Trimester Medical Termination Of Pregnancy Research Articles

Pain experience during first trimester medical termination of pregnancy: Clinical observation from a cohort of Asian women

Objective: Optimal pain management during medical termination of pregnancy (TOP) remains unclear. This study aimed to suggest practical points to help minimize the intensity of pain of women during first trimester medical TOP. Methods: A retrospective observational study which reviewed the pain experience and the need for analgesics of 44 Asian women, who underwent first trimester medical TOP. Results: Nulliparous women had higher pain scores and more likely to need analgesics than multiparous women. Most women requested analgesics between 87.8 and 154.4 min (95% confidence interval) after misoprostol administration. Conclusions: Prophylactic analgesics should be provided to all nulliparous women undergoing first trimester medical TOP; and if paracetamol is the analgesic of choice, it should be given one hour after vaginal misoprostol administration to optimize pain relief.

Pain experience during first trimester medical termination of pregnancy: Clinical observation from a cohort of Asian women

Pain experience during first trimester medical termination of pregnancy: Clinical observation from a cohort of Asian women

Mid Trimester Termination of Pregnancy : Role of Combined Mifepristone and Misoprostol

Background: Mid trimester abortions constitute 10%-15% of all induced abortionsworld wide. Over the last decade this increase is due to better prenatal screening. Itcan be done by surgical and medical methods. Medical methods such as Misoprostolis widely used for mid trimester abortion. Mifepristone has antiprogesteroneproperty,so addition of Mifepristone with Misoprostol can increase its effectiveness.To assess the safety, effectiveness and acceptibility of combined Mifepristone andMisoprostol for mid trimester medical termination of pregnancy (Between 13-24weeks of gestation).
 Materials and methods: This experimental study was conducted among 40 healthywomen who presented for mid trimester termination of pregnancy between 13-24weeks with missed abortion, gross congenital anomalies with or without previoushistory of one caesarian section. The study was conducted from March October2018 at Chattogram Maa-O-Shishu Hospital Medical College, Chattogram,Bangladesh. Each woman received a single dose of tablet Mifepristone 200mg. After24 hours, 200 mcg vaginal Misoprostol was administered which was repeated at 6hourly interval for maximum of 5 doses (1000 mcg) in 24 hours. Success was takenas complete expulsion of fetus and placenta within 24 hours of first dose ofMisoprostol. Primary and secondary outcomes were measured. Statistical analysiswas done using SPSS version 23.
 Results: Success rate of complete abortion was 97.5%. Mean Induction AbortionInterval was11.59 hours (SD± 3.34). Mean dose of Misoprostol was 1.85 (SD± 0.77)or 370 mcg. Over all safety of the study was satisfactory with only 1 patientexperienced fever and 1 had nausea .There was no major complication.
 Conclusion: The Mifepristone/Misoprostol regimen is a highly effective as well assafe option for mid trimester medical termination of pregnancy with a shortinduction abortion interval and it can also be used in scarred uterus with closesupervision.
 Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 63-67

Systematic review on efficacy of mifepristone and misoprostol combination on early trimester medical termination of pregnancy

Introduction: Mifepristone, also known as RU 486 is used to cause medical abortion during the early part of pregnancy. It is used up to 10 weeks of pregnancy. Mifepristone blocks the secretion of progesterone. Misoprostol is an analogue of prostaglandin that increases uterine contraction and cervical dilation. The combination of both is used in studies with variable efficacy for medical abortion. Objective: To find out the efficacy of mifepristone and misoprostol combination by systematic review of studies from different parts of the world. Materials and Methods: Literature search in internet was conducted with the topic of efficacy of mifepristone and misoprostol combination on early trimester medical termination of pregnancy. Sixteen articles were finalized after applying the review criteria. Four large trials on the efficacy of mifepristone and misoprostol conducted in USA and Australia and 12 studies from different parts of the world were included. Most of the studies are randomised control trials and descriptive type. Results: It was found that the efficacy of mifepristone and misoprostol varied from 70.93% to 100% with a mean of 92.19%. The time interval between intake of mifepristone and misoprostol, and complete abortion varied from 10 hrs to 24 hrs. Conclusion: Systematic review detected the mean efficacy of mifepristone and misoprostol combination to be 92.19%. Keywords: Early trimester termination of pregnancy, Efficacy, Mifepristone, Misoprostol, Systematic review.

