Termination Of Second Trimester Pregnancy Research Articles

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.

A Comparative Study of Vaginal Misoprostol Moistened with Acetic Acid and Normal Saline in Second-trimester Pregnancy Termination: A Randomized Clinical Trial

Introduction: Second-trimester pregnancy termination with live fetuses is an important issue in obstetric practice since it is more challenging than first- and third-trimester pregnancy termination. The present study aimed to compare the effectiveness of vaginal misoprostol moistened with normal saline and acetic acid in second-trimester pregnancy termination.Methods: This clinical trial was conducted on 95 pregnant women with the gestational age of 14-26 weeks admitted for medical induced abortion. The subjects were randomly divided into two groups. The first group was administered with vaginal misoprostol moistened with acetic acid (n=47), and the second group received vaginal misoprostol moistened with normal saline (n=48). The abortion rate within the first 24 hours, induced abortion interval, length of hospital stay, and curettage and its complications were assessed in the study groups using statistical methods, and the P-value of less than 0.05 was considered significant.Results: Abortion within the first 24 hours occurred in 100% of the patients in the acetic acid group and 75% of the subjects in the normal saline group, and the difference was considered statistically significant (P<0.001). The mean time for fetal delivery was significantly lower in the acetic acid group (12.3±4.8) compared to the normal saline group (17.5±6.6) (P<0.001). In addition, the length of hospital stay was significantly lower in the acetic acid group compared to the normal saline group (P=0.008). The rate of abortion following the second dose of misoprostol was 46.8% in the acetic acid group and 20.8% in the normal saline group. However, no significant differences were observed in curettage and its complications between the groups.Conclusion: According to the results, high vaginal acidity was associated with the increased effectiveness of misoprostol in second-trimester pregnancy termination.

OUTCOMES OF SECOND TRIMESTER SURGICAL ABORTION: THE EXPERIENCE OF A TERTIARY HEALTH FACILITY IN ETHIOPIA

ABSTRACTBACkGROUND: Abortion is defined as expulsion or extraction of a fetus before fetal viability. It is a very common occurrence globally (40-50 million per annum. There is increasing evidence to suggest that dilation and evacuation (D&amp;E) leads to fewer complications than medical abortion for second trimester termination of pregnancy. However, there is no recent documentation of the outcome of such a method in Ethiopia. Hence the aim of this study is to document the outcome of second trimester D&amp;E performed at St Paul Hospital and Millennium Medical College (SPHMMC). OBJECTIVE: To describe clinical characteristics and short-term outcomes of second trimester surgical abortion at SPHMMC. METHODS AND SUBJECTS: A retrospective cross-sectional study design was employed to review all cases of dilation and evacuation performed in the six months period from January 1, 2018- July 30, 2018. A structured questionnaire was used to collect selected socio-demographic data, clinical characteristics and acute complications. Data was entered and analyzed using IBM SPSS Statistics, version 20.0 (IBM Corp, Released 2011). RESULT: A total of 43 client records were reviewed and used for this analysis. The median (IQR) age of the study participants was 24 (20,26), with age range of 16 to 34 years old. The average gestational age is 16 weeks + 2 days (ranging from 13 weeks + 1 day to 20 weeks + 6 days). All women received doxycycline prior to performing D&amp;E. No ultrasound was used during all the procedures. Over all complication rate is 2.3%, with 1 case of uterine perforation. The contraceptive uptake rate was 88.4% (38/43). The most common post abortion family planning method was long acting reversible contraceptives (LARC). CONCLUSION: Our review demonstrated that D&amp;E is safe after applying recommended procedures in a tertiary health facility in Ethiopia. Further analysis using a larger sample should be undertaken and comparison should be made with medical induction in order to establish the safety and effectiveness of second trimester surgical abortion. kEY WORDS: second trimester safe abortion, Dilation &amp; Evacuation (Ethiopian Journal of Reproductive Health; 2019; 11;1:1-8)

A comparative study of successful abortion rate of mifepristone –misoprostol combination versus extra amniotic ethacridine lactate – misoprostol for termination of second trimester pregnancy at tertiary health care center

A comparative study of successful abortion rate of mifepristone –misoprostol combination versus extra amniotic ethacridine lactate – misoprostol for termination of second trimester pregnancy at tertiary health care center

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 &lt;0.00001). The mean dose of misoprostol in Group A was 613.88mcg compared to the Group B 1591.66mcg (p value &lt;0.00001). Conclusion: Pretreatment with mifepristone significantly reduces the induction abortion interval (I-A-I) and the misoprostol dose.

