Complete Abortion Rate Research Articles

Comparison of No-Test Telehealth and In-Person Medication Abortion

In the US, access to medication abortion using history-based (no-test) eligibility assessment, including through telehealth and mailing of mifepristone, has grown rapidly. Additional evidence on the effectiveness and safety of these models is needed. To evaluate whether medication abortion with no-test eligibility assessment and mailing of medications is as effective as in-person care with ultrasonography and safe overall. Prospective, observational study with noninferiority analysis. Sites included 4 abortion-providing organizations in Colorado, Illinois, Maryland, Minnesota, Virginia, and Washington from May 2021 to March 2023. Eligible patients were seeking medication abortion up to and including 70 days' gestation, spoke English or Spanish, and were aged 15 years or older. Study groups reflected the model of care selected by the patient and clinicians and included: (1) no-test (telehealth) eligibility assessment and mailing of medications (no-test + mail) (n = 228); (2) no-test eligibility assessment and pickup of medications (no-test + pickup) (n = 119); or (3) in-person with ultrasonography (n = 238). Effectiveness, defined as a complete abortion without the need for repeating the mifepristone and misoprostol regimen or a follow-up procedure, and safety, defined as an abortion-related serious adverse event, including overnight hospital admission, surgery, or blood transfusion. Outcomes were derived from patient surveys and medical records. Primary analysis focused on the comparison of the no-test + mail group with the in-person with ultrasonography group. The mean age of the participants (N = 585) was 27.3 years; most identified as non-Hispanic White (48.6%) or non-Hispanic Black (28.1%). Median (IQR) gestational duration was 45 days (39-53) and comparable between study groups (P = .30). Outcome data were available for 91.8% of participants. Overall effectiveness was 94.4% (95% CI, 90.7%-99.2%) in the no-test + mail group and 93.3% (95% CI, 88.3%-98.2%) in the in-person with ultrasonography group in adjusted models (adjusted risk difference, 1.2 [95% CI, -4.1 to 6.4]), meeting the prespecified 5% noninferiority margin. Serious adverse events included overnight hospitalization (n = 4), blood transfusion (n = 2), and emergency surgery (n = 1) and were reported by 1.1% (95% CI, 0.4%-2.4%) of participants, with 3 in the no-test + mail group, 3 in the in-person with ultrasonography group, and none in the no-test + pickup group. This prospective, observational study found that medication abortion obtained following no-test telehealth screening and mailing of medications was associated with similar rates of complete abortion compared with in-person care with ultrasonography and met prespecified criteria for noninferiority, with a low prevalence of adverse events.

Induction of abortion in the first trimester of pregnancy using letrozole and misoprostol combination versus misoprostol alone - A comparative observational study

Background: Medical abortion is safer than surgical abortion. Several studies have shown that combination of antiprogesterone drug mifepristone and prostaglandin misoprostol can increase complete abortion rate in medical management of first-trimester miscarriage compared to misoprostol alone. Letrozole, an aromatase inhibitor, has emerged as an alternative to mifepristone for induction of medical abortion as mifepristone is expensive and not registered in many countries. Aims and Objectives: The aim of the present study was to evaluate the safety and efficacy of combined regimen of letrozole and misoprostol in first-trimester medical abortion compared to misoprostol alone. Materials and Methods: It was a comparative observational study conducted at R. G. Kar Medical College, a tertiary care hospital in West Bengal, India. The study population was the antenatal mothers booked at antenatal clinic willing for termination of pregnancy at <12 weeks of gestational age. Participants were allocated, 39 in each group in a non-randomized manner. Patients in one group (Group A) were posted for medical abortion with combination regimen of tablet letrozole (10 mg) once daily for 3 days followed by application of tablet misoprostol 800 mcg sublingually on day 4. In other group (Group B), patients were on misoprostol-only regimen with the application of tablet misoprostol 800 mcg sublingually. Results: Induction-abortion time was significantly less in the letrozole group (11±0.79 h) than the misoprostol group (13.23±0.81 h), P=0.0001. Complete abortion rate was significantly higher in the letrozole group compared to misoprostol group (84.62% and 64.10%, respectively, P=0.03). 15.38% patients in the letrozole group and 35.90% patients in the misoprostol group had excessive vaginal bleeding and the difference was statistically significant, P=0.03. The duration of vaginal bleeding was also significantly less in the letrozole group (2.45±0.29 days) than the misoprostol group (2.82±0.37 days), P<0.0001. Incidence of side-effects was comparable and the severity of side-effects was not significantly different between the groups. Conclusion: Letrozole and misoprostol combination regimen leads to significant increase in complete abortion rate and also significant reduction of the duration of vaginal bleeding, induction-abortion time, and need for surgical intervention when compared to misoprostol regimen.

