High failure rates of medical termination of pregnancy after introduction to a large teaching hospital

Abortion among Adolescents in Israel: Intervention and Health Behavior Outcomes

The current study investigated the post-abortion health behaviors of adolescents. Authors assessed the association between pre-abortion interventions and receiving post-abortion checkups and uptake of effective contraceptives. Participants were 172 adolescents under 19 years of age who were recruited pre-abortion at 10 hospitals in Israel and followed up by phone one and two months post-abortion. Results indicate that a quarter of participants did not receive a post-abortion checkup. The reported reasons for this were mostly personal, with very few cases attributed to accessibility issues. Rates of effective contraceptive use increased from the pre- to post-abortion periods but were still not high. Longer duration of pre-abortion counseling with a social worker, having the checkup where the abortion took place, and parental involvement increased the odds of having a post-abortion checkup. Getting a prescription for oral contraceptive pills at the time of abortion increased the odds of uptake one month post-abortion. Nonadherence to post-abortion recommendations is a problem with the potential to cause health risks and more unintended pregnancies. Effective social work interventions to promote behavioral change are needed, especially those based on theory and evidence.

What is the right timing for ultrasound evaluation after pregnancy termination with mifepristone?

OBJECTIVE

To determine the timing for ultrasound evaluation after medical termination of pregnancy (MTOP).

STUDY DESIGN

The records of 301 consecutive women who underwent MTOP between July 2010 and July 2011 were studied retrospectively. The follow-up protocol included ultrasound evaluation 2 weeks after MTOP. Surgical termination was offered when pregnancy was found to be ongoing, and either hysteroscopy/curettage or a repeat ultrasound 2 weeks later was offered when the ultrasound findings were suspicious for retained products of conception. Pathology reports were used to confirm the presence of retained products of conception.

RESULTS

Women with ultrasound findings suspicious for retained products of conception were significantly older than women with negative ultrasound findings (30.9±7.7 years vs 24.8±6 years, p<0.0001). Two weeks after MTOP, ultrasound findings were negative in 236 women and suspicious in 66 women. This rate declined as the interval between ultrasound evaluation and MTOP increased (up to 10 weeks). Of the 18 women (5.98%) who underwent hysteroscopy/curettage, pathology reports indicated that 15 (83.3%) had true residua.

CONCLUSIONS

At 2 weeks after MTOP, ultrasound findings suspicious for retained products of conception do not conclusively indicate failure of the procedure. Ultrasound evaluation should be repeated 4-6 weeks later (6-8 weeks after MTOP) in women with suspected residua before diagnosing failure of the procedure.