Time Of Abortion Research Articles

Pattern and process in the evolution of the sole dioecious member of Brassicaceae.

BackgroundLepidium sisymbrioides, a polyploid New Zealand endemic, is the sole dioecious species in Brassicaceae and therefore the closest dioecious relative of the model plant Arabidopsis thaliana. The attractiveness of developing this system for future studies on the genetics of sex determination prompted us to investigate historical and developmental factors surrounding the evolution of its unisexual flowers. Our goal was to determine the evolutionary pattern of polyploidization of L. sisymbrioides and the timing and process of flower reproductive organ abortion. To that end, we used a combination of phylogenetics to place this species within the complex history of polyploidization events in Lepidium and histology to compare its floral ontogeny to that of its closest hermaphroditic relatives and to A. thaliana.ResultsUsing a nuclear locus (PISTILLATA), we reconstructed the gene tree among Lepidium taxa and applied a phylogenetic network analysis to identify ancestral genomes that contributed to the evolution of L. sisymbrioides. Combining this phylogenetic framework with cytological and genome size data, we estimated L. sisymbrioides as an allo-octoploid resulting from three hybridization events. Our investigations of flower development showed that unisexual flowers appear to abort reproductive organs by programmed cell death in female flowers and by developmental arrest in male flowers. This selective abortion occurs at the same floral developmental stage in both males and females, corresponding to Arabidopsis stage nine.ConclusionsDioecy in Brassicaceae evolved once in L. sisymbrioides following several allopolyploidization events, by a process of selective abortion of reproductive organs at intermediate stages of flower development. Different developmental processes, but similar timing of abortions, affect male versus female flower development. An increased understanding of how and when reproductive organs abort in this species, combined with our estimates of ancestral genome contributions, ploidy and genome size, lay the foundation for future efforts to examine the genetic mechanisms involved in the evolution of unisexual flowers in the closest dioecious relative of the best studied model plant.Electronic supplementary materialThe online version of this article (doi:10.1186/2041-9139-5-42) contains supplementary material, which is available to authorized users.

Time to second abortion or continued pregnancy following a first abortion: a retrospective cohort study.

What proportions of women have a second abortion or continued pregnancy within 12-46 months of a first abortion? Estimated return rates for a second abortion were 5, 10.9 and 19.8% at 12, 24 and 46-months, respectively, and rates of continued pregnancy were 5.6, 12.9 and 24.3% at the same intervals. Studies attempting to identify women at risk for 'repeat abortion' for intervention purposes have described a range of demographic and behavioural characteristics associated with presentation for more than one abortion, but few have taken timing of abortions into account. Retrospective cohort study involving women presenting for a first abortion at a public hospital abortion clinic in New Zealand (2007-2010). Electronically stored records were analysed for women discharged from a public hospital abortion clinic in New Zealand. Outcome measures were the proportion of women having a second abortion or continued pregnancy within 24 months of a first abortion, and characteristics associated with shorter time to subsequent pregnancy. Cox proportional hazards modelling was used to detect factors associated with time to a second abortion or continued pregnancy, and Kaplan-Meier survival analyses were used to estimate time to one of these two pregnancy outcomes. A total of 6767 women had a first abortion between 2007 and 2010. Some data were missing for 11 women so were excluded from the cohort and analyses. Return rates for a second abortion estimated from survival analyses were 5, 10.9 and 19.8% at 12, 24 and 46 months, respectively. Estimated rates of continued pregnancies were 5.6, 12.9 and 24.3% at 12, 24 and 46 months, respectively. Younger age, non-European ethnicity and greater parity were significantly associated with shorter time to a second abortion and to a subsequent continued pregnancy (P < 0.01 for all factor P-values). Hazard ratios (HR) for a second abortion were highest among those aged 16-19 years (HR 1.6, 95% confidence interval (CI) 1.3-1.9, Reference 20-24), of Pacific Island (HR 1.35, 95% CI 1.1-1.7) or Maori ethnicity (HR 1.26, 95% CI 1.1-1.5, Reference New Zealand European), and with 1 (HR 1.41, 95% CI 1.1-1.7) or 2 (HR 1.41, 95% CI 1.1-1.9, Reference nulliparous) children at the time of the first abortion. Both pregnancy outcomes were observed among 120 women (1.8%), with 60% of these women having a second abortion before the continued pregnancy. This study was limited to analysis of routinely collected clinical and demographic data for women presenting for abortion over a 4-year period. Conclusions could not be drawn about a wider range of personal and situational factors influencing pregnancy and pregnancy outcomes. Data were drawn from only one clinic but characteristics of the study sample were broadly representative of those reported nationally. Loss to follow-up for women seeking a second abortion elsewhere in the country cannot be ruled out and would serve to underestimate return rates reported here. To date, the most effective public health measure known to reduce abortion return rates within 24 months is the initiation of long-acting reversible contraception (LARC) at the time of an abortion. The high proportion of women seeking a second abortion <4 years after a first abortion (20%) could be significantly reduced by use of LARC, as could unintended pregnancies that are continued soon after a first abortion, particularly among teenaged and young women. Barrier-free access to a range of LARC methods should be prioritized to prevent unintended and mistimed pregnancies. Funded by a Lottery Health Research Grant and a University of Otago Research Grant. The authors have no competing interests. Not applicable.

