First Trimester Termination Of Pregnancy Research Articles

Development and validation of a stability-indicating method, structural elucidation of new degradation products from misoprostol by LC-MS time-of-flight, and an ex vivo study of vaginal permeation.

Misoprostol (MSP) is commonly prescribed in obstetrics and gynecology clinical practice for labor induction, cervical ripening, first-trimester pregnancy termination, and the treatment of postpartum hemorrhage. Furthermore, there is a lack of comprehensive discussion evaluating how different commercially available formulations influence the overall efficacy of MSP, even though reports indicate issues with the quality of these formulations, particularly regarding stability and vaginal absorption processes. This study investigates the stability of MSP under acidic conditions and its in vitro permeation using swine vaginal mucosa. A forced degradation study was conducted using 0.2 M HCl, and a high-efficiency LC method was developed. Three degradation products were identified and characterized using electrospray ionization-high-resolution quadrupole-time-of-flight-MS, with respective m/z values of 391.2508, 405.2705, and 387.2259, respectively. These results suggest that the degradation mechanism involves dehydration of the β-hydroxy ketone moiety, followed by isomerization to its most resonance-stable form and de-esterification. Finally, the in vitro permeation study revealed that the esterified form of MSP was unable to permeate the mucosa and required prior degradation for any component to be detected in the receptor fluid.

Effectiveness of Misoprostol Versus Manual Vacuum Aspiration for the Treatment of the First Trimester Pregnancy Termination

Objective: To compare the effectiveness of misoprostol versus manual vacuum aspiration (MVA) in the treatment of pregnancy termination at first 12 weeks of pregnancy, evaluating the outcomes among women undergoing these procedures. Methodology: A comparative analysis was carried out at the Obstetrics and Gynaecology department of Bakhtawar Amin Hospital, Multan from January 2023 to December 2023, included pregnant women presented with age of gestation age up to 12 weeks, open cervical os and indication for elective termination of pregnancy. Participants were randomized into two groups. Misoprostol group received 400 mcg of misoprostol intravaginally every 4 hours for up to three doses for softening cervix, its dilatation, and uterine contractions, with starting oxytocin infusion after 6 hours. While manual vacuum aspiration group underwent the procedure under general anesthesia without receiving any uterotonics. Patients were followed up on the 7th day post-procedure, undergoing ultrasonography to measure endometrial thickness for efficacy assessment based on complete abortion. Results: A total of 126 patients were comparatively studied; 63 in each group with mean age in the Misoprostol group was 33.45±3.11 years, and was slightly lower the MVA group as30.22±4.76 years. The average gestational age at the time of treatment was almost similar between the groups, 8.33 ±1.29 weeks for Misoprostol group and 7.99±2.56 weeks for the MVA group. The Misoprostol group exhibited an efficacy rate of 95.20% among patients, compared to 90.50% in the MVA group (P=0.148). Furthermore, the efficacy between Misoprostol and MVA across different age groups, gestational ages, and parity, was statistically insignificant (p->0.05). Conclusion: Basis on the study findings, the efficacy of misoprostol for first trimester termination of pregnancy was observed to be 95.20%, slightly higher than the 90.50% with manual vacuum aspiration (MVA).

Clinical and ultrasonographic characteristics of pregnancy-related enhanced myometrial vascularity: prospective cohort study.

