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PubMed2003

Medical abortion at 64 to 91 days of gestation: a review of 483 consecutive cases.

OBJECTIVE: The purpose of this study was to assess the uptake and outcome of medical abortion in the late first trimester of pregnancy. STUDY DESIGN: We conducted a review of the cases of 483 consecutive women in a university hospital who underwent medical abortion at 64 to 91 days of gestation and who used mifepristone that was followed 36 to 48 hours later by repeated doses of misoprostol. RESULTS: A total of 891 abortions were carried out at 64 to 91 days of gestation from October 2000 to April 2002; of these, 483 cases (54.2%) were undertaken medically. Complete abortion occurred in 458 cases (94.8%). Efficacy decreased with advancing gestational age. Surgical evacuation was carried out in 1 woman (0.9%) at 9 to 10 weeks of gestation, in 8 women (5.3%) at 10 to 11 weeks of gestation, in 7 women (6.2%) at 11 to 12 weeks of gestation, and in 9 women (7.9%) at 12 to 13 weeks of gestation. Indications for surgery included ongoing pregnancy in 8 cases (1.7%), missed abortion in 3 cases (0.6%), incomplete abortion in 13 cases (2.7%), and emergency curettage for bleeding in 1 case (0.2%). The mean number of misoprostol doses used was 2.3; of those women who had a complete abortion, 152 women (32.6%) aborted within 4 hours of receiving the misoprostol. The mean induction to abortion interval was 5.5 hours; most cases (452; 93.6%) were treated as day cases. CONCLUSION: Medical abortion between 64 and 91 days of gestation is effective and has a high uptake. Consideration should be given to extending the availability and choice of medical abortion to women in this gestational group.

Abortifacient Agents, Nonsteroidal↗

PubMed1989

Menstrual regulation by intramuscular injections of 16-phenoxy-tetranor PGE2 methyl sulfonylamide (sulprostone). A multicentre study. World Health Organization.

In a previous study we have shown that three intramuscular injections of 0.5 mg of the prostaglandin analogue, sulprostone (16-phenoxy-W-17,18,19,20-tetranor PGE2 methyl sulfonylamide), were equally effective as vacuum aspiration for menstrual regulation in women with a delay of up to 21 days in the onset of expected menses. To assess whether lower doses of the prostaglandin could be effective if treatment were restricted to women with a delay of menses of up to 14 days, a multicentre trial investigated the effect of two injections of 0.25 mg sulprostone given with a 4-h interval. After an interim analysis showed a clinically unacceptable low rate of complete abortion (41%) amongst the 64 pregnant women thus treated, the dose was doubled to two injections of 0.5 mg. In the group of 51 pregnant women treated with the increased dose, the frequency of complete abortion (67%) was significantly higher although still well below the 91% success rate achieved in our previous study. Both the duration and the subjective vaginal blood loss were greater in women with complete abortion than in those with incomplete abortion or continuing pregnancy. It is concluded that the sulprostone dose used in our previous study (3 x 0.5 mg) represents the minimal, required dose for menstrual regulation.

Abortifacient Agents↗

PubMed1989

[Yuanhuacin film for menstruation induction and termination of early pregnancy: analysis of 382].

Yuanhuacin Film was used in 382 cases, 26 cases for menstrual induction (successful rate 100%) and 356 for termination of early pregnancy. Among the latter group 336 cases resulted in complete abortion (94.4%), 12 cases in incomplete abortion (3.4%) and 8 cases in failure (2.2%). The embryonic sacs were discharged within 34.66 +/- 33.73 (means +/- s) hours. The amount of vaginal bleeding was less than or equal to that of menstruation, which lasted for 8.18 + 9.14 (means +/- s) days with mild abdominal pains. In the complete abortion group 237 cases (70.5%) were followed up and 236 cases were found to restore their menses within 40 days (99.6%), and 157 cases have decreased amount or the same amount of menstrual flow (66.2%), while in 80 cases the amount was increased (33.8%).

