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PubMed1981

Behavioral factors contributing to abortion deaths: a new approach to mortality studies.

One hundred six women were reported to have died from abortions (55 legal, 10 illegal, and 41 spontaneous) in the United States from 1975 through 1977. In reviewing these deaths, the authors developed a new approach to mortality studies. A catalogue was compiled of behavioral factors (including actions by physicians, patients, communities, and institutions) that in the authors' judgment increased the risk of death from abortion. The proportion of abortion deaths to which each behavioral risk factor contributed was determined. Of the 199 different behavioral factors, 5 contributed to more than 10% of legal abortion deaths, 5 to more than 10% of illegal abortion deaths, and 3 to more than 10% of spontaneous abortion deaths. The most frequent factors involved were delay in obtaining a legal abortion until 13 weeks' gestation or later, incomplete abortion, and inappropriate choice of antibiotics for septic abortion. Assessing the proportion of abortion deaths to which each factor contributed can help identify which factors deserve priority in prevention.

Abortion, Legal↗

PubMed1994

[Termination of early pregnancy by two regimens of mifepristone with misoprostol: a multicentre clinical trial].

Six hundred women in early pregnancy (< 49 days), who requested medical abortion were randomly allocated into 3 groups. In group 1 (n = 301), an initial dose of mifepristone 50 mg was given, followed by 25 mg every 12 hours up to a total dose of 150 mg mifepristone, plus a single oral dose misoprostol 600 micrograms in the morning of the third day. In group 2 (n = 150), the same regimen of mifepristone was given, but dl-15-methyl-PGF2 alpha (PG05) 1 mg vaginal suppository was inserted on the third day. In group 3 (n = 149), a single dose of mifepristone 200 mg was given and misoprostol 600 micrograms was used as in group 1. The complete abortion rate were 95.3%, 97.3% and 95.4% incomplete abortion rate were 3.0%, 2.0% and 2.6% for group 1, 2 and 3, respectively. No significant difference of the two rates was shown among these 3 groups approximate 82% of the women had lower abdominal pain. The overall, occurrence of diarrhea in PG05 group (38.7%) was significantly higher than that in the other 2 groups (21.6 and 20.1%, respectively) (P < 0.001), and so was the occurrence of vomiting. It was concluded that misoprostol, as an orally-effective prostaglandin, in combination with 2 regimens of mifepristone for induced abortion during early pregnancy was as effective as PG05 vaginal suppository. In addition, it has the advantages of convenience for use, less side effects, easy storage and transfer, and low cost.

Abortion, Induced↗

PubMedDate not supplied

[Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion].

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D and C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 +/- 2.40 vs 9.73 +/- 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 +/- 4.80 vs 22.68 +/- 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D and C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

Abortion, Incomplete↗

PubMed1988

Termination of early pregnancy by the 3 beta-hydroxysteroid dehydrogenase inhibitor epostane.

Progesterone is essential to sustain pregnancy in the first eight weeks. Its synthesis requires the enzyme 3 beta-hydroxysteroid dehydrogenase (3-HSD). We tested the efficacy of an orally administered 3-HSD inhibitor, epostane, in terminating unwanted early pregnancy. Fifty women in the fifth through eight weeks of pregnancy took epostane (200 mg orally every six hours) for seven days. By day 14, pregnancy had been terminated in 42 of the 50 patients (84 percent). Eight women (16 percent) did not abort and underwent dilation and curettage. Vaginal blood loss occurred on average on the third day of epostane treatment, and abortion on the fifth day. Two patients had incomplete abortions; one required a transfusion because of blood loss. Nausea was frequent (in 86 percent), but 76 percent of the participants concluded that epostane was preferable to dilation and curettage. The mean (+/- SD) pretreatment progesterone level (76 +/- 16 nmol per liter) decreased by day 7 (to 16 +/- 11 nmol per liter) and day 14 (to 10 +/- 9 nmol per liter) in those who aborted; levels of human chorionic gonadotropin also decreased from the mean at base line (73 +/- 72 kIU per liter) to 18 +/- 7 kIU per liter on day 7 and 9 +/- 5 kIU per liter on day 14. In those who did not abort after epostane treatment, progesterone levels decreased only slightly by day 7 (to 52 +/- 21 nmol per liter) and rose again (to 81 +/- 18 nmol per liter) by day 14. Among women who responded to epostane, normal menstrual periods had resumed by day 42 after the beginning of treatment in 72 percent. We conclude that epostane taken orally is an effective and safe method for the noninvasive termination of undesired early pregnancy.