Comparison of Effectiveness of Sublingual and Vaginal Misoprostol for Second-Trimester Abortion.

The aim of this study was to compare the efficacy and safety of sublingual and vaginal misoprostol in second-trimester termination of pregnancy in 24 and 48h. This is a retrospective study of 240 pregnant women seeking termination in second trimester (13-18.5weeks), in which the patients are subdivided into two groups-first group received 400mcg of misoprostol sublingually (n = 120), and second group received 400mcg of misoprostol vaginally (n = 120) every 4h for a maximum of five doses. The course of misoprostol was repeated if the patient did not abort within 24h. The mean induction-to-abortion interval was shorter in sublingual group (10.28 ± 3.1h) versus 14.68 ± 4.2h in vaginal group in 24h (p = 0.0001), and 36.9 ± 4.4h in sublingual versus 29.7 ± 14 in vaginal group in 48h (p = 0.0933). Mean dose requirement for misoprostol by sublingual route was low as compared to vaginal misoprostol (1048 ± 301mg versus 1250 ± 375mg; p = 0.0001 in 24h and 1110 ± 833mg versus 1325 ± 536mg; p = 0.0231 in 48h). No significant difference was found in the success rate (both at 24 and 48h) and in side effects among the two comparison groups. Misoprostol as such by any route has been proven as an effective abortifacient in second trimester. Both sublingual and vaginal routes are effective for medical abortion. But shorter induction-to-abortion interval in sublingual route, less dose requirement and higher acceptability makes sublingual route as a better choice.

Prophylactic uterine artery embolization in second-trimester pregnancy termination with complete placenta previa.

ObjectiveThis study was performed to assess whether prophylactic uterine artery embolization (UAE) is beneficial for second-trimester abortion with complete placenta previa (CPP).MethodsPatients with CPP who underwent second-trimester pregnancy termination by labor induction with or without UAE from January 2010 to January 2018 were retrospectively reviewed. In total, 25 patients were eligible for analysis. The primary outcomes were the abortion success rate and bleeding volume, and the secondary outcomes were the induction-to-abortion time, length of hospital stay, and complications.ResultsCPP occurred in all 25 patients. Fifteen patients underwent prophylactic UAE (UAE group) and 10 did not (control group). Abortion was successful in 13 of 15 (86.7%) women in the UAE group and in 9 of 10 (90.0%) women in the control group. There was no significant difference in the bleeding volume or induction-to-abortion time between the two groups. The hospital stay was longer and pyrexia was more common in the UAE than control group.ConclusionProphylactic UAE did not markedly improve the outcomes of second-trimester abortion in patients with CPP. Conversely, it may increase the risk of complications and prolong the hospital stay.

A case of uterine gangrene after termination of second trimester pregnancy complicated by chorioamnionitis

Uterine gangrene is a rare event during pregnancy. Here, we report the case of a 22-year-old patient pregnant in her second trimester presenting with premature rupture of membranes and a low-lying placenta. Hysterotomy was done to evacuate the pregnancy. The procedure was complicated by hemorrhage so bilateral uterine arteries and the left internal iliac artery were ligated to control the bleeding. She continued to run a fever in spite of antibiotics and on the 11th postoperative day, the patient developed signs of septicemia. Abdominal re-exploration was done revealing a gangrenous uterus with signs of peritonitis. Subtotal hysterectomy was done. The patient was discharged from the hospital in good health on the 10th post repeat laparotomy day.