To assess the ultrasonographic, epidemiological, clinical and evolutive characteristics of enhanced myometrial vascularity (EMV) following a first-trimester termination of pregnancy (TOP) or management of non-viable pregnancy. This prospective study included women who underwent follow-up ultrasound examination 5-6 weeks after a first-trimester TOP or after management of a first-trimester non-viable pregnancy at the University Hospital Polyclinic San Martino of Genoa between March 2021 and March 2022. EMV was characterized using two- and three-dimensional ultrasound and Virtual Organ Computer-aided Analysis. Ultrasonographic diagnosis of EMV was made when an unusual, tortuous myometrial vessel structure, with high-velocity blood flow, protruding towards the endometrium was observed, while an abnormal junctional zone, absent endometrial midline and heterogeneous endometrium supported the diagnosis. Patients with EMV underwent expectant management with planned ultrasonographic follow-up every 2 weeks until resolution. During the study period, 305 women underwent TOP, of whom 132 attended the initial follow-up 5-6 weeks later, at which 52 were diagnosed with EMV. Ninety-six women were managed for a non-viable pregnancy, of whom 32 presented for follow-up, at which six had a diagnosis of EMV. Thus, overall, 164 of 401 women were included in the study and EMV was identified in 58 (35%) of these. The prevalence of EMV 5-6 weeks after a TOP was therefore between 52/305 (17%) and 52/132 (39%), and that after management of a non-viable pregnancy was between 6/96 (6%) and 6/32 (19%). Bleeding/pelvic pain was present in half (29/58) of the women with EMV, and serum human chorionic gonadotropin was detectable in 29% (17/58) at the first follow-up examination. At ultrasound assessment, all cases with EMV presented abundant tortuous myometrial vessels with high-velocity flow projecting from the myometrium towards the endometrium, along with non-uniform heterogeneous endometrium in 97% of cases, which often (67% of these) contained cystic areas, absence of the endometrial midline in 98% of cases and an abnormal junctional zone in 97% of cases (64% interrupted, 33% irregular). Most (67%) women with EMV were parous and 90% of them had undergone TOP rather than management for a non-viable pregnancy. Medical management of the TOP or non-viable pregnancy was more frequent in women with than those without EMV (93% vs 77%, P = 0.023). Multiple regression analysis showed the risk of EMV to be increased following TOP vs non-viable pregnancy (odds ratio (OR), 3.67 (95% CI, 1.16-11.56), P = 0.026) and in parous compared with nulliparous women (OR, 2.95 (95% CI, 1.45-6.01), P = 0.002). All women with EMV underwent expectant management. Eleven women did not return for subsequent follow-up examinations and did not present to our outpatient or emergency facilities, so were lost to further follow-up. Spontaneous resolution of the lesion was observed within 7-16 weeks after the procedure in 96% (45/47) of the remaining cases. Two women chose to undergo surgery for pelvic discomfort, and histology showed the presence of neovessels mixed with retained chorionic villi. EMV is a transient and common finding 5-6 weeks following first-trimester TOP or management of non-viable pregnancy. TOP and being parous are risk factors for EMV. Expectant management of EMV is appropriate, because, in almost all cases, this resolves spontaneously, without complications, within 2-4 months. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

The Effect of Uterocervical Angle on Treatment Efficacy in First-Trimester Pregnancy Terminations

Aim: We aimed to evaluate the effectiveness and usability of the uterocervical angle, which we examined ultrasonographically before misoprostol treatment, which we used in first-trimester pregnancy terminations, and its relationship with the abortion time.
 Material and Method: This prospective study includes 207 pregnant women diagnosed with an ex-fetus in utero hospitalized for medical termination in a single center. These patients were divided into two groups patients whose treatment was completed in the first cycle and who needed additional cycles. The characteristics of all pregnant women, abortion times, and misoprostol doses used were compared with uterocervical angle and cervical length and analyzed between groups.
 Results: The mean age of the patients in the entire study group was 30.1±6.3, the median uterocervical angle was 112 degrees, and the cervical length was 36 mm. Increasing cesarean number and increasing uterocervical angle degree were positively correlated with increasing abortion time. The number of cesarean sections and the degree of uterocervical angle differ significantly between the group whose treatment was completed in the first cycle and the groups that needed additional cycles. In the treatment groups with elevated uterocervical angle degrees, the first cycle was higher than the successful group. Additional dose and cycle requirements arise if the uterocervical angle is >110 degrees.
 Conclusion: Evaluation of the uterocervical angle in first-trimester medical terminations may guide the clinician in the early completion of treatment. With this evaluation before medical treatment, the duration of hospitalization can be shortened, and the need for surgical intervention for patients can be reduced.