Effects of medical abortion assisted by traditional Chinese medicine: A network meta-analysis of randomized controlled trials.

To what extent traditional Chinese medicine (TCM) combined with mifepristone and misoprostol is beneficial for improving the complete abortion rate and duration of vaginal bleeding has been a subject of debate in the field of medical abortion. To assess the evidence regarding the complete abortion rate and duration of vaginal bleeding of medical abortion assisted by different kinds of TCM. We searched electronic databases such as PubMed, Web of Science and Cochrane Library database, China National Knowledge Internet, Wan fang Database, VIP Database, and China Biology Medicine disc from 2000 to February 15, 2023. The control group was medical abortion with mifepristone and misoprostol, and the experimental group was medical abortion assisted by TCM. Major data extraction included sample size, age, medicine used for abortion, outcome measures. RevMan 5.3 and Stata 15.1 software were used to assess the literature quality and perform network meta-analysis, respectively. A total of 73 randomized controlled trials (RCTs) with 11 683 patients and nine kinds of TCM were included in this study. Compared with mifepristone and misoprostol, eight kinds of TCM had statistical significance in improving the complete abortion rate. The effect value of Sancao decoction was 5.86 (95% confidence interval [CI] 2.53-13.58). Seven kinds of TCM shortened the duration of vaginal bleeding. The effect value of comfrey and trichosanthin decoction was -8.75 (95% CI -10.86 to -6.64). This network meta-analysis showed that Lenge Zhumo decoction and Sancao decoction could have a large beneficial effect on complete abortion rate in medical abortion during early pregnancy, and comfrey and trichosanthin decoction could be the best TCM for shortening the duration of vaginal bleeding.

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis.

To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. Misoprostol has been determined as a safe option with good acceptance by patients.

Letrozole plus misoprostol versus misoprostol alone in the induction of anembryonic missed abortion: a randomized controlled trial conducted in Upper Egypt

BackgroundA missed abortion is a spontaneous abortion in which the embryo or fetus has already died but has remained in the uterus for days or weeks with a closed cervical ostium. Termination of pregnancy could be achieved either by surgical evacuation or medical or expectant management. Letrozole is a third-generation aromatase inhibitor. According to many recent studies, letrozole given for three days before the administration of misoprostol was more effective than misoprostol alone at inducing abortion. Our study compared the efficacy of various letrozole regimens (10 mg/d for three days and a single dose of 20 mg) combined with misoprostol vs. misoprostol alone in inducing abortion. To find the most efficient regimen of letrozole administered before misoprostol to induce an abortion.MethodologyThis prospective, parallel, three-arm, single-blinded, allocation-concealed randomized controlled trial was conducted in Sohag Teaching Hospital in Upper Egypt. We randomly divided 105 patients with anembryonic missed abortion (up to 63 days gestation) with no history of medical disorders or a history of allergies to misoprostol or letrozole into three equal groups (a single-dose letrozole group, a multiple-dose letrozole group, and a misoprostol-only group). The complete abortion rate, incomplete abortion rate, failure to abort rate, and induction-to-abortion interval were all collected. All statistical calculations were performed using the computer program SPSS (Statistical Package for the Social Science, SPSS Inc., Chicago, IL, USA).ResultsThe complete abortion rate was significantly higher in the single-dose letrozole and multiple-dose letrozole groups than in the misoprostol group (p values = 0.0455 and 0.001, respectively). On the other hand, there was no significant difference in the complete abortion rate between the single-dose group and the multiple-dose letrozole group (p-value = 0.1713). The time to complete abortion was significantly shorter in the single-dose and multiple-dose letrozole groups than in the misoprostol group (p values = 0.0036 and 0.0049, respectively). On the other hand, there was no significant difference in the time to complete abortion between the single-dose letrozole group and the multiple-dose letrozole group (P = 0.532).ConclusionSingle- and multiple-dose letrozole regimens followed by misoprostol had a higher rate and a shorter time to complete abortion than misoprostol alone.Trial registrationThe trial is registered at gov with the name “letrozole and abortion” and the identifier “NCT05198050”. The date of registration was April 1, 2022, registered prospectively. URL: https://register.clinicaltrials.gov/prs/app/action/ViewOrUnrelease?uid=U0004GED&ts=25&sid=S000BPDQ&cx=43mobl.