Abortifacient Agents↗

PubMed1977

[Therapeutic induction of abortion in the 1st and 2nd trimesters with intramuscular 15-methyl-prostaglandin F2 alpha].

The effectiveness of intramuscular 15-methyl-prostaglandin F2alpha (15-methyl-PGF2alpha) application for therapeutic abortion was studied in 16 women during the first and second trimester (12 to 17 weeks) of pregnancy. 250 microgram 15-methyl-PGF2alpha were administered initial and at intervals of 2 hours. Of the 16 subjects, 2 aborted completely, 13 aborted incompletely and 1 failed to abort. The mean abortion time for the 15 successful abortions was 11,25 hours and the mean 15-methyl-PGF2alpha dosage 1,35 mgs. Vomiting and diarrhea were the most prevalent side effects occurring in 12 of 16 patients. No serious complications occurred. In 9 women between 7 to 13 weeks of pregnancy a single intramuscular injection of 250 microgram 15-methyl-PGF2alpha was administered 11 to 13 hours prior to vacuum aspiration. All subjects had a gradual softening and dilatation of the cervix (5 to 8 mm). In 7 of 9 patients occurring gastro-intestinal side effects. Acute ascension was observed in 2 women after vacuum aspiration. All subjects had a gradual softning and dilatation of the cervix (5 to 8 mm). In 7 of 9 patients occurring gastro-intestinal side effects. Acute ascension was observed in 2 women after vacuum aspiration. Intramuscular administration of 15-methyl-PGF2alpha appears to be an effective abortifacient. Gastro-intestinal side effects can be reduced by antiemetic and antidiarrheal agents or lowering the initial dose of 15-methyl-PGF2alpha.

Abortion, Therapeutic↗

PubMed2000

Early surgical abortion: an alternative to and backup for medical abortion.

Surgical abortion by vacuum aspiration is one of the most commonly reported surgical procedures in the United States. The developments of highly sensitive urinary pregnancy tests and transvaginal ultrasonography have encouraged the application of surgical abortion methods at earlier gestational ages. Manual vacuum aspiration with a handheld syringe safely accomplishes early abortion in a variety of settings, from elective abortion in the office or clinic setting to emergency care of a patient with an incomplete abortion. As a wider range of clinicians expresses interest in offering medical abortion, the appropriate use and technique of surgical backup are crucial in safely providing medical abortion. This article reviews vacuum aspiration during the first few weeks of pregnancy, with special attention to manual vacuum aspiration, both for elective surgical abortion and when intervention is required after medical abortion.

Abortifacient Agents↗

PubMed1982

Incomplete and inevitable abortion: treatment by suction curettage in the emergency department.

Suction curettage for inevitable and incomplete spontaneous abortion has been performed by emergency physicians in the emergency department of the Central Group Health Hospital in Seattle for more than seven years. The equipment and techniques used in our practice are described, and guidelines for treatment are presented. Also presented is an analysis of 111 consecutive patients treated with suction curettage during an 18-month period with a minimum follow up of six months. The complication rate was minimal (4.5%), and compares favorably with previously published results of inpatient treatment. Several significant advantages of treating incomplete and inevitable abortion with suction curettage in the emergency department are described.

Abortion, Incomplete↗

PubMed1993

Psoas abscess related to spontaneous abortion, intra-uterine contraceptive device and curettage.

This case report presents a patient with a psoas abscess related to a dilatation and (aspiration) curettage for an incomplete abortion with an IUD. Psoas abscess is extremely rare in obstetrics and gynecology and a life threatening condition. It is important to recognize the clinical presentation. Psoas abscess should be suspected in patients presenting with fever, pain in the leg, thigh, or low back region. Whether antibiotic prophylaxis in abortion curettage may prevent this and other complications is discussed.

Abortion, Incomplete↗

PubMed2006

Impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria.

