Induction Of Abortion Research Articles

No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods.

This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care. Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs. Women with an unintended or abnormal first or second trimester pregnancy. PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications. Results were restricted to English or French systematic reviews, randomized controlled trials, clinical trials, and observational studies published from 1979 to July 2017. National and international clinical practice guidelines were consulted for review. Grey literature was not searched. The quality of evidence in this document was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology framework. The summary of findings is available upon request. IA is safe and effective. The benefits of IA outweigh the potential harms or costs. No new direct harms or costs identified with these guidelines.

Reproductive Effects of Clanobutin Sodium or Menbutone Diethanolamine

The present study was conducted to evaluate the effect of clanobutin sodium and menbutone diethanolamine each alone on some male fertility parameters of male goats. Moreover, the possible adverse effects of repeated administration of these drugs on the foeti of pregnant female rats and/ or induction of abortion were evaluated. Therefore, two experiments were carried out; the first was done on 15 apparently healthy mature un-castrated male goats of Zaraibi breed (1.5-2 year old) were divided into 3 equal groups. The 1st group: goats received basal ration and water without any treatment, the 2nd group: goats administered with clanobutin sodium (20 mg/kg b.wt in the 1st day and 10 mg/kg b.wt. in the 2nd day weekly for 8 weeks) and the 3rd group: goats administered with menbutone diethanolamine (10 mg/kg b.wt in the 1st day and 5 mg/kg b.wt. in the 2nd day weekly for 8 weeks). The second experiment was done on 45 pregnant female rats were divided into 3 equal groups. The 1st group of rats received basal ration and water, the 2nd group: rats administered with clanobutin sodium (40 mg/kg b.wt from 5th to 15th day of pregnancy period) and the 3rd group: rats administered with menbutone diethanolamine (20 mg/kg b.wt from 5th to 15th day of pregnancy period). The obtained results showed that administration of these drugs showed a deteriorating effect on male and female fertility parameters. Both drugs induced significant decrease in sperm concentration, sperm progressive motility, normal sperm %, in comparison with the control group of male goats all over the periods of the experiment. Also, the drugs induced a significant reduction in serum testosterone with significant increase on serum FSH and LH levels with harmful histophthological alterations in testis and epididymis Moreover, in the second experiment number, weights of foeti and number of live foeti on both uterine horns of pregnant female rats was significantly decreased with increased number of dead foeti on both clanobutin sodium and menbutone diethanolamine treated groups of rats in comparison with the control group. These results concluded that the use of both drugs on male or female animals intended for breeding must be avoided.

Presence of Obstetrical Conditions among Women with Pelvic Inflammatory Diseases: Experience of 50 Cases in Bangladesh

Background: Pelvic Inflammatory Diseases can be associated with the different obstetrical condition. Objectives: The purpose of the present study was to see the Presence of Obstetrical Conditions among Women with pelvic inflammatory diseases (PID). Methodology: This cross-sectional of study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College, Dhaka from January 2007 to June 2007 for a period of six (6) months. Women with the age group of 15 - 45 years presented with lower abdominal pain, tenderness, per vaginal discharge and cervical motion tenderness were included in this study. A pre-designed data collection sheet was used to record the history of different obstetrical condition. Result: A total number of 50 women presented with PID were recruited for this study of which majority was in para 2 to 5 which was 30 (60.0%) cases. Majority of the patients had given the history of home delivery (74.0%) which was performed by untrained birth attendance (60.0%). The history of induced abortion was given by 24.0% cases. History of more than 2 times menstrual regulation (MR) and 2 to 5 times were performed in 20 (40.0%) cases in each. Among 50 cases majority used intrauterine device (IUCD) which were 20 (40.0%) cases. Conclusion: In conclusion majority of the women presented with PID have given the history of para 2 to 5, home delivery with untrained birth attendance, induction abortion and history of more than two times MR.