Sonographic Findings of Vascular Signals for Retained Products of Conception in Women Following First-Trimester Termination of Pregnancy

ObjectivesTo evaluate the occurrence of retained products of conception (RPOC) after termination of pregnancy in the first trimester and to assess the vascular signals with transvaginal ultrasonography (TVUS) examination in the detection of retained products. MethodsA retrospective cohort study was performed using TVUS examination in patients following termination of pregnancy. In cases of RPOC, 3 scales of vascular signal were identified: type 1, no or small amount, spot flow signals; type 2, medium amount, strip-like flow signals; type 3, rich amount, circumferential-like flow signals. The correlation between vascular signals and placenta accreta spectrum (PAS) staging was proposed by sonography and histopathology findings. ResultsThe 3 vascular patterns were differently distributed within non-RPOC as well as RPOC patients with and without PAS: type 1 vascular signal detection rates of non-RPOC and RPOC were 97.8% (262/268) and 28.1% (18/64), respectively. Of 64 cases of RPOC, 48.4% (31/64) of the patients had type 2 vascular signals. Vascular signals were enhanced in RPOC with PAS patients whose diagnosis was confirmed by histopathology. ConclusionsThe vascularity (amount of flow), vascular pattern (spot, strip- or circumferential-like flow), and the flow penetrating myometrium were significant findings for distinguishing concomitant RPOC with and without PAS. Additionally, RPOC may contribute to PAS progression, or PAS and RPOC in coordination strengthen the observed vascular signals.

Prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China: a cross-sectional study

ObjectivesTo determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China.MethodsA cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0.ResultsA total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18–54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39–6.29), had low social support (aOR = 2.95, 95% CI 1.39–6.29), were non-local residents (aOR = 2.51, 95% CI 1.15–5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15–5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18–3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67–47.09), had completed higher education (aOR = 12.28, 95% CI 1.24–121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37–8.32).ConclusionsThe magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women.

Medical versus surgical method of pregnancy termination during first trimester

Background: Medical as well as surgical methods for abortion is performed worldwide since many years. Medical methods are safe till first trimester of pregnancy. The present study is intended to compare success rate and side effects of both method of abortion during first trimester. Aims and Objectives: The aim of the study was to study and compare the success rate in both the methods of termination of pregnancy in first trimester and to study side effects and complications as well as satisfaction among study participants undergoing termination of pregnancy during first trimester in both methods. Materials and Methods: A prospective comparative study was conducted at the Department of Obstetrics and Gynecology of one of the teaching medical institute of Ahmedabad among women seeking Medical termination of pregnancy with less than or equal to 9 weeks of gestation. Total 150 participants were selected using purposive sampling (75 in each group). Group A consist of patients having medical termination of pregnancy by medical method and Group B consist of cases that required termination of pregnancy by surgical method. Results: Mean age of the patients in Group A was 27.98 ± 4.57 years and Group B was 27.58 ± 4.22 years. Proportion of complete abortion in medical and surgical method was 88% and 96%, respectively. Surgical method had more effectiveness and success rate for complete abortion as compare to medical method. The mean duration of bleeding per vagina in both groups were more among Group A. Abdominal pain and gastrointestinal symptoms such as nausea, vomiting, diarrhea, and fever were also found to be more in Group A as compared to Group B. Those who had medical method were more satisfied than surgical method. Conclusion: Both methods are safe and effective as far as termination of first trimester pregnancy is concerned. Proper counseling with appropriate selection can bring safe and effective outcome in first trimester of termination of pregnancy.

A randomized controlled study of acupuncture for pain relief during first trimester surgical termination of pregnancy performed under local analgesia.

