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Sium AF, Teklu H, Reeves M, Tolu LB, Prager S. One-day versus two-day mifepristone-misoprostol interval prior to initiation of misoprostol during late second trimester medication abortion: A cohort study. Contraception 2024; 132:110356. [PMID: 38151223 DOI: 10.1016/j.contraception.2023.110356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES To compare one-day versus two-day mifepristone-misoprostol interval in late second trimester medication abortion. STUDY DESIGN This retrospective cohort study was conducted at St. Paul's Hospital Millennium Medical College, in Ethiopia. Data were collected retrospectively and analysed with SPSS 23 using simple descriptive analysis, t-test, Chi-squared test, and regression analysis, as appropriate. P-value < 0.05 and adjusted odds ratio (AOR) with 95% CI were used to present results significance. RESULTS A total of 282 women who had medication abortion in the late second trimester (167 with one-day and 115 with two-day mifepristone-misoprostol intervals) at 20-28 weeks of gestation were analysed. Both median and mean induction to expulsion interval (I-E) were much higher in the one-day mifepristone-misoprostol (mife-miso) interval than in the two-day mife-miso interval group. The median (and mean) I-E in the one-day interval group was 24 hours (21.9+/-6.6 hours) compared to 12 hours (14.6+/-8.8 hours) in the two-day mife-miso interval group (p-value < 0.001). Expulsion rate within 12 hours of starting misoprostol was significantly higher in the two-day cohort than in the one-day cohort (73% vs 25.6%, p-value < 0.001, aOR = 19.08 95%, CI = 5.1-70.7). CONCLUSIONS For second trimester medication abortion at later gestation, a two-day mifepristone-to-misoprostol interval significantly reduces induction to expulsion time compared to a one-day interval. IMPLICATIONS Compared to one-day interval, administration of mifepristone two days prior to misoprostol initiation has a shorter interval of induction to expulsion and a higher rate of abortion completion within 12 hours of initiation of misoprostol during late second trimester medication abortion.
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Affiliation(s)
- Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Hana Teklu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sarah Prager
- Complex Family Planning Division, Department of Obstetrics and Gynecology, UW Medicine, Seattle, WA, USA
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Demont C, Dixit A, Foster AM. Later Gestational Age Abortion in Canada: A Scoping Review. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2023. [DOI: 10.3138/cjhs.2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Since the decriminalization of abortion in Canada in 1988, there have been no legal restrictions on when in pregnancy an abortion can take place. However, abortion care is only consistently available in Canada up to 23 weeks and 6 days; women, transgender men, and gender non-binary individuals who need abortion care after 24 weeks typically obtain services in the United States. Furthermore, abortion care beyond 16 weeks is unavailable in some regions of the country. The authors undertook this scoping review to explore what is currently known about later gestational age abortion in Canada. Using a six-stage framework, they identified 32 relevant sources that were published in the last 30 years, and they consulted with seven topic experts to validate the findings from our document synthesis. The limited body of literature on abortion after 16 weeks in Canada sheds light on the safety of both medical and instrumentation procedures, the type and training of abortion-providing clinicians, the characteristics of those obtaining abortion care after the first trimester, and geographic disparities in service availability. These topic experts emphasized the need for future research on patient experiences and developing and implementing strategies to help provinces and territories expand abortion care to later gestational ages and improve comprehensive reproductive health services.
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Affiliation(s)
- Carly Demont
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Anvita Dixit
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- National Abortion Federation, Victoria, British Columbia, Canada
| | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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Abebe M, Mersha A, Degefa N, Molla W, Wudneh A. Magnitude of second-trimester-induced abortion and associated factors among women who received abortion service at public hospitals of Arba Minch and Wolayita Sodo towns, southern Ethiopia: A cross-sectional study. Front Glob Womens Health 2022; 3:969310. [PMID: 36312870 PMCID: PMC9614144 DOI: 10.3389/fgwh.2022.969310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/05/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Second-trimester abortion accounts for 10-15% of all induced abortions, with varying rates across countries, and is responsible for two-thirds of major abortion complications. It is also associated with higher medical costs, morbidity, and mortality rates than first-trimester abortion. Even though it is a significant burden, there is a lack of adequate information about second-trimester-induced abortion, especially in the study area. As a result, the primary purpose of this study is to fill this research gap and assess the magnitude and associated factors of second-trimester-induced abortion in the public hospitals of Arba Minch and Wolayita Sodo towns, southern Ethiopia. Methods A facility-based cross-sectional study was conducted. Systematic sampling was used to select 353 study participants. Data were collected through face-to-face interviews using a structured questionnaire and record review by using Kobo collect version 3.1. Analysis was done by STATA 14. Logistic regression was used to identify associated factors of the second-trimester-induced abortion. Results The magnitude of second-trimester-induced abortion in the study setting was 23% (95%CI: 18.5%, 27.4%). The factors associated with second-trimester-induced abortion among women received abortion care services were respondent's age 25-29 and 30-34 years old (AOR = 0.38, 95%CI:0.15, 0.96 and (AOR = 0.31, 95%CI:0.10, 0.97, respectively), planned pregnancy (AOR = 0.22, 95%CI:0.11, 0.44), and delay confirming pregnancy (AOR = 2.21, 95%CI:1.15, 4.23). Conclusion This study showed that more than one-fifth of women who presented for abortion care services had second-trimester-induced abortions. Health institution organizations working on maternal health at various levels should provide counseling to women to help them early confirm their pregnancy and make decisions about whether or not to continue it as early as possible.
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Affiliation(s)
- Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia,*Correspondence: Mesfin Abebe
| | - Abera Mersha
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Nega Degefa
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Wondwosen Molla
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Aregahegn Wudneh
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Elasy AN, Ibrahem MAM, Elhawy LL, Hamed BM. Vaginal misoprostol versus combined intracervical foley's catheter and oxytocin infusion for second trimester pregnancy termination in women with previous caesarean sections: a randomised control trial. J OBSTET GYNAECOL 2022; 42:2962-2969. [PMID: 36149628 DOI: 10.1080/01443615.2022.2118572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Second trimester pregnancy termination has been reported to be associated with 3-5 times higher maternal morbidity and mortality risks more than first trimester termination. Medical methods had been thoroughly assessed and it is considered the anchor of the safe abortion care. Howevere, there is no global agreement regarding the ideal method for induction of the second trimester abortion in a scarred uterus. The aim of this study was to achieve vaginal expulsion in an expeditious manner with less maternal complications. A total of 158 women having, a history of previous caesarean section undergoing second trimester pregnancy termination, were randomly allocated into group (1) vaginal misoprostol group (n = 79) or group (2) combined intracervical foley's catheter plus intravenous oxytocin infusion group (n = 79). The primary endpoint was complete fetal expulsion. Meanwhile, secondary outcomes were the rates of maternal complications, in terms of the need for surgical evacuation of retained product of conception (ERPOC), severe haemorrhage, uterine rupture, blood transfusion, cervical laceration, diarrhoea, vomiting and fever. The registration number of this trial https://clinicaltrials.gov/ct2/show/NCT04501809. This study showed that the combined use of intracervical foley's catheter and oxytocin is an effective, and safe alternative to vaginal misoprostol for termination of the second trimester pregnancy in women having a previous caesarean delivery.Impact statementWhy was this study conducted? The purpose of this study is to achieve an expeditious delivery for second trimester pregnancy termination in a scarred uterus by combined mechanical and pharmacological methods without significant morbidity. Physicians should balance the benefit of achieving vaginal exlpusion in an expeditious manner versus the risk of uterine rupture or any other maternal complications.What does this add to what is known? This study showed that a combined mechanical and pharmacolohical approach for second trimester termination of pregnancy has comparable efficacy and safety to vaginal misoprostol which is more affordable to the low resources countries where termination of pregnancy in a scarred uterus still has an increased maternal morbidity.What is the implication of this study on clinical practice? The combined use of intracervical foley's catheter with intravenous oxytocin infusion is a safer option than vaginal misoprostol with less serious maternal complications.
