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Li F, Han M, Zhang J, Ji J, Wu Y, Wei J. Effects of medical abortion assisted by traditional Chinese medicine: A network meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2024; 166:152-162. [PMID: 38037875 DOI: 10.1002/ijgo.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/04/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND To what extent traditional Chinese medicine (TCM) combined with mifepristone and misoprostol is beneficial for improving the complete abortion rate and duration of vaginal bleeding has been a subject of debate in the field of medical abortion. OBJECTIVE To assess the evidence regarding the complete abortion rate and duration of vaginal bleeding of medical abortion assisted by different kinds of TCM. SEARCH STRATEGY We searched electronic databases such as PubMed, Web of Science and Cochrane Library database, China National Knowledge Internet, Wan fang Database, VIP Database, and China Biology Medicine disc from 2000 to February 15, 2023. SELECTION CRITERIA The control group was medical abortion with mifepristone and misoprostol, and the experimental group was medical abortion assisted by TCM. DATA COLLECTION AND ANALYSIS Major data extraction included sample size, age, medicine used for abortion, outcome measures. RevMan 5.3 and Stata 15.1 software were used to assess the literature quality and perform network meta-analysis, respectively. MAIN RESULTS A total of 73 randomized controlled trials (RCTs) with 11 683 patients and nine kinds of TCM were included in this study. Compared with mifepristone and misoprostol, eight kinds of TCM had statistical significance in improving the complete abortion rate. The effect value of Sancao decoction was 5.86 (95% confidence interval [CI] 2.53-13.58). Seven kinds of TCM shortened the duration of vaginal bleeding. The effect value of comfrey and trichosanthin decoction was -8.75 (95% CI -10.86 to -6.64). CONCLUSIONS This network meta-analysis showed that Lenge Zhumo decoction and Sancao decoction could have a large beneficial effect on complete abortion rate in medical abortion during early pregnancy, and comfrey and trichosanthin decoction could be the best TCM for shortening the duration of vaginal bleeding.
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Affiliation(s)
- Fuxing Li
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Mei Han
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiayu Zhang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jingru Ji
- Department of Obstetrics, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanfei Wu
- Department of Chinese Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Junni Wei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
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Marzan MB, Johnson E, Moore P, Jiang H, Hui L. Changes in the numbers of hospital-based abortions and outpatient early medical abortions in Victoria, 2012-22: a retrospective cohort study. Med J Aust 2024; 220:145-153. [PMID: 38305486 DOI: 10.5694/mja2.52203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/02/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To assess changes in the monthly numbers of hospital-based abortions and outpatient early medical abortions in Victoria during January 2012 - March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Population-based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data. SETTING, PARTICIPANTS All admitted care episodes in Victoria during 1 January 2012 - 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone-misoprostol (MS-2 Step) during 1 January 2015 (date of listing) - 31 March 2022. MAIN OUTCOME MEASURES Changes in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital-based and outpatient early medical abortions during the pre-pandemic period (January 2012 - March 2020), the first full month of the COVID-19 pandemic (April 2020), and the pandemic period (May 2020 - March 2022). RESULTS The monthly number of hospital-based abortions declined in Victoria during the pre-pandemic period (slope, -2.92 [95% CI, -3.45 to -2.38] per month); the rate of decline was greater during the pandemic period (slope, -5.74 [95% CI, -10.5 to -0.96] per month). The monthly number of outpatient early medical abortions increased during the pre-pandemic period (slope, 5.94 [95% CI, 5.34-6.34] per month); it declined during the first month of the pandemic (slope, -26.4 [95% CI, -70.1 to -17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre-pandemic median value. The pre-pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks' gestation intensified during the pandemic period. During January 2015 - March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%). CONCLUSIONS The use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone-misoprostol, which helped ensure access to abortion during the COVID-19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.