Acupuncture reduces pain levels in many painful conditions. This study compared pain levels during surgical termination of first trimester pregnancy by suction evacuation (SE) under local analgesia with and without the use of acupuncture. In all, 60 nulliparous women undergoing SE before 10 weeks of gestation were randomly assigned into one of the following three groups in a 1:1:1 ratio according to a computer-generated randomization list. In the control group, women received oral diazepam 5 mg and intramuscular (i.m.) injection of pethidine 30 and 15 min, respectively, prior to SE. In the acupuncture group, women received acupuncture 10 min before SE until the end of SE while oral diazepam 5 mg and i.m. injection of normal saline were given. In the combined group, women received acupuncture in addition to the drugs in the control group. Data from 52 participants were analysed. Pain scores during and after SE, post-operative side-effects and satisfaction levels were compared. The three groups had similar baseline characteristics. The median pain levels during SE differed significantly between the control, acupuncture, and combined groups (80, 50 and 66 mm, respectively, p = 0.03). Pain levels during SE in the acupuncture and combined groups were significantly lower than that of the control group. However, the anxiety scores did not differ between the three groups after SE (p = 0.86). Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.

Hysteroscopic Approach to a Morbidly Adherent Placenta in the Postpartum Period

<h3>Study Objective</h3> Morbidly adherent placenta (MAP) is associated with major maternal morbidity and mortality with risk factors most frequently related to previous uterine surgery. In rare occasions, retained products of conception (RPOC) could complicate low risk births or first trimester termination of pregnancy, resulting in abnormal bleeding patterns or infectious morbidity. We present a case of unsuspected focal (MAP) that was diagnosed two months after a cesarean delivery. Uterine Sparing treatment was accomplished by a 2-stage hysteroscopic resection without complications. <h3>Design</h3> Case Report Video. <h3>Setting</h3> Surgical Suite. <h3>Patients or Participants</h3> A 35-year-old G1 P0 woman had a cesarean delivery at 37 weeks and 4 days due to persistent fetal breech presentation and premature rupture of the membranes. The cesarean delivery was complicated by estimated blood loss of 1019mL with no mention of any precipitating factors. The patient presented with history of prolonged vaginal spotting while on Depot Provera. Office hysteroscopy and Pelvic MRI were utilized for diagnosis and evaluation. Uterine Sparing treatment was accomplished by a 2-stage hysteroscopic resection without complications. <h3>Interventions</h3> 2-stage hysteroscopic resection was performed. The first stage was approached by a mechanical morcellation device that resolved the main bulk of the RPOC. The second stage was approached with a Resectoscopic approach to the deep myometrial nodule that persisted on follow up imaging after the index procedure. <h3>Measurements and Main Results</h3> Complete resection of the RPOC and deep myometrial nodule was accomplished without complication. <h3>Conclusion</h3> Retained products of conception should be considered in the differential diagnosis of patients who present with abnormal uterine bleeding after birth. Treatment can be accomplished with hysteroscopic resection. Resectoscopic approach is more challenging and has a higher risk of uterine perforation yet has the ability to reach the deep-seated lesions. Provider's understanding of the limitations of each method and appropriate referral to an expert surgeon is key for optimal results.

Association between lymphadenopathy after toxoplasmosis seroconversion in pregnancy and risk of congenital infection.

The aim of the study was to describe the pregnancy outcome of a large cohort of women with toxoplasmosis seroconversion in pregnancy and to investigate the relation between maternal lymphadenopathy and risk of congenital toxoplasmosis (CT). This was a retrospective study involving women with confirmed toxoplasmosis seroconversion in pregnancy between 2001 and 2017. Women were clinically evaluated for lymphadenopathy and classified as follows: lymphadenopathy absent (L-) or lymphadenopathy present (L+). The mothers were treated and followed-up according to local protocol, and neonates were monitored at least for 1year in order to diagnose CT. A total of 218 women (one twin pregnancy) were included in the analysis. Pregnancy outcome was as follows: 149 (68%) of children not infected, 62 (28.3%) infected, 4 (1.8%) first trimester termination of pregnancy, 2 (0.9%) first trimester miscarriages, and 3 (1.4%) stillbirths (of which one already counted in the infected cohort). 13.8% of women were L+ , and they were nearly three times more likely to have a child with CT compared to L- women (aOR, 2.90; 95%CI, 1.28-6.58). Moreover, the result was still statistically significant when the analysis was restricted to 81 children whose mothers were clinically examined and received treatment within 5weeks from estimated time of infection. In conclusion, there is a positive association between L+ status in pregnant women, and risk of CT also confirmed when restricting the analysis to women with early diagnosis of seroconversion and treatment. This data could be very useful in counselling pregnant women with toxoplasmosis seroconversion and lead to direct a more specific therapeutic and diagnostic protocol.

