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PubMed2004

Physician assistants as providers of surgically induced abortion services.

OBJECTIVES: We compared complication rates after surgical abortions performed by physician assistants with rates after abortions performed by physicians. METHODS: A 2-year prospective cohort study of women undergoing surgically induced abortion was conducted. Ninety-one percent of eligible women (1363) were enrolled. RESULTS: Total complication rates were 22.0 per 1000 procedures (95% confidence interval [CI] = 11.9, 39.2) performed by physician assistants and 23.3 per 1000 procedures (95% CI = 14.5, 36.8) performed by physicians (P =.88). The most common complication that occurred during physician assistant-performed procedures was incomplete abortion; during physician-performed procedures the most common complication was infection not requiring hospitalization. A history of pelvic inflammatory disease was associated with an increased risk of total complications (odds ratio = 2.1; 95% CI = 1.1, 4.1). CONCLUSIONS: Surgical abortion services provided by experienced physician assistants were comparable in safety and efficacy to those provided by physicians.

Abortion, Incomplete↗
PubMed1991

Mifepristone or vacuum aspiration in termination of early pregnancy.

This trial compared the termination of early pregnancy (amenorrhoea less than 43 days) by 600 mg orally of the antiprogesteron Mifepristone to the traditional method of vacuum aspiration. Fifty women were randomly assigned to either of the treatments. All the patients treated with vacuum aspiration had a complete abortion. Three of these patients developed pelvic inflammatory diseasae (PID) after the aspiration. Another patient had the uterus perforated during the procedure, and an emergency laparotomy had to be performed. The patients in the evacuation group spent more days in bed and needed longer sick leave after the treatment than the patients in the Mifepristone group. In the Mifepristone group, six patients had incomplete abortions and all were treated by evacuation. Three of the patients developed PID after the evacuation. A decrease of 40% or more in beta hCG from the initial value to the value 1 week later were invariably associated with complete abortion. In both groups the changes in hemoglobin were insignificant and no patients needed blood transfusion or emergency evacuation. The Mifepristone treatment is a simple and safe alternative to vacuum aspiration for termination of early pregnancies.

Abortion, Incomplete↗
PubMedDate not supplied

[Improving the quality of care after spontaneous abortions in rural Senegal].

OBJECTIVES: To evaluate the feasibility and impact on quality of decentralising care for spontaneous abortion (post-abortion care, PAC) in rural areas of Senegal. PATIENTS AND METHOD: This prospective study concerns all patients who had PAC services at 6 medical centres in the districts of Kaolack and Fatick. A preintervention baseline study was performed to evaluate the number of cases treated in these centres. We then introduced a new treatment protocol for PAC, which included manual vacuum aspiration (MVA) and quarterly visits for supervision in each centre from 1 August 2001 through 30 September 2002. An evaluation was performed at the end of the program and 6 months after that. Results were compared with the baseline data for the 14 months before the intervention period. We used the chi(2) test to compare proportions and set the threshold of significance at 5%. RESULTS: The new model for PAC made it possible to increase the number of patients treated for incomplete abortion by 22%. Their average age was 25 years, and 71% had first-trimester pregnancy losses. MVA was performed for 56%. Hospitalisation lasted a mean of 4 hours compared with the 48 hours at baseline, and the proportion of patients referred to the regional hospital for complications fell from 35% to 7%. The mean direct average cost fell by 3,500 F CFA. The number of patients with contraception in place before discharge rose from 0 to 20%, and 94% of the patients questioned were satisfied with the quality of the services they received. Six month after the program ended, the level of utilisation of PAC services continued to increase (by 11%) and the proportion leaving with contraception reached 33%. CONCLUSION: Decentralisation of PAC treatment in rural areas is possible without major expense, and it improves care for women with incomplete abortions.

Abortion, Spontaneous↗
PubMed1980

Termination of early gestation with a single vaginal suppository of (15S)-15-methyl-prostaglandin F2alpha methyl ester.

