Trimester Termination Of Pregnancy Research Articles

Termination-of-Pregnancy Rights and Foetal Interests in Continued Existence in South Africa: The Choice on Termination of Pregnancy Act 92 of 1996

The aim of this article is to demonstrate that, although South Africa has permissive termination-of-pregnancy legislation, to the extent that women can terminate first- and second-trimester pregnancies on demand and for socio-economic reasons, foetal interests are in fact taken into account. The system of female reproductive rights progressively shelters foetal interests, albeit to a limited extent. South Africa is in the process of successfully balancing the conflicting notions of female reproductive rights and foetal interests. The article discusses the "right to terminate a pregnancy" with reference to the Constitution, the Choice on Termination of Pregnancy Act 92 of 1996 and relevant case law.
 
 On the topic of foetal interests, the article looks at the Choice on Termination of Pregnancy Act as legislative recognition of foetal interests since a woman's right to terminate her pregnancy is progressively limited as the pregnancy advances beyond the second trimester. The value of dignity justifies the recognition of foetal interests. Further, accepting that the Choice on Termination of Pregnancy Act limitedly protects foetal interests based on the value of dignity, the article questions why South Africa permits elective second trimester termination of pregnancies? Research indicates a need for second trimester terminations and the article discusses the position of a number of women seeking second trimester terminations.
 
 The article draws to an end by looking at the case of S v Mshumpa as an example of the balancing process that is needed when dealing with female reproductive rights and foetal interests. This article demonstrates the constitutional setting of women's termination-of-pregnancy rights on the one hand, and foetal interests on the other. Further, it illustrates that these conflicting positions, rather than being deepened, are in fact balanced by legislation and relevant case law.

Expectant therapy versus curettage for retained products of conception after second trimester termination of pregnancy: analysis of outcomes and complications

To evaluate the prognosis and complications of expectant therapy and curettage for retained product of conception (RPOC) after second trimester termination of pregnancy (TOP). A total of 270 patients with RPOC following second trimester TOP in Nanfang Hospital between January, 2014 and December, 2015 were included in this study. The duration of vaginal bleeding time and menstruation recovery interval were compared between patients receiving expectant therapy and curettage for RPOC, and binary logistic regression was used to assess the risk factors for complications in bivariate and multivariate analyses. The duration of vaginal bleeding time was significantly longer in expectant therapy group than in curettage group (P=0.005), while the menstruation recovery interval did not differ significantly between the two groups. The incidence of vaginal bleeding time for over 42 days was significantly higher in curettage group than in expectant therapy group (P=0.040), and the incidence of a menstruation recovery interval beyond 60 days was comparable between them. The incidence of complications was significantly higher in curettage group than in expectant therapy group either with adjustment of age, gravidity, parity, history of uterine surgery status, gestational age, type of indications, regimens for TOP and induction-abortion interval (OR=18.26 [95% CI: 3.57-93.42], P<0.001) or without adjustment (OR=10.60, [95% CI: 2.36-47.66], P=0.002). Expectant therapy and curettage for RPOC after second trimester TOP have comparable prognosis, but curettage is associated with a significantly higher rate of complications.