PO-0451 Defects Of Central Nervous System: A Review

Background and aims Central nervous system (CNS) appears in the 3rd week of development, derived from the ectodermal sheet and from the neural plate. The frequency of CNS abnormalities ranges from 0.8 to 1.3/100 live births, and neural tube defects (NTD) are the most common. They are associated with a variety of genetic syndromes, chromosomal abnormalities and a variety of environmental factors. Methods Retrospective descriptive study by review of medical records of patients diagnosed with CNS malformations in pregnancies controlled on our hospital between 2004–2012. Results There were 17,759 births, 515 fetuses with birth defects diagnosed prenatally and 114 were CNS defects. In 109 cases an abortion was performed, and 5 live births (acraneo, Dandy Walker, ventriculomegaly, choroid plexus cyst, and a combination). Among the aborted fetuses 49 cases were diagnosed of (NTD), 21 brain defects, 9 midline brain abnormalities, 2 cerebellum defects, and 28 syndromic or multiple malformations. Women with affected fetuses present a mean age of 31.5 years (range 14–44 years), 45 were primiparous. The mean gestational age at the time of abortion was 17 weeks (range 11–29). Conclusions Of all fetuses aborted with prenatal diagnosis of a congenital defect, CNS abnormalities corresponded to 22.5%. Women with prenatal diagnosis were not elderly, and most had previous pregnancies without abnormalities. An important number of CNS malformations are associated with genes or chromosomal syndromes (24%), and the most frequently isolated cases correspond to NTD (42.2%), it believes that this group can be prevented by the intake of preconception folic acid.

How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study.

BackgroundComplications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA).MethodsThis retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant.ResultsWomen with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death.ConclusionsClandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.

Contraceptive decision making at the time of abortion: a prospective qualitative study

Objectives: To describe decision making regarding contraceptive method choice in the postabortion setting, specifically between highly effective reversible contraception (HERC) and less effective methods (LEM).

Blood loss at the time of surgical abortion up to 14 weeks in anticoagulated women: a registry case series

Blood loss at the time of surgical abortion up to 14 weeks in anticoagulated women: a registry case series

Phenology of fruit development and abortion in sawgrass, Cladium jamaicense, and its consequences for seed bank viability