Evaluate the Efficacy and Safety of Normal Saline Instillation in Induction of Mid Trimester Abortions

Evaluate the Efficacy and Safety of Normal Saline Instillation in Induction of Mid Trimester Abortions

Mifepristone and Misoprostol Vs Misoprostol Alone in Second Trimester Termination of Pregnancy

During the last decade, medical methods for second trimester abortion have considerably improved and become safe and more accessible. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. But where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective. The objective of this study is to compare the efficacy of mifepristone with misoprostol and misoprostol alone for second trimester termination of pregnancy. It is a comparative study conducted on 60 patients from 13 to 18 weeks of gestation admitted for second trimester termination on legal indications. Mean induction abortion interval was comparable in both the groups. Of the 30 cases in each group, nine cases in each Group A and six cases in Group B had incomplete/failed expulsion. Among these 15 cases, only nine required check curettage for complete evacuation while others received oxytocics only for completion. The distribution of these cases was also comparable in both the groups. Only one patient in Group B had complete failure of expulsion and underwent surgical evacuation. However, the difference in dosage of misoprostol required for complete expulsion and incidence of side effects were significantly higher in the group B. Mifepristone and misoprostol combined together is now an established, highly effective and safe method for medical method of second trimester termination. However, when mifepristone is not available or affordable, misoprostol alone can also be used effectively, although a higher total dose is needed and side effects are higher than with the combined regimen.

Uterine Rupture after Misoprostol Use for Termination of Pregnancy in Second Trimester with Previous Caesarean Section: A Case Report

Modalities for termination of pregnancy may result in some adverse effects especially uterine rupture in women with the previous cesarean section. Here we report uterine rupture in the 23rd week of pregnancy after Misoprostol uses for abortion induction in second pregnancy with the previous cesarean section. The rupture was repaired via laparotomy. Totally, our results demonstrated that further cautions should be provided in women presenting for abortion in second pregnancy trimester especially in previous cesarean section and with dose adjustments and some other strategies to attain higher safety in this era and for reduction of possible uterine ruptures.

Сравнительная оценка современных методов подготовки шейки матки к хирургическому аборту и индукции родов

Сравнительная оценка современных методов подготовки шейки матки к хирургическому аборту и индукции родов

Does sublingual misoprostol reduce pain and facilitate IUD insertion in women with no previous vaginal delivery? A randomized controlled trial

Abstract Introduction Intrauterine devices (IUDs) are good contraceptive method for women as they have a long acting contraceptive effect compared to other hormonal methods. Misoprostol or prostaglandin El (PGE1) analogue is a synthetic prostaglandin that has been used to induce cervical ripening in vaginal delivery and in medical induction of abortion. Sublingual administration of misoprostol has been shown to be more effective for cervical priming compared with oral administration and equally effective as vaginal administration. Objectives Pain assessment using both the numeric rating scale & pain visual analog scale. The secondary outcome was the successful IUD insertion without the use of adjunctive measures. Material and methods The study was a double blinded randomized controlled trial included 400 cases attended the family planning clinic in Shatby Maternity University Hospital, compared sublingual 200 μg misoprostol with placebo to facilitate IUD insertion. The following parameters have been also studied: • Misoprostol side effects within 48 h of intake: nausea, vomiting, fever, pain and bleeding. • Difficulty in IUD insertion. • Pain assessment using both the numeric rating scale & pain visual analog scale. • Failure of IUD insertion. Results Regarding the easiness of uterine sounding, there was no statistical difference between the two groups. The combined pain assessment was done using numerical rating scale recorded by the woman and VAS recorded by the health provider; the higher reading of both scales for each case was recorded and analyzed there was no statistical significant difference as regard pain reduction in using misoprostol prior to IUD insertion. As regards successful insertion of IUD, the calculated p value did not show any significant difference regarding using misoprostol for successful IUD insertion. The cumulative side effects reported in both groups showed that there is a significant statistical difference between both groups. Conclusion Although misoprostol is used in cervical ripening in labour induction and medical evacuation of missed abortion, its use to facilitate IUD insertion in women with tight cervix or in whom vaginal delivery was not experienced, has no role in pain reduction or increase the ease of IUD insertion.