Induced termination of second trimester pregnancy in women with scarred uterus

Objective To investigate the suitable mode of induced termination of pregnancy at second trimester for women with scarred uterus. Methods A retrospective study was performed in 120 cases of second trimester pregnant women with scarred uterus, who requested termination of pregnancy in Department of Obstetrics, Ruijin Hospital of Shanghai Jiaotong University from January 2010 to July 2016. The indications of termination of pregnancy were fetal anomaly, serious pregnant complication, intrauterine fetal deaths and personal factors. The interval time of previous operation to this pregnancy were recorded. It was <2 years in 35 cases and ≥2 years in 85 cases. The patients with normal hepatic function began to take mifepristone combined with ethacridine lactate (group A, 62 cases). The method of mifepristone combined with misoprostol was used in the patients who failed to amniotomy to inject ethacridine lactatebecause of oligohydramnios or small gestational age (group B, 58 cases). The detail information of every patient was recorded, including age, gestational weeks, gravidity, parity, the mode of previous operation, previous operation time and indication, the mode of induced labor inthis pregnancy, the interval time from administration to uterine contraction, delivery or not and the interval time from induction to delivery, postpartum hemorrhage, the successful rate of induce labor, and placental retention ratio. Results ⑴ It had no significant differe-nce between groups A and B in age, gravidity, parity and the interval time of previous operation to this pregnancy (P>0.05). There was significant difference between two groups in gestational weeks of induction (P 0.05), but the time from induction to regular uterine contractionand delivery in group B was significant shorter than that of group A (P 0.05). Conclusions Both of methods of mifepristone combined with misoprostol and the mifepristone combined with ethacridine lactate are feasible to induce second trimester termination of pregnancy for women with scarred uterus. Key words: Uterus/PA; Cicatrix; Labor, induced; Pregnancy trimester, second

Sequential use of Foley catheter with misoprostol for second trimester pregnancy termination in women with and without caesarean scars: a prospective cohort study

Purpose: The aim of this study is to evaluate the effectiveness and safety of misoprostol and Foley catheter in second trimester termination in women with and without caesarean section (CS) scars.Materials and methods: Women with an indication for pregnancy termination between 14 and 22 completed weeks of gestation were included to the study. Enrolled women were allocated into three groups: (1) women with no history of CS, (2) women with one CS and (3) women with ≥2 CS. Study consisted 337 patients (233 group 1, 88 group 2 and 16 group 3). Misoprostol and Foley catheter were used sequentially. The primary outcome was the induction to abortion interval. Secondary outcomes were the successful vaginal abortion rate, the percentage of abortions in 24 h and the rates of surgical removal of the placenta, Foley catheter use and major maternal complications (transfusions, thromboembolic events, uterine rupture and death).Results: Demographic characteristics were comparable. All study outcomes were statistically similar among groups. There was no major maternal complication among all patients.Conclusions: Sequential use of misoprostol and Foley catheter is safe and effective in second trimester pregnancy termination for patients with and without CS scars.

Safety and efficacy of Mifepristone plus Misoprostol in Second Trimester Termination of Pregnancy in Previous CS

Safety and efficacy of Mifepristone plus Misoprostol in Second Trimester Termination of Pregnancy in Previous CS

Association between infection and fever in terminations of pregnancy using misoprostol: a retrospective cohort study

BackgroundFever is a well-known side effect of misoprostol, but clinically difficult to distinguish from an intra uterine infection. The aim of this study was to determine the incidence of fever in terminations of pregnancy (TOP) using misoprostol and to evaluate fever as indication of intra uterine infection.MethodsA retrospective cohort study was performed. Consecutive second trimester TOP with misoprostol between January 2008 and October 2012 were selected. We included 403 cases and determined the incidence of fever. To examine intra uterine infection as plausible cause of fever, pathological examination reports of placentas were reviewed for signs of infections.ResultsThe incidence of fever was 42%. Logistic regression showed a dose dependent association between dosage misoprostol and degree of fever (OR 1.86; 95% CI: 1.3–2.7). There was no association between fever and epidural analgesia. Fever has a sensitivity of 55% and a specificity of 58% as a marker of intra uterine infection. The positive predictive value of fever for an intra uterine infection is 4% and the negative predictive value is 98%.ConclusionAdministration of misoprostol for the indication TOP is strongly associated with fever during labor. Fever is a poor predictor of intra uterine infection in the context of TOP.