The common marsh macrophyte Cladium jamaicense (sawgrass) has high levels of fruit abortion. We investigated the phenology of post-fertilization fruit development and of fruit drop in southern Florida, USA, to determine the timing of fruit abortion in relation to fruit shedding. Fruits at two sites were harvested at 2-week intervals, weighed individually and examined for potential viability (PV) to document changes in fruit biomass, morphology, and abortion rate. Fruits shed into 1/4m2 traps placed in sawgrass patches at two sites were counted and assayed for PV every one or two weeks in summer 2009 and 2010. Sawgrass sheds fruits from mid-July to September with peak fruit drop in late July to mid-August, 2–2.5 months after flowering. Sawgrass fruits had high rates of abortion that differed among plants and between sites and increased from mid-July through August. One-third to one-half of all fruits shed by a plant over the summer were aborted. Sawgrass plants had late fruit abortion that occurred prior to shedding but after investment in fruit development, producing persistent aborted fruits. A model for the effect of these fruits on seed bank viability predicted levels of 2% seed viability in the seed bank for 50% fruit abortion, similar to values for seed bank germination from the literature. The low percent of viable sawgrass seeds reported here provides a baseline population parameter for Everglades and other Caribbean marsh restoration and indicates the need to determine the input of viable fruits when studying seed banks and/or germination.

Effects of a prolonged, 72 hours, interval between mifepristone and gemeprost in second trimester termination of pregnancy: a retrospective analysis

Objective: To evaluate if the 72 hours interval between mifepristone and gemeprost has a similar efficacy compared to the 48 hours interval for second trimester termination of pregnancyStudy Design: Two-hundred and fifteen consecutive pregnant women, admitted to our hospital, for second trimester TOP, were included in this retrospective analysis. Standard protocol was followed for all patients. On the first day of the procedure oral mifepristone 200 mg was administered. After 72 (group A, n = 78) or 48 hours (group B, n = 113) women were admitted for administration of gemeprost 1 mg pessary as per protocol. The induction to abortion time was defined as the interval between the insertion of the first gemeprost pessary and the expulsion of the fetus.Results: There are no significant differences in the number of pessaries in the two groups. The induction to abortion interval was longer in group A than in group B. Twenty-one women required surgical evacuation of the uterus for retained placenta or incomplete abortion without difference between groups.Conclusion: A 48-hours interval between mifepristone and gemeprost leads to better results than a 72-hours interval, with a shorter abortion length and represents the elective method for second trimester TOP.

Prohibiting consent: what are the costs of denying permanent contraception concurrent with abortion care?

Oregon and federal laws prohibit giving informed consent for permanent contraception when presenting for an abortion. The primary objective of this study was to estimate the number of unintended pregnancies associated with this barrier to obtaining concurrent tubal occlusion and abortion, compared with the current policy, which limits women to obtaining interval tubal occlusion after abortion. The secondary objectives were to compare the financial costs, quality-adjusted life years, and the cost-effectiveness of these policies. We designed a decision-analytic model examining a theoretical population of women who requested tubal occlusion at time of abortion. Model inputs came from the literature. We examined the primary and secondary outcomes stratified by maternal age (>30 and <30 years). A Markov model incorporated the possibility of multiple pregnancies. Sensitivity analyses were performed on all variables and a Monte Carlo simulation was conducted. For every 1000 women age <30 years in Oregon who did not receive requested tubal occlusion at the time of abortion, over 5 years there would be 1274 additional unintended pregnancies and an additional $4,152,373 in direct medical costs. Allowing women to receive tubal occlusion at time of abortion was the dominant strategy. It resulted in both lower costs and greater quality-adjusted life years compared to allowing only interval tubal occlusion after abortion. Prohibiting tubal occlusion at time of abortion resulted in an increased incidence of unintended pregnancy and increased public costs.