Fetal Survival in Second-trimester Termination of Pregnancy Without Feticide

(Obstet Gynecol 2018;131:575–579) The recommendations of the Society of Family Planning and guidelines of the Royal College of Obstetricians and Gynaecologists are that, in cases of late termination of pregnancy, feticide should be offered beyond 22 weeks of gestation to ensure stillbirth. However, data on live birth rates and survival times after pregnancy between 20 0/7 and 24 0/7 weeks of gestation are scarce and contradictory. In the present study, the authors reported on their own experience with termination of pregnancy procedures between 20 0/7 and 24 0/7 weeks of gestation not preceded by feticide; they evaluated the live birth rate and in cases of live birth, the duration of neonatal survival.

TERMINATION OF PREGNANCY

Objectives: To compare efficacy of extra-amniotic Foley’s catheter balloon aloneversus combined use of Foley’s catheter balloon and extra-amniotic instillation of prostaglandinF2-alpha in therapeutic termination of second trimester pregnancy. Study Design: Randomizedcontrolled trial. Setting: Department of Obstetrics &amp; Gynecology, Bahawal Victoria Hospital,Bahawalpur. Period: Two years. July 2014 to June 2016. Sample Technique: Non-probability,consecutive sampling technique. Patients &amp; Methods: A total of 256 patients, 16 to 38 years ofage with fetal death or missed abortion on ultrasonography in 2nd trimester (14-24 gestationalweeks) of pregnancy were included in the study. Patients with previous uterine surgery, multiplepregnancies and parity&gt;3 were excluded. Then selected patients were placed randomly intotwo groups i.e. Group A (extra-amniotic Foley’s catheter balloon alone) &amp; Group B (Foley’scatheter balloon along with extra-amniotic instillation of prostaglandin F2-alpha), by using lotterymethod. Outcome variables like efficacy i.e. expulsion of fetus within 24 hours of induction, werenoted. Results: The mean age of women in group A was 24.51 ± 4.77 and in group B was 24.29± 4.48 years. The mean gestational age in group A was 21.65 ± 2.01 weeks and in group Bwas 21.28 ± 1.93 weeks. Efficacy was 103 (80.47%) in group A (extra-amniotic Foley’s catheterballoon alone) and 119 (92.97%) in group B (combined use of Foley’s catheter balloon andextra-amniotic instillation of prostaglandin F2-alpha) with p-value of 0.003. Conclusion: Thisstudy concluded that combined use of Foley’s catheter balloon and extra-amniotic instillationof prostaglandin F2-alpha is better and more efficacious than extra-amniotic Foley’s catheterballoon alone in therapeutic termination of second trimester pregnancy.

THERAPEUTIC TERMINATION OF PREGNANCY IN SECOND TRIMESTER.

Objectives: To compare efficacy of extra-amniotic Foley’s catheter balloon aloneversus combined use of Foley’s catheter balloon and extra-amniotic instillation of prostaglandinF2-alpha in therapeutic termination of second trimester pregnancy. Study Design: Randomizedcontrolled trial. Setting: Department of Obstetrics &amp; Gynecology, Bahawal Victoria Hospital,Bahawalpur. Period: Two years. July 2014 to June 2016. Sample Technique: Non-probability,consecutive sampling technique. Patients &amp; Methods: A total of 256 patients, 16 to 38 years ofage with fetal death or missed abortion on ultrasonography in 2nd trimester (14-24 gestationalweeks) of pregnancy were included in the study. Patients with previous uterine surgery, multiplepregnancies and parity&gt;3 were excluded. Then selected patients were placed randomly intotwo groups i.e. Group A (extra-amniotic Foley’s catheter balloon alone) &amp; Group B (Foley’scatheter balloon along with extra-amniotic instillation of prostaglandin F2-alpha), by using lotterymethod. Outcome variables like efficacy i.e. expulsion of fetus within 24 hours of induction, werenoted. Results: The mean age of women in group A was 24.51 ± 4.77 and in group B was 24.29± 4.48 years. The mean gestational age in group A was 21.65 ± 2.01 weeks and in group Bwas 21.28 ± 1.93 weeks. Efficacy was 103 (80.47%) in group A (extra-amniotic Foley’s catheterballoon alone) and 119 (92.97%) in group B (combined use of Foley’s catheter balloon andextra-amniotic instillation of prostaglandin F2-alpha) with p-value of 0.003. Conclusion: Thisstudy concluded that combined use of Foley’s catheter balloon and extra-amniotic instillationof prostaglandin F2-alpha is better and more efficacious than extra-amniotic Foley’s catheterballoon alone in therapeutic termination of second trimester pregnancy.