English

BACKGROUND: Abortion is the termination of pregnancy by the removal or expulsion of the foetus or embryo from the uterus before the age of viability. Second trimester pregnancy termination has been reported to be associated with 3-5 times increased morbidity and mortality. Medical methods of induced abortions in the midtrimester has shown development and proven to be safe and accessible. The ideal agent for cervical softening should be clinically effective, it should have a low side effect profile and it should be easy to administer. The cervical ripening effects of nitric oxide donors and of prostaglandin might be additive. So if a small dose of nitric oxide donor is given in combination with a small dose of prostaglandin it will cause effective cervical ripening and reduce the side effects associated with larger doses of either agent used alone. OBJECTIVES: Our aim is to compare the traditional use of vaginal misoprostol versus misoprostol and Isosorbide mononitrate in medical management of second trimester abortions. The comparison involves aspects of efficacy which are evaluated by means of the difference in success rate of inducing abortion, induction to expulsion period, amount of misoprostol used rate of manual/ surgical removal of the placenta and the rate of post abortive haemorrhage and also comparison of safety profile of both drugs. METHODOLOGY: The study was conducted in the labour ward of Institute of Obstetrics and Gynaecology, Egmore (IOG) in the period from October 2014- July 2015. The patients included in the study were 100 pregnant women from 12 to 20 weeks of gestational age undergoing induced abortion. Women were divided into two groups: Group 1 – Combination of 400 mcg of misoprostol and 40 mg of ISMN placed intravaginally. Repeat doses included combination of 400 mcg of misoprostol and 20 mg ISMN every 4 hours for maximum 4 doses..Group 2 - 400 mcg of misoprostol placed intravaginally every 4 hours for maximum 4 doses. RESULTS: It was observed that in Group A. Mean induction abortion interval was significantly less (7 hrs 36 mins ) in Group A, compared with group B(9 hrs 55 min). The mean dose of misoprostol decreased in group A (848 mcg ) when compared with group B (936 mcg) In Group A 76% of the patients aborted with two doses where as in Group B 62 % of the patients aborted with two doses. It is interpreted that on adding ISMN the number of complete abortion rates are higher. There was no failure of abortion.. The side effects such as pain abdomen and fever were less in Group A(38 %) when compared to Group B(78%). Side effects specific to ISMN was very less and reported only in 2 % of study groups. There was no reported evidence of postpartum haemorrhage or increased blood loss. The drug ISMN, was also economical and cost effective. CONCLUSION : Vaginally administered ISMN seems to be safe and well tolerated and provides a merit in some situations, where uterine contractions are unwanted before cervical ripening. Combination therapy of prostaglandins with nitrates might therefore be an ideal method for second trimester termination of pregnancy.

Comparison of Misoprostol and PGF2a for second trimester termination of Pregnancy

Aims: To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostaglandin F2alpha (PGF2alpha) injection for termination of pregnancy. Study Design: Interventional study. Setting: This study was conducted in gynae unit III Nishter hospital Multan over period f 15 months. Material & Methods: Patients admitted to labour ward with pregnancy of less than 20 weeks of gestation requiring termination of pregnancy due to fetal and maternal causes were included in this study. A detailed history was taken followed by clinical examination especially the cervical scoring was done. Sixty patients were randomly assigned to receive either tablet misoprostol (cytotec) intravaginally or extra-amniotic injection of prostaglandin F2a Induction-expulsion interval, need for evacuation and the incidence of side effects were analyzed for both groups. Results: Successful termination was achieved in 98% patients with misoprostol and 94% with PGF2a Induction expulsion interval was < 12 hrs in 80% patients in misoprostol group and 60% in PGF2a group (P value < 0.000). Evacuation rate was 23.3% with PGF2a and 10% with misoprostol group. The incidence of prostaglandin-associated pyrexia, vomiting and diarrhea were significantly increased in the PGF2alpha group (p<0.05). Conclusion: In this study, vaginal misoprostol has been found to be more effective and associated with a shorter induction to expulsion interval, fewer ERPOC for incomplete evacuation and less side effects when compared with extra-amniotic PGF2alpha. In view of its effectiveness, as shown in this study, vaginally administered misoprostol has the potential to provide a better option for medical abortion in many parts of the world.