AIM: To evaluate the impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria. SETTING: Indigent South Africans managed in two public hospitals in the west of Pretoria. METHOD: Data were collected on all abortions (incomplete or induced) treated in the hospitals in the study area in 1997-1998 and 2003-2005. All cases of severe acute maternal morbidity and maternal deaths due to abortion were identified for these time periods. Data exclude referrals from outside the west of Pretoria. OUTCOME MEASURES: The case fatality rate (CFR), mortality index (MI) and maternal mortality ratio (MMR) due to abortions. RESULTS: In 1997-1998 there were 2 050 abortions, of which 80.2% were regarded as being incomplete, and in 2003-2005 there were 3 999 abortions, of which 42.8% were regarded as incomplete. Twenty-four women who were critically ill due to complications of abortion presented in 1997-1998 (a rate of 3.05/1 000 births), compared with 50 (2.76/1 000 births) in 2003-2005. There were 5 deaths in 1997-1998 (CFR of 2.4/1 000 abortions) compared with 1 death in 2003-2005 (CFR 0.25/1 000 abortions) (p = 0.01, relative risk (RR) 0.1, 95% confidence interval (CI) 0.01 - 0.89). The MI fell from 21.7% to 2.0% (p = 0.02, RR 0.1, 95% CI 0.01 - 0.89). The MMR was 63.6/100 000 births in 1997-1998 compared with 5.54/100 000 in 2003-2005 (p = 0.017, RR 0.09, 95% CI 0.01 - 0.74). CONCLUSION: The introduction of the Choice on Termination of Pregnancy Act has been associated with a massive reduction in women presenting with incomplete abortions. The prevalence of critically ill women due to complications of abortion has not changed, but the CFR, MI and MMR have declined significantly.

Abortion, Legal↗

PubMed1988

Intracervical administration of prostaglandin E2-gel prior to therapeutic abortion: a prospective randomized double-blind study.

Forty primigravid women due to undergo first trimester termination of pregnancy were randomly selected for intracervical application of 1 mg prostaglandin E2 in gel or gel only as placebo. In the PGE2-gel group, a marked dilatation of the cervical canal was obtained, with post-gel treatment mean Hegar dilatation of 11.18 mm in that group, compared to 4.4 mm in the control group (P 0.001). Moreover, 16 (80%) patients in the PGE2-gel group had a complete abortion, one (5%) patient had an incomplete abortion and in the remaining three (15%) patients, fetal demise was observed. The mean induction-abortion interval in this group was 7.5 h. In the placebo group, none of the above effects were observed. The only side effect noted was vomiting, which occurred in five (25%) of the patients in the PGE2-gel group. Termination of pregnancy was found to be easier in the PGE2-gel group, compared to the placebo group.

Abortion, Therapeutic↗

PubMed1978

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

ONO-802 was used in the form of vaginal suppositories for the termination of early pregnancy in 63 healthy volunteers. Fifty-four (86%) of the 63 cases had complete abortions and remaining 9 (14%) had incomplete abortions. One (1.6%) of the 63 cases complained of nausea and vomiting, and 3 (4.8%) complained of headaches. No other side effects were observed. These results suggest that ONO-802 is acceptable in the form of vaginal suppositories for the termination of early pregnancy.

Abortifacient Agents↗

PubMed1989

Effect of oral prostaglandin E2 on uterine contractility and outcome of treatment in women receiving RU 486 (mifepristone) for termination of early pregnancy.

