Method Of Second-trimester Abortion Research Articles

Study of the Efficacy and Success Rate of Single Dose Oral Mifepristone and Vaginal Misoprostol v/s Vaginal Misoprostol alone for Second Trimester Termination of Pregnancy

Background: Second trimester abortions constitute 10-15% of all induced abortions and are considered to be less safe than first trimester abortions. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Aim: To compare the efficacy and the success rate of single dose oral mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second trimester termination of pregnancy. Materials and Methods: A comparative study and was conducted in the Department of Obstetrics and Gynecology in a Tertiary Health Care Hospital. The study was carried out by dividing women into two groups (72 each). Group A received 200mg of oral Tablet Mifepristone and 400 of vaginal misoprostol (48 hours later) which was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Group B received 400 of vaginal misoprostol directly and the dose was repeated every 4 hourly by 200 of vaginal misoprostol up to a maximum of 4 doses. Results: The success rate in Group A was 98.6%, whereas in Group B was 84.7%. The mean induction abortion interval in Group A was lesser (6.2 hours) as compared to Group B (10.8 hours) (p value <0.00001). The mean dose of misoprostol in Group A was 613.88mcg compared to the Group B 1591.66mcg (p value <0.00001). Conclusion: Pretreatment with mifepristone significantly reduces the induction abortion interval (I-A-I) and the misoprostol dose.

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.

Assessment of the Efficacy of Different Methods of Second Trimester Abortion: An Initial Experience in Eastern Nepal

ABSTRACT Background Abortions performed in the second trimester account for a disproportionate amount of abortion-related morbidity and mortality. Materials and methods To assess the effectiveness of medical vs the surgical methods for second trimester abortions. Results A total number of 141 patients were included in the study from September 2009 till August 2012 who underwent second trimester abortion. A total number of 75 patients underwent medical abortion and 66 patients underwent surgical dilatation and evacuation (D&E). Surgical treatment with D&E was more effective and safer than medical treatment for second trimester abortion, The overall complications were seen more in the medically treated cohort with 20 vs 6% in the surgical cohort (p = 0.02), with higher incidence of incomplete abortion (13 vs 0) and a higher amount of blood loss (129.4 ± 20.6 ml vs 69.6 ± 11.4 ml, p < 0.001) requiring transfusion. Conclusion This study demonstrates that the surgical method of second trimester abortion is more effective and safe procedure in experienced centers and as compared to medical methods. The complication rates are lower and it also is more cost-effective as it can be performed in an outpatient setting and does not require hospital admission. How to cite this article Chhetri S, Pokharel H, Rijal R, Lama S. Assessment of the Efficacy of Different Methods of Second Trimester Abortion: An Initial Experience in Eastern Nepal. J South Asian Feder Obst Gynae 2015;7(3):182-184.

Surgical Abortion in the Second Trimester

The development of dilatation and evacuation (D&E) as a method of second trimester surgical abortion occurred soon after abortion law reform took place in the 1960s and 1970s in Europe and the United States. Today, D&E is the predominant method of second trimester abortion in many parts of the world. Debate still exists as to whether surgical or medical methods are optimal for second trimester pregnancy termination. A continuing challenge to provision of D&E is the availability of a large enough pool of skilled providers. This article reviews the current surgical methods used in second trimester abortion, as well as their safety, advantages and disadvantages, acceptability and associated complications. Methods used to ensure safe and efficient surgical termination of second trimester pregnancies such as cervical preparation and ultrasound guidance are also reviewed.