Use of contraception among women who request first trimester pregnancy termination in Norway

ObjectivesAmong women requesting pregnancy termination, we studied the proportion of women who reported having used contraception when they became pregnant and the contraceptive method that they had used. Study designWe included all requests for pregnancy termination in Norway during the years 2007–2011 (n=80,346) by obtaining information from the Norwegian Registry of Pregnancy Termination. By using a logistic regression model, we estimated odds ratios for using any contraceptive method associated with the woman's age, previous childbirth, previous pregnancy termination, marital status, employment status and educational level. ResultsIn total, 36.5% of the women who requested pregnancy termination (29,305/80,346) reported having used contraception when they became pregnant. Of all women, 16.6% reported having used the combined contraceptive pill/progestin pill, 11.5% the condom and 1.1% long-acting reversible contraceptives (1.0% intrauterine contraception). Overall, 38.9% of women 20–24years old had used contraception, compared to 29.9% of women 40–44years old (odds ratio 0.55, 95% confidence interval 0.51–0.60). Previous childbirth, previous pregnancy termination and high educational level were also associated with contraceptive use. ConclusionAmong women who requested pregnancy termination in Norway, 36.5% reported having used contraception when they became pregnant. Contraception use was associated with young age and having previously been pregnant. ImplicationsA large proportion of women who request pregnancy termination have experienced contraceptive failure. Women who are fertile and do not wish to become pregnant should be offered a contraceptive method that carries low risk of incorrect use.

A Comparative Study of Misoprostol Only and Mifepristone Plus Misoprostol in Second Trimester Termination of Pregnancy.

To compare the effectiveness, success rate and induction to abortion interval between administration of misoprostol only and mifepristone with misoprostol in second trimester abortions (14-20weeks) . The study was conducted by dividing women approaching for second trimester termination, into two groups each consisting of 100 women. Group-I received only misoprostol; 600mcg initial vaginal insertion followed by 400mcg sublingually every 3h until termination. Women in Group-II received mifepristone 200mg and after 24h started with 600mcg misoprostol, per vaginal followed by 400mcg sublingually till abortion was completed, up to a maximum of five doses in both groups. The success rate in Group-I was 89%, whereas in Group-II it was 96%. The mean induction abortion interval in Group-I was 10.67±3.96h compared to Group-II which was significantly less 6.19±2.70h (p value<0.01). The mean dose of misoprostol in Group-I was 1610±511.18mcg and in Group-II, it was lesser 1046±392.71mcg (p value<0.01). There was significant difference in the mean blood loss also, 97.20±36.35ml in Group-I and 52.55±27.96ml in Group-II. Also among the individual groups multigravidae and lower gestational age (<17weeks), women had lesser IAI as well as lesser misoprostol dose was required. Pretreatment with mifepristone significantly reduces the induction abortion interval and the misoprostol dose along with minimal blood loss.

Analgesic effects of acetaminophen, diclofenac and hyoscine N-butylbromide in second trimester pregnancy termination: a prospective randomized study

Objectives: This prospective, randomized study aimed to compare the analgesic effects of acetaminophen, diclofenac and hyoscine-N-butylbromide (HnBB) in cases of second trimester pregnancy termination.Methods: In 60 women with indications for second trimester pregnancy termination, three analgesic agents were randomized into three groups: group 1, acetaminophen; group 2, diclofenac; and group 3, HnBB. A visual analog scale (VAS) used for the evaluation of pain perception. The primary outcome of the study was mean VAS score during the procedure and last VAS score before the completion of termination. The secondary outcomes were the induction-to-abortion interval, the percentage of aborted cases within the first 24 h and finally the need for parenteral analgesia.Results: Demographic characteristics were similar among the groups. The mean VAS and last VAS scores before termination did not differ among the groups (p = 0.3 and 0.2, respectively). The need for parenteral analgesia did not differ among the groups (p = 0.3). Although a shorter induction-to-abortion interval and greater number of cases with successful termination before 24 h were found in the HnBB group, the differences were not statistically significant (p = 0.6 and 0.5, respectively).Conclusions: Our study did not demonstrate a difference in pain perception among second trimester pregnancy termination cases using acetaminophen, diclofenac and HnBB.

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.

Analgesia for Medically Induced Second Trimester Termination of Pregnancy: A Randomized Trial.