The role of serum podocalyxin levels in recurrent pregnancy loss

ObjectiveTo measure serum levels of podocalyxin (PODXL) in recurrent miscarriages as a marker of vascular endothelial dysfunction. Study designIn this case-control study, women who were hospitalized for singleton first-trimester pregnancy terminations due to missed abortion, anembryonic pregnancy, and inevitable abortion were included. There were 24 patients who were admitted for the first pregnancy termination, 39 patients who were admitted for recurrent pregnancy loss (RPL), and 25 fetal cardiac activity positive patients as the control group. Demographic features, medical and obstetric histories were recorded. The measurements of serum PODXL were done by a human enzyme-linked immunosorbent assay kit. ResultsSerum PODXL levels were found to be significantly higher in the RPL group than the control group and the first time miscarriage group (13.82 [10.09−113.54] vs. 11.78 [9.25−48.80], p = 0.016 and 13.82 [10.09–113.54] vs. 11.99 [8.20–20.47], p = 0.003; respectively). Serum PODXL levels were not statistically significantly different between the first miscarriage and the control group (p = 0.62). There were positive correlation between serum PODXL levels and the number of gravida and the number of miscarriages (r = 0.217, p = 0.042, and r = 0.291, p = 0.006; respectively). ConclusionRecurrent miscarriage patients had higher serum levels of PODXL than both normal pregnancies and first-time miscarriages. Our results suggest that maternal endothelial dysfunction might have a role in recurrent pregnancy losses.

Uterine Arteriovenous Malformation after First Trimester Termination of Pregnancy in a Patient with Hereditary Haemorrhagic Telangiectasia

Hereditary haemorrhagic teleangiectasia (HHT) is a rare autosomic dominant genetic disorder, characterised by epistaxis, cutaneous teleangiectasias, and arteriovenous malformations (AVMs) located mainly in lungs, gastrointestinal tract, liver, and central nervous system. We report a case of uterine arteriovenous malformation acquired after medical pregnancy interruption in a patient with HHT, discussing the atypical genetic setting and the strategy for the case management.

Impact of music therapy before first-trimester instrumental termination of pregnancy: a randomised controlled trial.

To evaluate the impact of preoperative Music Therapy (MT) on pain in first-trimester termination of pregnancy (TOP) under local anaesthesia. Randomised controlled trial comparing women undergoing a first-trimester TOP under local anaesthesia with or without a preoperative MT session. University Hospital of Angers from November 2016 to August 2017. Women who underwent first-trimester TOP under local anaesthesia. Women allocated to the MT group underwent a preoperative 20-minute session of MT. Pain was assessed using a visual analogue scale (VAS) just before the procedure, during the procedure, at the end of the procedure and upon returning to the ward. A total of 159 women were randomised (80 in the MT group, and 79 in the control group). Two women were excluded from the control group and six from the MT group. Therefore, 77 women were analysed in the control group and 74 in the MT group. The intensity of pain was similar in the two groups just before the procedure (VAS 4.0±2.9 versus 3.6±2.5; P=0.78), during the procedure (VAS 5.3±2.5 versus 4.9±2.9; P=0.78), at the end of the procedure (VAS 2.7±2.4 versus 2.6±2.4; P=0.43) and upon returning to the ward (VAS 1.8±2.0 versus 1.5±2.0; P=0.84). The difference in pain between entering the department and returning to the room after the procedure was similar between the MT and control groups (difference in VAS 0.3±2.5 versus 0.3±2.4; P=0.92). An MT session before a TOP under local anaesthesia procedure resulted in no improvement in patient perception of pain during a first-trimester TOP. Music therapy before first-trimester termination of pregnancy under local anaesthesia did not improve the perception of pain.