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Affiliation(s)
- Amina Nagy Elasy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Lamiaa Lotfy Elhawy
- Department of Community, Environmental and Occupational medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Basem Mohamed Hamed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Fessehaye A, Lucero-Prisno DE, Wondafrash M, Tolu LB, Asrat M. Late Request for Safe Abortion Care at a Tertiary Hospital in Ethiopia; the role of emotional factors: A Cross-Sectional Study. Int J Gynaecol Obstet 2021; 158:462-468. [PMID: 34888867 DOI: 10.1002/ijgo.14065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/13/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the prevalence of second trimester safe abortion and to examine it's association with emotional and interpersonal factors. METHODS We conducted a cross-sectional study on second-trimester pregnant women who requested for safe abortion care from June 2020 to December 2020 at St.Pauls Hospital Millennium Medical College. Data was collected using the interviewer-administered questionnaire on Open Data Kit (ODK) and analyzed using STATA release 15 (College Station, TX: StataCorp LLC). Variables with P value < 0.2 on bivariate analysis were entered for multivariable regression analysis. RESULTS The prevalence of induced second-trimester abortion in our study is found to be 64%. Women who had no emotional factors, who had no inter-personal problems, who were married , and who had middle and high income were less likely to present in second trimester for safe abortion care [( AOR=0.31, 95th CI 0.15-0.67), (AOR=0.55, 95th CI 0.32-0.92), (AOR=0.37, 95th CI 0.17-0.77) and (AOR=0.51, CI0.27-0.96) respectively]. CONCLUSION Sixty-four percent of safe abortion care clients in our study presented in second trimester . Emotional factors, interpersonal factors, being married and middle/high income were significantly associated with reduced risk of late request (presentation in second trimester) for safe abortion care.
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Affiliation(s)
- Abraham Fessehaye
- Department of Obstetrics and Gynecology, St.Paul's Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom.,Faculty of Management and Development Studies, University of the Philippines (Open University), Los Baños, Laguna, Philippines
| | - Mekitie Wondafrash
- St. Paul's Institute for Reproductive Health and Rights, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, St.Paul's Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Matias Asrat
- Department of Obstetrics and Gynecology, St.Paul's Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
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Determinants of Second-Trimester Safe Termination of Pregnancy in Public Health Facilities of Amhara Region, Northwest Ethiopia: An Unmatched Case-Control Study. ADVANCES IN PUBLIC HEALTH 2021. [DOI: 10.1155/2021/8832529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Second-trimester medical abortion is the termination of pregnancy between 13 and 28 weeks of gestational age. Although the majority of abortions are performed in the first trimester, 10–15% of terminations of pregnancies have taken place in the second trimester globally. Objective. To identify the determinant factors of second-trimester safe termination of pregnancy in public health facilities of the Amhara region, northwest Ethiopia. Methods. An institution-based unmatched retrospective case-control study conducted from 01/10/2019–30/02/2020. A systematic random sampling technique was used to select 119 cases and 238 controls. An interviewer-administered questionnaire was used to collect the data. A binary logistic regression model was fitted to identify determinant factors. The odds ratio with 95% CI was computed to assess the strength and significance of the association between dependent and independent variables. Result. Rural resident (adjusted odds ratio (AOR) = 1.9; 95% CI 1.07–3.25), irregular menses (AOR = 1.8; 1.06–3.13), had no known symptoms of pregnancy (AOR = 1.9; (95% CI 1.06–3.46)), not knowing the abortion law (AOR = 3.0; (95% CI 1.63–5.60)), low level of education (1st–8th grade) (AOR = 2.7; (95% CI 1.06–6.60), opposition against abortion care (AOR = 2.6; (1.22–5.42)), delayed referral (AOR = 10.1 (95% CI 4.02–29.18)), and not undertaking pregnancy test (AOR = 2.2; (95% CI (1.21–4.04)) were determinants of second-trimester safe termination of pregnancy. Conclusion. Women being rural residents, irregular menses, not undertaking pregnancy test, not knowing the abortion law, low-level educational status, delayed referral, no knowledge about signs and symptoms of pregnancy, and opposition of safe abortion were determinants of second-trimester safe termination. The Regional Health Bureau and Health Facilities should give emphasis to women living in rural areas, and they should increase awareness towards abortion law and sign and symptoms of pregnancy and encourage female education.
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Sharma J, Tiwari S, Pokhrel M, Lama L. Medical Induction for Mid trimester Abortion: A Hospital-based Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:794-797. [PMID: 34504357 PMCID: PMC7654484 DOI: 10.31729/jnma.5502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Second trimester abortion is known as termination of pregnancy from 13-28 weeks of gestation which can be further divided into early second trimester as 13-22 weeks and late as 23-28 weeks. In our study we have limited up to early second trimester. We intend to see the success rate of combination of mifepristone and misoprostol for medical induction, median time required for expulsion, complication and need of dilation and evacuation in some cases. This study also aims to give a review of current literature in mid trimester abortion with respect to efficacy, complication and also to provide evidencebase recommendation for safe regimens for mid trimester pregnancy termination. Methods: This was hospital-based descriptive cross-sectional study conducted among 40 pregnant women at second trimester admitted for termination of pregnancy in Kathmandu medical collage teaching hospital for the period of six month. Ethical approval was taken from the Institutional Review Committee of Kathmandu Medical College (Ref: 2207202002). Convenient sampling was done. All the pregnant women who need to terminate their pregnancy at second trimester (13-22weeks) were admitted at Kathmandu Medical College Teaching hospital for termination of pregnancy were included in the study. Results: Among the 40 women, who had termination of pregnancy at second trimester 37(92.5%) had successful medical termination whereas 3 (7.5%) needed dilatation and evacuation. Conclusions: The combination of Mifepristone and Misoprostol have excellent result for termination of pregnancy if appropriately used after evaluating the patient with minimal complications.
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Affiliation(s)
- Jyotshna Sharma
- Department of Obstetrics and Gyanecology, Kathmandu Medical College-Teaching Hospital, Kathmandu, Nepal
| | - Sanjeeb Tiwari
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, T.U., Maharajgunj, Kathmandu, Nepal
| | - Manoj Pokhrel
- epartment of Obstetrics and Gyanecology, Kathmandu Medical College-Teaching Hospital, Kathmandu, Nepal
| | - Lhakpa Lama
- Department of Obstetrics and Gyanecology, Kathmandu Medical College-Teaching Hospital, Kathmandu, Nepal
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Misoprostol complications in second-trimester termination of pregnancy among women with a history of more than one cesarean section. Obstet Gynecol Sci 2020; 63:323-329. [PMID: 32489977 PMCID: PMC7231932 DOI: 10.5468/ogs.2020.63.3.323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/15/2019] [Accepted: 12/29/2019] [Indexed: 11/08/2022] Open
Abstract
Objective This study aims to investigate the complications due to misoprostol administration for second-trimester termination of pregnancy among women with history of 2 or more cesarean scarring. Methods The cohort of this retrospective study included 678 subjects who required second-trimester pregnancy termination, from 2013 to 2015 and treated with vaginal misoprostol of 100 to 400 µg. The subjects were divided into 3 groups based on their history of cesarean sections: without a history of cesarean section, with a history of one cesarean section, and with a history of more than one cesarean section and uterine scaring. Results The results showed that the success rate of misoprostol administration for pregnancy termination was 95.72%. The rate of bleeding as a complication was significantly higher in subjects with a history of more than one cesarean section than in other participants (risk ratio [RR], 2.24; 95% confidence interval [CI], 1.11-4.0). The incidence of uterine rupture was higher in the group with a history of more than one cesarean section than in other groups. However, no significant difference was observed between the groups (RR, 1.44; 95% CI, 0.27-7.6). There was a significant relationship between the need for other auxiliary treatments in the pregnancy termination and the history of uterine scarring (RR, 3.3; 95% CI, 1.23-9.1). Conclusion The present study showed that pregnancy termination using smaller divided dose of misoprostol in patients with previous history of cesarean scarring may be associated with lower incidence of uterine rupture.