Manual Vacuum Aspiration (MVA) versus Electric Vacuum Aspiration (EVA) in first trimester medical termination of pregnancy (MTP)

Background: Approximately 47000 pregnancy related deaths occur due to complication of unsafe abortion. To correct this Ministry of Health and Family Welfare had appointed the expert group for MTP Act and amend it to enable increased access to safe abortion services for all women. The WHOs preferred methods to safely and effectively terminate pregnancy during the first trimester of pregnancy are vacuum aspiration and medication abortion. Objectives: To evaluate and compare the efficacy of MVA and EVA in first trimester pregnancy termination. Methods: Study includes cases of pregnancy with less than or equal to 12 weeks of gestation. After receiving consent, cases allocated in two groups Group A followed Manual Vacuum Aspiration while Group B followed Electric Vacuum Aspiration. Each group contains 75 cases. During these procedures, relation of uterine size, blood loss, post-operative pain score, complications were noted and compared between two procedures. Results: The average blood loss was significantly higher in MVA group in more than 10 weeks of gestation. MVA is comparatively less painful than EVA. There is no major difference in complications. Conclusion: MVA is best suited for infra-structure in rural areas and is very useful in poor resource setting hence It is best suited for rural setting, where there is an unmet need for abortion services. Key words: Manual Vacuum Aspiration (MVA), Electric Vacuum Aspiration (EVA), Medicaltermination of pregnancy

Comparative study of sublingual versus vaginal misoprostol following mifepristone in early first trimester medical termination of pregnancy - a prospective study

Comparative study of sublingual versus vaginal misoprostol following mifepristone in early first trimester medical termination of pregnancy - a prospective study

Self-management of first trimester medical termination of pregnancy: a qualitative study of women's experiences.

ObjectiveTo explore the experiences of women in Scotland who return home to complete medical termination of pregnancy (TOP) ≤63 days of gestation, after being administered with mifepristone and misoprostol at an NHS TOP clinic.DesignQualitative interview study.SettingOne National Health Service health board (administrative) area in Scotland.Population or SampleWomen in Scotland who had undergone medical TOP ≤63 days, and self‐managed passing the pregnancy at home; recruited from three clinics in one NHS health board area between January and July 2014.MethodsIn‐depth, semi‐structured interviews with 44 women in Scotland who had recently undergone TOP ≤63 days of gestation, and who returned home to pass the pregnancy. Data were analysed thematically using an approach informed by the Framework method.Main outcome measuresWomen's experiences of self‐management of TOP ≤63 days of gestation.ResultsKey themes emerging from the analysis related to self‐administration of misoprostol in clinic; reasons for choosing home self‐management; facilitation of self‐management and expectation‐setting; experiences of getting home; self‐managing and monitoring treatment progress; support for self‐management (in person and remotely); and pregnancy self‐testing to confirm completion.ConclusionsParticipants primarily found self‐administration of misoprostol and home self‐management to be acceptable and/or preferable, particularly where this was experienced as a decision made jointly with health professionals. The way in which home self‐management is presented to women at clinic requires ongoing attention. Women could benefit from the option of home administration of misoprostol.Tweetable abstractWomen undergoing medical TOP 63 days found home self‐management to be acceptable and/or preferable.

English

English

Intrauterine contraception after medical abortion: factors affecting success of early insertion

