.
2.	王春玉, 李蔓波, 李学荣, 董根泽. 药物流产与人工流产吸宫术终止早孕的临床观察[J]. 宁夏医学杂志, 1999; 21(12): 739～740.
3.	孙红珠, 吴尚纯, 徐慧颖, 肖碧莲. RU486药物流产与手术流产方法的可接受性比较研究[J]. 生殖医学杂志, 1995; 4(3): 138～141.
4.	杜明昆, 应玉娣, 郑怀美, 闻珍, 倪如钰. 药流与负压吸宫法的效果和可接受性研究[J]. 生殖与避孕, 1996; 16(3): 194～198.
5.	李丹,于立君,杨晓波,张经营,王寒梅. 米非司酮配伍米索前例醇和卡前列甲酯栓终止早孕与吸宫流产临床对比研究[J]. 中国计划生育学杂志, 1997; 31(5): 281～284.
6.	陈建萍. 药物流产与人工流产终止早期妊娠的比较[J]. 中国综合临床, 2002; 18(10): 954～955.
7.	韩丽萍,魏振玲,王世花. 人工流产术与药物流产215例疗效比较[J]. 郑州大学学报(医学版), 2003; 38(1): 123.
8.	史益凭,朱泰来,桂幼伦,贺昌海. 停经50～70天早孕妇女药物流产的安全性与有效性临床研究[J]. 中国计划生育学杂志, 1998; 6(10): 468～472.
9.	徐汉,岳维真,冯淑芝. 50 mg米非司酮终止早孕临床试验[J]. 中国计划生育学杂志, 1994; 47(3): 123～124.
10.	贺昌海,高尔生. 米索前列醇和PG05配伍米非司酮终止早孕的临床多中心随机对照试验[J]. 生殖与避孕, 1994; 14(1): 41～48.
11.	王慧, 王虹, 胡静华, 路彤, 孔佳. 阴道用米索前列醇配伍米非司酮终止早孕的临床观察[J]. 中国计划生育学杂志, 1998; 41(4): 412～413.
12.	李玲玲. 米非司酮不同给药方法对早孕药物流产效果的影响[J]. 吉林医学, 2001; 22(6): 347～348.
13.	周金桃,冯淑芝,曹来英,刘元姣. 米非司酮两种用法抗早孕临床疗效比较[J]. 医药导报, 2002;21(4):222～224.
14.	WHO Scientific Group. Medical methods for termination of pregnancy[Z]. World Health Organ Tech Rep Ser. 1997;871: 1-110.
15.	K. Singh,s.s.Ratnam.The influence of abortion legislation on maternal mortality[J]. Int-J-Gynecol-Obstet,1998;63 (suppl 1):s123-129.
16.	Ye H. Study actuality and developing direction of emergency contraception[J]. Maternal and Child Health Care of China, 2001;16(2):119-211.
17.	International Planned Parenthood Federation. Abortion and quality of care. International Planned Parenthood Federation Annual Report[Z]. New York, 1991-1992.
18.	Peyron R, Aubeny E, Targosz V, Silvestre L, Renault M, Elkik F, Leclerc P, Ulmann A, Baulieu EE. Early termination of pregnancy with mifepristone (RU 486) and the orally active prostaglandin misoprostol[J]. N Engl J Med, 1993; 328(21): 1509-1513.
19.	Kahn JG, Becker BJ, MacIsaa L, Amory JK, Neuhaus J, Olkin I, Creinin MD. The efficacy of medical abortion: a Meta-analysis[J]. Contraception, 2000; 61(1): 29-40.
20.	Creinin MD, Schwartz JL, Pymar HC, Fink W. Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial[J]. BJOG, 2001; 108(5):469-473.
21.	Zhou R, Elul B, Winikoff B. Medical abortion in China: Results of a Fact-Finding Mission.Critical Issues in Reproductive Health,Population Council New York, 2002; 1.
22.	Clarke M, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.1[updated June 2000]. In: Review Manager (RevMan)[Computer program].Version 4.2. Oxford, England: The Cochrane Collaboration, 2003.
23.	Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomized controlled trials[J]. BMJ, 1999; 319 (7211): 670-674.
