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Bettahar K, Koch A, Deruelle P. [Medical strategy for abortions between 14 and 16 weeks of gestation]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:735-740. [PMID: 36183986 DOI: 10.1016/j.gofs.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To adapt the protocols for the management of voluntary termination of pregnancy following the new law extending the practice to 16 weeks of gestation. MATERIAL AND METHOD A systematic review of the literature in French and English concerning the management of patients requesting medically induced abortion was performed on PubMed, Cochrane Library and on the recommendations of international learned societies. RESULTS The efficacy of the medical method is greater than 95% when the protocols are adapted to the gestational age. The combination of mifepristone and misoprostol currently represents the "gold standard" of drug-based management. Mifepristone 200mg is sufficient, followed 24 to 48hours later by misoprostol 800μg administered sublingually or buccally. After the first dose, 400μg should be administered every 3hours buccally or sublingually until expulsion. Adverse effects (digestive and thermoregulatory disorders) during medical abortion are usually mild and short-lived. An anti-emetic treatment should be proposed as a prophylactic measure. For pain, ibuprofen is the analgesic treatment of choice, with the addition of level 2 analgesics if necessary. CONCLUSION Medical abortion is a safe and effective method up to 16 weeks of gestation, provided that the protocols, which differ according to gestational age, are respected. Women must be informed of the advantages and disadvantages of the methods according to the term and the side effects, which will allow them to choose the method that fits them best.
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Affiliation(s)
- K Bettahar
- Service de gynecologie obstetrique, CHU de Strasbourg, 1, place de l'Hôpital, BP 426, site du CMCO, 67091 Strasbourg cedex, France.
| | - A Koch
- Service de gynecologie obstetrique, CHU de Strasbourg, 1, place de l'Hôpital, BP 426, site du CMCO, 67091 Strasbourg cedex, France.
| | - P Deruelle
- Service de gynecologie obstetrique, CHU de Strasbourg, 1, place de l'Hôpital, BP 426, site du CMCO, 67091 Strasbourg cedex, France.
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Erturk A, Karapinar BT, Tasgoz FN, Dundar B, Kender Erturk N. The safety of misoprostol alone use for second-trimester termination of pregnancy in women with previous caesarean deliveries. EUR J CONTRACEP REPR 2022; 27:473-477. [PMID: 36062521 DOI: 10.1080/13625187.2022.2115836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the safety of misoprostol use in second-trimester pregnancy termination among women with previous caesarean sections. MATERIALS AND METHODS This is a retrospective cohort study conducted in a tertiary centre, examining 359 patients whose pregnancy was terminated with misoprostol alone between 14 and 24 weeks with the indication of foetal anomalies. Two dose regimens were administered vaginally or sublingually: (1)400 mcg misoprostol every 3-6 h; (2) 200 mcg misoprostol every 3-6 h following a loading dose of 400 mcg. The patients were divided into three groups according to the number of previous caesarean sections (CSs) and compared in terms of demographic and clinical characteristics and complications. Termination-related complications were the primary outcomes considered. RESULTS Of the 217 patients, 80 (36.8%) had no previous uterine scar, 79 (36.4%) had one previous CS, and 58 (26.7%) had at least two prior CSs. The overall complication rate was 0.9%. There were no differences among groups in terms of complications (p > 0.05). There was no difference in complications in women with prior CS when they were compared according to the misoprostol regimens used (p > 0.05). The total dose of misoprostol used ranged from200 to 3,600 mcg. The treatment success of misoprostol during the second trimester was 92.1%. According to regression analysis, an increase in the week of gestation increased the failure rate of misoprostol for inducing second-trimester abortion by 2.7 times (95%CI (1.38-5.39)). CONCLUSION Misoprostol alone is a safe and effective option for terminating second-trimester pregnancies with one or more previous CSs in settings where mifepristone is unavailable.