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Tesfaye B, Tewabe M, Ferede A, Dawson A. Induced Second Trimester Abortion and Associated Factors at Debre Markos Referral Hospital: Cross-Sectional Study. WOMEN'S HEALTH (LONDON, ENGLAND) 2020; 16:1745506520929546. [PMID: 32578513 PMCID: PMC7315676 DOI: 10.1177/1745506520929546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most induced abortions in Ethiopia are performed in the first trimester, many women will still require second trimester abortions. While access to abortion in Ethiopia is limited, few data are being available concerning the demand for and associated outcomes of second trimester abortions. This knowledge is important for planning the health service response to abortion. OBJECTIVE The main objective of this study was to determine the proportion and associated factors of second trimester abortion among women presenting for abortion care services at Debre Markos Referral Hospital, Debre Markos, Northwest Ethiopia. METHODS An institution-based cross-sectional study was conducted at Debre Markos Referral Hospital on a sample of 262 calculated using the single population proportion formula. Women who sought abortion services were interviewed consecutively from 12 February 2017 to 14 March 2017. Data were collected in a face-to-face exit interview and document review and analyzed using SPSS version 24.0 software. Bivariate and multivariable analyses were undertaken to identify factors. RESULT Of the women who presented for abortion care services in Debre Markos Referral Hospital, 73 (29.6%) had induced second trimester abortion. Unmarried women (adjusted odds ratio = 4.93, 95% confidence interval = 1.41-17.16) and women employed at private business (adjusted odds ratio = 6.17, 95% confidence interval = 1.16-32.76) were associated with induced second trimester abortion. CONCLUSION This study revealed that almost one-third of women who presented for abortion care services at Debre Markos Referral Hospital had induced second trimester abortions. Raising awareness of the health consequence of second trimester abortion at community levels and counseling to avoid further occurrences are helpful to minimize the problem. Furthermore, early management of induced second trimester abortion is very crucial to prevent further complications.
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Affiliation(s)
- Bekele Tesfaye
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Mesenbet Tewabe
- Department of Medicine, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Aster Ferede
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Angela Dawson
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Dadhwal V, Garimella S, Khoiwal K, Sharma KA, Perumal V, Deka D. Mifepristone Followed by Misoprostol or Ethacridine Lactate and Oxytocin for Second Trimester Abortion: A Randomized Trial. Eurasian J Med 2019; 51:262-266. [PMID: 31692613 DOI: 10.5152/eurasianjmed.2019.18341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/22/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To compare two medical methods for second-trimester abortion, mifepristone followed by misoprostol versus mifepristone followed by ethacridine lactate and oxytocin for success rate, induction to abortion time and acceptability. Materials and Methods This is a randomized trial conducted from July 2014 to May 2016 and enrolled 120 women undergoing second trimester abortion (13-20 weeks). All patients received 200mg mifepristone orally and were randomized to receive further treatment after 36 hrs. Patients in Group M (n=60) received 400 microgram of misoprostol vaginally every 3 hours (maximum - 5 doses) and Group E (n=60) had extra-amniotic ethacridine lactate instillation followed by oxytocin infusion (max-100miu). Results Baseline demographic characteristics were comparable in both the groups. Success rate was 100% in group M and 98.3% in group E (p=0.31). Mean induction to abortion time was significantly shorter in group M than group E (8.2+2.3hours & 10.9+2.6 hours respectively; p=0.001). Majority of women reported side effects, 96.7% women in group M and 75% women in group E (p=0.001). Fall in hemoglobin after procedure was significantly higher in group M (0.70+0.33gram %) than group E (0.52+0.23 gram %) (p=0.001). Perception of intensity of pain was significantly more in group M but patient satisfaction in both groups was similar. Conclusion Both methods are comparable for success rate, induction interval was more for ethacridine lactate compared to misoprostol.
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Affiliation(s)
- Vatsla Dadhwal
- All India Institute of Medical Sciences, New Delhi, India
| | - Sita Garimella
- All India Institute of Medical Sciences, New Delhi, India
| | - Kavita Khoiwal
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Dipika Deka
- All India Institute of Medical Sciences, New Delhi, India
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Lerma K, Blumenthal PD. Current and potential methods for second trimester abortion. Best Pract Res Clin Obstet Gynaecol 2019; 63:24-36. [PMID: 31281014 DOI: 10.1016/j.bpobgyn.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022]
Abstract
Medical and surgical methods can both be recommended for second trimester abortion (after 12-weeks of gestational age). Induced abortion with a mifepristone and misoprostol regimen is the preferred approach; where mifepristone is not available, misoprostol alone for medical abortion is also effective. Dilation and evacuation (D&E) is the procedure of choice for surgical abortions, and adequate cervical preparation contributes significantly to safety. Availability of drugs and instruments, ability to provide pain control, provider skill and comfort, client preference, cultural considerations, and local legislation all influence the method of abortion likely to be performed in a given setting. Both surgical and modern medical methods are safe and effective when provided by a trained, experienced provider.
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Affiliation(s)
- Klaira Lerma
- Stanford University, Department of Obstetrics & Gynecology, Division of Family Planning Services & Research, Stanford, CA 94503, USA.
| | - Paul D Blumenthal
- Stanford University, Department of Obstetrics & Gynecology, Division of Family Planning Services & Research, Stanford, CA 94503, USA
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Shochet T, Dragoman M, Blum J, Abbas D, Louie K, Platais I, Tsereteli T, Winikoff B. Could second-trimester medical abortion be offered as a day service? Assessing the feasibility of a 1-day outpatient procedure using pooled data from six clinical studies. Contraception 2019; 99:288-292. [DOI: 10.1016/j.contraception.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
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13
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Feng W, Ma C, Gao G, Wang H, Sui Y, Xu W, Liu W, Han W, Li H. Elevated expression of EP4 in human decidua is associated with delayed embryo expulsion during medical abortion by promoting decidual cell proliferation. J Matern Fetal Neonatal Med 2019; 34:41-48. [PMID: 30810415 DOI: 10.1080/14767058.2019.1587405] [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: 10/27/2022]
Abstract
Purpose: Mifepristone in conjunction with misoprostol, is widely used in China as an effective medical abortifacient. However, a small proportion of women experience the unpleasant side effects of prolonged vaginal bleeding caused by delayed embryo expulsion. The aims of this study were to determine whether the expression levels of prostanoid receptors in human decidua are associated with delayed embryo expulsion in mifepristone-misoprostol induced an early medical abortion.Methods: Discharged decidua tissues were collected from females undergoing an artificial abortion (AA) (n = 28), females with early embryo expulsion during a medical abortion (EEMA) (n = 20) and delayed embryo expulsion in medical abortion (DEMA) (n = 30). The expression levels of prostanoid receptors in human decidua were assessed with immunohistochemistry and real-time PCR methods. Further, the RNAi method was used to silence prostanoid receptors 4 (EP4) in the primary decidual cells and human endometrial adenocarcinoma cell line Ishikawa cells in vitro and cell cycle analysis of these cells was performed.Results: All five prostanoid receptors (EP1-4, FP) were observed in human early pregnancy decidua. The protein and mRNA expression level of EP4 in the DEMA group were all significantly higher than that in the EEMA group. EP4 silence induced G1/S arrest of primary decidual cells and Ishikawa cells in vitro.Conclusions: Elevated expression level of EP4 in human decidua was significantly associated with delayed embryo expulsion in early medical abortion by promoting decidual cell proliferation. Detailed studies on the nature of roles EP4 plays in human decidua will help us to develop more effective prevention and noninvasive intervention approaches for delayed embryo expulsion during a medical abortion.