24.	Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group[J]. JAMA, 2000; 283(15): 2008-2012.
25.	Clark M, Oxman AD, editors. Cochrane Reviewers’Handbook 4.2 In:Review Manager(Revman)[Computer program]. Oxford: updated December 2003.
26.	Wang CY, Li MB, Li XR, Dong GZ. Clinical observation on the termination of early pregnancy with medical abortion and aspiration[J]. Medical Journal of Ningxia, 1999; 21(12): 739-740.
27.	Sun HZ, Wu SC, Xu HY, Xiao BL. Study on the acceptability of medical abortion with RU486 and surgical abortion[J]. Journal of Reproductive Medicine,1995; 4(3): 138-141.
28.	Du MK, Ying YD, Zheng HM, Wen Z, Ni RY. Study on the efficacy and acceptability of medical abortion and aspiration[J]. Reproduction&Contraception, 1996; 16(3): 194-198.
29.	Elul B, Ellertson C, Winikoff B,et al. Side effects of mifepristone- misoprostol abortion versus surgical abortion. Data from a trial in China, Cuba, and India[J]. Contraception,1999; 59(2):107-114.
30.	Li D, Yu LJ. Yang XB, Zhang JY, Wang HM. A controlled study on termination of early pregnancy by mifepristone with misoprostol or Carboprost Mehtylate versus surgical abortion[J]. Chinese Journal of Family Planning,1997; 31(5): 281-284.
31.	Chen JP. Comparison between the medical and surgical abortion in terminating early pregnancy[J]. China integrated clinical, 2002; 18(10): 954-955.
32.	Han LP, Wei ZL, Wang SH. Comparison of efficacy of 215 cases with medical and surgical abortion[J]. Journal of Zhengzhou University(Med Sci), 2003; 38(1): 123.
33.	Cabezas E. Medical versus surgical abortion[J]. International Journal of Gynecology & Obstetrics,1999;63 (suppl):141-146.
34.	Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States[J]. N Engl J Med,1998 ;338(18):1241-1247.
35.	Schaff EA, Fielding SL, Eisinger SH, Schaff EA. Fielding SL. Low-dose mifepristone followed by vaginal misoprostol at 48 hours for abortion up to 63 days[J]. Contraception,2000; 61(1): 41-46.
36.	Shi YP, Zhu TL, Gui YL, He CH. Study on safety and effectiveness of medical abortion for women menopause for 50-70 days[J]. Chinses Journal of Family Planning,1998; 6(10): 468-472.
37.	ICMR Task Force Study. Indian Council of Medical Research. A multicentre randomized comparative clinical trial of 200 mg RU486 (mifepristone) single dose followed by either 5 mg 9-methylene PGE(2) gel (meteneprost) or 600 microg oral PGE(1) (misoprostol) for termination of early pregnancy within 28 days of missed menstrual period[J]. Contraception,2000; 62(3): 125-130.
38.	Bartley J, Brown A, Elton R, Bartley J, Brown A, Elton R, Baird DT, et al. Double-blind randomized trial of mifepristone in combination with vaginal gemeprost or misoprostol for induction of abortion up to 63 days gestation[J]. Hum Reprod, 2001; 16(10): 2098-2102.
39.	Xu H, Yue WZ, Feng SZ. Clinical study on termination of early pregnancy with 50 mg mifepristone[J]. Chinese Journal of Family Planning, 1994; 47(3): 123-124.
40.	McKinley C, Thong KJ, Baird DT.The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol[J]. Hum Reprod, 1993; 8(9): 1502-1505.
41.	Schaff EA, Fielding SL, Westhoff C.Randomized trial of oral versus vaginal misoprostol 2 days after mifepristone 200 mg for abortion up to 63 days of pregnancy[J]. Contraception, 2002; 66(4): 247-250.
42.	Schaff EA, Fielding SL, Westhoff C.Randomized trial of oral versus vaginal misoprostol at one day after mifepristone for early medical abortion[J]. Contraception, 2001; 64(2): 81-85.
43.	He CH, Gao ES. A multi-center RCT on termination of early pregnancy with mifepristone-misoprostol and mifepristone- PG50[J]. Reproduction&Contraception,1994; 14(1): 41-48.