ObjectiveTo assess the success and factors affecting early intrauterine device (IUD) provision after first trimester medical termination of pregnancy (MTOP). Study designSubgroup analysis of a randomized contraceptive trial assessing the long-term effects of early provision of intrauterine contraception following abortion. Altogether, 606 women undergoing MTOP were included and followed for 3 months. The intervention group (n=307) was offered an IUD (either the levonorgestrel-releasing intrauterine system or copper-IUD) at a follow-up visit 1–4 weeks after MTOP. The control group (n=299) contacted primary health care for follow-up and contraceptive provision. Adverse events (infections, bleeding, residual tissue and incomplete abortion) were analyzed on intention-to-treat basis and IUD expulsions on per-protocol (PP) basis. ResultsIn the intervention group, 234 women (76.2%) received the IUD as scheduled, 46 later (altogether 91.2%). In the control group, the corresponding figures were 8 (2.7%) and 64 [altogether 24.1%, Odds ratio (OR) (95% Confidence interval (CI))=32.7 (20.3–52.6)]. Eighty-five (27.7%) women in the intervention group and 38 (12.7%) in the control group received treatment (administration of antibiotics, misoprostol or surgical evacuation) because of presumed adverse event [2.63 (1.72–4.01)], mainly residual tissue. In the control group, 23 (60.5%) of these occurred during the first 2 weeks. IUD expulsion occurred in 12 (5.4%) of the 222 women in the intervention group (PP basis). ConclusionsWhen provided as part of abortion service, most early insertions following MTOP were performed as planned. The main reason for postponement was overdiagnosis of adverse events suspected at follow-up. The rate of IUD expulsion was similar to that reported previously. ImplicationsEarly insertion following MTOP is safe, and the rate of IUD expulsion is low. Most adverse events possibly delaying IUD insertion occur early. Based on timing of adverse events in the control group, IUD insertion at approximately 2 weeks after completed MTOP seems optimal.

Second Trimester Medical Termination of Pregnancy with Combined Intracervical and Intravaginal Misoprostol: Comparative Analysis with Intravaginal Misoprostol—A Pilot Study

Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. In this IRB approved prospective study, twenty-two women (mean age 25.4±3.2 years, range 23-32 years; mean BMI 22.3±3.4kg/m(2); mean parity 2.1±1.4, average gestational age 17.9±2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. Mean induction-abortion interval for intravaginal group and combination group was comparable (t=7.9±1.8 and 6.5±3.5h, respectively). Three patients required surgical evacuation for incomplete abortion (n=2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6h was more in the intracervical-intravaginal group (36.3%). Patients with intracervical misoprostol complained of abdominal pain more often than those in other groups. Excessive bleeding and uterine rupture was not seen in any patient. Intracervical misoprostol is an effective method of medical treatment of second trimester pregnancy failure. Its short induction to abortion interval and acceptable safety profile makes induction via the cervical route acceptable for second trimester abortion.

Manual Vacuum Aspiration (MVA) versus Electric Vacuum Aspiration (EVA) in first trimester medical termination of pregnancy (MTP)

Manual Vacuum Aspiration (MVA) versus Electric Vacuum Aspiration (EVA) in first trimester medical termination of pregnancy (MTP)

Uterine Perforation and Extensive Large Bowel Injury

ABSTRACT Unsafe abortion represents a preventable yet major cause for maternal mortality in India. Complications may occur in these cases and ultimately require tertiary care. Large bowel injury is a rare complication and can occur when the uterus is perforated, allowing the instrument to pierce the underlying structures. Here, we discuss a case of a woman who sustained injury to large bowel during second trimester medical termination of pregnancy (MTP) and had to undergo complete large bowel resection. How to cite this article Chandran JR. Uterine Perforation and Extensive Large Bowel Injury. J South Asian Feder Obst Gynae 2015;7(3):225-226.

Experiences, Feelings and Thoughts of Women Undergoing Second Trimester Medical Termination of Pregnancy

Main ObjectiveThe objective of this study was to explore women's expectations and experiences of undergoing second trimester abortion.MethodsThis is a cross-sectional study using a screening questionnaire and semi-structured interviews for data collection. Thirty-one women filled out the questionnaire and 23 of them were later interviewed. The questionnaires were analyzed by descriptive statistics. The interviews were recorded, transcribed verbatim and analyzed with qualitative content analysis.Most Important FindingsIndications for the abortion were fetal malformation or unintended pregnancy. The women expressed similar feelings and these were irrespective for the reason for having an abortion. Both physical and mental pain was experienced during the abortion process and described by the women. Taking the mifepristone-pill was experienced as especially emotionally difficult for many participants. Professional support from the staff together with support from the partner, a friend or relative helped in transforming the worries related to something unknown to feelings of coping with a new and hard experience. Prior to the abortion most women stated that they did not want to view the fetus but women who chose to view the fetus described this as a way of confronting the reality and an opportunity to say farewell to the pregnancy/fetus. The analysis of the interview transcripts revealed five themes mirroring the women's experiences, thoughts and feelings related to the abortion.ConclusionsThe decision to undergo second trimester abortion sometimes exposes women to strong and conflicting emotions which are irrespective for the reason for having an abortion. Despite this women do not regret their decision to terminate the pregnancy. This analysis shows that their rational thinking outweighs their emotionally difficult feelings. It is important for the attending staff to be responsive to the needs of each individual woman whatever the indication is for the abortion.