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Affiliation(s)
- Wenhua Feng
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Chao Ma
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Guoqiang Gao
- Tengzhou Central People's Hospital, Tengzhou, China
| | - Hong Wang
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Yang Sui
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Wei Xu
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Wei Liu
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Weitian Han
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Hongtu Li
- Key Laboratory of Reproductive Health and Medical Genetics, National Health and Family Planning Commission, Liaoning Province Research Institute of Family Planning, China Medical University, Shenyang, China
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Yüce T, Yüksel D, Kalafat E, Koç A. Efficacy of second-trimester termination procedure; medical, mechanic, or combine? Interv Med Appl Sci 2018; 10:133-136. [PMID: 30713751 PMCID: PMC6343579 DOI: 10.1556/1646.10.2018.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives During mid-trimester, it is necessary to terminate pregnancy due to some fetal anomalies and intrauterine death. Therefore, in this study, we aimed to compare abortion induction methods and combined use retrospectively. Methods About 112 out of 223 pregnant patients were included in the study. The groups were determined as follows: Group 1 including pregnant patients who were administered misoprostol only (50 patients), Group 2 including pregnant patients who were administered single dose misoprostol (according to FIGO) and subsequently received cervical Foley catheter (30 patients), and Group 3 including pregnant patients who received Foley catheter only (32 patients). These three groups were compared in terms of effectiveness of the method, side effects, and complications as well as their characteristics. Results In terms of characteristic of the groups, the average age of the women in the Group 1 was significantly higher than other two groups (p < 0.001). In terms of effectiveness of the method, the termination period in Groups 1 and 2 was significantly lower than Group 3 (p < 0.001). However, in terms of complications, it was observed that uterine rupture was developed in Group 1. Conclusions Although medical methods may seem to be more effective in the process of termination, mechanical methods seem more reliable in terms of reliability. Especially combined methods can be used to increase effectiveness and also to reduce complications.
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Affiliation(s)
- Tuncay Yüce
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey
| | - Dilek Yüksel
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey
| | - Erkan Kalafat
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey
| | - Acar Koç
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey
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Abstract
PURPOSE OF REVIEW To review recent literature on second trimester abortion with medical methods. RECENT FINDINGS Across studies published in the recent past, it is apparent that women prefer shorter procedures and procedure times. Several randomized controlled trials have confirmed adding mifepristone to the second trimester medication abortion regimen results in shorter abortion intervals from first misoprostol administration to complete fetal expulsion. A study of simultaneous administration of mifepristone and misoprostol yielded shorter mean 'total' abortion times, presenting several logistical advantages. Recent studies on the continuous dosing of misoprostol have produced critical evidence to support continued dosing until expulsion. These studies had a more practical design compared with previous protocols that capped the number of misoprostol doses. SUMMARY Second trimester surgical abortion is well tolerated and increasingly expeditious. Further research is needed to refine second trimester medical abortion methods, specific to the mifepristone, misoprostol dosing interval. A 12-hour mifepristone to misoprostol interval may be the optimal interval balancing patient preferences and logistical considerations. Pragmatic dosing, including continuous dosing of misoprostol, could yield results that better inform clinical guidelines and reduce burden on patient, provider, and health facility.
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El Sharkwy IAE, Elsayed ML, Ahmed MA, Alnemer AAA. Low-dose vaginal misoprostol with or without Foley catheter for late second-trimester pregnancy termination in women with previous multiple cesarean sections. J Matern Fetal Neonatal Med 2018; 32:3703-3707. [PMID: 29742942 DOI: 10.1080/14767058.2018.1470236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Purpose: To compare between low dose vaginal misoprostol with and without Foley catheter for late second trimester pregnancy termination in women with previous multiple cesarean sections. Materials and methods: A prospective randomized controlled clinical trial, patients were randomly allocated to either low dose vaginal misoprostol group (n = 40) or combined low dose vaginal misoprostol plus Foley catheter group (n = 38). The primary outcome was complete abortion. Secondary outcomes were induction-to-abortion interval, the number of misoprostol doses and occurrence of complications. Results: Incomplete abortion rate was significantly lower in combined group than misoprostol only group (2.6%versus 15% respectively, p = .03). Induction-to-expulsion interval with the combined vaginal misoprostol plus Foley catheter was significantly shorter (p = .01) and the number of misoprostol doses in the combined group was significantly lower (p = .04). No statistically significant difference in the frequency of complications between both groups. Conclusions: The combination of low dose vaginal misoprostol and Foley catheter is an effective and safe method for termination of second trimester pregnancy in women with previous multiple cesarean sections.
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Cuellar Torriente M, Steinberg WJ, Joubert G. Misoprostol use for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries. Int J Gynaecol Obstet 2017; 138:23-27. [PMID: 28378361 DOI: 10.1002/ijgo.12168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/14/2017] [Accepted: 03/31/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To establish the safety and efficacy of misoprostol for second-trimester termination of pregnancy among women with one or more previous cesarean deliveries. METHODS In a retrospective study, data were reviewed from women attending a reproductive health clinic in Bloemfontein, South Africa, for second-trimester termination between 2010 and 2013. The study group, comprising women with one or more previous cesareans, was compared with a control group, comprising women with no previous cesarean or uterine scarring. Procedure-specific information was compared, including misoprostol use, termination duration, need for other methods (e.g. oxytocin), placenta delivery, termination outcome, and bleeding. RESULTS The study group comprised 268 women: 231 (86.2%) with one and 37 (13.8%) with two previous cesareans. The control group comprised 266 women. Incomplete abortion was recorded in 223 (85.4%) of 261 women in the study group and 213 (80.4%) of 265 in the control group. The number of women with retained placenta was higher in the study than in the control group (158/261 [60.5%] vs 146/265 [55.1%]; P<0.001). Severe bleeding was observed only in the control group (7/266 [2.6%]). No uterine rupture was observed. CONCLUSION Misoprostol was safe for second-trimester termination among women with previous cesareans; however, the efficacy of the local regimen was reduced owing to high placental retention.