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Affiliation(s)
- Anil Erturk
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Bayram Tunahan Karapinar
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Fatma Nurgul Tasgoz
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | | | - Nergis Kender Erturk
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
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Zhuo Y, Cainuo S, Chen Y, Sun B. The efficacy of letrozole supplementation for medical abortion: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2019; 34:1501-1507. [PMID: 31257957 DOI: 10.1080/14767058.2019.1638899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The efficacy of letrozole supplementation for medical abortion remains controversial. We conduct a systematic review and meta-analysis to explore the influence of letrozole supplementation for medical abortion. METHODS We searched PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of letrozole supplementation for medical abortion. This meta-analysis is performed using the random-effect model. RESULTS Six RCTs involving 555 patients are included in the meta-analysis. Overall, compared with control group for pregnant women, letrozole supplementation shows significantly increased complete abortion (RR = 1.38; 95% CI = 1.07-1.78; p = .01), and decreased estradiol (std. MD = -2.86; 95% CI = -4.45 to -1.27; p = .0004), but has no remarkable effect on induction-abortion time (std. MD = -1.03; 95% CI = -2.99-0.93; p = .30), progesterone (std. MD = 0.02; 95% CI = -0.30-0.34; p = .89), vaginal hemorrhage (std. MD = 1.84; 95% CI = 0.05-70.90; p = .74), nausea and vomiting (std. MD = 073; 95% CI = 0.44-1.21; p = .22). CONCLUSIONS Letrozole supplementation provides benefits to medical abortion in pregnant women.
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Affiliation(s)
- Yunqiao Zhuo
- Department of Obstetrics and Gynecology, Fenghua People's Hospital, Ningbo, China
| | - Shen Cainuo
- Department of Obstetrics and Gynecology, Fenghua People's Hospital, Ningbo, China
| | - Yier Chen
- Department of Obstetrics and Gynecology, Fenghua People's Hospital, Ningbo, China
| | - Bona Sun
- Obstetrics and Gynecology Department, Ningbo Zhenhai Longsai Hospital, Ningbo, Zhejiang, China
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Evaluation of effect of letrozole prior to misoprostol in comparison with misoprostol alone in success rate of induced abortion. J Gynecol Obstet Hum Reprod 2018; 47:113-117. [DOI: 10.1016/j.jogoh.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022]
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Association between infection and fever in terminations of pregnancy using misoprostol: a retrospective cohort study. BMC Pregnancy Childbirth 2017; 17:7. [PMID: 28056879 PMCID: PMC5217304 DOI: 10.1186/s12884-016-1188-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/07/2016] [Indexed: 11/24/2022] Open
Abstract
Background Fever 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. Methods A 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. Results The 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%. Conclusion Administration 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.
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Naghshineh E, Allame Z, Farhat F. The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:585-9. [PMID: 26600834 PMCID: PMC4621653 DOI: 10.4103/1735-1995.165964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: In developing countries it is important to the exploration of available and safe regimens for medical abortion. The present study was designed to assess the effect of letrozole compared to placebo pretreatment followed by sublingual misoprostol for therapeutic abortion in eligible women with gestational age less than 17 weeks. Materials and Methods: In this randomized control trail, 130 women eligible for legal abortions were randomly divided into two groups of case and controls. Cases received daily oral dose of 10 mg letrozole 10 mg letrozole for three days followed by sublingual misoprostol. Controls received daily oral dose of placebo followed by sublingual misoprostol. The dose of misoprostol was administrated according to ACOG guidelines based on patients’ gestational age. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed as main outcomes. Results: Complete abortion was observed in 46 (76.7%) letrozole group and 26 (42.6%) controls (P < 0.0001). Also, in 14 subjects of letrozole group and 35 subjects in placebo group, the placenta was not delivered during follow-up and curettage was performed. The mean interval induction-to-abortion was 5.1 h in letrozole group and 8.9 h in control (P < 0.0001). The cumulative rates of the induction-of-abortion time were a significant difference between the two groups (P < 0.0001). The incidence and severity of side-effects was comparable for the two groups (P = 0.9). Conclusion: Letrozole could be a quite beneficial adjuvant to misoprostol for induction of complete abortion in those who are candidates for legal medical abortion.