3-Hydroxysteroid Dehydrogenases↗

PubMed1995

Reproductive health clinic raided and closed in Bogota, Colombia.

On December 17, armed criminal investigative forces acting under the direction of Colombia's secretary and deputy secretary of health, brutally raided the main clinic of the Orientame reproductive health care federation in Bogota, Colombia. Allegedly responding to charges that the clinic was providing abortions, investigators entered the clinic without warning, brandishing automatic weapons. Once inside, they threatened and physically assaulted patients and clinic staff, destroyed office equipment, broke down doors, and ordered the clinic to close. Since its founding in 1977, Orientame has become Colombia's second largest non-governmental family planning organization. The federation, consisting of three clinics, provides a full range of obstetric, gynecological, and information services, including family planning counseling, cancer screening, treatment for sexually transmitted diseases, prenatal care, adoption placement and counseling, and treatment of incomplete abortion. Serving approximately 250,000 women in its 17 years of operation, Orientame has a sliding fee scale and often waives costs for women who are unable to pay. Were Orientame to close its doors permanently, women facing complications from unsafe abortions but unable to pay private doctors would be forced to go to public hospitals and risk arrest. Despite the country's prohibition of abortions not necessary to save a woman's life, an estimated 288,400 Colombian women underwent abortions in 1989; 57,680 were hospitalized for complications from unsafe or incomplete procedures.

Abortion, Induced↗

PubMed1988

The dynamic changes of several reproductive hormones during termination of early pregnancy by RU486 in combination with PG-05 in Chinese women.

8 pregnant women (below 49 days of amenorrhea) were administered 600 mg RU486 orally in a single dosage, and 1 mg PG-05 as a vaginal suppository 48 h afterwards. The plasma beta-hCG, progesterone, 17 beta-estradiol and PGFM (13,14-dihydro-15-keto-PGF2 alpha) were determined by RIAs throughout the treatment. In all 8 cases, beta-hCG and progesterone levels fell following the onset of bleeding, which happened in a mean time of 39 h after RU486 administration. In 7 women who experienced complete abortion, E2 dropped after 72 h and PGFM increased two-fold within 48 h. In comparison with these results of complete abortion, the concentrations of E2 in the woman experiencing incomplete abortion were much higher, while those of PGFM were much lower. The results suggest that the primary action site of RU486 is probably in the decidual tissue, because of the progesterone-antagonistic property of RU486, which in turn leads to the drop in beta-hCG, progesterone and E2. It also indicates that RU486 may facilitate the production of endogenous prostaglandins, which can be explained by the changes of decidual tissue induced by RU486.

Abortifacient Agents↗

PubMed1985

Progesterone receptor blockage. Effect on uterine contractility and early pregnancy.

RU 486 is an antiprogestin which acts at the receptor level. In the present study the effect of this compound on uterine contractility and sensitivity during early pregnancy was evaluated in 10 patients. Five patients in the 6th to 7th week of pregnancy received 25 mg RU 486 twice daily for four days. On the fourth day of treatment, uterine contractility was recorded. The remaining five early pregnant patients were untreated and served as control. Withdrawal of progesterone locally by RU 486 treatment resulted in the development of a regular uterine activity which was in sharp contrast to the low level contractility pattern found in the untreated control patients. Also the sensitivity to prostaglandin increased following RU 486 treatment. The efficacy of a sequential therapy of RU 486 and the PGE analogue 16-phenoxy-tetranor-PGE2 methyl sulfonylamide for termination of early pregnancy was also studied. Thirty-four early pregnant women (duration of amenorrhea for up to 49 days) admitted to the hospital for termination of their pregnancy volunteered for the study. The patients received 25 mg RU 486 twice or four times daily for four days. In the morning of the fourth day of RU 486 treatment, a small dose (0.25 mg) of the PGE analogue was given as a single intramuscular injection. The combined treatment resulted in complete abortion in 32 patients (94%). One patient experienced an incomplete abortion and in one patient the pregnancy continued unaffected.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortifacient Agents, Nonsteroidal↗

PubMed1993

Methotrexate and misoprostol for early abortion.

