Methods of Termination

In 2001 Mifegyne (mifepristone) 200 mg (formerly known as RU486) was approved by MedSafe, the Medicines Assessment Advisory Committee and the Ministry of Health for four indications:

• Early medical termination of pregnancy
• Priming the cervix before a surgical termination
• Second trimester medical termination of pregnancy
• Induction of labour for foetal death in utero

Mifepristone is an anti-progesterone that in pregnancy causes decidual shedding in pregnancies less than nine weeks gestation, sensitizes the myometrium to the contraction-inducing action of prostaglandin and causes cervical ripening.

Misoprostol is a prostaglandin analogue that causes uterine contractions and cervical dilatation.

In New Zealand early medical terminations consist of 200 mg mifepristone orally, followed 24–72 hours later by the vaginal administration of 800 mcg misoprostol (a prostaglandin analogue). This can be followed by smaller doses of oral misoprostol if required.

New Zealand law states that oral mifepristone followed by misoprostol 24 to 48 hours later, depending on the clinical protocol, must be taken in a licensed institution. If a woman lives close by she may not have to stay in the clinic after taking the medication, but it is important she knows who to call should she have any bleeding.

Medical termination is recommended by the UK RCOG as the method of choice for women up to nine weeks gestation.⁴ Medical terminations are associated with less infection and no perforation as compared with surgical termination. Bleeding may be a complication of medical termination.

Medical contraindications for early medical termination and use of Mifepristone.

• No confirmation of pregnancy
• Ectopic pregnancy
• Known bleeding disorder or current anticoagulant medication
• Chronic adrenal failure
• Porphyria
• Anaemia (Hb <100 g/L)
• IUCD in-situ
• Known allergy to either mifepristone or misoprostol
• Severe cardiovascular disease or greater than two cardiovascular risk factors
• Renal or liver failure
• Malnutrition
• Multiple uterine scars or history of uterine rupture
• Long-term steroid medication (mifepristone may make steroids less effective and hence increased doses may be needed)
• Breast feeding (theoretical risk of mifepristone being excreted in breast milk and so women are advised not to breast feed for two to three days after mifepristone)

Social contraindications for early medical termination⁵

• Woman unwilling to proceed to surgical termination if indicated
• Living more than one hour’s travelling time from emergency medical services
• Lack of direct telephone access or unable to communicate easily by telephone e.g language difficulties
• Lack of reliable transport i.e. car or money for taxis (for return visits and in the advent of an emergency)
• Unsuitable home environment and/or lack of support
• Woman’s inability to cope with cramping and heavy bleeding