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Because It's Cheaper?

[It appears that, because of the high cost for RU 486, which is used to kill the embryo, some are now using misoprostol only as an abortifacient. This causes uterine contractions and is apparently being used time after time until the embryo is expelled.]

"Reproductive Health Care," so called, continues to devolve, as more medical "coathanger" regimens are experimented with. See below.

Brazil already has an experience with "misoprostol only" abortions that shows a significant number of failed abortions result in babies with severe craniofacial and limb defects, presumably from intense fetal muscle contraction effects of high dose misoprostol, resulting in compromised blood supply, and compromised development.
 
Following is a report from one of our board members:
 
I think the trend is away from RU-486. I have been studying the regimens that "reproductive
health" organizations such as Gynuity and Ipas have been spreading throughout the third world.

The stated goal is do-it-yourself cheap abortion.

Now it is coming back to the U.S.A.

I just learned that at Kaiser Redwood City – near Palo Alto in one of the most affluent areas of the U.S. – they are doing misoprostol abortions. Women take up to three doses by themselves at home if the first dose doesn't work.

Kaiser, of course, is a closed HMO/IPA, and money saved on pharmaceuticals can go right into bonuses. Kaiser may be a larger abortion provider in California than Planned Parenthood and they have gone over heavily to medical abortion. I guess from the point of view of "cost effectiveness" there is not much of a contest between the $300+ FDA approved RU-486 regimen, the "Abortion Rights Mobilization" $75 RU-486 regimen and the $2-$6 misoprostol-alone regimen.

Gynuity and Ipas say that this is a great method for "low resource" countries. I
guess it was inevitable that the degradation of care would continue to spread in the U.S.A.
Now my Bay area private doctor colleagues are copying the "Redwood City" regimen, which is becoming the local standard of care. You can read about this regimen in this article (below):
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16022846&itool=pubmed_AbstractPlus

 

Misoprostol alone for early abortion: an evaluation of seven potential regimens.
Blanchard K, Shochet T, Coyaji K, Thi Nhu Ngoc
N, Winikoff B.
 
Ibis Reproductive Health, Cambridge, MA 02138, USA.

INTRODUCTION: A growing body of literature has shown that misoprostol alone could be effective for early medical abortion. We evaluated seven potential regimens in women up to 56 days of gestation in order to potentially identify an optimal regimen.

METHODS: In phase I of the study, women requesting early abortion were randomized to one of three misoprostol regimens (4×400 microg po every 3 h, 2×800 microg po every 6 h, 1×600 pv microg); in phase II, women were randomized to one of two regimens (2×800 microg po every 3 h, 1×800 pv microg). In phase III, we consecutively tested two regimens (800 microg pv wetted with saline repeated after 24 h if intact gestational sac, 2×800 microg pv wetted with saline) to validate previously published results.

RESULTS: Although most women experienced some side effects, all regimens were tolerable and acceptable. Five of the seven regimens resulted in complete abortion rates of 60% or less. Only repeated doses of 800 microg pv misoprostol resulted in efficacy exceeding 60%.

DISCUSSION: Misoprostol-alone abortion regimens using oral misoprostol are too ineffective for clinical use or further investigation. Regimens with repeated dosing of misoprostol 800 microg pv warrant further study to find the optimal treatment protocol.