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Affiliation(s)
- Melvin B Marzan
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
| | - Eleanor Johnson
- Northern Centre for Health Education Research, Northern Health, Melbourne, VIC
| | - Patricia Moore
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Royal Women's Hospital, Melbourne, VIC
| | - Heng Jiang
- La Trobe University, Melbourne, VIC
- Centre for Health Equity, the University of Melbourne, Melbourne, VIC
| | - Lisa Hui
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
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Lai SXL, Cohn A. Efficacy and safety of medical termination of pregnancy in a regional primary care setting. Aust N Z J Obstet Gynaecol 2024; 64:42-47. [PMID: 37528652 DOI: 10.1111/ajo.13738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/09/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Australia has demonstrated high efficacy and safety of medical termination of pregnancy (MToP) using a mifepristone-buccal misoprostol regime. The provision of medical termination services in primary care has the potential to alleviate access barriers, particularly in rural and regional populations. Large-scale data are needed to support the expansion of this model. AIM The aim was to determine the efficacy and safety of nurse-led MToP within a regional general practice clinic. METHODS A retrospective cohort study of patients prescribed MToP from October 2014 to April 2020. Clinic nurses assessed patient eligibility and provided information, non-directive counselling and instructions. The general practitioner then confirmed eligibility, obtained informed consent and prescribed. Patients were administered 200 mg of mifepristone orally in a pharmacy and then self-administered 800-μg buccal misoprostol 36-48 h later at home. RESULTS A total of 998 patients were included in this study, with the median patient age being 27.3 years and 30.3% of patients travelling over 100 km to access the service. MToP was successful in 965 (96.7%) patients. There were 36 (3.6%) complications, of which 33 were incomplete MToP. Haemorrhage requiring transfusion, pain requiring hospital treatment and suspected infection were rare, each having a frequency of one (0.1%). Our follow-up rate was 74.8%, with a strong correlation identified between increased gestational age and decreased follow-up (P < 0.001). CONCLUSION This study is a large Australian example demonstrating high efficacy and safety of nurse-led MToP within regional general practice. The establishment of similar services in rural and regional Australia may address geographical and financial barriers to termination access.
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Affiliation(s)
- Sara Xiao-Li Lai
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda Cohn
- Gateway Health, Wodonga, Victoria, Australia
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Melville C, Goldstone P, Moosa N. Telephone follow-up after early medical abortion using Australia's first low sensitivity urine pregnancy test. Aust N Z J Obstet Gynaecol 2023; 63:797-802. [PMID: 37452451 DOI: 10.1111/ajo.13731] [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: 06/07/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Follow-up after early medical abortion (EMA) in Australia often entails tracking serum human chorionic gonadotropin levels or performing ultrasonography in-clinic. In other countries, methods of follow-up such as using a low-sensitivity urine pregnancy test (LSUPT), telephone evaluation and a questionnaire have been demonstrated to be safe and acceptable. AIMS To evaluate the safety and efficacy of telephone follow-up after EMA using an LSUPT and questionnaire. MATERIALS AND METHODS A prospective observational cohort study of patients undergoing telephone follow-up after EMA using an LSUPT and questionnaire was conducted from March 26 to July 31, 2020. Outcomes of patients who returned to clinic because of a positive LSUPT were evaluated and adverse event rates were calculated. Routinely collected adverse event information was used to compare complication rates during the evaluation period with that prior to introduction of the LSUPT. RESULTS During the study period, 2223 patients underwent the new protocol. One hundred and ninety-seven patients had a positive LSUPT at their telephone follow-up. One hundred and thirty-two had an incomplete abortion, 11 had a continuing pregnancy, 53 had a complete abortion and one left the clinic before full assessment. CONCLUSIONS Introduction of telephone follow-up with an at-home LSUPT reduced the number of patients requiring unnecessary clinic appointments, with over 90% of patients completing their follow-up at home. Complication rates during the study period were found to be at least comparable with previously identified organisational adverse events.
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Osuga Y, Shirasu K, Tsushima R, Ishitani K. Short‐term efficacy and safety of early medical abortion in Japan: A multicenter prospective study. Reprod Med Biol 2023; 22:e12512. [PMID: 37013166 PMCID: PMC10066193 DOI: 10.1002/rmb2.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose To evaluate the short‐term efficacy and safety of a combined mifepristone‐misoprostol regimen in individuals seeking medical abortion at up to 63 days of gestational age. Methods This open‐label, multicenter, prospective study evaluated the short‐term efficacy and safety of medical abortion, with the primary outcome being the abortion success rate 24 h after misoprostol administration. The participants received 200 mg of mifepristone orally and 800 μg of misoprostol buccally in the hospital/clinic 36–48 h later. Bleeding and lower abdominal pain, which are the main symptoms associated with medical abortion, were recorded. Results The abortion success rate was 93.3% (95% confidence interval [CI]: 87.3–97.1%) within 24 h of misoprostol administration, 63.3% (95% CI: 54.05–71.94%) within 4 h, and 90.0% (95% CI: 83.18–94.73%) within 8 h. The median time from misoprostol administration to a successful abortion was 3.93 h. Bleeding was most commonly observed 0–4 h prior to the confirmation of gestational sac (GS) expulsion. The most intense lower abdominal pain occurred 0–1 h before the confirmation of GS expulsion. Conclusion The combined regimen of mifepristone and buccal misoprostol for medical abortion showed short‐term efficacy and a favorable safety profile.