Methotrexate is cytotoxic to trophoblast and, in low doses, has minimal side effects. It is used to treat both gestational trophoblastic neoplasia and ectopic pregnancy. The cytotoxic effects of methotrexate on intrauterine trophoblast should be equivalent. To test this hypothesis, ten pregnant women, < 8 weeks' gestation were treated with methotrexate 50 mg/m2 intramuscularly followed 3 days later by misoprostol, a prostaglandin E1 analogue. The first 4 patients received misoprostol 600 micrograms orally; none aborted soon after the misoprostol. Two patients aborted 25 and 26 days after the methotrexate injection and two elected a suction abortion after 14 days (one by choice and one because the pregnancy was still viable). The last 6 patients received misoprostol 800 micrograms vaginally and aborted within 3-8 hours. One patient had an incomplete abortion requiring a suction curettage 34 days after the misoprostol. Vaginal bleeding for these 6 patients lasted an average of 29 +/- 11 days (range, 12-42 days). No methotrexate side effects were observed. Vaginal misoprostol (800 micrograms) was significantly more effective (p = 0.005) than oral misoprostol (600 micrograms) in effecting abortion after intramuscular methotrexate.

Abortion, Induced↗

PubMed1979

Use of prostaglandin, hypertonic saline and oxytocin for second-trimester abortion.

The management of second-trimester abortion is still not satisfactory with respect to safety and side-effects; it is considered to be in a state of evolution. The goal of this investigation has been to combine, in reduced quantity, prostaglandin and hypertonic saline in order to minimize the complications and side-effects associated with the separate administration of each component. This study documents the results of a random sample of 385 abortions performed in the second trimester, induced by intra-amniotic instillation of prostaglandin (20 mg) and NaCl 5 and 10 g in different volumes and concentrations augmented with oxytocin. In a series of 20 patients, the coagulation profile is presented and the clinical characteristics of 4 groups are compared. This study demonstrated no coagulation defects. The gastrointestinal side-effects were reduced. In spite of the reduced dosage of each component, the instillation abortion interval still remained 17.08 h on the average. Incomplete abortion ranged from 32% to 48.78%. The data presented in this report suggests that combination of prostaglandin, hypertonic saline and oxytocin is feasible for midtrimester abortion.

Abortion, Induced↗

PubMed1978

Bacteriologic culture results obtained before and after elective midtrimester urea abortion.

Twenty patients undergoing elective midtrimester abortion by urea amnioinfusion had bacteriologic culture data obtained before and after the procedure. Despite the presence of pathogens in the vagina and cervix prior to the procedure, only 20% of patients exhibited endometrial growth following abortion. Factors that seem to favor such endometrial growth include increased injection-abortion intervals and the requirement for curettage to manage incomplete abortion.

Abortion, Induced↗

PubMed1989

[Experiences with the antigestagen mifepristone (RU 486) in the interruption of early pregnancy].

50 healthy women (mean age 29.9 +/- 6.4 years) with early unwanted pregnancy (mean duration 39.3 +/- 2.9 days post menstruationem) received a single oral dose of 600 mg of Mifepristone. Uterine bleedings occurred in all patients within 8 to 110 hours (43 +/- 23.3 hours) after the application, but its duration was very different and correlated with the results of treatment. 39 patients reported on an amount of bleeding exceeding by far the menstrual strength. But in most cases this heavy bleeding lasted only 1-3 days. Frequency of complete abortion was 80% (40 women). 4 patients had an incomplete abortion, and in 6 women the pregnancy was unaffected by the treatment. "Medical abortion" provides a novel alternative to the surgical procedure and is fairly accepted by the patients. Its efficacy, however, should be improved by focusing on early pregnancies not exceeding 10 days after the expected menstrual period and, perhaps, the additional usage of low doses of prostaglandin E derivatives.

Abortion, Induced↗

PubMed1997

Vaginal misoprostol administered at home after mifepristone (RU486) for abortion.

BACKGROUND: There have been no US studies published on the effectiveness, safety, time to bleeding, and acceptability of misoprostol administered by vagina at home and repeated, if needed, after mifepristone was administered for abortion in women up to 8 weeks pregnant. METHODS: A prospective trial was conducted with women up to 8 weeks pregnant wanting an abortion. After receiving mifepristone 600 mg orally, subjects self-administered vaginal misoprostol 800 micrograms at home 2 days later. Subjects returned within 7 days, and if the gestational sac was still present on ultrasound, a repeat dose of misoprostol was administered in the office. Subjects completed a daily symptom log and a questionnaire on the acceptability of the procedures. RESULTS: Of the 166 subjects, 163 (98%) had a complete medical abortion. Three subjects presented with persistent bleeding and an incomplete abortion from 27 to 35 days after taking mifepristone and required surgical intervention. Vaginal spotting or bleeding occurred in 104 (62%) subjects before taking misoprostol, and 18 (11%) did not use misoprostol. Bleeding occurred on average 3.5 hours (SD, 3.2) after taking misoprostol. Six (4%) subjects required a second dose of misoprostol. Gastrointestinal side effects were common, mild, and brief. One hundred fifty-nine (96%) subjects agreed that the procedure went well, and 146 (90%) agreed that home administration of misoprostol was acceptable. CONCLUSIONS: Two days after taking mifepristone, misoprostol administered by vagina was found to be safe, highly effective, and acceptable to women. Since only 6 subjects needed a second dose of misoprostol, conclusions about repeat doses are not possible. This procedure is a promising alternative to surgical abortion.