The Effectiveness of using Letrozole prior Tomisoprostol Versus Misoprostol alone for Successful Induction of missed Abortion: A Randomized Controlled Trial

Objective: To evaluate the efficacy of medical abortion induction when Letrozole and misoprostol are combined vs when misoprostol is used alone. Methods: It was intended for 150 women to participate in a randomized controlled experiment. They were split into two groups at random, each with 75 people. While the control group (misoprostol alone group) only got misoprostol, the case group (letrozole group) received pretreatment letrozole 12.5mg for two days. According to American College of Obstetrics and Gynecology (ACOG) recommendations based on gestational Age, misoprostol was administered to both groups in the following dosages: 800mg sublingually in a single dose during the first trimester and 400mg sublingually every 3 hours for up to 5 doses during the second trimester. Results: 137 women in all, 69 of whom received Letrozole and 68 of whom received misoprostol alone. Complete abortions were recorded in 96 instances (70.07%), 51 of which were associated with Letrozole (73.9%) and 45(66.2%) with misoprostol alone (P=0.32). However, the case and control groups had corresponding mean expulsion start times of 7.51.8 hours and 8.31.5 hours. This suggests that the case group had an ejection that began much sooner (P=0.003). Conclusion: The current study found that a combination of misoprostol with Letrozole did not lead to a significantly higher rate of complete abortion if compared with misoprostol alone among women with missed abortion up to 20 weeks gestation. It only significantly shortened the interval to the initiation of expulsion.

Manual Vacuum Aspiration vs Vaginal Misoprostol for the Management of First-Trimester Incomplete Miscarriage in term of complete abortion

Aim: To compare the complete abortion rate between manual vacuum aspiration and vaginal misoprostol for the management of First-Trimester Incomplete Miscarriage in term of complete abortion Study design: Randomized Controlled Trial. Study duration: April 2022 to October 2022. Setting: Department of Obstetrics & Gynecology Bahawal Victoria Hospital Bahawalpur. Methods: A total of 120 patients with First-Trimester Incomplete Miscarriage were chosen and equally divided into the MVA group and the MM group. The effectiveness of achieving a complete abortion was compared between the two groups. Results: Total 120 patients were selected. In MVA group, mean age and mean gestational was 31.47±5.82 years and 6.92±3.39 weeks while in MM group was 30.87±6.86 years and 5.78±3.47 weeks. Complete abortion was noted in 53(88.33%) patients of MVA group while in 44(73.33%) patients of MM group. Significantly (P=0.036) higher Efficacy (Complete abortion) rate was noted in MVA group. Practical Implication: It is a very good option in hospitals with low resources and in developing countries like Pakistan. Conclusion: In this study, we found MVA had higher complete abortion rate as compared to misoprostol intra vaginally. So, MVA is better treatment option than misoprostol intra vaginally as it has no systemic effects and it is a very good option in hospitals with low resources and in developing countries like Pakistan. Key words: Miscarriage, MVA, vaginal misoprostol, incomplete abortion, Gynecology, Pakistan

Comparing the Effects of Misoprostol/Letrozole and Misoprostol/Placebo on Medical Abortion Success Rate: A Randomized Clinical Trial

