Induction Of Second Trimester Abortion Research Articles

Effect of Intravenous Dexamethasone on Induction of Mid-Trimesteric Abortion Randomized Controlled Trial

Background: Medical abortion, the termination of pregnancy through the use of a drug or a combination of drugs, has the potential to reduce complications and to expand access to abortion provided not only by specially trained clinicians but also by other health care providers who may or may not have training in surgical methods of abortion.Aim: This study aimed to elicit the safety and efficacy of intravenous injection of dexamethasone with vaginal misoprostol for shortening the induction abortion interval in the second trimester of pregnancy.Materials and Methods: This study was conducted in Ain-Shams Maternity University Hospital where 140 pregnant females were included for induction of second trimester abortion from June 2018 till December 2019.Results: There was significant statistical difference between the two groups as regard induction-expulsion interval (P >0.001) and length of hospital stay (P > 0.001), mean induction-expulsion interval in dexamethasone group was 10.5 hours; while in the control group was 17.5 hours, the mean length hospital stay was 16 hours in the dexamethasone group while it was 23 hours in the control group. There was significant statistical difference between the two groups as regard dose of misoprostol used (P>0.001), mean dose of misoprostol in the dexamethasone group was 800 mcg while it was 1600 mcg in the control group.Conclusion: It was suggested that use of intravenous injection of dexamethasone with misoprostol was effective in shortening the induction- abortion interval, the length of hospital stay and reducing the misoprostol doses

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

English

English

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

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.

O017 IMPROVING EFFICACY OF MISOPROSTOL FOR INDUCTION OF SECOND TRIMESTER ABORTIONS

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S267-S267 Free communication (oral) presentations O017 IMPROVING EFFICACY OF MISOPROSTOL FOR INDUCTION OF SECOND TRIMESTER ABORTIONS A. Agarwal, A. AgarwalSearch for more papers by this authorR. Pandey, R. PandeySearch for more papers by this authorV. Das, V. DasSearch for more papers by this authorA. Pandey, A. PandeySearch for more papers by this authorS. Agarwal, S. AgarwalSearch for more papers by this authorV. Jain, V. JainSearch for more papers by this authorD. Srivastava, D. SrivastavaSearch for more papers by this author A. Agarwal, A. AgarwalSearch for more papers by this authorR. Pandey, R. PandeySearch for more papers by this authorV. Das, V. DasSearch for more papers by this authorA. Pandey, A. PandeySearch for more papers by this authorS. Agarwal, S. AgarwalSearch for more papers by this authorV. Jain, V. JainSearch for more papers by this authorD. Srivastava, D. SrivastavaSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60447-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S267-S267 RelatedInformation

Randomized trial of buccal versus vaginal misoprostol for induction of second trimester abortion

Background We evaluated the efficacy and acceptability of repeat doses of buccal misoprostol compared to vaginal misoprostol for second trimester pregnancy termination by induction. Study Design Women requesting termination of a pregnancy between18 and 22 weeks gestation were approached for participation. All women received 400 mcg misoprostol vaginally on admission. Participants were randomized to receive subsequent doses of 200 mcg misoprostol every 6 h either buccally or vaginally. All participants completed an acceptability survey. Results Sixty-four women participated. The mean gestational age was 19.7 weeks. The median time to abortion in the buccal group was 15 h, which was not significantly different (p=0.44) from the vaginal-only group of 12 h. Most women in both groups preferred their allocated administrative route. Conclusion Repeat doses of buccal misoprostol are as effective as vaginal misoprostol in inducing abortions in the midtrimester and are highly acceptable to most women. It is reasonable to offer both options to women.

A randomised comparative study on sublingual versus vaginal administration of misoprostol for termination of pregnancy between 13 to 20 weeks

Misoprostol is the drug of choice for medical abortion worldwide but consensus is yet to be reached regarding its preferred route of administration. To compare the outcome of sublingual with vaginal administrations of misoprostol for induction of second trimester abortion. A randomised comparative trial where 300 women at 13-20 weeks gestation, requiring medical abortion, were randomly assigned to sublingual or vaginal route for misoprostol administration with a dose schedule of 400 microg three-hourly, up to a maximum five doses over 24 h. The same doses were repeated for another 24 h in non-responders. Primary outcome measure was complete abortion rate at 24 and 48 h, and the secondary outcome measures were induction-abortion interval, failure rate, side-effects and patients' preference to the route. No statistically significant differences in the complete abortion rates were observed at 24 h (64.03% vs 61.59%, P = 0.767) and at 48 h (79.14% vs 82.01%, P = 0.651) when sublingual and vaginal groups were compared. Mean induction-abortion intervals in sublingual and vaginal groups were 14.1 and 14.5 h, respectively (P = 0.066). Other outcome measures were also more or less similar in both groups. Differences in the incidence of side-effects were also statistically insignificant when both groups were compared. Sublingual administration of the drug was preferred by most of the women as compared to vaginal administration (P < 0.0001). Both sublingual and vaginal administrations of misoprostol are equally effective in inducing medical abortion during second trimester but sublingual route was preferred by the patients.