44.	Wang H, Wang H, Hu JH,Lu T, Kong J. Clinical observation of early pregnancy termination with vaginal misoprostol in combination with mifepristone[J]. Chinses Journal of Family Planning, 1998; 41(4): 412-413.
45.	Li LL. The influence of different giving methods of mifepristone to the efficacy early pregnancy medical abortion[J]. Jilin Medicine, 2001; 22(6): 347-348.
46.	Sang GW, Weng LJ, Shao QX, Du MK, Wu XZ, Lu YL, Cheng LN. Termination of early pregnancy by two regimens of mifepristone with misoprostol and mifepristone with PG05-a multicentre randomized clinical trial in China[J]. Contraception, 1994; 50(6): 501-510.
47.	Zhou JT, Feng SZ, Cao LY, Liu YJ. Comparison of clinical efficacy between two giving methods of mifepristone in terminating early pregnancy[J]. Herald of Medicine, 2002; 21(4): 222-224.
48.	Creinin MD, Schwartz JL, Pymar HC, Creinin MD. Schwartz JL. Pymar HC. Fink W. Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial[J]. BJOG, 2001; 108(5): 469-473.
49.	Schaff EA, Fielding SL, Westhoff C, Ellertson C, Eisinger SH, Stadalius LS. Fuller L.Vaginal misoprostol administered 1, 2, or 3 days after mifepristone for early medical abortion: A randomized trial[J]. JAMA, 2000; 284(15):1948-1953.
50.	Creinin MD.Randomized comparison of efficacy, acceptability and cost of medical versus surgical abortion[J]. Contraception, 2000; 62(3): 117-124.
51.	Ulmann A, Silveatre L, Chemana L, Rezvani Y, Renault M, Aguillaume CJ, Baulieu EE. Medical termination of early pregnancy with mifepristone followed by a prosglandin analogue: Study in 16369 women[J]. Acta Obstet Gynecol Scannd, 1992; 71(4): 278-83.

1. 叶寒.紧急避孕的研究现状与发展方向[J].中国妇幼保健, 2001; 16(2): 119～211.
2. 王春玉, 李蔓波, 李学荣, 董根泽. 药物流产与人工流产吸宫术终止早孕的临床观察[J]. 宁夏医学杂志, 1999; 21(12): 739～740.
3. 孙红珠, 吴尚纯, 徐慧颖, 肖碧莲. RU486药物流产与手术流产方法的可接受性比较研究[J]. 生殖医学杂志, 1995; 4(3): 138～141.
4. 杜明昆, 应玉娣, 郑怀美, 闻珍, 倪如钰. 药流与负压吸宫法的效果和可接受性研究[J]. 生殖与避孕, 1996; 16(3): 194～198.
5. 李丹,于立君,杨晓波,张经营,王寒梅. 米非司酮配伍米索前例醇和卡前列甲酯栓终止早孕与吸宫流产临床对比研究[J]. 中国计划生育学杂志, 1997; 31(5): 281～284.
6. 陈建萍. 药物流产与人工流产终止早期妊娠的比较[J]. 中国综合临床, 2002; 18(10): 954～955.
7. 韩丽萍,魏振玲,王世花. 人工流产术与药物流产215例疗效比较[J]. 郑州大学学报(医学版), 2003; 38(1): 123.
8. 史益凭,朱泰来,桂幼伦,贺昌海. 停经50～70天早孕妇女药物流产的安全性与有效性临床研究[J]. 中国计划生育学杂志, 1998; 6(10): 468～472.
9. 徐汉,岳维真,冯淑芝. 50 mg米非司酮终止早孕临床试验[J]. 中国计划生育学杂志, 1994; 47(3): 123～124.
10. 贺昌海,高尔生. 米索前列醇和PG05配伍米非司酮终止早孕的临床多中心随机对照试验[J]. 生殖与避孕, 1994; 14(1): 41～48.
11. 王慧, 王虹, 胡静华, 路彤, 孔佳. 阴道用米索前列醇配伍米非司酮终止早孕的临床观察[J]. 中国计划生育学杂志, 1998; 41(4): 412～413.
