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The mifepristone-misoprostol combination is, by far, the most recommended drug regimen for medical abortions, but other drug combinations are available. Misoprostol alone, without mifepristone, may be used in some circumstances for medical abortion, and has even been demonstrated to be successful in the second trimester. [37]
Misoprostol is used for the prevention of NSAID-induced gastric ulcers.It acts upon gastric parietal cells, inhibiting the secretion of gastric acid by G-protein coupled receptor-mediated inhibition of adenylate cyclase, which leads to decreased intracellular cyclic AMP levels and decreased proton pump activity at the apical surface of the parietal cell.
Mifepristone combined with misoprostol is the preferred medication regimen for management of early pregnancy loss. While misoprostol alone can be used, the addition of a dose of mifepristone twenty-four hours before misoprostol administration improves treatment efficacy. [30]
The American College of Rheumatology and a Canadian consensus report both recommend GI-protective agents such as misoprostol be combined with long term NSAID therapy and a review concluded that diclofenac/misoprostol is a cost effective treatment in patients requiring long term NSAID therapy who are at increased risk of developing gastropathy. [4]
Vaginally administered misoprostol had improved outcomes of inducing labor within twenty four hours compared to oxytocin, but was associated with uterine hyperstimulation. [15] Misoprostol is an agonist of EP1 and EP3 receptors, and can cause a greater stimulation at lower concentrations.
An abortion is one of the most common surgical procedures in Trinidad and Tobago, and most occur during the first 12 weeks of pregnancy. [3]According to the World Health Organization (WHO), an unsafe abortion is "a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both". [3]