It has been shown that the antiprogestin RU 486 (mifepristone) increases the sensitivity of the early pregnant human uterus to the stimulatory action of synthetic prostaglandin E (PGE) analogues. To examine if RU 486 also increases uterine sensitivity to the naturally occurring PGE2 given orally, two investigative approaches were used in the present studies: (i) direct registration of uterine contractions before and after PGE2 administration in untreated and RU 486-treated early pregnant women; and (ii) a double-blind, randomized, controlled efficacy trial involving treatment of pregnant women (amenorrhoea of less than or equal to 49 days) with RU 486 (25 mg twice daily for 4 days) and PGE2 (1 mg once or twice) or placebo on the last day of RU 486 treatment. The results indicate that oral PGE2 at the doses employed had little or no stimulatory effect on uterine contractility and that it did not improve the rate of complete abortion achieved with RU 486 alone. Overall, 25 of 42 women (59%) had a complete abortion, 15 women (36%) did not abort and the remaining two had incomplete abortions. Women with complete abortions had significantly lower pretreatment levels of progesterone and a longer duration of induced bleeding than those who did not abort. Thus oral PGE2, when given in clinically acceptable doses, is not a suitable alternative to synthetic PGE analogues for use in combination with RU 486 for termination of early pregnancy.

Abortifacient Agents↗

PubMed1976

[Intrauterine extra-amnial administration of prostaglandin F 2 alpha for the induction of abortion in primigravidae and problem cases].

With 529 patients (4 groups) abortion was induced through intermittend extraamniotic application of PGF2alpha. In 97,9 per cent, the hourly instillation of PGF2alpha led to the desired success: 25 (4,7 per cent) complete abortions, 416 (78,6 per cent) incomplete abortions, 77 (14,6 per cent) "missed" abortions with opening of the cervix. In groups I to III (primigravidae betw-en the 6th and 12th weeks of pregnancy), in the mean PGF2alpha dosages there were no significant differences between 6,84 and 6,27 mg. The mean abortion time was between 8 hr 32 min and 7 hr 43 min. In group IV ("problem cases" in the first and second trimester of pregnancy), the mean PGF2alpha dosage was 10,68 mg. The mean abortion time 12 hr 04 min. The total complication rate was at 2,2 per cent.

Abortion, Induced↗

PubMed1992

[Clinical trial on termination of early pregnancy by using dl-15 methyl prostaglandin F2 alpha methyl ester in combination with testosterone propionate. Report of 244 cases].

244 subjects with amenorrhea < or = 56 days were given intramuscular injection of testosterone propionate 100 mg per day for 3 days, and in the morning of day 4, 1 mg dl-15 methyl prostaglandin F2 alpha methyl ester (PG05) suppository was inserted in the posterior fornix of the vagina every 2 hours up to the pass-out of the villi and sac for utmost 5 mg. At the same time 1-2 tablets of diphenyloxylate Co. were taken. The complete-abortion rate was 83% (191/231), the incomplete abortion rate was 13% (30/231), the total efficacy rate was 96% (221/231), and the failure rate was 4% (10/231).

Abortion, Induced↗

PubMed2006

[Antiprogesterone for medical abortion].

The purpose of the research was to evaluate clinical course and efficiency of the method of termination of pregnancy in the first end second trimesters by means of antiprogesterone. 384 women aged 15 to 45 in the first end second trimesters of pregnancy were investigated. 300 women had an early pregnancy (range=2-7 weeks) requesting abortion. All these women first took 600 mg antiprogesterone pencroftone ("Pencroft-Fharma", Russia) and 48 hours later - 400 mkg prostaglandin misoprostol. 84 patients with gestation period ranged from 14 to 22 weeks. Their contractility utterly was caused with 400 mg pencroftone and 48 hours later with 400 mkg prostaglandin misopristol. In the first trimester completed abortion was observed in 96,7%, incomplete abortion in 1,7%; missed abortion in 2,3% cases, continuing pregnancy in 1 case. In the second trimester in the case of therapy with pencroftone and prostaglandin E1 misoprostol the clinical effect was observed in 96,4% cases. Antiprogesterone pencroftone is an effective for medical abortion during I-II trimesters of pregnancy. It is characterized by minimal risk of complications in the course and the post abortion period.

Abortifacient Agents, Steroidal↗

PubMed1976

Intrauterine extra-amniotic 15(s)-15-methyl prostaglandin f2 alpha for induction of early midtrimester abortion.