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Affiliation(s)
- Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kazuhiro Shirasu
- Division of Review Board ManagementKanagawa National Health Insurance OrganizationKanagawaJapan
| | - Ruriko Tsushima
- Tsushima Ruriko Women’s Life Clinic Ginza Medical Corporation Women’s WellnessTokyoJapan
| | - Ken Ishitani
- Department of Obstetrics and GynecologyNippon Koukan HospitalKanagawaJapan
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Mazza D, Shankar M, Botfield JR, Moulton JE, Chakraborty SP, Black K, Tomnay J, Bateson D, Church J, Laba TL, Kasza J, Norman WV. Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice. BMJ Open 2023; 13:e065137. [PMID: 36948556 PMCID: PMC10040016 DOI: 10.1136/bmjopen-2022-065137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).
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Affiliation(s)
- Danielle Mazza
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Mridula Shankar
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica R Botfield
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica E Moulton
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Samantha Paubrey Chakraborty
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Kirsten Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Tomnay
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
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Shimels T, Getnet M, Shafie M, Belay L. Comparison of mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion: A systematic review and meta-analysis. Front Glob Womens Health 2023; 4:1112392. [PMID: 36970118 PMCID: PMC10038101 DOI: 10.3389/fgwh.2023.1112392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
ObjectiveTo compare mifepristone plus a misoprostol-combined regimen with misoprostol alone in the medical abortion of first trimester pregnancy.MethodsAn internet-based search of available literature was performed using text words contained in titles and abstracts. PubMed/Medline, Cochrane CENTRAL, EMBASE, and Google scholar were used to locate English-based articles published until December 2021. Studies fulfilling the inclusion criteria were selected, appraised, and assessed for methodological quality. The included studies were pooled for meta-analysis, and the results were presented in risk ratio at a 95% confidence interval.FindingsNine studies comprising 2,052 participants (1,035 intervention and 1,017 controls) were considered. Primary endpoints were complete expulsion, incomplete expulsion, missed abortion, and ongoing pregnancy. The intervention was found to more likely induce complete expulsion irrespective of gestational age (RR: 1.19; 95% CI: 1.14–1.25). The administration of misoprostol 800 mcg after 24 h of mifepristone pre-treatment in the intervention group more likely induced complete expulsion (RR: 1.23; 95% CI: 1.17–1.30) than after 48 h. The intervention group was also more likely to experience complete expulsion when misoprostol was used either vaginally (RR: 1.16; 95% CI: 1.09–1.17) or buccally (RR: 1.23; 95% CI: 1.16–1.30). The intervention was more effective in the subgroup with a negative foetal heartbeat at reducing incomplete abortion (RR: 0.45; 95% CI: 0.26–0.78) compared with the control group. The intervention more likely reduced both missed abortion (RR: 0.21; 95% CI: 0.08–0.91) and ongoing pregnancy (RR: 0.12; 95% CI: 0.05–0.26). Fever was less likely to be reported (RR: 0.78; 95% CI: 0.12–0.89), whereas the subjective experience of bleeding was more likely to be encountered (RR: 1.31; 95% CI: 1.13–1.53) by the intervention group.ConclusionThe review strengthened the theory that a combined mifepristone and misoprostol regimen can be an effective medical management for inducing abortions during first trimester pregnancy in all contexts. Specifically, there is a high-level certainty of evidence on complete expulsion during the early stage and its ability to reduce both missed and ongoing pregnancies.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019134213, identifier CRD42019134213.
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Affiliation(s)
- Tariku Shimels
- Research Directorate,St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Correspondence: Tariku Shimels
| | - Melsew Getnet
- Research Directorate,St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mensur Shafie
- Department of Pharmacology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay
- Department of Obstetrics and Gynaecology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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de Souza Pinto LP, Ferrari G, Dos Santos IK, de Mello Roesler CR, de Mello Gindri I. Evaluation of safety and effectiveness of gestrinone in the treatment of endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet 2023; 307:21-37. [PMID: 36434439 DOI: 10.1007/s00404-022-06846-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Endometriosis is a common chronic gynecological disease defined as the presence of endometrial glands and stroma tissue outside the uterus. Gestrinone is an effective antiestrogen that induces endometrial atrophy and/or amenorrhea. The purpose of this systematic review is to provide an evaluation of safety and effectiveness of gestrinone for the treatment of endometriosis. METHODS We performed a search in six electronic databases: PubMed, MEDLINE (ovid), Embase, Cochrane CENTRAL (clinical trials), Web of Science and Scopus. Our selected primary outcomes were the changes in dysmenorrhea, pain relief including pelvic pain and dyspareunia. The secondary outcomes embrace hormones parameters, pregnancy rate and adverse events. RESULTS Of 3269 references screened, 16 studies were included involving 1286 women. All studies compared gestrinone with other drugs treatments (placebo, Danazol, Mifepristone tablets, Leuprolide acetate, Quyu Jiedu Recipe) during 6 months. When compared with other drugs treatments, gestrinone relieved dysmenorrhea, pelvic pain, and morphologic response in the ovary. There was an increase on the pregnancy rate. Regarding the side effects observed, gestrinone showed the same adverse events and increased the risk of acne and seborrhea when compared to other treatments. Even if there was any difference in efficacy between gestrinone, danazol, leuprolide acetate, or Quyu Jiedu Recipe Chinese Medicine, it remains unclear due to insufficient data. CONCLUSION Based limited evidence available suggests that gestrinone appeared to be safe and may have some efficacy advantages over danazol, as well as other therapeutic interventions for treating endometriosis. However, this conclusion should be interpreted with caution, due the quality of the evidence provided is generally very low or unclear. TRIAL REGISTRATION CRD42021284148.