Background: Abortion is the medical or surgical termination of pregnancy before the 20th week. However, dilation and curettage have been associated with hazards such as uterine rupture, heavy bleeding, and infection. Therefore, in recent decades, pharmacological therapies have become more widely accepted. Objectives: This research compared the medical abortion success rates of misoprostol/letrozole versus misoprostol/placebo. Methods: This randomized clinical study was conducted at Mashhad University of Medical Sciences hospitals between 2018 and 2019, involving pregnant women who were candidates for medical abortion. The study population was divided into two groups based on whether they had undergone cesarean section (CS). Each group was randomly assigned to either a control or an intervention group. In the CS group, there were 52 patients in the intervention group and 52 in the control group. The control group received a regimen of misoprostol and placebo, while the intervention group received a combination of misoprostol and letrozole. Results: There was no statistically significant difference in age (31.59 ± 5.6 vs. 31.06 ± 4.6, P value = 0.605), gestational age by ultrasound (11.20 ± 3.3 vs. 10.29 ± 2.6, P value = 0.135), or blood pressure between the control and intervention groups. However, the analysis showed a statistically significant difference in the rate of complete abortion (12 (23.5%) vs. 28 (54.9%), P value = 0.001) between the two groups. In the non-CS group, there was a significant difference in age between the control and intervention groups. The study analyses also revealed a significant difference in the rate of complete abortion between the two groups (24 (46.2%) vs. 36 (72.0%), P value = 0.008). Conclusions: Letrozole is recommended in combination with misoprostol for medical abortions because it increases the likelihood of complete abortion and reduces the duration of the abortion process.

Comparison between different dose regimens of misoprostol in termination of early pregnancy

Objective: compares efficacy & side effects of vaginal put of 400 or 600 microgram of cytotic in repeated doses in termination of first trimester gestational age. Desgn: Randomized prospect study. Setting and duration of study: Maternity teaching hospital in Sulaimani from 1st of January to the end of June 2009. Patients and methods: This study was included 90 pregnant women admitted during first trimester of gestation, requiring termination of pregnancy because of fetal demise. These patient are divided into two groups: (45) women received 600 mcg of misoprostol vaginally and other group 45 were received 400 mcg of it also vaginally. Misoprostol was given every 6hr for three doses. They were observed and evaluated in 24 hours.Result: Group1 had a complete abortion rate of 35.6% while group2 abortion rate of 13.3% this was significant. The time interval from put abortion was 8.04 ± 4.280 hours in group1 and 9.62 ± 5.237 hours in group2. Side effects such as diarrhea, nausea and headache showed no statistically significant difference in both patients.

Comparison of Different Medical Treatment of Missed Abortion

Missed abortion constitutes a significant problem in gynecology patient, as itrepresents an unfortunate outcome of early pregnancy. Despites its frequencyhowever, there is still scope for improvement in patient care as it remains responsiblefor considerable emotional and psychological trauma to the patients. Aim of TheStudy:- This study is designed to evaluate for using misoprostol therapy in compareto other medical therapy for Iraqi female. Patients and Method:- The current studyrepresent a prospective clinical trial that was done on patients with missed abortion.The total number of cases that involving in the study were included 104 cases & 52 ofthem use mifepristone in a standard regimen and 52 use misoprostol in standardregimen, and those who failed to response from the two groups were selected to use acombination of these two drugs. Of these drugs misoprostol alone regimen was shownto be the most effective method for inducing complete abortion in 77.8% of thepatient using this drug alone within a shorter duration (<12 hours), and equal rate ofcomplication with other groups while mifepristone shows (55%) rate of completeabortion while the rate for combination of drugs was (43.6%). Other factors such asthe gestational age of the patient, types of delivery, Parity and the patient age werenot show to be significantly correlated with the end results. Conclusion:- The currentstudy found a significant correlation between the duration from the last delivery andthe end result, that complete miscarriage occurs more in patient delivered since morethan 11 months.

Comparison of the clinical efficacy of surgical versus medical method for first trimester pregnancy termination in Iran: A quasi-experimental research.