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Affiliation(s)
- Elham Naghshineh
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Allame
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faezah Farhat
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Ting WH, Peng FH, Lin HH, Lu HF, Hsiao SM. Factors influencing the abortion interval of second trimester pregnancy termination using misoprostol. Taiwan J Obstet Gynecol 2015; 54:408-11. [DOI: 10.1016/j.tjog.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 10/23/2022] Open
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Shokry M, Fathalla M, Hussien M, Eissa AA. Vaginal misoprostol versus vaginal surgical evacuation of first trimester incomplete abortion: Comparative study. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2014. [DOI: 10.1016/j.mefs.2013.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Küçükgöz Güleç Ü, Urunsak IF, Eser E, Guzel AB, Ozgunen FT, Evruke IC, Buyukkurt S. Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries. Int J Gynaecol Obstet 2012. [DOI: 10.1016/j.ijgo.2012.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The use of misoprostol in termination of second-trimester pregnancy. Taiwan J Obstet Gynecol 2012; 50:275-82. [PMID: 22030039 DOI: 10.1016/j.tjog.2011.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2008] [Indexed: 11/23/2022] Open
Abstract
Misoprostol, a synthetic prostaglandin E1 analog, is initially used to prevent peptic ulcer. The initial US Food and Drug Administration-approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory drugs use. In recent two decades, misoprostol has approved to be an effective agent for termination of pregnancy in various gestation, cervical ripening, labor induction in term pregnancy, and possible management of postpartum hemorrhage. For the termination of second-trimester pregnancy using the combination of mifepristone and misoprostol seems to have the highest efficacy and the shortest time interval of abortion. When mifepristone is not available, misoprostol alone is a good alternative. Misoprostol, 400 μg given vaginally every 3-6 hours, is probably the optimal regimen for second-trimester abortion. More than 800 μg of misoprostol is likely to have more side effects, especially diarrhea. Although misoprostol can be used in women with scarred uterus for termination of second-trimester pregnancy, it is recommended that women with a scarred uterus should receive lower doses and do not double the dose if there is no initial response. It is also important for us to recognize the associated teratogenic effects of misoprostol and thorough consultation before prescribing this medication to patients regarding these risks, especially when failure of abortion occurs, is needed.
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Sioutas A, Sandstrom A, Fiala C, Watzer B, Schweer H, Gemzell-Danielsson K. Effect of bacterial vaginosis on the pharmacokinetics of misoprostol in early pregnancy. Hum Reprod 2011; 27:388-93. [DOI: 10.1093/humrep/der407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mifepristone and Misoprostol Compared With Misoprostol Alone for Second-Trimester Abortion. Obstet Gynecol 2011; 118:601-608. [DOI: 10.1097/aog.0b013e318227214e] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Labor induction abortion is effective throughout the second trimester. Patterns of use and gestational age limits vary by locality. Earlier gestations (typically 12 to 20 weeks) have shorter abortion times than later gestational ages, but differences in complication rates within the second trimester according to gestational age have not been demonstrated. The combination of mifepristone and misoprostol is the most effective and fastest regimen. Typically, mifepristone 200 mg is followed by use of misoprostol 24-48 h later. Ninety-five percent of abortions are complete within 24 h of misoprostol administration. Compared with misoprostol alone, the combined regimen results in a clinically significant reduction of 40% to 50% in time to abortion and can be used at all gestational ages. However, mifepristone is not widely available. Accordingly, prostaglandin analogues without mifepristone (most commonly misoprostol or gemeprost) or high-dose oxytocin are used. Misoprostol is more widely used because it is inexpensive and stable at room temperature. Misoprostol alone is best used vaginally or sublingually, and doses of 400 mcg are generally superior to 200 mcg or less. Dosing every 3 h is superior to less frequent dosing, although intervals of up to 12 h are effective when using higher doses (600 or 800 mcg) of misoprostol. Abortion rates at 24 h are approximately 80%-85%. Although gemeprost has