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Affiliation(s)
| | - Gustavo Ferrari
- Iaso Biodelivery Fabricação de Dispositivos com Liberação de Fármacos LTDA, Florianópolis, SC, Brazil.,Biomechanics Engineering Laboratory, Department of Mechanical Engineering, University Hospital &, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Bio Meds Pharmaceutica LTDA, Florianópolis, SC, 88050-001, Brazil.,NIMMA-Núcleo de Inovação em Moldagem e Manufatura Aditiva, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Carlos Rodrigo de Mello Roesler
- Biomechanics Engineering Laboratory, Department of Mechanical Engineering, University Hospital &, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Izabelle de Mello Gindri
- Iaso Biodelivery Fabricação de Dispositivos com Liberação de Fármacos LTDA, Florianópolis, SC, Brazil. .,Bio Meds Pharmaceutica LTDA, Florianópolis, SC, 88050-001, Brazil.
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Moulton JE, Mazza D, Tomnay J, Bateson D, Norman WV, Black KI, Subasinghe AK. Co-design of a nurse-led model of care to increase access to medical abortion and contraception in rural and regional general practice: A protocol. Aust J Rural Health 2022; 30:876-883. [PMID: 36264024 PMCID: PMC10946737 DOI: 10.1111/ajr.12937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
PROBLEM Women in rural and regional Australia experience a number of barriers to accessing sexual and reproductive health care including lack of local services, high costs and misinformation. SETTING Nurse-led task-sharing models of care for provision of long-acting reversible contraception (LARC) and early medical abortion (EMA) are one strategy to reduce barriers and improve access to services but have yet to be developed in general practice. KEY MEASURES FOR IMPROVEMENT Through a co-design process, we will develop a nurse-led model of care for LARC and EMA provision that can be delivered through face-to-face consultations or via telehealth in rural general practice in Australia. STRATEGIES FOR CHANGE A co-design workshop, involving consumers, health professionals (particularly General Practitioners (GPs) and Practice Nurses (PNs)), GP managers and key stakeholders will be conducted to design nurse-led models of care for LARC and EMA including implant insertion by nurses. The workshop will be informed by the 'Experience-Based Co-Design' toolkit and involves participants mapping the patient journey for service provision to inform a new model of care. EFFECTS OF CHANGE Recommendations from the workshop will inform a nurse-led model of care for LARC and EMA provision in rural general practice. The model will provide practical guidance for the set-up and delivery of services. LESSONS LEARNT Nurses will work to their full scope of practice to increase accessibility of EMA and LARC in rural Australia.
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Affiliation(s)
- Jessica E. Moulton
- SPHERE, NHMRC Centre of Research Excellence, Department of General PracticeMonash UniversityNotting HillVICAustralia
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General PracticeMonash UniversityNotting HillVICAustralia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual HealthUniversity of MelbourneMelbourneVICAustralia
| | - Deborah Bateson
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
- Family Planning NSWSydneyNSWAustralia
| | - Wendy V. Norman
- Department of Family PracticeUniversity of British ColumbiaVancouverBCCanada
| | - Kirsten I. Black
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - Asvini K. Subasinghe
- SPHERE, NHMRC Centre of Research Excellence, Department of General PracticeMonash UniversityNotting HillVICAustralia
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10
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Melville C. Abortion care in Australasia: A matter of health, not politics or religion. Aust N Z J Obstet Gynaecol 2022; 62:187-189. [PMID: 35482706 DOI: 10.1111/ajo.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
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Abstract
Early medical abortion is a safe, cost effective and acceptable alternative to surgical abortion. It offers privacy and autonomy and can be provided by general practitioners who have completed an online training module. Abortion can be induced with mifepristone and misoprostol up to nine weeks of gestation. Apart from anticoagulation and severe anaemia, there are few contraindications and precautions for medical abortion. Obtaining informed consent requires the provision of information on expected effects, adverse effects and complications. The woman must know when to present to an emergency department. Follow-up must be arranged to ensure the abortion is complete. A serum human chorionic gonadotropin concentration or a low-sensitivity urine pregnancy test is used to confirm completion. Most contraceptive methods can be started immediately following medical abortion. If an intrauterine device is preferred, it should be inserted after confirming the abortion is complete.