12. 李玲玲. 米非司酮不同给药方法对早孕药物流产效果的影响[J]. 吉林医学, 2001; 22(6): 347～348.
13. 周金桃,冯淑芝,曹来英,刘元姣. 米非司酮两种用法抗早孕临床疗效比较[J]. 医药导报, 2002;21(4):222～224.
14. WHO Scientific Group. Medical methods for termination of pregnancy[Z]. World Health Organ Tech Rep Ser. 1997;871: 1-110.
15. K. Singh,s.s.Ratnam.The influence of abortion legislation on maternal mortality[J]. Int-J-Gynecol-Obstet,1998;63 (suppl 1):s123-129.
16. Ye H. Study actuality and developing direction of emergency contraception[J]. Maternal and Child Health Care of China, 2001;16(2):119-211.
17. International Planned Parenthood Federation. Abortion and quality of care. International Planned Parenthood Federation Annual Report[Z]. New York, 1991-1992.
18. Peyron R, Aubeny E, Targosz V, Silvestre L, Renault M, Elkik F, Leclerc P, Ulmann A, Baulieu EE. Early termination of pregnancy with mifepristone (RU 486) and the orally active prostaglandin misoprostol[J]. N Engl J Med, 1993; 328(21): 1509-1513.
19. Kahn JG, Becker BJ, MacIsaa L, Amory JK, Neuhaus J, Olkin I, Creinin MD. The efficacy of medical abortion: a Meta-analysis[J]. Contraception, 2000; 61(1): 29-40.
20. Creinin MD, Schwartz JL, Pymar HC, Fink W. Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial[J]. BJOG, 2001; 108(5):469-473.
21. Zhou R, Elul B, Winikoff B. Medical abortion in China: Results of a Fact-Finding Mission.Critical Issues in Reproductive Health,Population Council New York, 2002; 1.
22. Clarke M, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.1[updated June 2000]. In: Review Manager (RevMan)[Computer program].Version 4.2. Oxford, England: The Cochrane Collaboration, 2003.
23. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomized controlled trials[J]. BMJ, 1999; 319 (7211): 670-674.
24. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group[J]. JAMA, 2000; 283(15): 2008-2012.
25. Clark M, Oxman AD, editors. Cochrane Reviewers’Handbook 4.2 In:Review Manager(Revman)[Computer program]. Oxford: updated December 2003.
26. Wang CY, Li MB, Li XR, Dong GZ. Clinical observation on the termination of early pregnancy with medical abortion and aspiration[J]. Medical Journal of Ningxia, 1999; 21(12): 739-740.
27. Sun HZ, Wu SC, Xu HY, Xiao BL. Study on the acceptability of medical abortion with RU486 and surgical abortion[J]. Journal of Reproductive Medicine,1995; 4(3): 138-141.
28. Du MK, Ying YD, Zheng HM, Wen Z, Ni RY. Study on the efficacy and acceptability of medical abortion and aspiration[J]. Reproduction&Contraception, 1996; 16(3): 194-198.
29. Elul B, Ellertson C, Winikoff B,et al. Side effects of mifepristone- misoprostol abortion versus surgical abortion. Data from a trial in China, Cuba, and India[J]. Contraception,1999; 59(2):107-114.
30. Li D, Yu LJ. Yang XB, Zhang JY, Wang HM. A controlled study on termination of early pregnancy by mifepristone with misoprostol or Carboprost Mehtylate versus surgical abortion[J]. Chinese Journal of Family Planning,1997; 31(5): 281-284.
31. Chen JP. Comparison between the medical and surgical abortion in terminating early pregnancy[J]. China integrated clinical, 2002; 18(10): 954-955.
32. Han LP, Wei ZL, Wang SH. Comparison of efficacy of 215 cases with medical and surgical abortion[J]. Journal of Zhengzhou University(Med Sci), 2003; 38(1): 123.
33. Cabezas E. Medical versus surgical abortion[J]. International Journal of Gynecology & Obstetrics,1999;63 (suppl):141-146.
34. Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States[J]. N Engl J Med,1998 ;338(18):1241-1247.