Evaluating the Effect of the Parental Notification Law on Minors Seeking Abortions in New Hampshire

INTRODUCTION: In 2012, New Hampshire enacted a parental notification requirement for minors seeking an abortion with the rationale that parental involvement will decrease abortion rates in minors. Previous studies have demonstrated conflicting results with respect to changes in abortion rates and rates of parental involvement and often failed to account for crossing state borders to obtain an abortion. METHODS: A retrospective chart review was performed within the Planned Parenthood of Northern New England system including Vermont, New Hampshire, and Maine. All abortions performed on minors for the year before (2011) and after (2012) the enactment of the law were reviewed. Abortion rates, gestational age, and parental involvement were noted. RESULTS: A total of 103 abortions were performed during the study period with a decrease from 57 to 46 after enactment of the law (P=.641). Average gestational age increased from 7.77 to 8.35 completed weeks (95% confidence interval −1.44 to 28, P=.183). No change was detected in the number of New Hampshire minors seeking abortions out of state; however, we observed a decrease in Massachusetts minors seeking abortions in New Hampshire (n=30 compared with n=8, P=.011). Both parental awareness and presence at the time of abortion increased among New Hampshire minors (68–89%, P=.017 and 58–78%, P=.050, respectively). CONCLUSIONS: The parental notification law did not significantly affect the abortion rate or gestational age among minors seeking abortions. There was, however, a significant decrease in Massachusetts minors seeking abortions in New Hampshire and a significant increase in parental involvement after enactment of the law.

Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade

With no single regimen recognized as the standard for the treatment of first trimester cervical pregnancy, this report offers a successful treatment option with suction curettage and balloon tamponade. This is a retrospective review, with institutional review board approval, of 13 consecutive first trimester cervical pregnancies, from 1995-2014, all treated with the same surgical technique by the author. Successful termination of thirteen consecutive first trimester cervical pregnancies, all treated with the same surgical technique: suction curettage with cervical canal balloon tamponade. Cervical pregnancy is the rarest of ectopic pregnancies. Before the now common use of early pregnancy transvaginal ultrasound, cervical pregnancies were frequently diagnosed at the time of spontaneous abortion or reached the second trimester, both associated with life-threatening hemorrhage frequently requiring hysterectomy. With early transvaginal ultrasound, especially with 3 dimensional rendering, these implantations are easily identified and can successfully be terminated with a specialized suction curettage technique.

Expression and regulatory mechanism of microRNA-155 in the villi of patients with unexplained recurrent spontaneous abortion patients

To study the expression and the mechanism of miR-155in the villi of patients with unexplained recurrent spontaneous abortion (URSA). The expression of miR-155 in the villi of 36 cases with URSA (URSA group) and 25 women with normal early pregnancy (control group) were detected by stem-loop real-time reverse transcription (RT) qPCR.Expression of hypoxia inducible factor-1 (HIF-1α), vascular endothelial cell growth factor (VEGF) and micro lymphatic vessel density (MVD) in the villi of were measured by immnohistochemical staining among two groups. (1)miR-155 expression:the mean miR-155 expression were 1.456 (0.489, 2.459) in URSA group and 2.833 (1.740, 3.794) in control group, which reached statistical difference (P < 0.05). The mean expression of miR-155 of 1.683 (0.902, 2.459) in URSA group with abortion times ( ≤ 3) was significantly higher than 1.229 (0.489, 1.719) in URSA group with more than 4 times abortion (P < 0.05). (2) Indexes :the expression of HIF-1α, VEGF and MVD value were 121 ± 12, 134 ± 12, 36 ± 6 in URSA group and 99 ± 10, 109 ± 10, 28 ± 4 in control group, which reached statistical difference (P < 0.01). The expression of HIF-1α, VEGF and MVD value of 119 ± 12, 134 ± 12, 35 ± 5 in URSA group with less than 3 times abortion was significantly lower than 128 ± 12, 138 ± 12, 43 ± 6 in URSA group with more than 4 times abortion (P < 0.01). The expression of miR-155 and HIF-1α is topically stimulated by oxygen signal.HIF-1α adjusts the transcription and translation of VEGF, which together involved in placental trophoblast invasion and placental angiogenesis. The low expression of miR-155 could interfere with expression of HIF-1α and VEGF, which might be involved in villous vascular dysplasia in URSA.