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Affiliation(s)
- Deborah Bateson
- Family Planning New South Wales, Ashfield, Sydney.,Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney.,Family Planning Victoria, Box Hill, Melbourne.,Department of Obstetrics and Gyneacology, Monash University, Melbourne.,Sexual and Reproductive Health, Institute for Urban Indigenous Health, Brisbane
| | - Kathleen McNamee
- Family Planning New South Wales, Ashfield, Sydney.,Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney.,Family Planning Victoria, Box Hill, Melbourne.,Department of Obstetrics and Gyneacology, Monash University, Melbourne.,Sexual and Reproductive Health, Institute for Urban Indigenous Health, Brisbane
| | - Caroline Harvey
- Family Planning New South Wales, Ashfield, Sydney.,Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney.,Family Planning Victoria, Box Hill, Melbourne.,Department of Obstetrics and Gyneacology, Monash University, Melbourne.,Sexual and Reproductive Health, Institute for Urban Indigenous Health, Brisbane
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Anticancer effects of mifepristone on human uveal melanoma cells. Cancer Cell Int 2021; 21:607. [PMID: 34789240 PMCID: PMC8597220 DOI: 10.1186/s12935-021-02306-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/29/2021] [Indexed: 12/27/2022] Open
Abstract
Background Uveal melanoma (UM), the most prevalent intraocular tumor in adults, is a highly metastatic and drug resistant lesion. Recent studies have demonstrated cytotoxic and anti-metastatic effects of the antiprogestin and antiglucocorticoid mifepristone (MF) in vitro and in clinical trials involving meningioma, colon, breast, and ovarian cancers. Drug repurposing is a cost-effective approach to bring approved drugs with good safety profiles to the clinic. This current study assessed the cytotoxic effects of MF in human UM cell lines of different genetic backgrounds. Methods The effects of incremental concentrations of MF (0, 5, 10, 20, or 40 μM) on a panel of human UM primary (MEL270, 92.1, MP41, and MP46) and metastatic (OMM2.5) cells were evaluated. Cells were incubated with MF for up to 72 h before subsequent assays were conducted. Cellular functionality and viability were assessed by Cell Counting Kit-8, trypan blue exclusion assay, and quantitative label-free IncuCyte live-cell analysis. Cell death was analyzed by binding of Annexin V-FITC and/or PI, caspase-3/7 activity, and DNA fragmentation. Additionally, the release of cell-free DNA was assessed by droplet digital PCR, while the expression of progesterone and glucocorticoid receptors was determined by quantitative real-time reverse transcriptase PCR. Results MF treatment reduced cellular proliferation and viability of all UM cell lines studied in a concentration-dependent manner. A reduction in cell growth was observed at lower concentrations of MF, with evidence of cell death at higher concentrations. A significant increase in Annexin V-FITC and PI double positive cells, caspase-3/7 activity, DNA fragmentation, and cell-free DNA release suggests potent cytotoxicity of MF. None of the tested human UM cells expressed the classical progesterone receptor in the absence or presence of MF treatment, suggesting a mechanism independent of the modulation of the cognate nuclear progesterone receptor. In turn, all cells expressed non-classical progesterone receptors and the glucocorticoid receptor. Conclusion This study demonstrates that MF impedes the proliferation of UM cells in a concentration-dependent manner. We report that MF treatment at lower concentrations results in cell growth arrest, while increasing the concentration leads to lethality. MF, which has a good safety profile, could be a reliable adjuvant of a repurposing therapy against UM. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02306-y.
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Moulton JE, Subasinghe AK, Mazza D. Practice nurse provision of early medical abortion in general practice: opportunities and limitations. Aust J Prim Health 2021; 27:427-430. [PMID: 34548127 DOI: 10.1071/py20304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/08/2021] [Indexed: 11/23/2022]
Abstract
Approximately one in three Australian women with an unintended pregnancy will have an abortion, yet significant barriers remain to ensure the delivery of equitable and timely medical abortion services, including lack of trained providers, high out-of-pocket costs, abortion stigma, conscientious objection and large geographical distance to services. Practice nurses can be suitably trained to provide early medical abortion in general practice; however, there remain several key limitations to the implementation of nurse-led models of care. This forum article discusses these limitations, including issues concerning legislation, funding models, lack of access to medical abortion training, practice structure and systems, and makes recommendations as to how increased access to medical abortion in Australia can be achieved.