Evaluation of mid-trimester abortion: A way forward

Background: Need of second trimester abortion has been increasing because of the wide scale introduction of prenatal screening programs detecting women whose pregnancies are complicated by serious fetal abnormalities. Lack of accredited centers and skills required for mid trimester abortion have made this procedure inaccessible to rural population of Nepal.Objectives: This study was conducted to assess correlation of uterine size measured by clinical examination and that assessed by ultrasound, foetal foot length measurement post abortion, dose of misoprostol required and induction delivery interval in medical induction and dilatation and evacuation cases.Methods: This is a hospital based cross-sectional study conducted from April 2011 to July 2012. gestational age was assessed by clinical palpation and ultrasound in women undergoing mid trimester abortion. Standard protocol was followed for medical and surgical abortion. Fetal foot length was measured post abortion. Mean dose of misoprostol and induction abortion interval were noted.Results: Mean age of the patients in dilatation and evacuation group and medical induction group were similar 28 (SD= 6.2) and 27 (SD=7) respectively. The mean dose of misoprostol requiredwas 400 micrograms for dilatation and evacuation and 600 micrograms for medical induction. There was moderate degree of relationship between foot length measurement of the fetus and USG findings, high degree of positive relationship between size of the uterus and fetal foot length measurement.Conclusion: Clinical estimation of period of gestation by size of the uterus correlated well with ultrasonography findings and fetal foot length measurement post abortion. The mid trimester service can thereforebe provided in the centers where sophisticated appliances like ultrasonography is not available.

Comparison between 24 and 48 Hours Interval between Mifepristone and Misoprostol for Induction of Abortion

Comparison between 24 and 48 Hours Interval between Mifepristone and Misoprostol for Induction of Abortion

Different Time Schedules of Mifepristone and Misoprostol in Second Trimester Medical Abortion: A Comparative Study

Background & aim: Recently, the use of mifepristone followed by misoprostol after 36-48 h has been demonstrated to be an effective and safe method for the second trimester medical abortion. However, this regimen entails long total abortion time, and consequently increases the financial burden and anxiety in the patients. We hypothesize that one day interval would be also effective and can be used to provide the abortion care. Regarding this, the present study aimed to compare the effectiveness and safety of 24- and 36-hour intervals between the administration of mifepristone and misoprstol for second trimester abortion. Methods: This prospective comparative study was conducted on 70 females who opted for second trimester medical abortion between 12-20 weeks. Mifepristone (200 mg) was followed by sublingual misoprostol (800 mcg) after one and two days in the first and second groups, respectively. Four hours after the administration of 800 mcg misoprostol, all patients received 400 mcg sublingual misoprostol every 4 h (maximum of four doses in 24 h). For the purpose of the study, such parameters as the rate of successful abortion 24 h after the first dose of misoprostol, abortion duration, and the associated side effect profile were examined. Results: According to the results of the present study, the two-day interval (100%) was more effective than the one-day interval (91.4%) (P=0.021). Furthermore, the mean induction abortion duration was significantly less in the two-day regimen. However, the side effect profiles were comparable in both groups. Conclusion: As the findings of the present study indicated, both schedules of mifepristone and misoprostol were safe and effective in second trimester abortion. The 36-hour interval between mifepristone and misoprostol was more effective than the 24-hour interval. Furthermore, it had shorter abortion duration. We can individualize the patient care by offering a one-day interval regimen since it is more effective and has less duration for total abortion.

English

English

Key Role of Capsular Polysaccharide in the Induction of Systemic Infection and Abortion by Hypervirulent Campylobacter jejuni.

Campylobacter jejuni is a zoonotic pathogen, and a hypervirulent clone, named clone SA, has recently emerged as the predominant cause of ovine abortion in the United States. To induce abortion, orally ingested Campylobacter must translocate across the intestinal epithelium, spread systemically in the circulation, and reach the fetoplacental tissue. Bacterial factors involved in these steps are not well understood. C. jejuni is known to produce capsular polysaccharide (CPS), but the specific role that CPS plays in systemic infection and particularly abortion in animals remains to be determined. In this study, we evaluated the role of CPS in bacteremia using a mouse model and in abortion using a pregnant guinea pig model following oral challenge. Compared with C. jejuni NCTC 11168 and 81-176, a clone SA isolate (IA3902) resulted in significantly higher bacterial counts and a significantly longer duration of bacteremia in mice. The loss of capsule production via gene-specific mutagenesis in IA3902 led to the complete abolishment of bacteremia in mice and abortion in pregnant guinea pigs, while complementation of capsule expression almost fully restored these phenotypes. The capsule mutant strain was also impaired for survival in guinea pig sera and sheep blood. Sequence-based analyses revealed that clone SA possesses a unique CPS locus with a mosaic structure, which has been stably maintained in all clone SA isolates derived from various hosts and times. These findings establish CPS as a key virulence factor for the induction of systemic infection and abortion in pregnant animals and provide a viable candidate for the development of vaccines against hypervirulent C. jejuni.