Second Trimester Medical Abortion with Mifepristone–Misoprostol and Misoprostol Alone: A Review of Methods and Management

Second trimester abortions constitute 10–15% of all induced abortions worldwide but are responsible for two-thirds of major abortion-related complications. During the last decade, medical methods for second trimester induced abortion have been considerably improved and become safe and more accessible. Today, in most cases, safe and efficient medical abortion services can be offered or improved by minor changes in existing health care facilities. Second trimester medical abortion can be provided by a nurse–midwife with the back-up of a gynaecologist. Because of the potential for heavy vaginal bleeding and serious complications, it is advisable that second trimester terminations take place in a health care facility where blood transfusion and emergency surgery (including laparotomy) are available. This article provides basic information on regimens recommended for second trimester medical abortion. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective, although a higher total dose is needed and efficacy is lower than for the combined regimen. Therefore, whenever possible, the combined regimen should be used. Efforts should be made to reduce unnecessary surgical evacuation of the uterus after expulsion of the fetus. Future studies should focus on improving pain management, the treatment of women with failed medical abortion after 24 hours, and the safety of medical abortion regimens in women with a previous caesarean section or uterine scar.

Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial

This study was conducted to evaluate the efficacy and side effects of a new regimen of 800 microg misoprostol administered intravaginally every 6 h up to a maximum of three doses in 24 h for second trimester pregnancy termination. A total of 66 women seeking termination of second trimester pregnancy (30 fetal structural anomaly, six chromosomal abnormality and 30 fetal death) were randomly assigned to one of two treatment groups: (i) intravaginal misoprostol moistened with 3 ml of 5% acetic acid in group A (n = 33); or (ii) intravaginal misoprostol moistened with 3 ml of saline in group B (n = 33). The overall median (range) induction-abortion interval was 10 h (2-46) [10 h (4-35) in 36 live fetuses and 9 h (2-46) in 30 dead fetuses, P = 0.515]. All of the patients in both groups aborted within 48 h (100% success rate). The median (range) induction-abortion interval revealed a significantly faster delivery time (P < 0.001) in group A [8 h (2-24)] than in group B [14 h (3-46)]. This new regimen of 800 microg of vaginal misoprostol every 6 h for a maximum of three doses in 24 h was an effective alternative method for second trimester abortion. In addition, misoprostol moistened with acetic acid was significantly more effective than misoprostol moistened with saline.

Second-Trimester Abortions in the United States

Late abortion remains a complex and difficult issue in the United States, where about 10 percent of all abortions are performed at 13 or more weeks' gestation. The reasons why women delay having abortions appear to be largely personal, and most are not amenable to public health intervention. Dilatation and evacuation (D&E) is the most frequently used method of second-trimester abortion, and the safest. Its greatest safety advantage lies in the 13-16-week-interval; for later abortions, D&E and instillation abortion have similar risks of complications and death. The rare instances in which an abortion procedure ends in a live birth represent the most controversial aspect of second-trimester abortion. However, trends toward abortions at earlier gestational ages, use of D&E and increased reliance on ultrasonography to confirm gestational age should reduce the frequency with which such events occur. Research in the area of midtrimester abortion should seek ways to reduce the need for such procedures, to improve their safety and to minimize the trauma of the experience for women.

Termination of pregnancy by “super coils”: Morbidity associated with a new method of second-trimester abortion

Fifteen women in the second trimester of pregnancy had abortions induced by insertion of “super coils”, a new and relatively untested method. In this series, the morbidity associated with the “super coil” method (60 per cent) was higher than for all commonly used abortion methods described in the JPSA. Factors other than the method itself may have contributed to the excessive morbidity in this small group. In contrast to the previously available literature regarding this method, we conclude that, until its safety is demonstrated in the hands of competent medical personnel and in a controlled research setting, the “super coil” abortion technique is not appropriate to use by paramedical personnel. Fifteen women in the second trimester of pregnancy had abortions induced by insertion of “super coils”, a new and relatively untested method. In this series, the morbidity associated with the “super coil” method (60 per cent) was higher than for all commonly used abortion methods described in the JPSA. Factors other than the method itself may have contributed to the excessive morbidity in this small group. In contrast to the previously available literature regarding this method, we conclude that, until its safety is demonstrated in the hands of competent medical personnel and in a controlled research setting, the “super coil” abortion technique is not appropriate to use by paramedical personnel.