Incidence and contributing factors for uterine rupture in patients undergoing second trimester termination of pregnancy in a large tertiary hospital - a 10-year case series

IntroductionUterine rupture is a rare complication in second trimester termination of pregnancy (TOP) with an overall incidence of up to 1.1%. There are concerns that patients with previous caesarean section(s) were at an increased risk of uterine rupture. However, there is no published data in our local population to date. This study aims to identify the incidence and contributing factors for uterine rupture in women undergoing TOP in Singapore. Study DesignThis is a retrospective review of all women who had TOP between 14+0 weeks to 23+6 weeks gestation from January 2005 to December 2014 in a large tertiary hospital. Patients’ characteristics and details of TOP were retrieved from pre-existing hospital databases. The gestation age and dose of gemeprost used were retrieved from an internal hospital audit conducted from December 2012 to July 2016. ResultsA total of 3385 patients underwent TOP from 2005 to 2014. An estimated 339 patients had a scarred uterus. Seven cases of uterine rupture were identified, with an overall incidence of 0.21% (7/3385). The incidence of uterine rupture in patients with scarred uterus was 2.1% (7/339). Contributing factors identified included higher mean dose of abortifacient, usage of multiple abortifacients and methods, advanced gestation age and short interval between last caesarean section and current TOP. ConclusionSecond trimester TOP on scarred uterus warrants careful usage of abortifacient with minimal cumulative dosage and should be carried out in early second trimester gestation whenever feasible. Prostaglandin analogues appeared to be safe for TOP in unscarred uteruses.

The efficiency of the uterocervical angle in the prediction of second-trimester pregnancy terminations in multiparous women

Aim: To show how uterocervical angles are used for the prediction of second-trimester pregnancy terminations in multiparous women.Material and methods: A total of 148 multiparous singleton women in their second trimesters were enrolled in this prospective study. The intracervical Foley catheter was used for the induction of delivery. The cervical length (CL) and the uterocervical angle (UCA) were measured before the beginning of induction. The study population was subdivided into four groups; successful and failed terminations at the end of 24 and 48 h time frames. A stepwise multiple regression analysis was carried out to examine the contribution of UCA and other parameters to the induction-to-delivery time. A survival analysis was conducted to compare two groups defined by the cut-off value.Results: The UCA was broader in the successful termination group compared to the failed termination group in 24 h of induction (112.50° ± 29.00° versus 100.68° ± 27.13°, p = .02). A negative correlation was found between the UCA and the induction-to-delivery time (r = −0.27, p = .0007). A cut-off value of 97.5° was found for the UCA in predicting induction outcomes. During the 24-h period, 63.1% of women with the UCA ≥97.5° terminated successfully while 36.8% of women with the UCA <97.5° terminated successfully (p = .001). The mean induction-to-delivery time was significantly shorter in the UCA ≥97.5° group compared to the UCA <97.5° group (38.2 ± 19.5 h versus 47.8 ± 27.5 h, p = .02). The binary logistic regression analysis showed that the UCA was the only contributor to a successful termination (OR = 1.01, 95% CI: 1–1.02, p = .02).Conclusion: The UCA is broader in multiparous women who successfully terminated and is linked to a shorter duration of induction. The UCA by itself is the only significant contributor to the outcome of second trimester pregnancy terminations.Trial registration: ClinicalTrials.gov identifier: NCT03400358.

