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Title: Menstrual induction : methods and mechanisms of action
Author: Norman, Jane Elizabeth
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1992
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One hundred and ninety five thousand abortions were performed in Britain in 1989, a rate of 13 per 1000 women of reproductive age. Data from England and Wales indicates that 35% of women undergoing abortion in 1989 were at less than nine weeks gestation when menstrual induction can readily be performed. The method of abortion in almost all these women was vacuum aspiration, but there is increasing interest in menstrual induction, whereby early pregnancy can be terminated medically without the need for surgical intervention. The development of the progesterone antagonist mifepristone offers the possibility of a safe method of menstrual induction (in combination with a prostaglandin), which is effective and has minimal side effects. The minimum effective dose, and the mechanism of action of mifepristone are however unknown. The work in this thesis has investigated these two questions further. When the efficacy and side effects of three different doses of mifepristone: 200mg, 400mg and 600mg followed 48 hrs later by 1mg gemeprost in women of ≤56 days amenorrhoea were compared, all three regimes were equally effective, with a mean complete abortion rate of 98% . There were no differences in the incidence of side effects between the three groups. In contrast a lower complete abortion rate of 87% was seen in women at the same gestation following gemeprost alone (1mg 6 hrly to a total of 3mg) (p< 0.01). In a randomised comparison between the two methods, there was a significantly greater requirement for analgesia following the use of gemeprost alone (p< 0.02). The effects of a new prostaglandin (misoprostol) which could be used in combination with mifepristone were also studied. A significant increase in uterine tone was observed 30-120 minutes after 200-600μg misoprostol alone (p&60 0.01); in women pretreated 48 hours earlier with 200mg mifepristone, an increase in uterine contractility measured in Montivideo units was observed 30 minutes after 200-600μg misoprostol (p< 0.01). Eighteen out of twenty one women aborted using 200mg mifepristone followed 48 hours later by 200-1000μg misoprostol.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available