similar outcomes as compared to misoprostol, it has higher cost, requires refrigeration, and can only be used vaginally. High-dose oxytocin can be used in circumstances when prostaglandins are not available or are contraindicated. Osmotic dilators do not shorten induction times when inserted at the same time as misoprostol; however, their use prior to induction using misoprostol has not been studied. Preprocedure-induced fetal demise has not been studied systematically for possible effects on time to abortion. While isolated case reports and retrospective reviews document uterine rupture during second-trimester induction with misoprostol, the magnitude of the risk is not known. The relationship of individual uterotonic agents to uterine rupture is not clear. Based on existing evidence, the Society of Family Planning recommends that, when labor induction abortion is performed in the second trimester, combined use of mifepristone and misoprostol is the ideal regimen to effect abortion quickly and completely. The Society of Family Planning further recommends that alternative regimens, primarily misoprostol alone, should only be used when mifepristone is not available.
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Association between gestational age and induction-to-abortion interval in mid-trimester pregnancy termination using misoprostol. Eur J Obstet Gynecol Reprod Biol 2011; 156:140-3. [PMID: 21507550 DOI: 10.1016/j.ejogrb.2010.12.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/05/2010] [Accepted: 12/23/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study was aimed to evaluate the effectiveness, outcome, and pain intensity of the vaginal administration of misoprostol for the induction of abortion between 13 and 24 gestational weeks. STUDY DESIGN A retrospective study was conducted at our tertiary medical center from January 2006 to December 2009 on 122 consecutive women who underwent termination of pregnancy (TOP) in the mid-trimester. They were given 400 mcg of vaginal misoprostol every 6h, up to four doses. The induction-to-abortion interval and the level of pain experienced during the process were assessed. Success was defined by the fetus being expelled within 48 h. RESULTS Vaginal misoprostol was effective in 84% (98/122) of patients. The median duration of the induction-to-abortion interval was 16 (5-48)h. The induction-to-abortion interval was correlated with gestational age, while inversely correlated with parity. A correlation was also found between gestational age and pain intensity at 12h from induction. CONCLUSION Misoprostol is safe and effective in mid-trimester abortion induction. The induction-to-abortion interval is shorter and abortion less painful with lower gestational age. Higher parity is also associated with shorter induction to abortion interval.
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Dilek TUK, Doruk A, Gozukara I, Durukan H, Dilek S. Effect of cervical length on second trimester pregnancy termination. J Obstet Gynaecol Res 2011; 37:505-10. [PMID: 21349126 DOI: 10.1111/j.1447-0756.2010.01391.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the value of sonographic measurement of cervical length as a predictor of abortion or delivery within 24 h by misoprostol in second trimester termination of pregnancy (TOP). MATERIAL AND METHODS One hundred and sixty-three women underwent TOP between 14 and 26 weeks of pregnancy due to various indications. The primary outcome was abortion within 24 h. Cervical length was measured before transvaginal administration of misoprostol. The effects of cervical length, total misoprostol dose, parity, and gestational age at diagnosis on successful TOP were evaluated. RESULTS One hundred and sixty-three women were eligible who met the inclusion criteria. TOP occurred in 80.5% of patients within 24 h. Parous women had shorter prolonged induction to expulsion period over 24 h (14.1% vs 28.6%, P = 0.061). Total misoprostol dose and history of abortion were parameters that affected induction to delivery period (P = 0.002 and P = 0.041). Using an optimum cutoff of 36 mm, 58.2% sensitivity and 68.2% specificity were obtained. In addition, positive and negative predictive values were 85.36% and 33.3%, respectively. Pregnant women whose preinduction cervical length was shorter than 36 mm had a shorter induction time and needed a lower total misoprostol dose to achieve TOP than women with a cervical length longer than 36 mm (P = 0.027 and P = 0.011, respectively). CONCLUSION Transvaginal measurement of cervical length before administration of prostaglandin analogue was not correlated with successful TOP within 24 h. It cannot be used as a predictor in light of our findings.