Induction of second trimester abortion (12–20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases

Induction of second trimester abortion (12–20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases

Induction of second trimester abortion (12–20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases

Design A retrospective analysis of 386 women who underwent termination of pregnancy between 12 and 24 weeks' gestation. Methods Each woman received 200 mg mifepristone orally followed by vaginal misoprostol 800 μg 36 to 48 h later. Three hours after the initial misoprostol administration, 400-μg doses of vaginal misoprostol were administered every 3 h, to a maximum of four doses in 24 h. If abortion failed, 200 mg mifepristone is given again 3 h after the last misoprostol dose, followed by 12 h of rest before vaginal misoprostol administration is repeated as per previous course of treatment. Results Overall, 97.9% and 99.5% of the women aborted within 24 and 36 h, respectively. The median induction-to-abortion interval was 6.7 h (range: 1.4–73.8 h), and nulliparous women took significantly longer time to abort (6.0 h in multiparous women compared to 7.6 h in nulliparous women; p<.0001). One woman failed to abort within 48 h. Surgical evacuation of the uterus was performed in 5% of women for incomplete abortion or retained placenta. Multiparous women were less likely to need analgesic administration for pain relief, and to experience vomiting and diarrhea, than nulliparous women. Conclusion The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and noninvasive regimen for termination of pregnancy between 12 and 20 weeks.

Misoprostol versus cervagem for the induction of labour to terminate pregnancy in the second and third trimester: A systematic review

Aims to compare the benefits and harms of misoprostol to induce labour in the second and third trimester of pregnancy with cervagem. Methods MEDLINE was searched using the terms abortion, induced; abortifacient agents; pregnancy, second trimester; pregnancy, third trimester; misoprostol; cervagem; and gemeprost to identify randomised controlled trials in which misoprostol was compared with cervagem, for induction of labour to terminate pregnancy in the second or third trimester. Outcomes included vaginal birth not achieved within 24 h; induction to delivery interval; analgesia requirements; blood loss; blood transfusion; surgical evacuation of the uterus; maternal death or serious maternal morbidity; side effects. Results Six randomised trials were included. Five compared vaginal misoprostol with cervagem [el Refaey H, Hinshaw K, Templeton A. The abortifacient effect of misoprostol in the second trimester: a randomized comparison with gemeprost in patients pre-treated with mifepristone (RU486). Hum Reprod 1993;8(10):1744–6; Ho PC, Chan YF, Lau W. Misoprostol is as effective as gemeprost in termination of second trimester pregnancy when combined with mifepristone: a randomised comparative trial. Contraception 1996;53(5):281–3; Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second trimester abortion. Obstetr Gynecol 1997;90(6):896–900; Wong KS, Ngai CS, Wong AY, Tang LC, Ho PC. Vaginal misoprostol compared with vaginal gemeprost in termination of pregnancy: a randomized controlled trial. Contraception 1998;58(4):207–10; Dickinson JE, Godfrey M, Evans SF. Efficacy of intravaginal misoprostol in second trimester termination of pregnancy: a randomized controlled trial. J Mater Fetal Med 1999;7(3):115–9], and one oral misoprostol with gemeprost [Bartley J, Baird DT. A randomised study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy. Br J Obstetr Gynaecol 2002;109(11):1290–4]. Vaginal misoprostol compared with cervagem was associated with reduced narcotic analgesia (3 studies, 169 women, RR 0.64 95% CI 0.49–0.84), and surgical evacuation of the uterus (5 studies, 319 women, RR 0.71 95% CI 0.53–0.95). No other statistically significant differences were observed for other outcomes with reported data. In the single trial comparing oral misoprostol with gemeprost, reported outcomes were similar. Conclusions Vaginal misoprostol for the termination of second and third trimester of pregnancy appears as effective as cervagem, but information about maternal safety is limited.

