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 (greater-than-or-equal-to 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.