35. Schaff EA, Fielding SL, Eisinger SH, Schaff EA. Fielding SL. Low-dose mifepristone followed by vaginal misoprostol at 48 hours for abortion up to 63 days[J]. Contraception,2000; 61(1): 41-46.
36. Shi YP, Zhu TL, Gui YL, He CH. Study on safety and effectiveness of medical abortion for women menopause for 50-70 days[J]. Chinses Journal of Family Planning,1998; 6(10): 468-472.
37. ICMR Task Force Study. Indian Council of Medical Research. A multicentre randomized comparative clinical trial of 200 mg RU486 (mifepristone) single dose followed by either 5 mg 9-methylene PGE(2) gel (meteneprost) or 600 microg oral PGE(1) (misoprostol) for termination of early pregnancy within 28 days of missed menstrual period[J]. Contraception,2000; 62(3): 125-130.
38. Bartley J, Brown A, Elton R, Bartley J, Brown A, Elton R, Baird DT, et al. Double-blind randomized trial of mifepristone in combination with vaginal gemeprost or misoprostol for induction of abortion up to 63 days gestation[J]. Hum Reprod, 2001; 16(10): 2098-2102.
39. Xu H, Yue WZ, Feng SZ. Clinical study on termination of early pregnancy with 50 mg mifepristone[J]. Chinese Journal of Family Planning, 1994; 47(3): 123-124.
40. McKinley C, Thong KJ, Baird DT.The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol[J]. Hum Reprod, 1993; 8(9): 1502-1505.
41. Schaff EA, Fielding SL, Westhoff C.Randomized trial of oral versus vaginal misoprostol 2 days after mifepristone 200 mg for abortion up to 63 days of pregnancy[J]. Contraception, 2002; 66(4): 247-250.
42. Schaff EA, Fielding SL, Westhoff C.Randomized trial of oral versus vaginal misoprostol at one day after mifepristone for early medical abortion[J]. Contraception, 2001; 64(2): 81-85.
43. He CH, Gao ES. A multi-center RCT on termination of early pregnancy with mifepristone-misoprostol and mifepristone- PG50[J]. Reproduction&Contraception,1994; 14(1): 41-48.
44. Wang H, Wang H, Hu JH,Lu T, Kong J. Clinical observation of early pregnancy termination with vaginal misoprostol in combination with mifepristone[J]. Chinses Journal of Family Planning, 1998; 41(4): 412-413.
45. Li LL. The influence of different giving methods of mifepristone to the efficacy early pregnancy medical abortion[J]. Jilin Medicine, 2001; 22(6): 347-348.
46. Sang GW, Weng LJ, Shao QX, Du MK, Wu XZ, Lu YL, Cheng LN. Termination of early pregnancy by two regimens of mifepristone with misoprostol and mifepristone with PG05-a multicentre randomized clinical trial in China[J]. Contraception, 1994; 50(6): 501-510.
47. Zhou JT, Feng SZ, Cao LY, Liu YJ. Comparison of clinical efficacy between two giving methods of mifepristone in terminating early pregnancy[J]. Herald of Medicine, 2002; 21(4): 222-224.
48. Creinin MD, Schwartz JL, Pymar HC, Creinin MD. Schwartz JL. Pymar HC. Fink W. Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial[J]. BJOG, 2001; 108(5): 469-473.
49. Schaff EA, Fielding SL, Westhoff C, Ellertson C, Eisinger SH, Stadalius LS. Fuller L.Vaginal misoprostol administered 1, 2, or 3 days after mifepristone for early medical abortion: A randomized trial[J]. JAMA, 2000; 284(15):1948-1953.
50. Creinin MD.Randomized comparison of efficacy, acceptability and cost of medical versus surgical abortion[J]. Contraception, 2000; 62(3): 117-124.
51. Ulmann A, Silveatre L, Chemana L, Rezvani Y, Renault M, Aguillaume CJ, Baulieu EE. Medical termination of early pregnancy with mifepristone followed by a prosglandin analogue: Study in 16369 women[J]. Acta Obstet Gynecol Scannd, 1992; 71(4): 278-83.

Chinese Journal of Evidence-Based Medicine

Evaluation of the Effectiveness of Mifepristone Concomitant with Misoprostol for Medical Abortion

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