The surgical and medical options for management of pregnancy termination procedures are acceptable in practice but differ in clinical efficacy, costs, and patient experiences, and deciding what the best method is not clear always. This study aimed to compare clinical efficacy, outcomes, and patient acceptance of dilatation and curettage (D and C) versus medical abortion using misoprostol for first trimester of gestation in Iranian context. A prospective, multicenter, quasi-experimental research conducted from July 2021 to January 2022. The primary outcomes were the rate of composite complications or complete abortion. Data were analyzed with SPSS 18 using descriptive statistics, independent t-test, analysis of variance and non-parametric tests. Secondary outcomes were quality of life using EQ5D questionnaire, estimated blood loss, pelvic infection, pain level, hospital stay, and acceptability of intervention and relative risk as the effect size. Finally, 168 patients were included in this study. The composite complication rate among medical abortion patients is significantly more than that of surgical abortion patients (39.3% vs. 4.76%). The relative risk calculated 8.25 (3.05-22.26 CI). Medical abortion patients have experienced higher levels of ongoing bleeding, pain, and symptoms of pelvic infection. The higher level of acceptance has been reported by surgical group patients in comparison to the medical group patients (85.7% vs. 59.5%). Quality of life scores for surgical and medical group estimated 0.6605 and 0.5419, respectively. Surgical method of abortion using D and C is a very safe and highly successful option in comparison to the medical method using misoprostol alone and is associated with better clinical outcomes, acceptance, and quality of life in first trimester of pregnancy among Iranian women.

A prospective comparative study of 3 different regimens involving mifepristone and oral/ vaginalmisoprostol combination in medical termination of pregnancy at less than 9 weeks gestation

Background and Objectives: Medical abortion with a combination of mifepristone and a prostaglandin analogue (Misoprostol) is a well-established and adequately studied as an alternative to surgical abortion in early pregnancy for many years now but still no consensus has been reached regarding superiority of one route and dosage. This study is an attempt to compare efficacy in terms of rate of complete abortion, side effects and women’s perceptions of three mifepristone/misoprostol regimens and to study the effect of continued oral misoprostol for one week in medical termination of pregnancies of less than nine weeks gestation. Materials and Methods: Abortion seeking women of less than nine weeks period of gestation were included in this study and were divided into three groups: GROUP I also referred as O+O group, GROUP II the V+O group, and GROUP III referred as V ONLY group. This is an outpatient regimen requiring minimum three visits on day 1, 3 and 15. Initially, tablet mifepristone 200 mg was administered orally in all three groups on day 1. This was followed on day 3 by oral misoprostol 0.8 mg in group I and vaginal 0.8 mg misoprostol in group II & III. It was placebo controlled. Patients were sent home after 4 hour observation period. The oral group and one of the vaginal groups i.e. group I and II continued 0.4 mg of oral misoprostol twice daily for 7 days. Final assessment was done on day 15. Results: All three groups were comparable in terms of rates of complete abortion: Group I 93.06%; II 94.44% and group III 93.06%. Incomplete abortion occurred in 9.72% women in group I, 5.52% in group II and 6.94% women in group III. 73.61 % of women in group I, 76.38% women in group II and 77.76% in group III suffered from lower abdominal pain & cramping. 100% women cited oral route as their preferred route and overall 199 (92%) women were satisfied with treatment, 12(5.6%) were unsure and 5(2.4%) were dissatisfied. For future purposes 100 % women cited medical abortion to be their preferred mode compared to surgical one Conclusion: In light of previous studies establishing superiority of vaginal route over oral, continuation of misoprostol for 7 days possibly improved the efficacy for oral misoprostol group(group I) but it did not seem to further increase the efficacy for vaginal Misoprostol (group II) as all three groups were of comparable efficacy. Additional misoprostol did not shorten the duration of bleeding or induction abortion interval compared to group not continuing additional one week misoprostol. Successful abortion was associated more with lower gestational age,multigravidas and multiparas.Oral group had higher frequency of nausea, vomiting and diarrhea than vaginal administration. Statistically insignificant but still lower number of women were satisfied in the end with the treatment in the oral group compared to vaginal groups despite oral mode being the preferred mode. Additional larger studies are required on initial oral misoprostol administration and its continuation to establish its equivalence to vaginal route.

Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy

IntroductionAbortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was...

PROSPECTIVE STUDY ON EFFICACY OF MIFEPRISTONE AND MISOPROSTOL VS MISOPROSTOL ALONE IN 1ST TRIMESTER MTP.

Background: Unsafe abortions are the third leading cause of maternal mortality in India, close to 8 women die from unsafe abortion each day.(1) MMR in India is 103/100,000 live births (2017-2019),unsafe abortion account for 8% of the MMR. Both MTP act of 1971 and MTP amendment act 2021,which expanded the scope of the act and provides impetus for safer abortions, are progressive and encouraging. Each year 4.7-13.2%of maternal death attributed due to unsafe abortions (2). Unsafe abortion accounts for 13% of maternal deaths worldwide of which 19% occurs in South East Asia (3, 4).Medical methods of abortion has become preferable method with availability of prostaglandin analogue misoprostol and antiprogesterone mifepristone. There are many studies for both drugs and each study claims its schedule to be superior and safer than others.(5,6,7) AIM:This study mainly aims to compare efficacy of Mifepristone and Misoprostol combination versus Misoprostol alone in procuring complete abortions in first trimester by comparing their Need for Manual /electric vacuum aspiration. OBJECTIVES: Ÿ To compare efficacy in relation to gestational period. Ÿ To compare the Success rate of combination drugs with misoprostol alone. Ÿ To compare Induction to abortion time intervals. Ÿ To evaluate the Safety. This is a prospective observational study conducted at Government Victoria hospital, Department of Obstetrics & Gynaecology,Andhra Medical College,Visakhapatnam,and Andhra Pradesh Total no.of patients – 100 No.of women who were given Mifepristone & Misoprostol combination 50 No.of women received Misoprostol alone -50 Observations of this study 1.Maternal age was compared in both the groups.Majority of patients belongs to 21 to 25 years age group. 2.Majority are multigravida in both groups 3.Majority (64%) have opted for termination before 45days in mifepristone +misoprostol group,where as in misoprostol group 60% between 45-63 days 4.In both major indication for termination is unwanted pregnancy. 5. In mifepristone and misoprostol group 46 cases had complete abortion whereas 4 cases required electric vacuum aspiration 6.when comparing induction and abortion interval mifepristone and misoprostol group mean interval is 4.31 hours whereas misoprostol group is 16.18 hours and p value is <0.0001 showing induction abortion interval is less in mifepristone and misoprostol group 7.Unwanted symptoms were noted in both groups but significantly more with misoprostol only group but the p value was not significant. 8.There were no statistically significant major complications in both groups,none required blood transfusion 9. Although Mifepristone and Misoprostol combination is costly but more effective with higher rate of complete expulsion,should be preferred over Misoprostol alone where cost is not a restraining factor. CONCLUSION Based on findings from this study it can be concluded that 1. Mifepristone plus vaginal misoprostol combination group is associated with shorter induction abortion interval and 96% success rate when compared to misoprostol group alone. 2. Mifepristone plus vaginal misoprostol combination group is associated with complete abortion rate compared to misoprostol alone group.Vaginal misoprostol alone group is cost effective. 3. Routine use of Mifepristone-Misoprostol combination is an effective option for early MTP where cost is not a consideration and is ideal for home management. 4.Complication are less in Mifepristone-Misoprostol combination The only confounding factor is the cost involved which is about 20 times that of Misoprostol alone

A telemedicine model for abortion in South Africa: a randomised, controlled, non-inferiority trial