Role of sublingual misoprostol for cervical priming in first trimester medical termination of pregnancy.

To evaluate the efficacy and safety of sublingual misoprostol as facilitator in first trimester medical termination of pregnancy (MTP) by surgical method. This was a prospective open label study conducted at a tertiary center. A total 150 patients at 6-12 wks gestation requesting for MTP were randomized into two groups. Patients in study group (n=75) received sublingual misoprostol three hours before surgical abortion and in control group (n=75) directly underwent surgical abortion without prior cervical priming with misoprostol. The outcomes of both groups were recorded in terms of baseline cervical dilatation, need of additional cervical dilatation, intraoperative blood loss, operative time and procedure related complications. The results were statistically analyzed using student-t test and chi-square test. p-value of <0.05 and <0.001 were considered significant and highly significant respectively. The mean baseline cervical dilatation was significantly more in study group compared to control group (8.6±1.3mm versus 5±2.3mm; p <0.001) and the operative time and intraoperative blood loss were also less (p<0.001). Higher incidence of side effects like nausea, vomiting and pyrexia were recorded in sublingual misoprostol group but were well tolerable to the patients. Sublingual misoprostol is an effective and safe drug for cervical priming prior to surgical evacuation and has good patient acceptability.

Medical termination of pregnancy during the second versus the first trimester and its effects on subsequent pregnancy

ObjectiveThe objective was to compare the risks of preterm birth, low birth weight, small for gestational age (SGA) infants and placental complications in subsequent pregnancy after second vs. first trimester medical termination of pregnancy (MTOP) in primigravid women. Study DesignA total of 88,522 women who underwent termination of pregnancy during 2000–2009 were identified using Finnish health registers. Of them, primigravid women who underwent MTOP and had subsequent pregnancy ending in live birth up to the end of 2009 (n=3843) were included in the study. The incidences and risks of preterm birth, low birth weight, SGA infants and placental complications after first- (n=3427) vs. second-trimester MTOP (n=416) were compared. ResultsDifferences between the study groups in the incidences of preterm birth (3.9% in both groups), low birth weight (3.9% in the second- vs. 3.2% in the first-trimester group), SGA infants (2.4% vs. 2.5%) and placental complications (1.9% vs. 2.6%) were statistically insignificant. Second-trimester MTOP was associated with similar risks of preterm birth, low birth weight, SGA infants and placental complications compared with first-trimester MTOP after adjustment for background characteristics. After second-trimester MTOP, 51.2% of women underwent surgical evacuation, and 4.3% were diagnosed with infection. The differences in the risks of preterm birth, low birth weight, SGA infants and placental complications were statistically insignificant between women with vs. without these complications following second-trimester MTOP. ConclusionsSecond-trimester MTOP among primigravid women did not increase the risks of preterm birth, low birth weight, SGA infants or placental complications in subsequent pregnancy compared with first-trimester MTOP. ImplicationsThe present study suggests that medical termination of pregnancy in primigravid women during second vs. first trimester does not increase the risks of adverse outcomes in subsequent pregnancy and delivery. The data are of value when counseling women undergoing second-trimester TOP.