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Affiliation(s)
- Talat Umut Kutlu Dilek
- Department of Obstetrics and Gynecology, School of Medicine, Mersin University, Mersin, Turkey.
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Lee VC, Ng EH, Ho P. Issues in second trimester induced abortion (medical/surgical methods). Best Pract Res Clin Obstet Gynaecol 2010; 24:517-27. [DOI: 10.1016/j.bpobgyn.2010.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 02/04/2010] [Indexed: 11/30/2022]
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Midtrimester abortion using vaginal misoprostol for women with three or more prior cesarean deliveries. Int J Gynaecol Obstet 2010; 110:50-2. [DOI: 10.1016/j.ijgo.2010.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/16/2010] [Accepted: 03/08/2010] [Indexed: 11/20/2022]
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Gómez O, Borrás A, Rabanal A, Palacio M, Carceller A, Coll O, Gratacós E. Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval. Contraception 2010; 81:97-101. [DOI: 10.1016/j.contraception.2009.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 09/19/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
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Yilmaz B, Ertas IE, Kelekci S, Sut N, Mollamahmutoglu L, Danisman N. Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens. EUR J CONTRACEP REPR 2010; 15:54-9. [DOI: 10.3109/13625180903417486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vaginal misoprostol for second-trimester pregnancy termination after one previous cesarean delivery. Int J Gynaecol Obstet 2009; 108:48-51. [DOI: 10.1016/j.ijgo.2009.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 07/30/2009] [Accepted: 08/25/2009] [Indexed: 11/18/2022]
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Dickinson JE, Doherty DA. Optimization of third-stage management after second-trimester medical pregnancy termination. Am J Obstet Gynecol 2009; 201:303.e1-7. [PMID: 19632665 DOI: 10.1016/j.ajog.2009.05.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 04/26/2009] [Accepted: 05/22/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Comparison of 3 regimens for third-stage management after second-trimester intravaginal misoprostol termination. STUDY DESIGN Prospective randomized trial. Three third-stage management strategies were compared: 10 units of intramuscular oxytocin (group 1), 600 microg oral misoprostol (group 2), or no additional medication (group 3) after fetal expulsion. Primary study outcome was the incidence of placental retention. RESULTS Two hundred fifty-one women were randomly assigned to the groups. There was a significant difference in placental retention rates: group 1, 8 of 83 (10%) vs group 2, 24 of 83 (29%) vs group 3, 26 of 85 (31%); P = .002. Blood loss was significantly lower in group 1, 100 mL (interquartile ranges, 50-200) vs group 2, 200 mL (interquartile ranges, 100-370) vs group 3, 200 mL (interquartile ranges, 100-375); P < .001. Requirement for blood transfusion: group 1, 1 of 83 (1%) vs group 2, 1 of 83 (1%) vs group 3, 5 of 85 (6%); P = .103. CONCLUSION Intramuscular oxytocin administered after fetal delivery after second-trimester medical termination significantly increases placental expulsion rates and decreases short-term postpartum blood loss.