Abortion was induced in 20 women who were less than 49 days pregnant with a vaginal suppository containing 3.0 mg (15S)-15-methyl-prostaglandin F2alpha methyl ester. Peripheral serum levels of (15S)-15-methyl F2alpha free acid, beta hCG and progesterone were measured before, during the 10 hours after treatment and over the next 14 days. Eighteen of the subjects had a complete follow-up: ten were aborted (53%), three had incomplete abortions and five were failures. There was a correlation between serum levels of F2alpha (15S)-15-methyl-prostaglandin F2alpha free acid, and the incidence of success. Progesterone was significantly reduced in all three groups of subjects and, therefore, could not be utilized to judge the success of the procedure. A small but insignificant reduction of betahCG occurred in all subjects regardless of outcome during the ten-hour observation period. Since minor side effects of diarrhea and vomiting occurred in less than half of the aborted and only a few of the not aborted subjects, a larger amount of drug might improve the success rate.

Abortion, Induced↗
PubMed1977

Termination of early pregnancy by ONO-802 (16,16-dimethyl-trans-delta2-PGE1 methyl ester).

ONO-802 was infused into the uterine cavity for the termination of early pregnancy in 45 healthy volunteers. Forty two (93%) of the 45 cases had complete abortions and two had incomplete abortions. Nine (20%) of the 45 volunteers complained of nausea, 7 (16%) vomited and 5 (11%) complained of abdominal pain. Neither diarrhea nor weakness was observed. These results suggest that ONO-802 is more acceptable for the termination of early pregnancy than is PGF2alpha.

Abortion, Induced↗
PubMed2003

Menstrual induction with mifepristone and misoprostol.

Menstrual induction refers to early uterine evacuation without laboratory confirmation of pregnancy in women with delayed menses. Mechanical aspiration is the method used in many countries but, as suggested by a pilot study, mifepristone followed by a prostaglandin analogue could also be effective. We launched the present study to evaluate the efficacy and side effects of 150 mg of mifepristone, followed 2 days later by 0.4 mg misoprostol vaginally, for menstrual induction among women with a menstrual delay of up to 7 days. The outcome of treatment was uterine evacuation, which could mean menstruation or termination of early pregnancy. A total of 720 women were recruited. The mean delay of menstruation at recruitment was 4.9 (SD = 1.7) days. Retrospective analysis of human chorionic gonadotropin from serum samples taken at admission showed that 492 (68.3%) women were pregnant at admission, and 228 (31.7%) women had delayed menstruation without pregnancy. One nonpregnant woman was lost to follow-up. Bleeding was induced in 479 (97.4%) pregnant women and in 222 (97.8%) nonpregnant women. Among the pregnant women, 455 (92.5%) had complete abortion, 12 (2.4%) had incomplete abortion and pregnancy continued in 25 (5.1%) women, including one ectopic pregnancy. Side effects were mild and uncommon. We conclude that 95.8% of the women treated had the expected outcome. Further research is needed to compare the efficacy, safety and acceptability of the medical regimen to vacuum aspiration. A rather high continuing pregnancy rate in this study is a concern.

Adult↗
PubMed1990

Correlation between pathologic and ultrasound findings in first trimester spontaneous abortions.

We compared the pathologic and ultrasonographic findings of 31 first trimester spontaneous abortions to determine the benefits of such studies. The ultrasound diagnoses included empty gestational sac (n = 11), intrauterine fetal death (n = 11), abortion in progress or incomplete abortion (n = 8), and live embryo (n = 1). Two subgroups of empty sacs were identified by pathologic examination. Embryonic development appeared to be more advanced in one group as indicated by the presence of embryonic red blood cells (RBC's) in the placental vessels. Although an embryo or fetus was identified more frequently by sonar than by pathologic examination, we were able to diagnose developmental anomalies in small embryos that current ultrasound equipment cannot resolve. Such anomalies were identified even in the presence of fetal heart activity. Pathologic examination was also informative when heavy bleeding obscured the contents of the uterine cavity to sonar and was thus supplementary of a suboptimal ultrasound examination. Placental examination proved to be reliable in assessing gestational age at the time of embryonic/fetal death. There was a good correlation between RBC morphology and sonographic measurement of crown-rump length. First trimester ultrasound and pathologic examination of the embryo and placenta are informative and complement each other.