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Affiliation(s)
- Jessica E Moulton
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
| | - Asvini K Subasinghe
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Danielle Mazza
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
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Keogh LA, Gurrin LC, Moore P. Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data. Med J Aust 2021; 215:375-376. [PMID: 34365649 DOI: 10.5694/mja2.51217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Louise A Keogh
- Centre for Health Equity, University of Melbourne, Melbourne, VIC
| | - Lyle C Gurrin
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
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Low ST, Chen ZE, Cameron S. Women's experiences of self-referral to an abortion service: qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:37-42. [PMID: 32269055 DOI: 10.1136/bmjsrh-2019-200568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Guidelines from the UK recommend that women should be able to self-refer to abortion services. In 2016, a self-referral system was introduced to the abortion service in Edinburgh, Scotland, as an option for women. Women could telephone a dedicated phone line during office hours and speak to an administrative assistant working in the abortion service who provided them the next available appointment to be seen in the service. This study aimed to evaluate a self-referral service to abortion by investigating its impact on women's experiences of the referral process. METHODOLOGY 21 semistructured interviews of women attending a specialist abortion service in Edinburgh, Scotland, were conducted. Interviews were transcribed verbatim and thematically analysed. The interviews focused on women's experience of the referral process. RESULTS Three main themes arose from the interviews, including reasons for choosing self-referral, experience of self-referral and challenges to using self-referral. Reasons for choosing self-referral were related to convenience, privacy and autonomy. Women found the experience of self-referral to be pleasant, non-judgemental and patient-centred, and self-referral prepared them for the appointment at the specialist abortion service. However, some women felt rushed, and self-referral made them anxious to attend the appointment. Challenges were difficulty with getting through on telephone lines, varying levels of support required for different individuals and awareness about the option of self-referral. CONCLUSION Women valued the option of self-referral. Women felt that the service should be expanded to increase availability,and promoted to women more widely within the community .
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Affiliation(s)
- Shin Thong Low
- The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Zhong Eric Chen
- Clinical Effectiveness Unit of the FSRH, Chalmers Centre, Edinburgh, UK
| | - Sharon Cameron
- Clinical Effectiveness Unit of the FSRH, Chalmers Centre, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Murdoch J, Thompson K, Belton S. Rapid uptake of early medical abortions in the Northern Territory: A family planning-based model. Aust N Z J Obstet Gynaecol 2020; 60:970-975. [PMID: 32909248 DOI: 10.1111/ajo.13240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Abortion law reform does not necessarily translate into services, especially for those in regional areas. Although abortion has been legal in the Northern Territory (NT) since 1974, prior to 2017 legislation change, early medical abortions (EMAs) were effectively prohibited in primary care. In July 2017, Family Planning Welfare Association of the Northern Territory (FPNT) was awarded funding to provide EMAs free of charge for Medicare eligible clients. AIMS To describe the demographics and clinical outcomes of clients accessing the EMA service in the first 12 months after legislation change. MATERIALS AND METHODS Retrospective audit of FPNT's Unplanned Pregnancy Database from 1 July 2017 to 30 June 2018 and analysis of the NT Government's Termination of Pregnancy 12 Month Data Report. RESULTS Of 742 abortions in the NT in the first 12 months after legislation change, 426 were EMAs prescribed at FPNT. Eleven percent of these (47/426) were for Aboriginal or Torres Strait Islander women and 15% (64/426) were for women from Remote or Very Remote Australia. Outcomes were definitively documented for 326 (77%); 5% of these required further misoprostol and 99% had a complete abortion without surgical intervention. Eighty-six percent (281/326) commenced effective hormonal contraception following their EMA. CONCLUSIONS Providing funding to a Family Planning service was effective in devolving the majority of abortions from tertiary to primary healthcare and increasing the use of effective contraception. Some women remain under-represented, particularly women from more remote areas of the NT. Further work is required to ensure equity of access to services for these women.