To compare the efficacy between intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) in women undergoing medically induced second trimester termination of pregnancy (TOP). We conducted a randomized trial in a Canadian quaternary care hospital. We included in the study women of gestational age 12 weeks to 23+6 weeks who were undergoing second trimester induction of labour between June 2012 and January 2014. Participants were computer-randomized to receive either IVPCA with fentanyl or PCEA with bupivacaine and fentanyl, with the option to cross over between treatment groups. We administered Quality of Recovery-40 (QoR-40) questionnaires pre-procedure, at the time of discharge, and 24 hours after discharge. Pain scores, satisfaction scores, and obstetrical complications also were noted. One hundred thirty-eight women were approached for participation in the study; 80 declined and 16 were ineligible, leaving 42 participants. Three women subsequently withdrew consent, and two were not included in the results because of protocol violations. A total of 37 women completed the study. Twenty (54%) were allocated to the IVPCA group and 17 (46%) to the PCEA group. Although the QoR-40 values at the time of discharge and at 24 hours after discharge were significantly higher in the PCEA group, they also were significantly higher before the procedure in that group. The within-group differences in QoR-40 (between QoR-40 at discharge and QoR pre-procedure, and between QoR-40 at 24 hours after discharge and QoR pre-procedure), maximum pain scores, satisfaction, and obstetrical complication rates did not differ significantly between the two groups. IVPCA and PCEA provide similar quality of recovery, quality of analgesia, and satisfaction for women undergoing second trimester TOP.

Review of Comparative Study of Mifepristone with Vaginal Misoprostol for First Trimester Termination of Pregnancy with Different Gestational Age

Review of Comparative Study of Mifepristone with Vaginal Misoprostol for First Trimester Termination of Pregnancy with Different Gestational Age

Misoprostol versus misoprostol and foley catheter combination in 2nd trimester pregnancy terminations

Objective: The efficacy and safety were assessed of a misoprostol regimen used alone or in combination with foley catheter for second trimester pregnancy termination. Methods: A retrospective examination was made of the records of patients who underwent pregnancy termination at 14–24 weeks of gestation in our university hospital between January 2011 and June 2014. Records were available for patients 378 who underwent terminations. Group 1 comprised patients with no history of cesarean section. An initial dose of 200 μg misoprostol was administered intravaginally and then until the termination was completed an additional 200 μgr dose was administered sublingually every 4 hours (Group 1: 234 patients). Group 2 comprised patients with a history of cesarean section. An initial dose of 200 μg misoprostol was administered intravaginally and 2 hours later an intracervical foley catheter was inserted (Group 2: 144 patients). Results: The total misoprostol dosage used was 1160 μg and 560 μg (p< 0.001), intervals from the administration of the first misoprostol tablet until termination were 854.8 and 704.2 minutes (p= 0.03) in Groups 1 and 2, respectively. Conclusions: The misoprostol + foley catheter combination reduces the total dosage of misoprostol required for termination and shortens the termination interval, thereby increasing patient’s comfort. Based on these results, the usage of the misoprostol + foley catheter combination can be recommended especially for patients with a history of caesarian section.

Second trimester dilation and evacuation: a risk factor for preterm birth?

To evaluate whether second trimester pregnancy termination with dilation and evacuation (D&E) vs induction of labor (IOL) affects subsequent risk of preterm birth. Our cohort was a retrospective cohort of women undergoing second trimester pregnancy termination for fetal anomalies, fetal death or previable premature rupture of membranes. We analyzed the rates of spontaneous delivery <37 weeks in the first pregnancy following the termination. We also compared preterm birth rates in our cohort with national averages and analyzed by the total number of prior procedures. There were 173 women in our cohort. Women who had undergone a D&E (n=130) were less likely to have a subsequent preterm birth (6.9 vs 30.2%; P<0.01). This held true for a low risk subset without obstetric risk factors. There was no statistical difference in preterm birth rates for women who had undergone a D&E as compared with national averages, nor between the rates of preterm birth for women with 0, 1, 2 or 3 or more prior first or second trimester procedures. We did not find that D&E was a risk factor for preterm delivery when compared with women with a prior IOL or national rates.