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Affiliation(s)
- Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, and The Women and Infants' Research Foundation, Perth, Western Australia
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Shokry M, Shahin AY, Fathalla MM, Shaaban OM. Oral misoprostol reduces vaginal bleeding following surgical evacuation for first trimester spontaneous abortion. Int J Gynaecol Obstet 2009; 107:117-20. [PMID: 19616778 DOI: 10.1016/j.ijgo.2009.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/18/2009] [Accepted: 06/11/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of misoprostol to reduce the amount and duration of vaginal bleeding following surgical evacuation for first trimester spontaneous abortion. METHODS A total of 160 patients who underwent surgical evacuation for first trimester spontaneous abortion between 8 and 12 weeks of pregnancy were randomized into 2 groups to receive either 200 microg of oral misoprostol immediately after evacuation followed every 6 hours for 48 hours or no misoprostol. Pain scores, duration and amount of bleeding, and endometrial thickness were assessed over 10 days. RESULTS Women who received misoprostol had significantly fewer bleeding days after evacuation (4.11+/-2.69 vs 5.89+/-3.06; P<0.001), fewer patients reported vaginal bleeding lasting 10 days or more (3.8% vs 15.0%; P=0.014), and endometrial thickness 10 days after evacuation was less (6.25+/-2.38 vs 7.23+/-1.94; P=0.05). Pain scores were comparable in both groups (1.54+/-0.65 vs 1.63+/-0.83; P=0.40) after 10 days. CONCLUSION Oral misoprostol is effective in reducing the prevalence and amount of vaginal bleeding after surgical evacuation for first trimester spontaneous abortion.
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Affiliation(s)
- Mahmoud Shokry
- Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University, Assiut, Egypt
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Alsibiani SA. Misoprostol for pregnancy termination in grand multiparous women with three cesarean deliveries. Int J Gynaecol Obstet 2009; 106:255-6. [DOI: 10.1016/j.ijgo.2009.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 02/06/2009] [Accepted: 03/04/2009] [Indexed: 10/20/2022]
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Hammond C. Recent advances in second-trimester abortion: an evidence-based review. Am J Obstet Gynecol 2009; 200:347-56. [PMID: 19318143 DOI: 10.1016/j.ajog.2008.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Revised: 10/12/2008] [Accepted: 11/09/2008] [Indexed: 11/16/2022]
Abstract
The proportion of US abortions performed in the second trimester has varied little since 1992. Although 30 years of cumulative data corroborate the safety of dilation and evacuation (D&E), the most commonly used method of second-trimester abortion in the United States, both D&E and alternative induction regimens continue to evolve such that the traditional safety gap between medical and surgical regimens has narrowed. Providers now have options that allow them to either expedite D&E by diminishing the cervical-ripening period or reduce induction abortion intervals during medical induction.
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Affiliation(s)
- Cassing Hammond
- Obstetrics and Gynecology, Section in Family Planning and Contraception, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
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27
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Tsu VD, Coffey PS. New and underutilised technologies to reduce maternal mortality and morbidity: what progress have we made since Bellagio 2003? BJOG 2009; 116:247-56. [PMID: 19076957 DOI: 10.1111/j.1471-0528.2008.02046.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 2003, maternal health experts met in Bellagio, to consider new and underutilised technologies vital to pregnancy-related health services in low-resource settings. Five years later, we examine what progress has been made and what new opportunities may be on the horizon. Based on a review of literature and consultation with experts, we consider technologies addressing the five leading causes of maternal mortality: postpartum haemorrhage, eclampsia, obstructed labour, puerperal sepsis, and unsafe abortion (pregnancy termination and miscarriage). In addition, we consider technologies related to obstetric fistula, which has received more attention in recent years.
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Affiliation(s)
- V D Tsu
- PATH, Seattle, WA 98107, USA.
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28
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Benagiano G, Bastianelli C, Farris M. Selective progesterone receptor modulators 1: use during pregnancy. Expert Opin Pharmacother 2008; 9:2459-72. [DOI: 10.1517/14656566.9.14.2459] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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29
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Velazco Boza A, Gómez Ponce de León R, Salas Castillo L, Yi Mariño DR, Mitchell EM. Misoprostol Preferable to Ethacridine Lactate for Abortions at 13–20 Weeks of Pregnancy: Cuban Experience. REPRODUCTIVE HEALTH MATTERS 2008; 16:189-95. [PMID: 18772100 DOI: 10.1016/s0968-8080(08)31392-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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