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Affiliation(s)
- Martin Cuellar Torriente
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Wilhelm J Steinberg
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Koh DSC, Ang EPJ, Coyuco JC, Teo HZ, Huang X, Wei X, Ng MJ, Lim SL, Tan KH. Comparing two regimens of intravaginal misoprostol with intravaginal gemeprost for second-trimester pregnancy termination: a randomised controlled trial. ACTA ACUST UNITED AC 2017; 43:252-259. [PMID: 28432086 DOI: 10.1136/jfprhc-2016-101652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/21/2017] [Accepted: 03/20/2017] [Indexed: 11/03/2022]
Abstract
AIM To compare the efficacy and safety of intravaginal misoprostol 200 µg, 400 µg and gemeprost regimens for second-trimester termination of pregnancy (TOP). METHODS A three- armed randomi sed controlled trial (Clinical Trial Certificate 1100015) where 116 women undergoing second-trimester TOP were given intravaginal misoprostol 200 µ g (n=37), misoprostol 400 µg (n=40) or gemeprost 1 mg (n=39) at 4- hour intervals until abortion occurred with a maximum of five doses. RESULTS The misoprostol 400 µg group had the highest incidence of successful abortions (92.5%) compared to the misoprostol 200 µg (70.3%; p=0.017) and gemeprost 1 mg (74.4%; p=0.037) within 48 hours. There was no significant difference in abortion rate between misoprostol 200 µg and gemeprost. The misoprostol 400 µg group had the highest incidence of fever (70.0%) compared to misoprostol 200 µg (24.3%; p<0.001) and gemeprost 1 mg (46.2%; p=0.041). The gemeprost group had the highest incidence of diarrhoea (38.5%) compared to misoprostol 400 µg (10.0%; p=0.004) and misoprostol 200 µg (8.1%; p=0.003) groups. CONCLUSIONS Intravaginal misoprostol 400 µ g at 4- hour intervals was the most effective regimen but was associated with a high incidence of fever. Misoprostol 200 µg demonstrated similar effectiveness as gemeprost and had lower incidence of diarrhoea. Gemeprost should not be first line for medical therapy given the cost, storage requirements and lower efficacy.
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Affiliation(s)
- Daniel Seow Choon Koh
- Associate Consultant, Division of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Esther Pei Jing Ang
- Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jurja Chua Coyuco
- Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hua Zhen Teo
- Clinical Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaoling Huang
- Clinical Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xing Wei
- Executive, Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mor Jack Ng
- Manager, Division of Obstetrics & Gynecology, OBGYN Academic Clinical Program, KK Women's and Children's Hospital, Singapore, Singapore
| | - Serene Liqing Lim
- Associate Consultant, Division of Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Senior Consultant, Division of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
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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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20
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Louie KS, Chong E, Tsereteli T, Avagyan G, Abrahamyan R, Winikoff B. Second trimester medical abortion with mifepristone followed by unlimited dosing of buccal misoprostol in Armenia. EUR J CONTRACEP REPR 2016; 22:76-80. [DOI: 10.1080/13625187.2016.1258461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Gayane Avagyan
- Department of Obstetrics and Gynaecology No2, Yerevan State Medical University, Yerevan, Armenia
| | - Ruzanna Abrahamyan
- Republican Institute of Reproductive Health, Perinatology, Obstetrics and Gynaecology, Yerevan, Armenia
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Constant D, Harries J, Malaba T, Myer L, Patel M, Petro G, Grossman D. Clinical Outcomes and Women's Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa. PLoS One 2016; 11:e0161843. [PMID: 27583448 PMCID: PMC5008795 DOI: 10.1371/journal.pone.0161843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To document clinical outcomes and women’s experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. Methods Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2–4 weeks after discharge for the 2014 cohort. Results The 2014 cohort received 200 mg mifepristone, which was self-administered 24–48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3–4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts. Conclusion The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.
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Affiliation(s)
- Deborah Constant
- Women’s Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Jane Harries
- Women’s Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thokozile Malaba
- Women’s Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Malika Patel
- Department of Obstetrics & Gynaecology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gregory Petro
- Department of Obstetrics & Gynaecology, University of Cape Town and New Somerset Hospital, Cape Town, South Africa
| | - Daniel Grossman
- Ibis Reproductive Health, Oakland, California, United States of America
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Freeman MD, Porat N, Rojansky N, Elami-Suzin M, Winograd O, Ben-Meir A. Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester. Int J Gynaecol Obstet 2016; 135:154-157. [PMID: 27539053 DOI: 10.1016/j.ijgo.2016.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/15/2016] [Accepted: 07/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the physical and emotional effects of two medical protocols for induced abortion during the second trimester. METHODS The present study was part of a prospective randomized controlled trial comparing mifepristone followed by oxytocin or misoprostol that was conducted at the Hadassah Hebrew University Medical Center, Jerusalem, Israel, from January 10, 2009, to February 22, 2012. Inclusion criteria were pregnancy (14-24weeks), epidural analgesia, and medical induction of abortion (either elective or following missed abortion). A structured questionnaire was used to assess the participants' physical symptoms and emotional responses. The primary outcome for the present analysis was the degree of physical symptoms reported. RESULTS Overall, 68 women in the oxytocin group and 67 in the misoprostol group received epidural analgesia and completed the questionnaire. As assessed using a five-point Likert scale, women in the misoprostol group were more likely than those in the oxytocin group to experience diarrhea (1.34±0.84 vs 1.10±0.55; P=0.05) and shivers (3.03±1.75 vs 1.75±1.21; P<0.001). No other between-group differences were detected for the physical or emotional variables evaluated. CONCLUSION Differences in physical symptoms experienced by the two treatment groups did not influence the participants' subsequent emotional response. ClinicalTrials.gov: NCT00784797.
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Affiliation(s)
- Martine D Freeman
- Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Nurit Porat
- Quality, Safety and Accreditation Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nathan Rojansky
- Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Matan Elami-Suzin
- Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Orit Winograd
- Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Assaf Ben-Meir
- Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Mitchell LM. “Time with Babe”: Seeing Fetal Remains after Pregnancy Termination for Impairment. Med Anthropol Q 2016; 30:168-85. [DOI: 10.1111/maq.12173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Velipasaoglu M, Ayaz R, Senturk M, Arslan S, Tanir HM. Analgesic effects of acetaminophen, diclofenac and hyoscine N-butylbromide in second trimester pregnancy termination: a prospective randomized study. J Matern Fetal Neonatal Med 2016; 29:3838-42. [DOI: 10.3109/14767058.2016.1148134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Melih Velipasaoglu
- Department of Obstetrics and Gynecology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Reyhan Ayaz
- Department of Obstetrics and Gynecology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Metin Senturk
- Department of Obstetrics and Gynecology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Samet Arslan
- Department of Obstetrics and Gynecology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Huseyin Mete Tanir
- Department of Obstetrics and Gynecology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Ercan Ö, Köstü B, Özer A, Serin S, Bakacak M. Misoprostol versus misoprostol and foley catheter combination in 2nd trimester pregnancy terminations. J Matern Fetal Neonatal Med 2015; 29:2810-2. [PMID: 26452400 DOI: 10.3109/14767058.2015.1105950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Önder Ercan
- a Department of Obstetrics and Gynecology , Kahramanmaras Sütçü İmam University Hospital , Kahramanmaras , Turkey and
| | - Bülent Köstü
- a Department of Obstetrics and Gynecology , Kahramanmaras Sütçü İmam University Hospital , Kahramanmaras , Turkey and
| | - Alev Özer
- a Department of Obstetrics and Gynecology , Kahramanmaras Sütçü İmam University Hospital , Kahramanmaras , Turkey and
| | | | - Murat Bakacak
- a Department of Obstetrics and Gynecology , Kahramanmaras Sütçü İmam University Hospital , Kahramanmaras , Turkey and
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Programmed intermittent epidural bolus versus continuous epidural infusion for pain relief during termination of pregnancy: a prospective, double-blind, randomized trial. Int J Obstet Anesth 2015; 25:37-44. [PMID: 26431778 DOI: 10.1016/j.ijoa.2015.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/07/2015] [Accepted: 08/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain 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. METHODS Women 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. RESULTS Motor 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. CONCLUSIONS During 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.