Twenty-six patients 13 to 15 weeks pregnant received extraovular 15(S)-15-methyl prostaglandin F2 alpha in a dosage of 1 mg every 18 to 24 hours for three doses. Twenty-five (96%) of the patients aborted; fifteen patients aborted incompletely. The mean induction-to-abortion time was 15.8 hours. A decrease in plasma progesterone levels could not be consistently correlated with abortifacient activity, and there was no statistically significant relationship between abortion time and parity or gestational age. One patient failed to abort after 36 hours of therapy and was aborted by curettage. She was the only patient who developed a postabortion uterine infection. Results with the extraovular technique appear to be similar to those with the intra-amniotic and the intramuscular prostaglandin techniques. Therefore, extraovular administration may be useful for inducing abortion in patients who are in the early midtrimester of pregnancy.

Abortion, Induced↗

PubMed2002

Socio-demographic characteristics of adolescent post-abortion patients in Blantyre, Malawi.

BACKGROUND: Unsafe sex, unwanted pregnancy and unsafe abortion are some of the emerging adolescent reproductive health challenges in Malawi. OBJECTIVES: To study socio-demographic characteristics of adolescent post-abortion patients and that of their male partners, with the aim of better understanding the determinants of adolescent fertility in Malawi, thus facilitating design of appropriate intervention strategies. DESIGN: A descriptive, cross-sectional study. SETTING: The Queen Elizabeth Central Hospital, Blantyre, Malawi. SUBJECTS: A total of 446 out of 465 eligible adolescents managed for incomplete abortion during the study period were enrolled from January 1st to December 31st 1997. RESULTS. Their mean age was 17.5 years (SD +/- 1.3), while that of their male partners was 22.4 years (SD +/- 3.4). The unmarried adolescents comprised 43.9% and students 38.6%. About 30.0% had attained secondary school level of education. The mean age at sexual debut was 15.7 years (SD +/- 1.75), about a year after that at menarche (14.3 years, (SD +/- 1.4)). The mean number of sexual partners they had had was 1.5 (SD +/- 0.86), the highest being 10. The index pregnancy was reportedly unwanted in 45. 1% of the total. The rate was higher among the young, single and students. They were also less likely to have informed their partners about the pregnancy or the abortion (p = 0.0001). About 52.8% of the female students were involved with fellow male students. Of the married adolescents, 4.4% reported having had extramarital affairs. CONCLUSION: There is need to design appropriate programmes to promote safe sex and reduce unwanted pregnancy and unsafe abortion with its potential sequelae among adolescents in Malawi.

Abortion, Incomplete↗

PubMed2000

Group B streptococcal meningitis complicating elective abortion: report of 2 cases.

The incidence of invasive disease due to Streptococcus agalactiae (group B streptococcus [GBS]) in adults is on the rise; however, meningitis in adults due to GBS remains rare. We report 2 cases of GBS meningitis complicating elective abortion, 1 of which was a septic incomplete abortion. Only 1 case of bacterial meningitis complicating elective abortion has been reported previously.

Abortion, Septic↗

PubMed1980

The use of prostaglandin E1 analogue pessaries in patients having first trimester induced abortions.

A new prostaglandin analogue, 16,16-dimethyl=trans-delta 2-PGE1 methyl ester (16 me E1) was used for preoperative cervical dilatation in 23 pregnant women who had abortion induced for socio-economical reasons in the first trimester of pregnancy. A single vaginal pessary containing 1 mg 16 me E1 was inserted into the posterior fornix at 3-hour intervals. Thirteen (56.5 per cent) of the 23 patients had complete abortions and two patients (8.7 percent) had incomplete abortions. In six patients (26.1 per cent) the cervix was dilated to at least 10 mm and the remaining two patients (8.7 per cent) required mechanical dilatation at the time of vacuum evacuation. Apart from mild gastrointestinal symptoms, no serious side effects were noted. It is concluded that the new prostaglandin analogue, 16 me E1, could be used safely and effectively for preoperative dilatation of the cervix before surgical abortion in early pregnancy.

Abortion, Induced↗