Telemedicine for medical abortion increases access to safe abortion but its use has not been described in a controlled trial. We aimed to investigate the effectiveness, adherence, safety, and acceptability of a modified telemedicine protocol for abortion compared with standard care in a low-resource setting. In this randomised, controlled, non-inferiority trial we recruited women seeking medical abortion at or before 9 gestational weeks at four public health clinics in South Africa. Participants were randomly allocated (1:1) by computer-generated blocks of varying sizes to telemedicine or standard care. The telemedicine group received asynchronous online abortion consultation and instruction, self-assessed gestational duration, and had a uterine palpation as a safety measure. Participants in this group took 200 mg mifepristone and 800 μg misoprostol at home. The standard care group received in-person consultation and instruction together with an ultrasound, took 200 mg mifepristone in clinic and 800 μg misoprostol at home. Our primary outcome was complete abortion after initial treatment, assessed at a 6-week interview. Our non-inferiority margin was 4%. Group differences were assessed by modified intention-to-treat (mITT) analysis and per protocol. The trial is registered at ClinicalTrials.gov, NCT04336358, and the Pan African Clinical Trials Registry, PACTR202004661941593. Between Feb 28, 2020, and Oct 5, 2021, we enrolled 900 women, 153 (17·0%) of whom were discontinued before the abortion and were not included in the analysis. By mITT analysis, 355 (95·4%) of 372 women in the telemedicine group had a complete abortion compared with 338 (96·6%) of 350 in the standard care group (odds ratio 0·74 [95% CI 0·35 to 1·57]). The risk difference was -1·1% (-4·0 to 1·7). Among women who completed treatment as allocated (per protocol), 327 (95·6%) of 342 women in telemedicine group had complete abortion, compared with 338 (96·6%) of 350 in the standard care group (0·77 [0·36 to 1·68]), with a risk difference of -1·0% (-3·8 to 1·9). One participant (in the telemedicine group) had a ruptured ectopic pregnancy, and a further four participants were admitted to hospital (two in each group), of whom two had blood transfusions (one in each group). Asynchronous online consultation and instruction for medical abortion and home self-medication, with uterine palpation as the only in-person component, was non-inferior to standard care with respect to rates of complete abortion, and did not affect safety, adherence, or satisfaction. Grand Challenges Canada and the Swedish Research Council.

مقارنة بين جرعات الميزوبروستول في إنهاء الحمل في الثلث الأول من الحمل

Objective: The aim of this study is to compare the efficacy of vaginal misoprostol with different doses for abortion in the first trimester. Patients and Methods: Descriptive Comparative Study conducted for the period one year (July 2020 –July 2021) at Tishreen University Hospital in Lattakia- Syria. The study included 80 pregnant women in the first trimester who had a therapeutic indication for termination of pregnancy after taken consent from it and her fathers, and were divided into group A was (40 women): were administrated 400 µg of vaginal misoprostol and repeated every 6 h for 48 h, and group B was (40 women): were administrated 800 µg of vaginal misoprostol repeated after 24 h. Results: Abortion rate after the first dose in group B was higher than group A (67.5% vs.10%). The rate of complete abortion was significantly higher in group B (72.5%) vs. (17.5%) in group A, p= 0.0001, and mean induction- abortion interval in group B was significantly shorter than group A (13.8±3.3 vs. 29.4±5.9, p: 0.004). There weren't significant associations between both indications and results of abortion with the number of pregnancies in the two groups (p>0.05). Nausea was the most frequent side effect in the two groups without significant difference (p>0.05). Conclusion: Misoprostol represents a safe and effective alternative to invasive methods for termination early intrauterine pregnancy.

Complications of second trimester induction for abortion or fetal demise for patients with and without prior cesarean delivery