Randomized trial of buccal vs. vaginal misoprostol for induction of second trimester abortion

Introduction: Our objective was to evaluate the efficacy and acceptability of repeat doses of buccal misoprostol compared to vaginal misoprostol for second trimester pregnancy termination by induction. Materials and Methods: Women were eligible to enroll if they requested termination of a pregnancy over 18 weeks' gestation. All had intra-amniotic injection of 1.5 mg digoxin on Day 1. On Day 2 all women received 400 ��g misoprostol vaginally as their first dose. Participants were then randomized to repeat doses of 200 ��g misoprostol every 6 h either buccally (Group B) or vaginally (Group V). Induction time was defined as the interval from the first misoprostol dose to fetal expulsion. Prior to discharge, participants completed an acceptability survey. Results: Fifty-five women were enrolled. The mean gestational age was 19.7 weeks. Two subjects did not complete the study; one came to the hospital 18 h late and received vaginal misoprostol, the other had a dilatation and evacuation (D&E) prior to completing the study due to vaginal bleeding. The mean time to delivery in the buccal group was 14 h, which was not statistically significantly different (p=.44) than the vaginal-only group of 13 h. Twenty percent of women thought they would prefer the other method. Discussion: Our study found no difference in the efficacy of both routes of administration. Both methods were acceptable to most women. Conclusion: Buccal misoprostol is preferable to some women undergoing second trimester induction. Therefore, it may be reasonable to offer both options to women.

The use of misoprostol for termination of early pregnancy

Misoprostol is a prostaglandin analogue which has uterotonic properties. Administered vaginally, it is an effective agent for induction of second trimester abortions. This study was undertaken to determine if the vaginal administration of misoprostol is effective for inducing first trimester abortions. Fifty-eight women with pregnancies less than 10 weeks gestation who desired pregnancy termination received varying dosages of vaginal misoprostol, either alone or in combination with laminaria or tamoxifen. The overall success rate for a complete abortion was 61%. The use of laminaria or tamoxifen did not affect success rates. Abortions occurred within 24 hours of administration of misoprostol. Side effects were minimal. There were no significant differences in any of the following between those who had a successful abortion and those who did not: gravidity, parity, prior elective abortion, age, gestational age of the pregnancy, and level of human chorionic gonadotropin. Although not as successful as other combination regimens, misoprostol alone is readily available, easy to administer, and without major side effects. The use of this agent could eliminate the need for about two-thirds of surgical abortions in the first 10 weeks of gestation.

Induction of second trimester abortion with mifepristone and gemeprost

Objective To determine the efficacy of a new regimen of the antiprogestogen mifepristone and gemeprost for midtrimester abortion. Design Prospective study. Setting Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh. Subjects One hundred women undergoing midtrimester abortion. Interventions Women were pretreated with 200 mg mifepristone 36 h before prostaglandin; 1 mg gemeprost was administered every 6 h for the first 24 h. If abortion had not occurred, 1 mg gemeprost was administered 3 hourly over the next 12 h. Measurement and main results Ninety-six percent and 99% women aborted within 24 h and 48 h, respectively. The median prostaglandin-abortion interval was significantly shorter in multigravidae compared to primigravida (6.6 vs 8.2 h, P<0.01). The median number of gemeprost pessaries to induce abortion was only two and 47% of women required one pessary. The incidence of vomiting and diarrhoea was 31% and 5%, respectively. Eighty-four percent of women required intramuscular diamorphine for analgesia. Thirty-three percent of women required an evacuation of the uterus following abortion. Conclusions The shortened induction-delivery interval following pretreatment with mifepristone makes it possible to conduct midtrimester abortion on a daycare basis.

Induction of second trimester abortion with mifepristone and gemeprost.

To determine the efficacy of a new regimen of the antiprogestogen mifepristone and gemeprost for midtrimester abortion. Prospective study. Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh. One hundred women undergoing midtrimester abortion. Women were pretreated with 200 mg mifepristone 36 h before prostaglandin; 1 mg gemeprost was administered every 6 h for the first 24 h. If abortion had not occurred, 1 mg gemeprost was administered 3 hourly over the next 12 h. Ninety-six percent and 99% women aborted within 24 h and 48 h, respectively. The median prostaglandin-abortion interval was significantly shorter in multigravidae compared to primigravida (6.6 vs 8.2 h, P < 0.01). The median number of gemeprost pessaries to induce abortion was only two and 47% of women required one pessary. The incidence of vomiting and diarrhoea was 31% and 5%, respectively. Eighty-four percent of women required intramuscular diamorphine for analgesia. Thirty-three percent of women required an evacuation of the uterus following abortion. The shortened induction-delivery interval following pretreatment with mifepristone makes it possible to conduct midtrimester abortion on a daycare basis.

Induction of second trimester abortion by intraamniotic instillation of rivanol (ethacridine) combined with oxytocin infusion

We report our experience of 0.1% intraamniotic Rivanol in the interruption of 100 midtrimester pregnancies (15-24 gestation weeks). The mean injection to abortion interval was 37.2h and there were no complications. Intraamniotic Rivanol injection combined with oxytocin infusion seemed an effective and safe method for terminating second trimester pregnancies.