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Cetin C, Buyukkurt S, Seydaoglu G, Kahveci B, Soysal C, Ozgunen FT. Comparison of two misoprostol regimens for mid-trimester pregnancy terminations after FIGO's misoprostol dosage recommendation in 2012. J Matern Fetal Neonatal Med 2015; 29:1314-7. [PMID: 26067264 DOI: 10.3109/14767058.2015.1046831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations. METHODS Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics's (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications. RESULTS Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates. CONCLUSIONS We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.
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Affiliation(s)
| | | | - Gulsah Seydaoglu
- b Department of Biostatistics , University of Cukurova School of Medicine , Adana , Turkey
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Induced second trimester abortion and associated factors in Amhara region referral hospitals. BIOMED RESEARCH INTERNATIONAL 2015; 2015:256534. [PMID: 25918704 PMCID: PMC4396136 DOI: 10.1155/2015/256534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although the vast majority of abortions are performed in the first trimester, still 10-15% of terminations of pregnancies have taken place in the second trimester period globally. As compared to first trimester, second trimester abortions are disproportionately contribute for maternal morbidity and mortality especially in low-resource countries where access to safe second trimester abortion is limited. The main aim of this study was to assess the prevalence and associated factors of induced second trimester abortion in Amhara region referral hospitals, northwest Ethiopia. METHODS Institution based cross-sectional study was conducted in Amhara region referral hospitals among 416 women who sought abortion services. Participants were selected using systematic sampling technique. Data were collected using pretested structured questionnaire through interviewing. After the data were entered and analyzed; variables which have P value < 0.2 in bivariate analysis, not colinear, were entered into multiple logistic regressions to see the net effect with 95% CI and P value < 0.05. RESULTS The prevalence of induced second trimester abortion was 19.2%. Being rural (AOR = 1.86 [95% CI = 1.11-3.14]), having irregular menstrual cycle (AOR = 1.76 [95% CI = 1.03-2.98]), not recognizing their pregnancy at early time (AOR = 2.05 [95% CI = 1.21-3.48]), and having logistics related problems (AOR = 2.37 [95% CI = 1.02-5.53]) were found to have statistically significant association with induced second trimester abortion. CONCLUSION Induced second trimester abortion is high despite the availability of first trimester abortion services. Therefore, increase accessibility and availability of safe second trimester abortion services below referral level, counseling and logistical support are helpful to minimize late abortions.
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Elsafty MSE, Hassanin AS, Laban M, Ibrahim AM, Ahmed WU, Abou Elnoor AA. Intravenous carbetocin shot is superior to oxytocin infusion for placental delivery in second trimester abortion: a pilot randomized controlled trial. J Matern Fetal Neonatal Med 2015; 29:850-4. [PMID: 25758628 DOI: 10.3109/14767058.2015.1021673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study the efficacy of 100 μg intravenous shot of carbetocin compared to 20 IU oxytocin intravenous infusion to prevent placental retention in second trimester medical termination of pregnancy. METHODS A double-blinded randomized controlled trial was conducted at Ain Shams University Maternity Hospital from 1 April 2013 to 30 November 2013. A total of 132 women between 14 and 24 weeks gestation indicated for termination were randomized to receive either 20 IU oxytocin infusion (n = 66) or 100 μg carbetocin shot (n = 66) after fetal expulsion. Patients were observed for time elapsed between fetal and placental expulsion, presence of placental retention and blood loss. RESULTS Third stage was 33.4 ± 20.4 min in oxytocin group & 23.1 ± 16.8 min in carbetocin group (p = 0.002). Eight patients (12.1%) in oxytocin group had complete placental retention versus two patients (3.0%) in carbetocin group (p = 0.05). Eight patients (13.8%) received oxytocin had remnants of placenta compared to four patients (6.2%) received carbetocin (p = 0.04). Sixteen patients (24.2%) received oxytocin and six patients (9%) received carbetocin needed surgical curettage (p = 0.04). Third stage blood loss was 87.2 ± 33.7 ml in carbetocin and 206.9 ± 35.2 ml in oxytocin groups (p = 0.001). CONCLUSION Carbetocin is superior to oxytocin infusion for management of placental delivery in second trimester abortion.
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Affiliation(s)
- Mohammed S E Elsafty
- a Faculty of Medicine, Department of Obstetrics and Gynecology , Ain Shams University , Cairo , Egypt
| | - Alaa S Hassanin
- a Faculty of Medicine, Department of Obstetrics and Gynecology , Ain Shams University , Cairo , Egypt
| | - Mohammed Laban
- a Faculty of Medicine, Department of Obstetrics and Gynecology , Ain Shams University , Cairo , Egypt
| | - Ahmed M Ibrahim
- a Faculty of Medicine, Department of Obstetrics and Gynecology , Ain Shams University , Cairo , Egypt
| | - Wafaa U Ahmed
- a Faculty of Medicine, Department of Obstetrics and Gynecology , Ain Shams University , Cairo , Egypt
| | - Ayman A Abou Elnoor
- a Faculty of Medicine, Department of Obstetrics and Gynecology , Ain Shams University , Cairo , Egypt
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Systems pharmacology of mifepristone (RU486) reveals its 47 hub targets and network: comprehensive analysis and pharmacological focus on FAK-Src-Paxillin complex. Sci Rep 2015; 5:7830. [PMID: 25597938 PMCID: PMC4297966 DOI: 10.1038/srep07830] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/09/2014] [Indexed: 02/06/2023] Open
Abstract
Mifepristone (RU486), a synthetic steroid compound used as an abortifacient drug, has received considerable attention to its anticancer activity recently. To explore the possibility of using mifepristone as a cancer metastasis chemopreventive, we performed a systems pharmacology analysis of mifepristone-related molecules in the present study. Data were collected by using Natural Language Processing (NLP) and 513 mifepristone-related genes were dug out and classified functionally using a gene ontology (GO) hierarchy, followed by KEGG pathway enrichment analysis. Potential signal pathways and targets involved in cancer were obtained by integrative network analysis. Total thirty-three proteins were involved in focal adhesion-the key signaling pathway associated with cancer metastasis. Molecular and cellular assays further demonstrated that mifepristone had the ability to prevent breast cancer cells from migration and interfere with their adhesion to endothelial cells. Moreover, mifepristone inhibited the expression of focal adhesion kinase (FAK), paxillin, and the formation of FAK/Src/Paxillin complex, which are correlated with cell adhesion and migration. This study set a good example to identify chemotherapeutic potential seamlessly from systems pharmacology to cellular pharmacology, and the revealed hub genes may be the promising targets for cancer metastasis chemoprevention.