What Proportion of Canadian Women Will Accept an Intrauterine Contraceptive at the Time of Second Trimester Abortion? Baseline Data From a Randomized Controlled Trial

ObjectiveThis report details enrolment findings related to a Canadian randomized controlled trial comparing immediate to delayed intrauterine contraception (IUC) placement after a second trimester abortion. We report acceptance of IUC, satisfaction with prior contraception, adherence to the CONSORT criteria, and challenges faced in the recruitment process. MethodsWomen seeking second trimester abortion and selecting either of two methods of IUC as their preferred contraception method were enrolled and randomized to insertion either immediately post-abortion or four weeks later. Enrolled participants completed a Contraception Satisfaction Questionnaire detailing prior contraceptive satisfaction. ResultsAmong 1813 women assessed, 1500 (83%) met eligibility criteria and IUC was chosen for post-abortion contraception by over one half of them (792/1500, 53%). When both types of device were available cost-free, women selected the levonorgestrel-releasing intrauterine system more than 20 times more frequently than a copper IUD. Participants had an average age of 26. 0 (standard deviation [SD] 6. 8) years, and an average gestational age of 16. 1 (SD 3. 1) weeks. Almost one half (48. 4%) had had a prior abortion and 46. 9% had a prior delivery. Two thirds of participants were using a contraception method at the time of conception, but almost one third of these were using methods in the lowest tiers of effectiveness. There was a weak correlation between prior contraceptive compliance and education level. ConclusionMore than one half of eligible women seeking a second-trimester abortion chose IUC for post-abortion contraception. In Canada, health care for unintended pregnancies is universally subsidized but contraception is not. Offering comprehensive information on the range of contraceptive methods and providing cost-free IUC is an effective strategy to increase uptake of intrauterine contraception among Canadian women who wish to prevent further unintended pregnancy.

Biochemical study on the effect of Toxoplasma gondii on Liver function in Women

The aim of this study was to detect the effect of toxoplasmosis on some liver enzyme activity such as bilirubin concentration, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline Phosphatase (ALP) in serum. Twenty hundred and fifty women were examining by Enzyme-linked immunosorbent assay (ELISA). One hundred and thirty-four were infected with toxoplasmosis with different number of abortion (1-4) times were used in this work. All Serum ALT and AST activities were increased and ALP and total bilirubin level decreased in infected women below the normal value. The analysis of the plasma enzyme distribution pattern suggests that liver cell damage occurred during virulent and low virulent infection, leads to be inflated cells as provided and expansion in Central necrosis of hepatic veins and damage in various parts of the liver

Reproductive health status and its influence factors of migrant female workers in service industry of Chang'an Town

Objective To learn the reproductive health status and health need of the migrant female workers in service industry of Chang'an Town and to provide some references for proper intervention on improving the reproductive health of the migrant female workers in service industry.Methods A cluster sampling was carried out on 523 sexually active unmarried and married women in hotel,salon,and entertainment venues of Chang'an Town.In order to find out the common,multiple reproductive diseases and their risk factors,relevant inspection was carried out on them and then the results were statistically analyzed.Results The overall incidence of reproductive diseases of the migrant female workers in service industry of Chang'an Town was 72.1％.The incidences of cervicitis,pelvic inflammation,and vaginitis were 31.4％,25.4％,and 16.8％,respectively.These indicated that reproductive diseases were the common and frequentlyoccurring diseases of the migrant female workers in service industry of Chang'an Town.There were statistical differences between the different education levels,ages,incomes,ages of first sexual intercourse,abortion times,working hours,and frequency of regular Health check of the workers (P ＜ 0.05).The females having low level of education,young age,low income,first sexual intercourse in young age,long work hours,and irregular health check had a higher probability in getting reproductive diseases.There was no statistical difference in the numbers of sexual partners (P ＞ 0.05).Conclusion In order to increase the reproductive health level of the migrant female workers in service industry,multichannel and multiform health education should received by them in term of the levels of their own education and receptivity. Key words: Service industry; Migrant female workers; Reproductive health; Influence factor