Use of hysteroscopy in diagnosis and follow-up of acquired uterine enhanced myometrial vascularity

To describe the role of hysteroscopy in diagnosis and subsequent follow-up of uterine enhanced myometrial vascularity (EMV). Uterine EMV, previously known as arteriovenous malformation (AVM), is a rare but cannot-miss finding often associated with prior pregnancy or uterine surgery and is typically suspected when a vascular mass is found on ultrasound. Color Doppler imaging will demonstrate high-velocity, low-impedance flow, with more significant shunts demonstrating higher peak systolic velocity (PSV). If not already diagnosed by ultrasound, accurate recognition during hysteroscopy is mandatory prior to any uterine instrumentation, as biopsy or curettage can lead to unanticipated massive hemorrhage. While many cases of EMV may resolve spontaneously, actively bleeding patients may require treatment with embolization, a procedure that may decrease ovarian reserve and impair fertility, though favorable reproductive outcomes have been reported. Others have reported success with hysteroscopic management using a bipolar electrosurgical loop. Case report. Academic hospital system. We describe a 22-year-old G2P1011 who presented to the emergency department with heavy vaginal bleeding and a negative urine human chorionic gonadotropin 9 weeks following a first-trimester termination of pregnancy. Her ultrasound demonstrated a heterogeneous 2.6×2.3×2.6 cm vascular mass in the endometrial canal that was initially interpreted as retained products of conception. Unfortunately, PSV in the lesion was not measured. During observation, bleeding continued, and her hemoglobin dropped from 8.3 g/dL to 6.9 g/dL the next morning. She was transfused 2 units of blood and taken to the operating room for hysteroscopic evaluation and possible uterine curettage. Hysteroscopy revealed a large pulsating 2cm bluish vascular mass that was recognized as a uterine EMV and the procedure was terminated with the plan for embolization. Given fertility concerns, the diagnosis was confirmed with MRI/MRA, which identified a 2.7cm mass-like process with early post-contrast enhancement in the arterial phase. An angiogram demonstrated bilaterally enlarged tortuous uterine arteries perfusing a hypervascular EMV that was treated with selective bilateral uterine artery embolization. Further bleeding or evidence of EMV. Follow-up office hysteroscopy at 2 weeks demonstrated a 2 cm raised area of tissue without pulsations. At 6 weeks post-procedure, bleeding had ceased, and office hysteroscopy revealed only a small 0.5 cm calcified nodule with a circumferential pseudo-decidual reaction. Hysteroscopy may be used to diagnose EMV when ultrasound is not conclusive. Recognition of the pulsating vascular appearance of EMV on hysteroscopy is critical in preventing hemorrhage from inappropriate curettage. Resolution of the lesion following embolization can be readily demonstrated with office hysteroscopy.

Potency and acceptability of oral misoprostol compared with vaginal misoprostol prior to first trimester abortions

Present study was done to assess the effectiveness and acceptability of oral misoprostol compared with vaginal misoprostol for cervical priming before termination of first trimester pregnancy. Recently, prostaglandin E1 analogue misoprostol has caught much attention as cervical priming agent. Prostaglandins are used in different doses and different routes considering the different available results. Misoprostol was originally marketed for prevention of peptic ulcers caused by Prostaglandin synthetase inhibitor (NSAIDS) but now it has a widespread role in obstetric practice specially as a cervical priming agent. The aim of present study is to compare oral misoprostol versus vaginal misoprostol for cervical ripening and to assess its acceptability among women.

First trimester termination of pregnancy.