Abortion, Spontaneous↗
PubMed1976

Amniotic fluid removal prior to saline abortion.

To evaluate whether removal of the amniotic fluid prior to the instillation of 200 ml of 20% hypertonic saline has any effect on the success, speed, and safety of the abortion process, 192 patients at 15--20 weeks' gestation were aborted according to one of the following procedures: 1) instillation of 200 ml saline without removal of the amniotic fluid (92 subjects), 2) removal of 100 ml of amniotic fluid prior to saline instillation (46 subjects), and 3) removal of 150 ml of amniotic fluid prior saline instillation (54 subjects). The study indicated that there are no apparent advantages to the removal of the amniotic fluid prior to the instillation of 200 ml of hypertonic saline. The median times from instillation to abortion and rates of incomplete abortion were similar for the three groups of patients. Rates of specific complications, except for fever, were similar for the three groups.

Abortion, Induced↗
PubMed1976

Amniotic fluid removal prior to saline abortion.

To evaluate whether removal of the amniotic fluid prior to the instillation of 200 ml of 20% hypertonic saline has any effect on the success, speed, and safety of the abortion process, 192 patients at 15-20 weeks' gestation were aborted according to one of the following procedures: 1) instillation of 200 ml saline without removal of the amniotic fluid (92 subjects), 2) removal of 100 ml of amniotic fluid prior to saline instillation (46 subjects), and 3) removal of 150 ml of amniotic fluid prior saline instillation (54 subjects). The study indicated that there are no apparent advantages to the removal of the amniotic fluid prior to the instillation of 200 ml of hypertonic saline. The median times from instillation to abortion and rates of incomplete abortion were similar for the three groups of patients. Rates of specific complications, except for fever, were similar for the three groups.

Abortion, Induced↗
PubMed1983

Ruptured appendix after elective abortion. A case report.

Abdominal pain and fever after an uncomplicated elective abortion usually point to incomplete abortion and endometritis. We treated a woman for acute suppurative appendicitis one week after such an abortion. When fever, nausea, vomiting and pain are not relieved by the standard doses of medication, acute appendicitis must be added to the usual gynecologic differential diagnoses.

Abortion, Induced↗
PubMed1989

Evaluation of prophylactic use of tetracycline after evacuation in abortion in Harare Central Hospital.

A randomised controlled trial involving 140 non-septic incomplete abortions was performed to determine the efficacy of prophylactic tetracycline as practiced in these cases in Harare Central Hospital. The treatment group (62) received tetracycline (500 mg four times daily) for a week. The remainder acted as controls. No significant difference in sepsis rate between treatment and control groups was noted. The high sepsis recorded in the treatment group was thought to be due to poor compliance. A new prophylaxis regimen has been suggested.

Abortion, Incomplete↗
PubMed1992

Ultrasound diagnosis of complete abortion can reduce need for curettage.

One hundred and fifty-five patients presenting with signs of incomplete abortion were evaluated by ultrasound. Of these, 112 (72.26%) were found to have retained products of conception and were treated by dilatation and curettage. The remaining 43 (27.74%) were found on ultrasound to have no products of conception and were followed-up conservatively. Only one of the latter group of patients needed admission later for dilatation and curettage; this patient was found to have a small sub-mucus fibroid and endometritis. Predictive value for those not requiring D & C was 97.6%, suggesting that this test may be useful in identifying those patient who have had a complete abortion.

Abortion, Incomplete↗
PubMed1996

Induced abortion in Kenya: its determinants and associated factors.