Expression and function of placental uric acid transporter GLUT9

Expression and function of placental uric acid transporter GLUT9

Programmed intermittent epidural bolus versus continuous epidural infusion for pain relief during termination of pregnancy: a prospective, double-blind, randomized trial

BackgroundPain is a major concern during medical abortion but no evidence-based recommendations for optimal analgesia during medical termination of pregnancy are available. We compared two methods of epidural analgesia during second trimester termination of pregnancy, with the primary aim of assessing the incidence of motor block. MethodsWomen were randomly assigned to receive continuous epidural infusion (CEI Group; n=52) or programmed intermittent epidural bolus (PIEB Group; n=52). Assessment of motor block was performed every hour. Patients with a modified Bromage score <6 were considered to have motor block. ResultsMotor block occurred more frequently in the CEI Group compared with the PIEB Group (46.2% vs. 5.8%, P<0.001). Pain scores were low and comparable between groups. Patients in the CEI Group experienced nausea more frequently than those in the PIEB Group (34.6% vs. 13.5%, P=0.022). The degree of satisfaction was higher in the PIEB Group compared with the CEI Group. ConclusionsDuring second trimester termination of pregnancy in our patient groups, a programmed intermittent epidural bolus technique was associated with less motor block and greater patient satisfaction than continuous epidural infusion. Both techniques had similar analgesic efficacy.

Factors influencing the abortion interval of second trimester pregnancy termination using misoprostol

ObjectivesTo determine the factors influencing the abortion interval (AI) for medical termination of second-trimester pregnancy using misoprostol. Materials and MethodsAll patients who were admitted for second-trimester pregnancy termination between January 2008 and August 2013 were reviewed. Those who received either 200 μg or 400 μg of priming vaginal misoprostol, followed by 200 μg of misoprostol orally at 6-hour intervals were enrolled. ResultsIn a total of 101 patients, delivery occurred within 24 hours of commencement in 62 patients (61%) and within 48 hours in 84 patients (83%), and the median AI was 16.5 hours. One patient (1%) failed to deliver. The remaining 100 fetuses were delivered successfully, and the median AI was 16.3 hours. Higher parity [hazard ratio (HR) = 1.28, p = 0.04], the presence of intrauterine fetal demise (HR = 2.66, p = 0.003), and the presence of premature preterm rupture of membranes (HR = 4.51, p = 0.003) were associated with shorter AI. Additionally, all women with premature preterm rupture of membranes delivered successfully within 12 hours; higher parity (odds ratio = 2.12, p = 0.01) and lower fetal birth body weight (odds ratio = 0.992, p = 0.01) were associated with successful delivery within 12 hours. There was no significant difference in AI in the groups that received different doses of priming vaginal misoprostol (200 μg vs. 400 μg). ConclusionHigher parity, intrauterine fetal demise, and preterm premature rupture of membranes were associated with shorter AI. The regimen of 200 μg oral misoprostol at 6-hour intervals following a 200 μg or 400 μg priming vaginal dose is feasible and efficacious for second trimester pregnancy termination.

Comparative Study of Mifepristone with Vaginal Misoprostol for First Trimester Termination of Pregnancy at Different Gestational Ages.

This study for medical abortion was conducted in the Department of Obstetrics and Gynaecology, Zenana Hospital, SMS Medical College, Jaipur during 2011-2012. In total 280 cases were taken for the study and divided into two groups, among whom there were six defaulters in each group who failed to present for follow-up. The objectives of this study were to (1) compare the success rates of abortion at different gestational ages, (2) study the side effects of the drugs, and (3) study the acceptability in both the groups. The medical abortion with the given regimen and protocol was observed to be highly successful, and complete abortion was achieved in 98.51 and 97.76% of the patients in Group-A and Group-B, respectively. Failure rates observed were only 1.49% in Group-A and 2.24% in Group-B. Medical abortion can be safely performed in cases up to 63days of gestation, but women should be counseled about the increased blood loss and duration of bleeding.