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Affiliation(s)
- Jacqueline Murdoch
- Clinical Division, Family Planning Welfare Association of the Northern Territory, Darwin, Northern Territory, Australia
| | - Kirsten Thompson
- Clinical Division, Family Planning Welfare Association of the Northern Territory, Darwin, Northern Territory, Australia
| | - Suzanne Belton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Cheng HC, Black K, Woods C, Costa C. Views and practices of induced abortion among Australian Fellows and trainees of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists: A second study. Aust N Z J Obstet Gynaecol 2020; 60:290-295. [DOI: 10.1111/ajo.13038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Hon Chuen Cheng
- Department of Obstetrics and Gynaecology James Cook University College of Medicine Cairns QueenslandAustralia
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology University of SydneyCamperdown New South Wales Australia
- Royal Prince Alfred Hospital CamperdownNew South Wales Australia
| | - Cindy Woods
- School of Health University of New England Armidale New South Wales Australia
| | - Caroline Costa
- Department of Obstetrics and Gynaecology James Cook University College of Medicine Cairns QueenslandAustralia
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Abstract
OBJECTIVES To provide advice on the use of mifepristone for medical abortion. TARGET AUDIENCE All health professionals providing gynaecological care, and patients. VALUES The evidence was reviewed by the Women's Health Committee RANZCOG, and applied to local factors relating to Australia and New Zealand. BACKGROUND This statement was first developed by Women's Health Committee in November 2007 and reviewed in March 2019. FUNDING The development and review of this statement was funded by RANZCOG.
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de Moel-Mandel C, Graham M, Taket A. Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria. Aust J Rural Health 2019; 27:237-244. [PMID: 31070843 DOI: 10.1111/ajr.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to identify enablers and barriers to the provision of medication abortion in the primary health care setting of regional and rural areas of Victoria, Australia. DESIGN An online cross-sectional questionnaire was used. SETTING Regional and rural areas of Victoria, Australia. PARTICIPANTS Thirty-nine GPs and 30 primary health care nurses. MAIN OUTCOME MEASURES Abortion views, medication abortion knowledge and practice, interest in medication abortion training and provision, and perceived uptake barriers. RESULTS Most participants reported being consulted by women with unintended pregnancies and most of them included abortion counselling in their consultation. However, familiarity with provision of medication abortion was limited, and only five GPs and two primary health care nurses were currently medication abortion providers. The majority of participants expressed a high level of interest in receiving medication abortion training, but indicated a wide range of barriers to service provision, such as a lack of training opportunities, legal uncertainties or surgical access concerns in case of complications. CONCLUSIONS Findings demonstrate the need for education on medication abortion and training opportunities. Most identified barriers to service uptake are addressable and relate to a lack of local support services, including the absence of a 24-hour contact advice service, insufficient follow-up access and a lack of local ultrasound facilities. These barriers require educational programs at professional, organisational and community level to ensure that interested rural and regional primary health care providers can start offering medication abortion for their patients.
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Affiliation(s)
- Caroline de Moel-Mandel
- Faculty of Health, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Melissa Graham
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Ann Taket
- Faculty of Health, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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de Costa CM, Black KI, Russell DB. Medical abortion: it is time to lift restrictions. Med J Aust 2019; 210:248-249.e1. [PMID: 30861138 DOI: 10.5694/mja2.50060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Kirsten I Black
- University of Sydney, Sydney, NSW.,Royal Prince Alfred Hospital, Sydney, NSW
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Warden S, Genkin I, Hum S, Dunn S. Outcomes During Early Implementation of Mifepristone-Buccal Misoprostol Abortions up to 63 Days of Gestation in a Canadian Clinical Setting. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:647-652. [PMID: 31007171 DOI: 10.1016/j.jogc.2018.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE In January 2017, mifepristone became available in Canada. The goal of this study was to determine the effectiveness and safety of mifepristone-misoprostol abortion during its early implementation in a Canadian setting. METHODS This retrospective chart review included the first 477 patients who had a mifepristone-misoprostol abortion from March 13 to October 31, 2017, in an urban sexual health clinic. Women with pregnancies up to 63days of gestation had an initial dating ultrasound and β-human chorionic gonadotropin determination. They were provided mifepristone 200 mg orally in clinic, followed 24-48hours later with misoprostol 800 µg buccally at home. Follow-up, 7-14days later, in clinic or by telephone, used symptom review and follow-up β-human chorionic gonadotropin or ultrasound. The primary outcome was successful abortion, defined as expulsion of pregnancy without uterine aspiration. RESULTS Of 477 consecutive mifepristone abortions, 422 women (88.5%) had documented follow-up, with 408 (96.7%) successful abortions, including eight in women who had a repeat dose of misoprostol. Fourteen (3.3%) unsuccessful abortions required uterine aspiration, two (0.5%) for ongoing pregnancy and 12 (2.8%) for incomplete abortion or persistent bleeding. Seventeen women (4.0%) had emergency department visits, one (0.2%) of whom was hospitalized and three (0.7%) of whom received blood transfusion. Four women (1.0%) were treated for infection. CONCLUSION Mifepristone-misoprostol medical abortion was safe and effective during early implementation in Canada, comparable to previously published outcomes.