First trimester termination of pregnancy (TOP) is a safe and effective procedure. The complete abortion rates of surgical and medical abortion are approximately 97% and 95%, respectively. Vacuum aspiration (VA) either by electrical suction or manual aspiration is the method of choice for surgical TOP. Risk of significant bleeding is≤5% in VA, while major complications occur in <1%. The risk of infection after VA can be reduced significantly by using prophylactic antibiotics or by the screen-and-treat strategy. Pre-operative administration of misoprostol can also reduce the risk of complications. The combination of 200mg mifepristone followed by 800μg misoprostol 24-48h later is recommended for first trimester medical TOP. If mifepristone is not available, misoprostol can also be used alone, but repeated doses may be required and the complete abortion rate may be lower. Due to the reduced efficacy in more advanced gestation, repeated doses of misoprostol may be required for medical TOP over 9 weeks of gestation. The complete abortion rate with this regimen is 95% or more. Gastrointestinal upsets can occur in up to 50% of women, but major complications are rare. There was no lower limit of gestational week for TOP, although extra precaution is required for the confirmation of completion of procedures and exclusion of ectopic pregnancy.

A cohort study comparing the severity and outcome of intrauterine adhesiolysis for Asherman syndrome after first- or second-trimester termination of pregnancy

ObjectiveTo compare the clinical characteristics of Asherman syndrome and the outcomes of hysteroscopic adhesiolysis in women after first or second-trimester termination of pregnancy (TOP). MethodsThis was a retrospective descriptive analysis of patients with moderate-to-severe intrauterine adhesiolysis (IUAs) after TOP and treated by hysteroscopic adhesiolysis and followed by “second-look” hysteroscopy 3 months later at The Beijing Obstetrics and Gynecology Hospital (China) between January 2013 and March 2016. The American Fertility Society (AFS) scoring system was used to evaluate the intrauterine adhesions. ResultsA total of 236 patients with 180 first-trimester TOP and 56 s-trimester TOP patients were included. The severe adhesion and amenorrhea rates during the second-trimester group (69.6% and 39.3%, respectively) were significantly higher than those in the first-trimester group (36.7% and 7.2%, respectively). AFS score reduction in the second-trimester group (6.2 ± 2.8) was significantly lower than in the first-trimester group (6.5 ± 2.5). The pregnancy rates in the second-trimester group (21.4%) were significantly lower than that in the first-trimester group (43.3%). The pregnancy rate of severe intrauterine adhesions in second-trimester TOP (10.3%) was significantly lower than in first-trimester TOP (40.9%). ConclusionThese findings suggested that second trimester TOP was associated with more severe intrauterine adhesion and a worse prognosis after hysteroscopic adhesiolysis in women with Asherman syndrome when compared to first-trimester TOP.

Comparison of intravaginal misoprostol and intramuscular carboprost for cervical priming in the first trimester of medical termination of pregnancy

Background: Suction evacuation is a widely used method for elective termination of pregnancy in the first trimester. The step of mechanical cervical dilatation during this procedure is probably the most critical step. Difficult cervical dilatation may cause incomplete evacuation, cervical laceration, and uterine perforation. Prior cervical priming with pharmacological agents like prostaglandin derivatives, although not free from side effects, makes the procedure easier with reduced overall complication rate and hence recommended in several guidelines. Aim: The aim of the study was to compare, two prostaglandin derivatives, intravaginal misoprostol (15-deoxy-16-hydroxy 16-methylprostaglandin E1) with intramuscular carboprost (15-methyl prostaglandin F2α) for cervical priming prior to suction evacuation in the first-trimester termination of pregnancy. Settings and Design: A prospective study was conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra. Materials and Methods: Eighty women requesting pregnancy termination from 6th to 12th week gestation were randomized into two groups. Two hours prior to suction evacuation, the first group (n = 40) received 400 μg of intravaginal misoprostol, while the second group (n = 40) received 125 μg of intramuscular injection carboprost. The outcomes of both the groups were recorded in terms of baseline cervical dilatation, immediate complications, drug-induced side effects, and patient's acceptability by questionnaire. Results: The “mean baseline cervical dilatation” prior to suction and evacuation in the misoprostol group was 8.11 ± 0.95 mm in the carboprost group was 6.25 ± 0.06 mm which is highly significant (t = 7.02, P 8 mm, compared to 17.5% in carboprost group (P = 0.004). The side effects including nausea, vomiting, and abdominal cramps were more in carboprost group as compared to the misoprostol group. No patient had diarrhea in misoprostol group as against 32.5% in carboprost group (P

Sexual well-being after first trimester termination of pregnancy: Secondary analysis of a randomized contraceptive trial.