ObjectiveCompare complication rates of second trimester induction for abortion or fetal demise for patients with and without prior cesarean delivery. Study designRetrospective cohort study examining induction for abortion or fetal demise for pregnancies from 14w0d to 23w6d gestation at 2 urban academic medical centers from 2009 to 2019. Exclusion criteria included preterm labor or cervical insufficiency, neonatal interventions, or if misoprostol was not the primary induction method. Complication rates were compared between those with no prior, 1 prior, and 2 or more (2+) prior cesarean deliveries. Complications analyzed were retained placenta, failed induction, infection, hemorrhage, blood transfusion, uterine rupture, intensive care unit admission, death, and readmission. Secondary analysis included cumulative misoprostol dosages and complete abortion rate within 24 hours. ResultsOf 520 patients, 411 patients had no prior cesarean delivery, 77 had 1 prior cesarean delivery, and 32 had 2+ prior cesarean deliveries. Eleven patients had a prior vertical uterine incision. About 26.5% of all patients received mifepristone. The 2+ prior cesarean delivery group was significantly older (35 vs 32 vs 32, p < 0.001) and more likely to be induced for fetal demise (62.5 vs 41.56 vs 39.17%, p = 0.04). Both cesarean groups were more likely to be obese (58.62 vs 49.35 vs 34.26%, p = 0.003). Patients with 2+ prior cesarean deliveries were more likely to experience uterine rupture (6.25 vs 0 vs 0%, p = 0.004), and require ICU admission (6.45 vs 1.3 vs 0.49%, p = 0.02). Secondary analysis outcomes were similar. Logistic regression showed patients with 2+ prior cesarean deliveries were more likely to experience a complication than those with 1 prior (adjusted odds ratio [aOR] 2.71, confidence interval [CI] 1.09–6.86, p = 0.03) or 0 prior cesarean deliveries (aOR 3.00, CI 1.30–7.02, p = 0.01). Patients with 1 prior or no prior cesarean deliveries had a similar risk of experiencing a complication (aOR 1.11, CI 0.64–1.89, p = 0.7). ConclusionsMost patients with prior cesarean deliveries can safely undergo induction in the second trimester for abortion or fetal demise. Patients with 2+ prior cesarean deliveries had a higher rate of at least 1 complication when compared to those with one or no prior cesarean delivery, despite similar misoprostol dosages and rates of complete abortion. ImplicationsThis large 10-year retrospective study examines the impact of prior cesarean delivery on the safety of second trimester induction. While second trimester labor induction abortion remains an option for all patients, specialized counseling for patients with 2 or more prior cesarean deliveries may be warranted.

Pain management for medical abortion before 14 weeks' gestation.

Pain management for medical abortion before 14 weeks' gestation.

Prospective open-label non-inferiority randomised controlled trial comparing letrozole and mifepristone pretreatment in medical management of first trimester missed miscarriage: study protocol

IntroductionMedical treatment is a less invasive alternative to surgical management of missed miscarriage. Studies have shown that pretreatment with mifepristone can increase the complete abortion rate in management of first-trimester...

Sublingual misoprostol versus manual vacuum aspiration for treatment of incomplete abortion in Nigeria: a randomized control study

Introductionsingle-dose of sublingual misoprostol 400mcg with the participant followed-up at the gynecology clinic one week after with an ultrasound scan for the completeness of the uterine evacuation. Objective: to compare the effectiveness of single-dose sublingual misoprostol to manual vacuum aspiration in the treatment of incomplete spontaneous abortion in Enugu, Nigeria.Methodsthe primary outcome measure was the incidence of complete uterine evacuation (complete abortion) after one week of treatment while the secondary outcome measures included incidence, types, and tolerability of treatment side effects as well as participants' satisfaction with the treatment received.Resultstwo hundred and three participants who met the study criteria and completed the study were randomised into the intervention group (n=102) received single-dose sublingual misoprostol 400mcg and the control group (n= 101) received manual vacuum aspiration. Incidence of complete abortion was 86.3% for the misoprostol group and 100.0% for the control group, RR = 0.86, (CI 95%: 0.80 - 0.93), p <0.001. The most common side effect was abdominal pain with an incidence of 27.5% versus 48.55 for the misoprostol and control groups respectively (p = 0.002). Most participants in each group (81.1% versus 77.6% for the misoprostol and control groups respectively) considered the side effects as tolerable. The mean visual analogue scale score for maternal satisfaction was higher in the misoprostol group (86.7 ± 14.11) than the control group (81.36 ± 11.10), p < 0.001.Conclusionthe treatment of incomplete spontaneous abortion with single-dose sublingual misoprostol 400mcg produced a high rate of complete abortion among women in Enugu, Nigeria. Despite having a lower complete abortion rate, maternal satisfaction was higher when compared with women that had manual vacuum aspiration of the uterus. Trial registration: trial registration number - PACTR202009857889210, date of registration - September 23rd, 2020. Retrospectively registered.