Understanding women's desires for contraceptive counseling at the time of first-trimester surgical abortion

ObjectiveThe objective was to investigate whether or not women presenting for a first-trimester surgical abortion want to discuss contraception on the day of their procedure. Study DesignBetween October 2012 and January 2013, an anonymous self-administered survey was distributed to women receiving first-trimester surgical abortions at four northern California family planning clinics. The survey obtained demographic information about each woman and inquired about her desire for contraceptive counseling during her appointment. Results were analyzed using both univariate and multivariable regression analyses to assess trends in responses related to desire for contraceptive counseling based on demographic and other variables. ResultsOf the 199 respondents, 64% reported that they did not want to talk to a counselor or doctor about contraception on the day of their abortion. About half of the women (52%) who did not want to discuss contraception indicated they already knew what they wanted for pregnancy prevention. Of the 25% who reported that they did want to discuss contraception, the most important topic desired from the counseling was identification of methods that were easier to use than what they used previously. ConclusionThe majority of women seeking first-trimester surgical abortion may not desire additional information about contraception on the day of the procedure. Implications StatementThis study demonstrates that a significant proportion of women may not want contraceptive counseling on the day of a planned surgical abortion.

Randomized controlled trial comparing efficacy between a vaginal misoprostol loading and non‐loading dose regimen for second‐trimester pregnancy termination

The aim of this study was to compare the efficacy of vaginal misoprostol loading dose regimen with non-loading dose regimen for termination of second-trimester pregnancy with live fetuses. A randomized controlled trial was conducted on pregnant women with a live fetus at 14-28 weeks. The patients were randomly allocated to receive either the vaginal misoprostol loading dose regimen (600 mcg, then 400 mcg every 6 h) or the non-loading dose regimen (400 mcg every 6 h). Failure to abort within 48 h was considered to be a failure. Of 157 recruited women, 77 were assigned to be in group 1 (loading group) and 80 were in group 2 (non-loading group). The median abortion time was not statistically different between the groups (14.08; 95% confidence interval: 12.45-17.77 h and 14.58; 95% confidence interval: 12.8-17.27 h, P > 0.05). The rates of abortion within 24 h and 48 h were also comparable between the groups. Fever and chills were more common in the loading group. No other serious complications, such as postpartum hemorrhage and uterine rupture, were found. Vaginal misoprostol in the loading dose regimen had a similar efficacy to the non-loading dose regimen but was associated with more adverse maternal effects.

Study on Antiphospholipid/Anticardioliplin Antibodies in Women With Recurrent Abortion

BackgroundAntiphospholipid antibodies are associated with recurrent abortion but correlation between level of antibodies and gestational age of abortion and duration post abortion is not clear.ObjectivesAim of this study was study on relation between antiphospholipid antibodies in women with recurrent abortion and their gestational age and duration post abortion.Patients and MethodsWe performed a case-control study on 197 pregnant women who had history of spontaneous recurrent abortion as case group and 50 pregnant healthy women as control group. Demographic characteristic of all participants filled in questionnaire forms. Antipospholipid and anticardiolipin antibodies were measured in their serum by Enzyme linked Immunoassay with orgenec kits. Data analyzed by SPSS software (version 13) and T statistical test. P value less than 0.05 was considered significant.ResultsMean age of participants was 24-39 years old. The average rate of antiphospolipid antibodies in patients with normal anticardiolipin was greater than those with abnormal anticardiolipin and T-test showed significant difference between two groups.(P = 0.000) In case group the number of abortions was more, mean of antiphosopolipid antibody levels were also higher. Mean anticardiolipin and antiphospholipid antibodies rate was greater with increasing gestational age at time of first abortion. Almost mean antipospholipid and anticardiolipin antibodies in all patients remained in high level just in first 5 years with any number of abortions and five years later, antibodies began to fall.ConclusionsAntipospholipid antibodies based on number of abortions and gestational age of abortions were increased. Mean antipospholipid and anticardiolipin antibodies in all patients remained in high level just in first 5 years post abortion and then began to fall.