In a study involving 1077 women who were admitted and treated for incomplete abortion and its related problems at eight hospitals (seven district and one mission hospitals) in six of the eight provinces of Kenya, between October 1988 and March 1989, 169 (15.7%) had illegally induced unsafe abortion, based on their own history and clinical findings. The illegally induced unsafe abortions were common among both rural and urban dwellers, and women from almost all social and economic strata were involved. However, they were more common among the youth (< 25 year olds), school girls, those with high formal education, in formal employment, and not currently married. Majority (90.4%), of the induced group said their pregnancies were unwanted, as compared to only 29.1% of the non-induced (p < 0.05). The main determining factor for termination of pregnancy amongst these women appeared to be the fact that it was unwanted and/or unplanned, either because of inappropriate timing, the type of man responsible, the relationship itself and the social and economic implications thereof. This is contributed to by poor contraceptive use inspite of very good awareness, and/or desire to use. There is urgent need to integrate abortion care and related services into the overall reproductive health care and as a part of the broader safe motherhood initiative in Kenya. In addition it is necessary to revise the legal provisions on abortion so as to make them more relevant. Appropriate management of adolescent fertility, should be undertaken with the aim of reducing the extent of illegally induced unsafe abortion with attendant sequealae.

Abortion, Illegal↗
PubMed1989

Circulating levels of placental protein 12 in complications of first trimester pregnancy.

Serum placental protein 12 (PP12) levels were determined in 34 women with threatened miscarriage in whom a diagnosis of anembryonic pregnancy (n = 19), missed abortion (n = 4), complete or incomplete abortion (n = 5), hydatidiform mole (n = 1) and subsequent abortion of a live fetus (n = 5), was made ultrasonically and confirmed by histological examination. Twenty-four of the 34 patients had one or more levels between the 10th and 90th centiles of the reference range. In 7 of the 19 patients (37%) with anembryonic pregnancy and in 3 of the 4 patients (75%) with a missed abortion, PP12 levels were markedly elevated. However, in cases where serial measurements were available (n = 6), PP12 levels were seen to fall in all cases. It is concluded that pregnancies that have failed or will subsequently fail in the first or second trimester are not associated with depressed maternal PP12 levels, suggesting that the decidual synthesis of this protein is independent of the presence or viability of the fetus.

Abortion, Spontaneous↗
PubMed2003

Pilot study on the use of sublingual misoprostol in termination of pregnancy up to 7 weeks gestation.

BACKGROUND: This study was conducted to assess the efficacy and incidence of side effects of a regimen of repeated doses of 400 microg sublingual misoprostol for termination of pregnancy of <7 weeks gestation. METHOD: Fifty women were given 400 microg sublingual misoprostol every 3 h for three doses. Two additional doses were given if necessary. RESULTS: Forty-three women (86%) had a complete abortion. Two women (4%) had incomplete abortion and 5 (10%) had an ongoing pregnancy. The median interval between the first dose of misoprostol and the passage of tissue mass was 14.1 h (3.25-561.6 h). The median duration of vaginal bleeding was 20 days (8-85 days). Side effects were mild and there was no significant drop in hemoglobin level. CONCLUSIONS: Our preliminary results on sublingual misoprostol show that it is a promising method for medical termination of pregnancy of <7 weeks. It may be used as an alternative for women who do not want surgical evacuation and who live in an area where mifepristone is not available.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

Study supports the introduction of early medical abortion in Turkey.

In Turkey, there is an unmet need for induced abortion services provided by the public health services, especially in rural and semi-urban areas. The objective of this clinical study was to show that early medical abortion could be introduced safely in Turkey to improve women's access to services. In the study, women aged 18-49 up to 56 days of pregnancy were offered a choice between medical abortion with 200 mg mifepristone followed by 400 mcg oral misoprostol and MVA with local anaesthesia. 209 chose medical and 149 surgical abortion. Data from an additional 112 women were collected to obtain a similar number of surgical abortion cases. Women's preference for and satisfaction with the chosen method, side effects and complications up to the 14-day follow-up visit were recorded. 75% of women who chose medical abortion opted for home use of misoprostol. Pain with medical abortion on average lasted 3.6 +/- 3.0 days and with surgical abortion 3.7 +/- 2.9 days. 90% of women who had medical abortion said they would prefer it again compared to 70% of those having surgical abortion. There were 1.4% ongoing pregnancies in the medical abortion group and none in the surgical group. Provider training and familiarity with medical abortion are crucial. The high incomplete abortion rate indicates that the dose and regimen of misoprostol should be reconsidered. The findings support the introduction of early medical abortion in Turkey.

Abortifacient Agents, Nonsteroidal↗