A random allocation comparison of intracervical prostaglandin E2and gemeprost vaginal pessaries for induction of second trimester abortion

SummaryA regimen of intracervical prostaglandin E, gel (Prepidil) was compared with gemeprost pessaries for induction of second trimester abortion. In the chosen dose of 2 mg applied intracervically, the prostaglandin E, method was found to be ineffective for termination of middle trimester pregnancies. If intracervical prostaglandin ' E, gel without oxytocin augmentation is to be an alternative to gemeprost vaginal pessaries a higher dose in a reduced volume of gel is certainly necessary.

STUDIES ON 15(S)15 METHYL PGF2α BY INTRAMUSCULAR ROUTE FOR SECOND TRIMESTER ABORTION (THREE HOURLY SCHEDULE).

A multicentre study was undertaken to study the intramuscular 15(S)-5 methyl PGF2α (Prostin 15M, Upjohn) for induction of second trimester abortion. The patients were premedicated with Imodium and Perinorm for control of gastrointestinal side effects. Prostin 15M was given 250 µg every three hours and the progress was assessed before each injection. If there was no progress at the end of 10 injections the case was classified as a failure. Sixty-two patients were recruited for the study, 24 were primigravidae and 38 multigravidae. Twenty-three out of 24 primigravidae and 34 out of 38 multigravidae aborted with the treatment. The mean induction abortion interval in the primigravidae was 23.5 hours while it was 18.0 hours in the multigravidae. The mean number of vomitings was 2.9 and that of diarrhoea 5.0. The overall incidence of incomplete abortion was only 10.5%.

ADJUNCTIVE USE OF LAMINARIA TENT WITH INTRAMUSCULAR 15(S)15 METHYL PGF2α FOR INDUCTION OF SECOND TRIMESTER ABORTION.

The adjunctive use of laminaria tent along with intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) was studied for induction of second trimester abortion. Three hundred and two patients from eight centres were recruited for the study. Ninety-two were primigravidae and 210 were multigravidae. One to three laminaria tents were inserted overnight and they were removed before the start of treatment with 250 µg Prostin 15M administered intramuscularly every two hours till abortion. Of primigravida 81.5% and of the multigravidae 79.5% aborted within 24 hours of treatment. The induction abortion interval in the primigravida was 11.2 hours and in multigravidae it was 12.0 hours. The overall incomplete abortion rate was 31.0%. The pimigravidae had higher mean number of episodes of vomiting (2.5) and diarrhea (2.9) than the multigravidae (1.7 and 1.5, respectively). No other complications or injuries to genital tract were reported.

STUDIES ON 15(S)15 METHYL PGF2α BY INTRAMUSCULAR ROUTE FOR SECOND TRIMESTER ABORTION (TWO HOURLY SCHEDULE)

A multicentre study was undertaken to study intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Upjohn) for induction of second trimester abortion. The patients were premedicated with Imodium and Perinorm to control the gastrointestinal side effects. The dose of Prostin 15M was 250 µg every two hours and the progress of the abortion was assessed before each injection. If there was no progress at the end of 10 injections the case was classified as a failure. Ninety-seven patients were recruited for the study, 39 were primigravidae and 58 multigravidae. Twenty-four out of 39 primigravidae and 52 out of 58 multigravidae aborted with the treatment. The mean induction abortion interval was 17.8 hours in the primigravidae and 14.5 hours in the multigravidae patients. The mean number of episodes of vomiting was 2.9 and diarrhoea 4.2 per patient per trial. The primigravidae had slightly higher incidence of gastrointestinal side effects. The overall incidence of incomplete abortion was 17.1%.

RANDOMIZED COMPARISON BETWEEN TWO-HOURLY AND THREE-HOURLY INTRAMUSCULAR TREATMENT WITH 15(S)15 METHYL PGF2α FOR TERMINATION OF SECOND TRIMESTER PREGNANCY.

In a multicentre trial, intramuscular 15(S)15 methyl PGF2α (Prostin 15M, Up-john) was tried at 2-hourly and 3-hourly intervals for induction of second trimester abortion. The time schedule was assigned randomly. Eighty-eight patients for 2-hourly schedule and 89 patients for 3-hourly schedule were recruited. Of 2-hourly 83% and of 3-hourly schedule 88.8% of the patients aborted with the treatment. The induction abortion interval was 15.9 hours in 2-hourly and 17.2 hours in 3-hourly schedule. The dose of Prostin 15M was 2.2 mg and 1.7 mg respectively. The incidence of incomplete abortion was 21.9% in 2-hourly and 27.8% in the 3-hourly. The incidence of vomiting was less in the 3-hourly schedule, however, there was no difference in the incidence of diarrhoea.