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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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Vayssière C, Gaudineau A, Attali L, Bettahar K, Eyraud S, Faucher P, Fournet P, Hassoun D, Hatchuel M, Jamin C, Letombe B, Linet T, Msika Razon M, Ohanessian A, Segain H, Vigoureux S, Winer N, Wylomanski S, Agostini A. Elective abortion: Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2018; 222:95-101. [PMID: 29408754 DOI: 10.1016/j.ejogrb.2018.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
The number of elective abortions has been stable for several decades. Many factors explain women's choice of abortion in cases of unplanned pregnancies. Early initiation of contraceptive use and a choice of contraceptive choices appropriate to the woman's life are associated with lower rates of unplanned pregnancies. Reversible long-acting contraceptives should be favored as first-line methods for adolescents because of their effectiveness (grade C). Ultrasound scan before an elective abortion must be encouraged but should not be obligatory (professional consensus). As soon as the embryo appears on the ultrasound scan, the date of pregnancy is estimated by measuring the crown-rump length (CRL) or, from 11 weeks on, by measuring the biparietal diameter (BPD) (grade A). Because reliability of these parameters is ±5 days, the abortion may be done if measurements are respectively less than 90 mm for CRL and less than 30 mm for BPD (professional consensus). A medically induced abortion, performed with a dose of 200 mg mifepristone combined with misoprostol, is effective at any gestational age (Level of Evidence (LE) 1). Before 7 weeks, mifepristone should be followed 24-48 h later by misoprostol, administered orally, buccally, sublingually, or even vaginally followed if needed by a further dose of 400 μg after 3 h, to be renewed if needed after 3 h (LE 1, grade A). After 7 weeks, administration of misoprostol by the vaginal, sublingual, or buccal routes is more effective and better tolerated than by the oral route (LE 1). Cervical preparation is recommended for systematic use in surgical abortions (professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 μg (grade A). Vacuum aspiration is preferable to curettage (grade B). A uterus perforated during surgical aspiration should not routinely be considered to be scarred (professional consensus). An elective abortion is not associated with a higher risk of subsequent infertility or ectopic pregnancy (LE 2). The medical consultation before an elective abortion generally does not affect the decision to end or continue the pregnancy, and most women are sufficiently certain about their choice at this time. Women appear to find the method used most acceptable and to be most satisfied when they were able to choose the method (grade B). Elective abortions are not associated with an increased rate of psychiatric disorders (LE 2). However, women with psychiatric histories are at a higher risk of psychological disorders after the occurrence of an unplanned pregnancy than women with such a history (LE 2). For surgical abortions, combined hormonal contraceptives - oral or transdermal - should be started on the day of the abortion, while the vaginal ring should be inserted 5 days afterwards (grade B). For medical abortions, the vaginal ring should be inserted in the week after mifepristone administration, while the combined contraceptives should begin the same day as the misoprostol or the day after (grade C). Contraceptive implants should be inserted on the same day as a surgical abortion, and may be inserted the day the mifepristone is administered for medical abortions (grade B and C respectively). In case of medical abortion, the implant can be inserted the same day the mifepristone is administered (grade C). Both the copper IUDs and levonorgestrel intrauterine system should be inserted on the day of the surgical abortion (grade A). After medical abortions, an IUD can be inserted in 10 days after mifepristone administration, after ultrasound scan verification of the absence of an intrauterine pregnancy (grade C).
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Affiliation(s)
- Christophe Vayssière
- Pôle Femme-Mère-Couple, service de gynecologie-obstétrique, Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France; UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France.
| | - Adrien Gaudineau
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Luisa Attali
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Karima Bettahar
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Sophie Eyraud
- 3 rue Pierre d'Artagnan, 92350 Le Plessis-Robinson, France
| | - Philippe Faucher
- Unité fonctionnelle d'orthogénie, Hôpital Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Patrick Fournet
- Service de Gynécologie Obstétrique, Centre Hospitalier du Belvedere 72, rue Louis Pasteur, 76451 Mont Saint Aignan, France
| | | | | | | | - Brigitte Letombe
- Service de Gynécologoe-Obstétrique, Hôpital Jeanne de Flandre, CHRU Lille, 2 av Oscar Lambret, 59000 Lille, France
| | - Teddy Linet
- Service de Gynécologie Obstétrique, Centre Hospitalier Loire Vendée Océan, Bd Guerin, 85300, Challans, France
| | - Marie Msika Razon
- MFPF, Mouvement français pour le planning familial, Tour Manto, Bd Massena, 75013 Paris, France
| | - Alexandra Ohanessian
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
| | - Hélène Segain
- Service de Gynécologie-Obstétrique, CHI de Poissy-St-Germain, 45 rue du Champs Gaillard, 78303 Poissy, France
| | - Solène Vigoureux
- Service de gynécologie-obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), U1018, Equipe « Genre, Sexualité et Santé », 94276 Le Kremlin-Bicêtre, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Sophie Wylomanski
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Aubert Agostini
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
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