The incidence of fetomaternal haemorrhage following elective termination of first-trimester pregnancy

Changes in the concentration of alpha-fetoprotein and placental hormones following two methods of medical abortion in early pregnancy

OBJECTIVE

Measurement of alpha-fetoprotein (AFP) was used to investigate the occurrence of feto-maternal haemorrhage in women undergoing medical abortion.

DESIGN

Three groups of women with amenorrhoea of 56 or less days were studied. A control and a mifepristone group had two blood samples taken 48 h apart. Women undergoing medical abortion with gemeprost had two blood samples taken 24 h apart.

SETTING

Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh.

SUBJECTS

Three hundred and thirty-five women requesting abortion.

INTERVENTIONS

Blood samples taken at 24 h or 48 h apart.

MEASUREMENTS AND MAIN RESULTS

The rise in concentration of AFP in plasma was much higher (P = 0.01) in the two groups of women in whom abortion was induced by gemeprost or mifepristone than in control women. Whereas only 5% of women in the control group had a significant rise in AFP, 27% and 33% of women in the mifepristone and gemeprost groups, respectively, had a rise in AFP level which exceeded the 95th centile (> or = 38%). The concentration of hCG rose by 48 h in both control and mifepristone groups. Progesterone remained unchanged, and oestradiol decreased (P < 0.02) in the mifepristone group. By 24 h, there was a significant fall in the concentrations of hCG, progesterone and oestradiol in the group who had aborted after being given gemeprost.

CONCLUSIONS

Anti-D prophylaxis must be administered to rhesus negative women to avoid rhesus iso-immunisation.

Changes in circulating alphafetoprotein following administration of mifepristone in first trimester pregnancy

The occurrence of fetomaternal haemorrhage was investigated in 30 women by measuring maternal serum alphafetoprotein (AFP) levels before and after the administration of mifepristone (RU 486) for termination of first trimester pregnancy. A significant rise in AFP levels was seen in 21 women (70%), the increase ranging from 6 to 660% of baseline levels. The apparent frequency of fetomaternal haemorrhage was similar to that reported previously for surgical termination of first trimester pregnancies.