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Rezk MAA, Sanad Z, Dawood R, Emarh M, Masood A. Comparison of intravaginal misoprostol and intracervical Foley catheter alone or in combination for termination of second trimester pregnancy. J Matern Fetal Neonatal Med 2014; 28:93-6. [DOI: 10.3109/14767058.2014.905909] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Searle L, Tait J, Langdana F, Maharaj D. Efficacy of mifepristone for cervical priming for second-trimester surgical termination of pregnancy. Int J Gynaecol Obstet 2014; 124:38-41. [PMID: 24135291 DOI: 10.1016/j.ijgo.2013.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 05/30/2013] [Accepted: 09/18/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether mifepristone plus misoprostol was as effective as misoprostol with or without laminaria (depending on gestational age) for cervical preparation for second-trimester termination of pregnancy. METHODS A retrospective cohort study was carried out among women who underwent surgical termination between 14 and 19+6 weeks of pregnancy. Those who received preoperative mifepristone were compared with those who did not. The study group received mifepristone plus misoprostol before dilation and evacuation of the uterus between May 2008 and September 2011. The comparison (non-mifepristone) group received misoprostol with or without laminaria between January 2005 and April 2008. RESULTS There was no difference between the groups in terms of difficulty of cervical dilation, with an overall relative risk for moderate-difficult dilation in the mifepristone group of 0.91 (95% confidence interval, 0.49-1.68). There was no difference between the groups with regard to complications arising from the procedure. CONCLUSION Mifepristone is effective for cervical priming prior to second-trimester dilation and evacuation in both multiparous and primiparous women, without an increase in complication rates.
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Affiliation(s)
- Leigh Searle
- Department of Obstetrics and Gynecology, Capital and Coast District Health Board, Wellington, New Zealand.
| | - John Tait
- Department of Women's and Children's Health and Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Fali Langdana
- Department of Obstetrics and Gynecology, Capital and Coast District Health Board, Wellington, New Zealand; Department of Obstetrics and Gynecology, University of Otago, Dunedin, New Zealand
| | - Dushyant Maharaj
- Department of Obstetrics and Gynecology, Capital and Coast District Health Board, Wellington, New Zealand; Department of Obstetrics and Gynecology, University of Otago, Dunedin, New Zealand
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Chaudhuri P, Mandal A, Das C, Mazumdar A. Dosing interval of 24 hours versus 48 hours between mifepristone and misoprostol administration for mid-trimester termination of pregnancy. Int J Gynaecol Obstet 2013; 124:134-8. [DOI: 10.1016/j.ijgo.2013.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/09/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
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Woolner A, Bhattacharya S, Bhattacharya S. The effect of method and gestational age at termination of pregnancy on future obstetric and perinatal outcomes: a register-based cohort study in Aberdeen, Scotland. BJOG 2013; 121:309-18. [DOI: 10.1111/1471-0528.12455] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 01/15/2023]
Affiliation(s)
- A Woolner
- Obstetrics & Gynaecology; Division of Applied Health Sciences; School of Medicine and Dentistry; University of Aberdeen; Aberdeen UK
- Department of Obstetrics & Gynaecology; Aberdeen Maternity Hospital and Aberdeen Royal Infirmary; NHS Grampian; Aberdeen UK
| | - S Bhattacharya
- Obstetrics & Gynaecology; Division of Applied Health Sciences; School of Medicine and Dentistry; University of Aberdeen; Aberdeen UK
- Department of Obstetrics & Gynaecology; Aberdeen Maternity Hospital and Aberdeen Royal Infirmary; NHS Grampian; Aberdeen UK
| | - Soh Bhattacharya
- Obstetric Epidemiology; Dugald Baird Centre for Research on Women's Health; Aberdeen Maternity Hospital; Aberdeen UK
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Pongsatha S, Tongsong T. Randomized controlled trial comparing efficacy between a vaginal misoprostol loading and non-loading dose regimen for second-trimester pregnancy termination. J Obstet Gynaecol Res 2013; 40:155-60. [PMID: 24033985 DOI: 10.1111/jog.12147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/04/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to compare the efficacy of vaginal misoprostol loading dose regimen with non-loading dose regimen for termination of second-trimester pregnancy with live fetuses. MATERIAL AND METHODS A randomized controlled trial was conducted on pregnant women with a live fetus at 14-28 weeks. The patients were randomly allocated to receive either the vaginal misoprostol loading dose regimen (600 mcg, then 400 mcg every 6 h) or the non-loading dose regimen (400 mcg every 6 h). Failure to abort within 48 h was considered to be a failure. RESULTS Of 157 recruited women, 77 were assigned to be in group 1 (loading group) and 80 were in group 2 (non-loading group). The median abortion time was not statistically different between the groups (14.08; 95% confidence interval: 12.45-17.77 h and 14.58; 95% confidence interval: 12.8-17.27 h, P > 0.05). The rates of abortion within 24 h and 48 h were also comparable between the groups. Fever and chills were more common in the loading group. No other serious complications, such as postpartum hemorrhage and uterine rupture, were found. CONCLUSION Vaginal misoprostol in the loading dose regimen had a similar efficacy to the non-loading dose regimen but was associated with more adverse maternal effects.
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Affiliation(s)
- Saipin Pongsatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Aggarwal P, Agarwal P, Zutshi V, Batra S. Do women presenting for first and second-trimester abortion differ socio-demographically? Ann Med Health Sci Res 2013; 3:187-90. [PMID: 23919187 PMCID: PMC3728860 DOI: 10.4103/2141-9248.113659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: To identify the socio-demographic differences between a sample of women who present for first-trimester and second-trimester abortion. Aim: To determine whether women presenting late (in the second trimester) for abortion differ socio-demographically from those presenting early (in the first trimester). Materials and Methods: Data over 4 years for women presenting for second-trimester abortion were collected from the records of Family Planning Clinic at a public tertiary level teaching hospital in India. Eighty-four cases were analysed. The case presenting for first-trimester abortion after each second-trimester abortion was included for comparison. Information was gathered concerning age, parity, educational background, employment status, educational background of the husband, family expenditure and religion. Data were statistically analysed and significance determined using logistic regression analysis. Results: Second-trimester abortions represented 2% (84/4254) of all abortions in the study period. More women of higher age (P = 0.03) and parity (P = 0.02) and higher educational status (P = 0.04) presented for second-trimester abortion as compared to first-trimester abortion. The occupational status of the woman, husband's educational background, monthly family expenditure per person and religion did not significantly influence the time of presentation for abortion. Conclusion: Second-trimester abortions are associated with both increasing age and parity and higher education. This group of educated, older and multiparous women should be one of those targeted for counseling to reduce the risks associated with second trimester abortion.
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Affiliation(s)
- P Aggarwal
- Department of Obstetrics and Gynaecology, Safdarjang Hospital and Vardhman Mahavir Medical College, New Delhi, India
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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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Vaginal acidity enhancement with a 3% acetic acid gel prior to misoprostol treatment for pregnancy termination in the midtrimester. Int J Gynaecol Obstet 2012; 119:248-52. [PMID: 22980429 DOI: 10.1016/j.ijgo.2012.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/26/2012] [Accepted: 08/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate whether enhancing vaginal acidity improves the success of medical abortions in the midtrimester. METHODS A double-blind, randomized, placebo-controlled trial was conducted with 48 women with missed midtrimester abortions. Twice daily, the study participants (n=24) were treated with a 3% acetic acid gel and the controls (n=24) with a placebo gel, starting 2 days prior to initiating the misoprostol treatment. The primary outcome measures were the rates of successful abortion within 24 and 48 hours. Secondary measures included gel tolerability and adverse effects of the misoprostol treatment. RESULTS The success rates were higher in the study group, within both 24 hours (11/23 vs 3/24; P=0.011) and 48 hours (18/23 vs 6/24; P<0.001). Among the women with a vaginal pH of 5 or higher at baseline, acidic gel was also associated with higher success rates within 24 hours (8/13 vs 2/15; P<0.01) and 48 hours (13/13 vs 3/15; P<0,001). The vaginal gels were well tolerated and the misoprostol treatment produced no serious adverse effects. CONCLUSION A 3% acetic acid gel appears to be an effective and safe preparatory adjuvant to vaginal misoprostol treatment for midtrimester medical abortions, especially in women with a vaginal pH of 5 or higher. www.controlledtrials.com: ISRCTN75746444.