Misoprostol in Abortion Care: Review and Update

Purpose of Review We seek to update readers on misoprostol use in abortion care. We discuss literature on misoprostol use in first trimester medication abortion, second trimester induction abortion, management of early pregnancy loss, and first and second trimester surgical abortion. We review publications investigating efficacy, acceptability, and safety of misoprostol doses, routes of administration, use with mifepristone and osmotic dilators, and timing in relation to mifepristone or surgery.

Study of Foley`S Bulb for Cervical Ripening in Induction of Second Trimester Abortion

Study of Foley`S Bulb for Cervical Ripening in Induction of Second Trimester Abortion

Immunopathology Behind Toxoplasma IFN-Γ R1 (CD119) in the Induction of Abortion Immunopathology Behind Toxoplasma Gondii Induced Abortion: The Role of IFN-Γ and IFN-Γ R1 (CD119) in the Induction of Abortion

Immunopathology Behind Toxoplasma IFN-Γ R1 (CD119) in the Induction of Abortion Immunopathology Behind Toxoplasma Gondii Induced Abortion: The Role of IFN-Γ and IFN-Γ R1 (CD119) in the Induction of Abortion

Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy

In this prospective randomized parallel group study, subjects with a pregnancy of less than 63 d were randomized to receive either (i) 200 mg oral mifepristone plus 400 μg misoprostol per vaginally concurrently (group A); (ii) or the administration of misoprostol after 48 h (group B). Transvaginal sonography was performed on the 14th day of misoprostol administration to confirm complete abortion. The primary outcome was to compare the rates of complete abortion in two groups. Secondary outcomes were to compare induction abortion interval, side effects and compliance. A total of 200 subjects included in the study were randomized into groups A and B (100 each). Both the groups were comparable for age, parity, gestational age and history of previous abortion. The complete expulsion rate in group A was 96% (95% confidence interval (CI) 95.1–98.2%) and group B was 95% (95% CI 93.0–96.8%) (p > 0.100). A gestational age of more than 56 d was found to predict failure of treatment in both groups. The adverse effect profile in the two groups was the same. Efficacy of concurrent mifepristone and misoprostol in combination is similar to that when misoprostol is given 48 h later (ctri.nic.in CTRI/2010/091/001422).

Efficacy of mifepristone and misoprostol in termination of pregnancy in second and third trimester versus intraamniotic application of prostaglandins

Introduction: According to the published data, a combination of mifepristone and misoprostol is recommended in literature for labour induction in the second and third pregnancy trimester after a foeticide due to a fetal malformation or intrauterine fetal death and for abortion induction in the first pregnancy weeks. At our department we perform foeticide by applying Fentanyl and Xylocaine into the fetal heart. Since the intraamnial input is applied in this procedure, we also perform labour induction by intraamnial prostaglandin application. During the first weeks of pregnancy we performs abortion induction with mifepristone and misoprostol. Through the analysis of our own data, we aimed at establishing in what time fetal expulsion occurs after abortion induction with mifepristone and misoprostol compared to labour induction through intraamnial prostaglandin application. Methods: The retrospective study included all women on whom abortion or labour induction was performed between 2010 and 2015 due to fetal malformations established by means of ultrasound. The first group included all participants in the 16th–24th week of pregnancy or with the fetus weight under 500 g determined through ultrasound where the abortion induction was performed with mifepristone and misoprostol according to the following protocol: mifepristone 200 mg orally, followed 36–48 h later by misoprostol 800 μg vaginally, then misoprostol 400 μm orally, 3-hourly, to a maximum of four further doses. The second group included women after the 24th week of pregnancy or with the fetus weight above 500 g determined through ultrasound. Labour induction were performed through intraamnial 1000 μg prostaglandin application. We compared the time at which the fetal expulsion occurred after the beginning of induction in the first group with the same time in the second group. Results and conclusions: Based on the data from literature, the best abortion or labour induction method is the application of mifepristone and misoprostol regardless of the duration of pregnancy. The aim of our research was to establish whether the cases when a foeticide needs to be performed and therefore intraamnial input is already being used it also makes sense to apply prostaglandins in order to commence induction at the same time. Compared to the protocol with mifepristone and misoprostol we benefit from extra time since it is recommended to wait 36–48 h after mifepristone application before misoprostol application is continued. Based on the data from literature, the time to fetal expulsion in case of induced abortions or labours is proportional to the duration of pregnancy. With our research, we aimed to prove that in the group with the labour induction by means of intraamnial prostaglandin application despite being further into the pregnancy, the time to fetal expulsion is shorter due to the 36–48-h-long break in the mifepristone and misoprostol protocol.