Although termination of pregnancy is one of the most common procedures conducted worldwide, little is known about sexual well-being after termination of pregnancy. The objective of this study was to assess sexual well-being after termination of pregnancy, and factors affecting it during a 1-year follow up. In total, 748 women requesting first trimester termination of pregnancy and participating in a randomized controlled trial on early provision of intrauterine contraception were provided with questionnaires regarding their sexual life, anxiety, quality of life and contraceptive method used at the time of termination of pregnancy, 3 and 12months after termination of pregnancy. Sexual well-being was measured by the 9-item McCoy Female Sexuality Questionnaire. Anxiety and quality of life were assessed by the State-Trait Anxiety Inventory (STAI) Scale and EuroQoL questionnaire (EQoL). The McCoy index remained unchanged during the follow up. At all three time-points measured, higher (ie, better) McCoy scores were associated with a lower STAI index (mean difference -2.26 [95% CI -3.23 to -1.29], P<0.001; -3.76 [95% CI -4.79 to -2.74], P<0.001; -4.50 [95% CI -5.88 to -3.12], P<0.001) and being in a relationship (1.16 [95% CI 0.08-2.25], P=0.023; 1.67 [95% CI 0.43-2.89], P<0.001; 2.81 [95% CI 1.28-4.34], P<0.001), and correlated positively with a higher EQoL index (r=0.20, r=0.20, r=.27, P<0.001) and higher frequency of intercourse (r=0.50, r=0.46, r=0.42, P<0.001). Women using intrauterine contraception had higher McCoy index measurements at 3months compared with others. There were no significant differences between users of hormonal vs non-hormonal contraceptive methods. Sexual well-being does not change significantly after termination of pregnancy. Instead, it is strongly and positively associated with quality of life, relationship status and frequency of intercourse. Anxiety is negatively associated with sexual well-being.

The Safety, Acceptability and Continuation Rate of Immediate Versus Delayed Insertion of Levonorgestrel Releasing Intrauterine System Following First Trimester Surgical Abortion: An Observational Study

Objective: To assess the safety, acceptability and six-month continuation rate of immediate versus delayed insertion of the levonorgestrel releasing intrauterine system (LNG-IUS) following surgical termination of first trimester pregnancy. Methods: This prospective observational study was conducted on 180 patients who underwent surgical abortion and opted for LNGIUS and divided into two groups; immediate group=86 and delayed group=94. Pain scores, adverse effects, acceptability and continuation rate were recorded. Results: More patients in the delayed insertion group exhibited higher perception of pain (p&lt; 0.001) and requested additional analgesia upon LNG-IUS insertion (p&lt; 0.05) with no significant difference between the two groups regarding other adverse effects (fainting, abnormal vaginal bleeding, expulsion and pelvic infection), request for removal and re-insertion of LNG-IUS (p&gt;0.05). The continuation rate and patient acceptability in terms of overall satisfaction and recommendation to other women, were comparable between the two groups (p&gt;0.05) while overall discomfort was higher in the delayed group at one, three and six months after insertion (p&lt; 0.05) Conclusion: Although immediate insertion of LNG-IUS after first trimester surgical abortion has higher expulsion rate, yet it has lower pain intensity, request for additional analgesia and overall discomfort compared to delayed insertion of LNG-IUS with comparable continuation and acceptability rates at 6 months after insertion. Keywords: levonorgestrel releasing intrauterine system; abortion; post abortive contraception