Mifepristone–Misoprostol Dosing Interval and Effect on Induction Abortion Times

To examine the effect of the interval between mifepristone and misoprostol administration on induction time (first misoprostol dose to abortion), total procedure time (mifepristone administration to abortion), and safety and efficacy in second-trimester induction abortion (13-24 weeks). We searched MEDLINE (1966-2012), ClinicalTrials.gov, POPLINE, and the Cochrane Controlled Trials Register using search terms for second trimester, abortion, misoprostol, and mifepristone and reviewed reference lists of published reports. Our search revealed 138 articles of which 29 met inclusion criteria: 20 randomized controlled trials and nine observational studies. Studies were included if, in any study arm, mifepristone and misoprostol were used for medical abortion in the second trimester. Two authors independently reviewed the articles and abstracted the data using standardized data abstraction templates to summarize data. Discrepancies were resolved by consensus. Three studies directly compared a 1-day to 2-day mifepristone-misoprostol interval; they showed small differences in median induction times (weighted average 7.3 hours, range 7-8.5 for a 1-day interval; weighted average 6.8 hours, range 6.3-7.2 for a 2-day interval) and no significant difference in percent expelled by 12 hours or 24 hours. When all randomized studies using mifepristone and misoprostol were pooled by comparable mifepristone-misoprostol interval and misoprostol dose, induction times (first misoprostol dose to expulsion) were only 1-2 hours longer for a 12- to 24-hour interval compared with a 36-48-hour interval, whereas total abortion times (mifepristone to expulsion) were at least 18 hours longer in the 36- to 48-hour group. Induction times varied by misoprostol dosing, with 400-microgram misoprostol protocols resulting in shorter induction times than 200-microgram protocols. Shortening the mifepristone-misoprostol interval, thereby reducing total abortion time, does not compromise the safety or efficacy of second-trimester medication abortion and may be used to accommodate patient or health care provider preference.

Meta-analysis of pregnancy outcomes in pooled randomized trials on a prophylactic adjuvanted glycoprotein D subunit herpes simplex virus vaccine

The primary objective of this investigation was to assess whether the AS04-adjuvanted herpes simplex virus (HSV) glycoprotein D candidate prophylactic vaccine against genital herpes disease increases the risk of spontaneous abortion associated with pregnancy conceived within the vaccination exposure window (vaccine dose received within the period starting 60 days before and ending 20 weeks post-conception day). We performed a meta-analysis of studies designed as part of the clinical development program for this vaccine, to examine the relative risk of abortion (spontaneous or elective) associated with unintended vaccination exposure during pregnancy. Nineteen studies, completed before September 2010, were eligible; 5 matched the inclusion criteria for this analysis (presence of a control arm and at least one adverse pregnancy outcome reported). All vaccinated women (N=19,727) were included, of whom 660 reported a pregnancy during the study period. Overall, 13.3% of pregnancies in the HSV vaccine group and 11.0% in the control group resulted in spontaneous abortion; 24.2% and 20.0% resulted in elective abortion. Among 180 women with a first pregnancy conceived in the vaccination exposure window, 16.7% (HSV vaccine) and 9.5% (control) had a spontaneous abortion and 38.5% and 33.3%, elective abortion. The relative risk for spontaneous abortion associated with vaccine exposure during the risk period for abortion in the course of pregnancy was 1.7 (95% CI: 0.7–4.6). For all women receiving HSV vaccine, this relative risk was 1.3 (95% CI: 0.8–2.1). The corresponding relative risks for elective abortion were 1.2 (95% CI: 0.7–2.0) and 1.3 (95% CI: 0.9–1.8). There was no apparent relationship to dosing and no difference between groups in gestational age at the time of spontaneous or elective abortion. In conclusion there is no statistical evidence that the investigational HSV vaccine increased the risk of spontaneous or elective abortion.