Trends in gestational age at time of surgical abortion for fetal aneuploidy and structural abnormalities

Screening for fetal aneuploidy has evolved over the past 2 decades. Whether these advances impact gestational age at abortion has received little study. We sought to describe trends in the gestational age at the time of abortion by fetal diagnosis over an 11-year study period. We hypothesized that gestational age at time of abortion would decrease for fetal aneuploidy but remain unchanged for structural abnormalities. We conducted a retrospective case series of all women undergoing surgical abortion for fetal aneuploidy or structural abnormalities up to 24 weeks' gestation from 2004 through 2014 in a hospital operating room setting at a single, urban medical center. We excluded labor induction abortions (<1% of abortions at our medical center) and suction aspirations performed in the office practice. We performed suction aspiration up to 14 weeks and dilation and evacuation after that gestational age. We describe the median gestational age at abortion by fetal indication and year. For women undergoing abortion for fetal aneuploidy (n= 392), the median gestational age at time of abortion decreased from 19.0 weeks (interquartile range 18.0-21.0) in 2004 to 14.0 weeks (interquartile range 13.0-17.0) in 2014 (Kruskal-Wallis P < .0001). For women undergoing abortion for fetal structural abnormalities (n= 586), the median gestational age was ≥20 weeks for each year during the study interval (P= .1). As gestational age decreased in the fetal aneuploidy group, fewer women underwent dilation and evacuation and more became eligible for suction aspiration (<14 weeks). In 2004, >90% of women underwent dilation and evacuation for either indication. By 2014, 31% of women with fetal aneuploidy were eligible for suction aspiration compared to 11% of those with structural anomalies. Gestational age at the time of abortion for fetal aneuploidy decreased substantially from 2004 through 2014; earlier abortion is safer for women. In contrast, women seeking abortion for fetal structural abnormalities did not experience a change in timing. Legislation restricting gestational age at the time of abortion could disproportionately affect women with fetal structural abnormalities.

Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester

ObjectiveTo compare the physical and emotional effects of two medical protocols for induced abortion during the second trimester. MethodsThe present study was part of a prospective randomized controlled trial comparing mifepristone followed by oxytocin or misoprostol that was conducted at the Hadassah Hebrew University Medical Center, Jerusalem, Israel, from January 10, 2009, to February 22, 2012. Inclusion criteria were pregnancy (14–24weeks), epidural analgesia, and medical induction of abortion (either elective or following missed abortion). A structured questionnaire was used to assess the participants’ physical symptoms and emotional responses. The primary outcome for the present analysis was the degree of physical symptoms reported. ResultsOverall, 68 women in the oxytocin group and 67 in the misoprostol group received epidural analgesia and completed the questionnaire. As assessed using a five-point Likert scale, women in the misoprostol group were more likely than those in the oxytocin group to experience diarrhea (1.34±0.84 vs 1.10±0.55; P=0.05) and shivers (3.03±1.75 vs 1.75±1.21; P<0.001). No other between-group differences were detected for the physical or emotional variables evaluated. ConclusionDifferences in physical symptoms experienced by the two treatment groups did not influence the participants’ subsequent emotional response.ClinicalTrials.gov: NCT00784797