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Mifepristone (RU 486) is a drug that inhibits the action of progesterone, a hormone essential for maintaining pregnancy. It is believed that intensity of uterine contractions and the onset of labor depend on the balance of progesterone and prostaglandin, a hormone-like substance that acts on the smooth muscle of the uterus. Mifepristone in itself is thought to increase uterine contractions and sensitivity to prostaglandins. Most studies examining the effect of mifepristone on uterine contractions were conducted among women in the first three months of pregnancy. The effect of mifepristone on uterine contractions and sensitivity to prostaglandins has now been studied among women who were between 16 and 18 weeks pregnant. Ten women were given a single 600 milligram dose of mifepristone while 10 others were given a placebo 24 hours before they were to begin conventional (prostaglandin instillation) termination of pregnancy in the second trimester (between 12 and 24 weeks). Pressure within the uterus was measured before and after stimulating the uterus with either prostaglandin (PGE2) or oxytocin, agents that cause the uterus to contract. Uterine activity and sensitivity to prostaglandins and ergotamine (another agent that increases uterine contractions) but not oxytocin, were increased after mifepristone administration. The amount of prostaglandin by-products in the blood was similar in the mifepristone- and placebo-treated women. It took less time to achieve complete abortion in women receiving mifepristone than in the nontreated women (512 minutes versus 1,128 minutes). It is concluded that when the action of progesterone is inhibited, uterine contractibility increases and the uterus becomes more sensitive to agents that increase smooth muscle contractions (oxytocics). Mifepristone does not appear to increase uterine contractions, and decreases abortion times by increasing prostaglandins that are naturally produced by the body. Mifepristone may be useful in preparing the uterus prior to conventional prostaglandin-instilled second trimester abortion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mifepristone (RU 486) is a synthetic drug that stops the action of progesterone, the hormone necessary for the maintenance of a pregnancy. In some countries, mifepristone is used to achieve early therapeutic abortions. Abortions performed between the 12th and 24th week of pregnancy (second trimester) can be induced using prostaglandins, a hormone-like substance involved in the onset of labor. Second trimester abortions are more easily induced with fewer side effects when mifepristone is given before prostaglandin infusion. Similarly, mifepristone might be useful in improving the induction of labor at the end of pregnancy by softening the cervix before labor induction agents are given. However, mifepristone is transferred through the placenta to the fetus. Since mifepristone can reduce the level of progesterone and glucocorticoids (hormones involved in a variety of physiological processes), the use of this drug late in pregnancy could potentially effect the fetus. Before mifepristone can be used to enhance labor, the effects on the fetus must be known. The hormonal changes experienced by the mother and fetus during mifepristone treatments were assessed during second trimester pregnancy terminations. Six women between 16 and 19 weeks of pregnancy received 600 milligrams of mifepristone, and six women received a placebo prior to prostaglandin-induced termination of pregnancy. Mifepristone and its by-products were measured in the blood of the mother, the fetus, and in the fluid surrounding the fetus. There were no significant changes in the concentration of progesterone, cortisol (glucocorticoid), estrogen, or aldosterone (hormone that regulates fluids) in the mother's blood. However, the fetuses in the mifepristone-treated group had significantly higher aldosterone levels than the fetuses of women receiving the placebo (an average of 1,699 versus 999 pmol per liter). Concentrations of progesterone, estrogen, and cortisol were unchanged. Although, the small study population precludes any definitive statements regarding the effects of mifepristone on fetal hormones, further studies are warranted before mifepristone can be used to enhance labor induction. (Consumer Summary produced by Reliance Medical Information, Inc.)

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