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Tanha FD, Golgachi T, Niroomand N, Ghajarzadeh M, Nasr R. Sublingual versus vaginal misoprostol for second trimester termination: a randomized clinical trial. Arch Gynecol Obstet 2012; 287:65-9. [DOI: 10.1007/s00404-012-2508-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
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Domröse CM, Geipel A, Berg C, Lorenzen H, Gembruch U, Willruth A. Second- and third-trimester termination of pregnancy in women with uterine scar — a retrospective analysis of 111 gemeprost-induced terminations of pregnancy after previous cesarean delivery. Contraception 2012; 85:589-94. [PMID: 22079607 DOI: 10.1016/j.contraception.2011.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
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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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Singh S, Seligman NS, Jackson B, Berghella V. Fetal intracardiac potassium chloride injection to expedite second-trimester dilation and evacuation. Fetal Diagn Ther 2011; 31:63-8. [PMID: 22189183 DOI: 10.1159/000333815] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 09/22/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether potassium chloride (KCl)-induced feticide prior to termination by dilation and evacuation (D&E) improves surgical outcome. METHODS We conducted a retrospective study of women who underwent second-trimester (13 0/7 to 23 6/7 weeks) D&E at an urban university-based hospital between January 2000 and July 2010. Women were divided into 3 cohorts: (1) D&E for termination of pregnancy after feticide, (2) D&E without feticide, and (3) D&E for spontaneous pregnancy loss. We compared maternal characteristics, various perioperative variables, and surgical outcomes for all 3 groups. Anesthesia time was used as a surrogate for operative time in the primary outcome. RESULTS We analyzed 128 pregnancies (group 1: n = 23, group 2: n = 53, group 3: n = 52). Baseline maternal characteristics did not differ among the 3 groups. Anesthesia time was longest in the termination with KCl group (group 1: 116.9 min vs. group 2: 94.5 min and group 3: 90.3 min, p = 0.004), however, the effect was mitigated after controlling for fetal size (p = 0.176). There was no difference in blood loss (p = 0.968). Complications were uncommon, however, cervical lacerations were more common in the termination with KCl group (2 vs. 0 and 0, p = 0.010). CONCLUSION Presurgical feticide with KCl was not associated with shorter anesthesia time. The decision to perform feticide should be based on other considerations, such as patient preference.
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Affiliation(s)
- Sareena Singh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
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BEN-AMI IDO, FUCHS NOGA, SCHNEIDER DAVID, PANSKY MOTY, HALPERIN REUVIT. Coagulopathy associated with dilation and evacuation for second-trimester abortion. Acta Obstet Gynecol Scand 2011; 91:10-15. [DOI: 10.1111/j.1600-0412.2011.01296.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A randomized comparative study on vaginal administration of acetic acid-moistened versus dry misoprostol for mid-trimester pregnancy termination. Arch Gynecol Obstet 2011; 285:311-6. [PMID: 21735193 DOI: 10.1007/s00404-011-1949-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Absorption and effectiveness of vaginally administered misoprostol tablets may vary according to the medium in which it is placed. This study was directed to compare the outcomes of vaginal administrations of acetic acid-moistened misoprostol tablets with those of dry tablets for induction of second-trimester abortion. METHODS A randomized comparative trial where 322 women at 13-20 weeks gestation, requiring medical abortion, were randomly assigned to vaginal administration of either acetic acid-moistened or dry misoprostol tablets with a dose schedule of 400 μg three-hourly, up to a maximum five doses over 24 h. The same doses were repeated for another 24 h in nonresponders. Primary outcome measure was complete abortion rate at 24 and 48 h, and the secondary outcome measures were induction-abortion interval, failure rate and side effects. A difference of 15% in success rates at 24 h was used to calculate the sample size required with a power of 0.8 at the 5% significance level. RESULTS No statistically significant differences in the complete abortion rates were observed at 24 h (70.95 vs. 68.71%, P = 0.675) and at 48 h (86.49 vs. 84.35%, P = 0.604) when both groups were compared. The difference in mean induction-abortion interval was also statistically insignificant between the groups (12.5 ± 1.6 vs. 12.8 ± 1.5 h, P = 0.97). Other outcome measures were also comparable in both groups. CONCLUSION Moistening misoprostol tablets with 5% acetic acid before vaginal application creates no difference in outcomes when compared with those after the vaginal application of dry tablets for the termination of second-trimester pregnancy.
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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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Second-trimester abortion for fetal anomalies or fetal death: a comparison of techniques. Obstet Gynecol 2011; 117:775-776. [PMID: 21422846 DOI: 10.1097/aog.0b013e318211c234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Jackson E, Kapp N. Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review. Contraception 2011; 83:116-26. [DOI: 10.1016/j.contraception.2010.07.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 06/29/2010] [Accepted: 07/14/2010] [Indexed: 11/27/2022]
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CABRERA Y, FERNÁNDEZ-GUISASOLA J, LOBO P, GÁMIR S, ÁLVAREZ J. Comparison of sublingual versus vaginal misoprostol for second-trimester pregnancy termination: A meta-analysis. Aust N Z J Obstet Gynaecol 2011; 51:158-65. [DOI: 10.1111/j.1479-828x.2010.01264.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wagner N, Abele H, Hoopmann M, Grischke EM, Blumenstock G, Wallwiener D, Kagan KO. Factors influencing the duration of late first and second-trimester termination of pregnancy with prostaglandin derivates. Eur J Obstet Gynecol Reprod Biol 2010; 155:75-8. [PMID: 21112135 DOI: 10.1016/j.ejogrb.2010.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/14/2010] [Accepted: 10/26/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the time interval between first induction and fetal expulsion in fetal defect-related termination of pregnancy and to determine the relevant factors that influence this time interval. STUDY DESIGN Retrospective study involving singleton pregnancies that were terminated due to fetal abnormalities between 2005 and 2009. Induction was done by either 200 μg misoprostol, 1 mg gemeprost or in case of a previous caesarean section by 0.5 mg dinoprostone gel or 1mg gemeprost. The length of the induction interval between first induction and fetal expulsion was examined according to different maternal and fetal characteristics. Univariate and multivariate logistic regression analyses were used to determine the significant contributors for a delivery within 24 h. RESULTS One hundred and eighty-four singleton pregnancies fulfilled the inclusion criteria. The median gestational age at first induction was 19.2 weeks of gestation. The median time interval between first induction and expulsion was 18 h (25-75th centile, 11-30 h) and in 59 (32.1%) cases, the induction interval was longer than 24 h. Multivariate logistic regression analysis in the prediction of fetal expulsion within 24 h after first induction indicated significant contribution from gestational age and history of spontaneous delivery without previous caesarean section. CONCLUSIONS The only relevant contributors to an estimation of the time interval were gestational age and previous history of spontaneous delivery. By combining this information it was possible to correctly anticipate fetal expulsion within 24h after first induction in 90% of the cases.
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Affiliation(s)
- Norbert Wagner
- Department of Obstetrics and Gynaecology, University of Tuebingen, Tuebingen, Germany
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