Efficacy and safety of vaginal misoprostol in second trimester medical termination of pregnancy

Search for safe and effective method for second trimester termination of pregnancy continue from the time, when pregnancy termination was legalized through MTP act in India. With the knowledge about the potent uterotonic potential of misoprostol ,a synthetic prostaglandin analog , it is being (off label) used for second trimester termination of pregnancy with satisfactory results .Various dosage schedules and routes have been tried for this purpose .Present study was carried out to know the efficacy and safety of vaginal administration of misoprostol for second trimester of pregnancy .One hundred forty eight women seeking termination of pregnancy in second trimester, for various indications as per MTP act, over three years period at government approved MTP center, attached to Medical college hospital, were included in the study .Initial dose of 400 microgram of misoprostol by per vaginal route ,followed by 200 microgram was used for induction of abortion. Overall success rate was 92 percent and average induction abortion interval was 14 hours .There were no serious side effects or complications related to misoprostol .Average dose required for complete abortion was 1200 micrograms .Misoprostol was found to be safe and effective for second trimester medical termination of pregnancy.

Second Trimester Abortion with Vaginal Misoprostol: Is There Any Advantage with Prior Mifepristone Priming? A Comparative Study

ABSTRACT Objective Second trimester medical termination of pregnancy (MTP) can be done by surgical or nonsurgical methods or by various combinations of the two. Every method has its advantages and disadvantages. An ideal method would be one which was safe, quick and 100% effective, inexpensive and without any immediate or late side-effects. However, in the absence of such, various methods in synergistic combinations have been tried to come close to an ideal method. The successes of medical method now appear to be useful in MTP even in second trimester of pregnancy. Our objective is to investigate the effectiveness of only vaginal misoprostol and compare with oral mifepristone plus vaginal misoprostol in second-trimester induction abortions (≥12 and ≤20 weeks). Methods The patients are selected after careful examination and necessary investigations were divided into group A (n = 62) which received 400 μg of vaginal misoprostol followed by 200 μg vaginal misoprostol 4 hourly till expulsion of fetus or a maximum dose of 2000 μg and group B (n = 60) which received 200 mg of oral mifepristone followed 48 hours later by vaginal misoprostol as in group A. Main outcomes measured were efficacy, blood loss, induction-abortion interval and complication. Results The present study showed that the both methods were effective in 2nd trimester MTP. Average blood loss was lesser in group B (131.66 ml) compared to group A (150 ml). Induction abortion interval was shorter in group B (6.62 hours) than in group A (12.19 hours). Ninty percent of group B and 80.7% of group A had no complications. Success rate was higher in group B. Conclusion Therefore, in our study, pretreatment mifepristone followed by misoprostol was found to be a very effective regimen for 2nd trimester abortion with lesser complications and higher efficacy. How to cite this article Mukhopadhyay P, Bag TS, Kyal A, Bhuniya A, Saha TK. Second Trimester Abortion with Vaginal Misoprostol: Is There Any Advantage with Prior Mifepristone Priming? A Comparative Study. J South Asian Feder Obst Gynae 2012;4(1):25-27.

One- and two-day dosing intervals between mifepristone and misoprostol in second trimester medical termination of pregnancy--a randomized trial

The recommended time interval between mifepristone and misoprostol in medical second trimester termination of pregnancy (TOP) has been 36-48 h. However, a more flexible interval would be of value. The aim of this investigation was to compare one- and two-day intervals in second trimester medical TOP. The main outcome measures were induction-to-abortion time and the rate of surgical evacuation. This open randomized trial included 227 women undergoing TOP between gestational weeks 13-24. Mifepristone (200 mg) was followed by misoprostol (400 mcg) after one (17-28 h) or two (41- 45 h) days. In intention-to-treat analysis, the median induction-to-abortion interval was 1h longer in the one-day group (8.5 versus 7.2 h, P = 0.038), but in per-protocol analysis, the rate of surgical evacuation was higher in the 2-day group [30/115 (25%) versus 40/112 (37%); 95% confidence interval 0.3-24.1, P = 0.044]. A subgroup analysis showed that the median induction-to-abortion interval was 3h longer in the one-day group, amongst women without previous vaginal deliveries (10.1 versus 7.6, P = 0.013) and when gestation exceeded 16 weeks (10.8 versus 7.2, P = 0.024). Both one- and two-day dosing intervals seem to be suitable for second trimester medical TOP, but women with no previous deliveries and those whose gestation exceeds 16 weeks may benefit from the longer interval. However, evaluated on the basis of surgical evacuation, the one-day interval could be supported as an option for second trimester medical TOP. Effective use of both one- and two-day dosing intervals is important when optimizing clinical service. ISRCTN09944151.