Low-dose vaginal misoprostol with or without Foley catheter for late second-trimester pregnancy termination in women with previous multiple cesarean sections

Purpose: To compare between low dose vaginal misoprostol with and without Foley catheter for late second trimester pregnancy termination in women with previous multiple cesarean sections.Materials and methods: A prospective randomized controlled clinical trial, patients were randomly allocated to either low dose vaginal misoprostol group (n = 40) or combined low dose vaginal misoprostol plus Foley catheter group (n = 38). The primary outcome was complete abortion. Secondary outcomes were induction-to-abortion interval, the number of misoprostol doses and occurrence of complications.Results: Incomplete abortion rate was significantly lower in combined group than misoprostol only group (2.6%versus 15% respectively, p = .03). Induction-to-expulsion interval with the combined vaginal misoprostol plus Foley catheter was significantly shorter (p = .01) and the number of misoprostol doses in the combined group was significantly lower (p = .04). No statistically significant difference in the frequency of complications between both groups.Conclusions: The combination of low dose vaginal misoprostol and Foley catheter is an effective and safe method for termination of second trimester pregnancy in women with previous multiple cesarean sections.

Fetal Survival in Second-Trimester Termination of Pregnancy Without Feticide.

To evaluate the rate of live birth and the duration of survival after termination of pregnancy without feticide. We conducted a retrospective analysis of 241 terminations of pregnancy without feticide for fetal anomalies or genetic abnormalities between 20 0/7 and 24 0/7 weeks of gestation at a single tertiary care referral center in Europe between February 2003 and May 2017. A multivariate binary regression model was used to evaluate factors associated with live birth. Pregnancies were terminated at a mean gestational age of 22.1±1.1 completed weeks of gestation. Median birth weight was 440 g (range 141-1,890 g). Live birth occurred in 122 cases (50.6%, 95% CI 44.4-56.8); median survival time was 32 minutes (range 1-267 minutes). Factors associated with live birth were gestational age at labor induction (odds ratio 1.41, 95% CI 1.01-2.01; P=.049) and fetal anomalies (P=.046). After termination of pregnancy without feticide between 20 0/7 and 24 0/7 weeks of gestation, the live birth rate was 50.6% (95% CI 44.4-56.8). A lower gestational age at labor induction and the presence of skeletal, cerebral, renal, or multiple fetal anomalies increased the chance of stillbirth.

The predictive nature of uterocervical angles in the termination of second trimester pregnancy

Aim: To establish how useful and the predictive capacity of uterocervical angles (UCA) in the termination of second trimester pregnancies.Material and methods: This prospective cohort study was conducted at a tertiary center with a total of 120 singleton pregnancies delivered between 14 and 24 gestational weeks. Before the beginning of misoprostol induction, patients were screened for both cervical length (CL) and uterocervical angles (UCA). The UCA is defined as an angle constructed by the measurement of the cervical canal and lower uterine segment. The study population was subdivided into four groups; successful and failed terminations at the end of 24 hours of induction and successful and failed terminations at the end of 48 hours of induction. We decided to further evaluate our study population based on their UCAs, and placed them into four categories; UCA ≥95°, UCA <95°, UCA ≥105°, and UCA <105°.Results: In the 24-hour time frame group, the mean UCA was 105.50 ± 15.38 degrees in the successful termination group and was 100.22 ± 11.12 degrees in the failed group (p = .001). In the 48-hour time frame group, the mean UCA was 104.19 ± 13.51° in the successful termination group and was 93.52 ± 7.84° in the failed group (p = .007). The mean hour of induction was shortest in the UCA ≥105° group.Conclusions: Regardless of the time frames, patients who had successful terminations had a broader angle, less amount of misoprostol use and shorter duration of induction as compared to the failed termination groups. What do the results of this study add? The uterocervical angle has never been measured in second trimester pregnancies to predict the timing of termination. Our study demonstrated the useful application of this ultrasonographic finding in the prediction of successful second trimester terminations.Trial registration: ClinicalTrials.gov identifier: NCT03220607.

