Erfahrungen mit dem medikamentösen Schwangerschaftsabbruch, insbesondere Nachkontrolle, Nachbehandlung und nachfolgende Kontrazeption

Abstract

Objectives: The medical method of artificial abortion is established and well accepted in Switzerland. During the postabortion control period, however, issues arise concerning the interpretation of the results of the sonography as well as how to treat residual material in the uterus and when to begin with contraception. Particularly when switching to at home administration of Misoprostol, however, definite and evidence-based management is crucial. The present study's objective is to evaluate the medical abortions carried out at our clinic during one year with a special focus on the ultrasound findings two weeks after the administration of Mifepriston and Misoprostol, the therapeutical interventions in case of residuals and the subsequent contraception. Materials and Methods: The data of all 232 patients who underwent medical abortion in the period from March 1, 2002 to February 28, 2003 were retrospectively reviewed. The cases were evaluated with regard to success rate, frequency of expulsion within the first four hours, ultrasound findings, possible therapeutic intervention and subsequent contraception, if known. The data were evaluated using descriptive statistics; statistical significance was calculated by means of the chi-square test, where appropriate. Results: Ninety-five percent of the women had a successful medical abortion. With the applied dosage 60% of the expulsions took place within the first four hours. Only one third of the patients had no more vaginal bleeding at time of the postabortion control. In almost 40% of the cases residuals were suspected, in about two thirds the endometrium was thicker than 10 mm. In those cases, where data on this matter were available, the endometrium returned to normal with and without administration of Misoprostol. For less than half of the patients, subsequent contraception had already been initiated or had already been planned. Conclusions: The presented data seem to justify a watchful wait without further therapeutic intervention in the case of suspected residuals and/or an endometrium thickness of maximally 16 mm. Based on our findings we assume that this management is applicable in the case of Misoprostol administered at home, as well. Further analysis of our results will have to be performed to assess their validity.