Immediate adverse events after second trimester medical termination of pregnancy: results of a nationwide registry study

BACKGROUND Increasing gestational age is associated with an increased risk of complications in studies assessing surgical termination of pregnancy (TOP). Medical TOP is widely used during the second trimester and little is known about the frequency of complications. This epidemiological study was undertaken to assess the frequency of adverse events following the second trimester medical TOP and to compare it with that after first trimester medical TOP. METHODS This register-based cohort study covered 18 248 women who underwent medical TOP in Finland between 1 January 2003 and 31 December 2006. The women were identified from the Abortion Registry. Adverse events related to medical TOP within 6 weeks were obtained from the Hospital Discharge Registry. RESULTS When compared with first trimester medical TOP, second trimester medical TOP increased the risk of surgical evacuation [Adj. odds ratio (OR) 7.8; 95% confidence interval (CI) 6.8-8.9], especially immediately after fetal expulsion (Adj. OR 15.2; 95% CI 12.8-18.0). The risk of infection was also elevated (Adj. OR 2.1; 95% CI 1.5-2.9). Within the second trimester, increased length of gestation did not influence the risk of surgical evacuation or infection after medical TOP. CONCLUSIONS Medical TOP during the second trimester is generally safe. Surgical evacuation of the uterus is avoided in about two-thirds of cases, though it is much more common than after first trimester medical TOP. The risks of surgical evacuation and infection do not increase with gestational weeks in the second trimester TOP.

Medical methods for mid-trimester termination of pregnancy

With the improvement of ultrasound technology, the likelihood of detection of major fetal structural anomalies in mid-pregnancy has increased considerably. Upon the detection of serious anomalies, women typically are offered the option of pregnancy termination. Additionally, there are still many reasons other than fetal anomalies why women seek abortion in the mid-trimester. To compare different methods of second trimester medical termination of pregnancy for their efficacy and side-effects. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, Popline and reference lists of retrieved papers and other sources. All randomised controlled trials (RCTs) examining medical regimens for termination of pregnancy of a singleton living fetus between 12-28 weeks' gestation were analysed. The outcome measures were the induction to abortion interval, abortion rate within 24 hours, need for surgical evacuation, blood loss, uterine rupture, pain, and side-effects.Trials including >20% fetal death, multiple pregnancies, previous uterine scars and regimens which involved cervical preparation were excluded. Two authors selected the trials and three authors extracted data. Fourty RCTs were included, addressing various agents for pregnancy termination and methods of administration. When used alone, misoprostol was an effective inductive agent, though it appeared to be more effective in combination with mifepristone. However, the evidence from RCTs is limited.Misoprostol was preferably administered vaginally, although among multiparous women sublingual administration appeared equally effective. A range of doses of vaginally administered misoprostol has been used. No randomised trials comparing doses of misoprostol were identified; however low doses of misoprostol appear to be associated with fewer side-effects while moderate doses appear to be more efficient in completing abortion. Four RCTs showed that the induction to abortion interval with 3-hourly vaginal administration of prostaglandins is shorter than 6-hourly administration without an increase in side-effects.Many studies reported the need for surgical evacuation. Indications for surgical evacuation include retained products of the placenta and heavy vaginal bleeding. Fewer women required surgical evacuation when misoprostol was administrated vaginally compared with women receiving intra-amniotical PGF(2a) . Mild, self-limiting diarrhoea was more common among women who received misoprostol compared to other agents. Medical abortion in the second trimester using the combination of mifepristone and misoprostol appeared to have the highest efficacy and shortest abortion time interval. Where mifepristone is not available, misoprostol alone is a reasonable alternative. The optimal route for administering misoprostol is vaginally, preferably using tablets at 3-hourly intervals. Apart from pain, the side-effects of vaginal misoprostol are usually mild and self limiting. Conclusions from this review are limited by the gestational age ranges and variable medical regimens, including dosing, administrative routes and intervals of medication, of the included trials.