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Affiliation(s)
- Sarah Warden
- Department of Family and Community Medicine, University of Toronto, Toronto, ON; Women's College Hospital Family Practice Health Centre, Toronto, ON
| | - Inna Genkin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON; Women's College Hospital Family Practice Health Centre, Toronto, ON.
| | - Susan Hum
- Women's College Hospital Family Practice Health Centre, Toronto, ON
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON; Women's College Hospital Family Practice Health Centre, Toronto, ON
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Chen W, Xiao Y, Cheng Y, Chen J, Chen J, Jiang K, Zhou Y, Jia L. Pharmacokinetic differences of mifepristone between sexes in animals. J Pharm Biomed Anal 2018; 154:108-115. [DOI: 10.1016/j.jpba.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/04/2018] [Accepted: 03/04/2018] [Indexed: 01/19/2023]
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Hyland P, Raymond EG, Chong E. A direct-to-patient telemedicine abortion service in Australia: Retrospective analysis of the first 18 months. Aust N Z J Obstet Gynaecol 2018; 58:335-340. [DOI: 10.1111/ajo.12800] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Paul Hyland
- Tabbot Foundation; Sydney New South Wales Australia
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Garratt D, Turner JV. Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone. EUR J CONTRACEP REPR 2017; 22:472-475. [PMID: 29260618 DOI: 10.1080/13625187.2017.1412424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Abortion is often a difficult and traumatic decision for a woman to make. Perhaps greater distress occurs when a woman commences a medical abortion but then changes her mind and wishes to keep the now-threatened pregnancy. One published case series detailed a potential method to counter/reverse the abortifacient effect of mifepristone by administering parenteral progesterone in such situations. OBJECTIVES The present report details cases of women in similar circumstances who have been treated with progesterone. The aims were to document occurrences of where women have changed their mind after commencing medical abortion, as well as to explore some of the controversies and clinical issues surrounding their circumstances. METHODS Women who had commenced medical abortion by ingesting mifepristone but who had not taken misoprostol independently contacted a national pregnancy support service the same day. Those meeting criteria for treatment received progesterone pessaries per vaginum for two weeks. RESULTS Cases: 28-year-old woman, 6 weeks plus 1 day gestation; 35-year-old woman, 8 weeks plus 5 days gestation; and 27-year-old woman, 7 weeks plus 3 days gestation. Outcomes respectively were: healthy male baby delivered at 39 weeks gestation; healthy male baby delivered at term; and completed medical abortion. CONCLUSIONS Women have changed their mind after commencing medical abortion. Progesterone use in early pregnancy is low risk and its application to counter the effects of mifepristone in such circumstances may be clinically beneficial in preserving her threatened pregnancy. Further research is required, however, to provide definitive evidence.
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Affiliation(s)
- Deborah Garratt
- a School of Nursing , University of Notre Dame , Sydney , Australia
| | - Joseph V Turner
- b School of Rural Medicine , University of New England , Armidale , Australia.,c Rural Clinical School, Faculty of Medicine , University of Queensland , Toowoomba , Australia.,d School of Medicine - Rural Clinical School , University of New South Wales , Coffs Harbour , Australia
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Abstract
The synthesis of mifepristone, an antiprogestin blocking the action of progesterone at the receptor level, started a new era of medical termination of pregnancy (MTOP). The initial results of MTOP with mifepristone alone were disappointing; however, mifepristone can sensitise the myometrium to the action of prostaglandins. Clinical trials have shown that the sequential administration of mifepristone followed 1-2 days later by a prostaglandin analogue is a safe, effective, and acceptable method for MTOP. This article will review the events and challenges leading to the development of the current evidence-based and yet off-label regimen for first-trimester MTOP. TWEETABLE ABSTRACT This article reviews the events and challenges in the development of medical termination of pregnancy.
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Affiliation(s)
- P C Ho
- Centre of Reproductive Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Black KI, Bateson D. Medical abortion is fundamental to women's health care. Aust N Z J Obstet Gynaecol 2017; 57:245-247. [DOI: 10.1111/ajo.12642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kirsten I. Black
- Discipline of Obstetrics, Gynaecology and Neonatology; Central Clinical School, University of Sydney; Sydney New South Wales Australia
- Women's and Babies, Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology; Central Clinical School, University of Sydney; Sydney New South Wales Australia
- Family Planning NSW; Sydney New South Wales Australia
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