Standardizing Second-Trimester Medical Termination: Effects on Clinical Outcomes.

The objective of this study was to evaluate length of induction and postdelivery complications before and after implementation of a standardized approach to second-trimester medical termination of pregnancy. This was a retrospective cohort study of all women undergoing medical termination of pregnancy between 130/7 and 266/7 weeks of gestation at a single, academic institution from July 1, 2012, through June 30, 2015. The primary outcome was the time from the start of induction of labor to delivery of the fetus. Postdelivery complications including the need for dilation and curettage (D&C), blood transfusion, and readmission to the hospital were secondary outcomes of interest. A total of 62 women met inclusion criteria; 38 before and 24 after the intervention. There were no differences in measured baseline characteristics (p > 0.05). There was a significant decrease in induction time after the intervention (12.3 compared with 8.6 hours, p = 0.031). There was no significant difference in rates of D&C or other measured complications (p > 0.05). Implementation of a standardized clinical guideline for second-trimester medical termination was associated with a decrease in length of induction. There was no significant difference in need for D&C or postdelivery complications; however, we were underpowered for these secondary outcomes.

Second trimester termination of pregnancy complicated by abnormal placentation

Introduction: The presence of placenta praevia or a morbidly adherent placenta with or without co-existing previous caesarean sections can complicate 2.3% of second trimester terminations of pregnancy. Potential lifethreatening haemorrhage can pose significant risks to the patient. Available guidance on second trimester terminations does not distinguish between cases with or without abnormal placentation and/ or previous caesarean deliveries. Case Series: We present our experience with three cases requiring termination of pregnancy for foetal anomalies. The first patient presented with placenta accreta, the second had placenta praevia and the third patient had 3 previous caesarean sections and placenta praevia. They were managed differently and had varying outcomes. A search of the existing literature demonstrated that there is a lack of evidence to suggest the most appropriate method of management of these difficult clinical situations. Conclusion: These isolated cases need to be reported, to constitute a base for collective evidence in the future to inform optimal management.

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.

156: The impact of progesterone on the risk of preterm birth among women with second trimester bleeding. A multicenter, randomized, double-blind, placebo controlled trial

Progesterone administration to women who had a second-trimester short cervix or a previous preterm birth (PTB) has been shown to reduce the risk of PTB. Second-trimester vaginal bleeding increases as well the risk for spontaneous PTB, and it is unknown whether progesterone affects this risk. We aimed to examine the efficacy of vaginal progesterone to reduce the risk of PTB in women with second-trimester vaginal bleeding. We conducted a multicenter, double-blind, placebo-controlled trial involving pregnant women with second-trimester vaginal bleeding. Women with documented bleeding of uterine origin were randomly assigned in a 1:1 ratio to receive once daily 200 mg of micronized vaginal progesterone or placebo at 16 to 26 weeks until 36 weeks of gestation. The primary outcome was spontaneous delivery < 37 weeks. To detect a reduction in the incidence of spontaneous PTB from 30% to 15% in the placebo and progesterone groups respectively, 134 women in each group were needed. The analysis was performed according to the intention-to-treat principle. Between March 2011 and January 2017, 128 women gave consent and were randomized; 16 withdrew consent and 3 women had a second-trimester termination of pregnancy. Overall, 109 women were included in the final analysis; 60 in the progesterone group and 49 in the placebo group. The study was ended prematurely because of slow recruitment in six years. Demographic and obstetric characteristics did not differ between the groups. Spontaneous delivery at < 37weeks occurred in 19 (31.7%) and 12 (24.5%) in the progesterone and placebo groups respectively (p=0.53; OR 1.43; 95% CI 0.57-3.69). The proportion of births < 34 weeks was similar between the groups (p=0.72), as were the survival curves from randomization to delivery (p=0.48). There were no significant differences in neonatal morbidities between the groups. Antepartum vaginal progesterone does not seem to reduce the incidence of preterm birth in women with second-trimester bleeding. Clinical Trial Registration: clinicaltrials.gov Identifier: NCT01269450.