Misoprostol for induction of second trimester abortion in pregnancies resulting from sexual violence: effectiveness analysis of a protocol applied in the Brazilian public health service

Abstract

ObjectiveTo evaluate the effectiveness of misoprostol protocol on abortion of pregnancies resulting from sexual violence. MethodRetrospective study with a convenience sample of 253 patients with pregnancy between 13 and 22 weeks of pregnancy who underwent legal abortion in the Hospital Pérola Byington, São Paulo, Brazil, between January 2008 and December 2014. Doses of misoprostol 400μg (13–17 weeks of gestation) and 200μg (18–22 weeks of gestation) were administered vaginally every 12h. The dose was doubled after two doses of no response and maintained for up to four days. In the absence of fetal expulsion, a second cycle of misoprostol was conducted after a 72-h pause. The failure of misoprostol was considered complete after two cycles without fetal elimination. The outcome was complete or incomplete fetal expulsion, evaluated in number of days and misoprostol dose required for abortion. Data were entered in Microsoft Excel 2010 program. ResultsThe age ranged from 11 to 44 years of age, average 22.6±8.2 years of age, with the mean gestational age of 16.8±2.6 weeks. Abortion occurred in 248 cases (98.0%) with an average of 1468.8μg of misoprostol. The analysis of the dispersion of the total dose of misoprostol indicates no significant change with increasing gestational age (y=0.9475x+1453) (R2=0.0001). The average induction time was 2.3 days and in 81.8% of the cases abortion occurred in the first 72h. Excessive and immediate uterine bleeding after fetal elimination was observed in 2.6% of the cases. ConclusionMisoprostol protocol used was effective and safe for second trimester abortion in pregnancy resulting from sexual violence.