Abortifacient Agents, Nonsteroidal↗

PubMed1992

Improved sensitivity and specificity of a single measurement of serum progesterone over serial quantitative beta-human chorionic gonadotrophin in screening for ectopic pregnancy.

The sensitivity and specificity of a single serum progesterone measurement was compared against two beta-human chorionic gonadotrophin (HCG) measurements 48 h apart in screening for abnormal pregnancy, i.e. ectopic pregnancy, completed or incomplete abortion. Of 1120 patients in the first trimester presenting with a positive urinary pregnancy test, 116/1120 (10.4%) had an ectopic pregnancy, 755/1120 (67.4%) had ultrasonographically confirmed intra-uterine pregnancies, and 249/1120 (22.2%) had abnormal intra-uterine pregnancies documented as complete, incomplete or missed abortions. Of the ectopic pregnancies, 113/116 (97.4%) had a serum progesterone level less than 25 ng/ml while 516/755 (68.3%) viable intra-uterine pregnancies had a serum progesterone level greater than or equal to ng/ml. Of the 1120 patients screened, 402 (35.9%) had both a serum progesterone and two HCG measurements and were eligible for inclusion in this study. Setting a cut-off of 25 ng/ml, the sensitivity and specificity of a single serum progesterone measurement was then compared against two serial HCG measurements, utilizing receiver operating characteristic curves. This analysis demonstrated that a single serum progesterone measurement was significantly more sensitive (P less than 0.05) than two HCG measurements in screening for an abnormal pregnancy. In some patients, a single serum progesterone makes possible the diagnosis of ectopic pregnancy 2 days earlier than two HCG determinations because a second blood sample was not required. We conclude that a single serum progesterone measurement should be added to serial HCG determinations as a standard diagnostic screening test for ectopic pregnancy.

Chorionic Gonadotropin↗

PubMed1987

Serum CRP in the diagnosis and treatment of pelvic inflammatory disease.

The usefulness of serum C-reactive protein (CRP) measurement was studied in a population of 152 patients admitted to a gynaecological emergency unit. Fifty-one of 55 patients with PID had raised (over 10 mg/l) (13-270 mg/l) CRP levels with a mean of 76.1 mg/l. CRP was elevated (12-40 mg/l) in 2 of 18 patients with threatened abortion with successful outcome, in 8 of 28 patients with incomplete abortion, and in 2 of 16 patients with ectopic pregnancy. Furthermore, 6 of 35 patients with noninfectious disorders (ovarian cyst, uterine fibroid, unexplained pelvic pains) had slightly elevated (12-59 mg/l) CRP levels. Thus, in this series a CRP greater than 10 mg/l had good sensitivity (93%) and specificity (83%) in the diagnosis of PID. Furthermore, CRP levels became normal much sooner than did erythrocyte sedimentation rate following effective antibiotic therapy, suggesting that it is useful in monitoring therapeutic response.

Adult↗

PubMed2004

Randomized, double-blind, controlled trial of mifepristone in capsule versus tablet form followed by misoprostol for early medical abortion.

OBJECTIVE: To compare the efficacy and side-effects of mifepristone 75 mg in capsule form versus 150 mg in tablet form followed by misoprostol for medical termination of early pregnancy. STUDY DESIGN: In a prospective randomized, double-blind, placebo-controlled trial, a total of 480 women who were 49 days or less pregnant were randomized by means of a random number table to receive either two tablets in the morning and one tablet 12 h later for 2 days (group A) or three capsules orally twice daily for 2 days, the first dose being double all subsequent doses (group B). After a further 48 h, 600 microg misoprostol was given orally. Successful abortion was defined as complete abortion with no need for surgical aspiration. RESULTS: There were no significant differences between the two study groups in the rates of complete abortion (95.4% in group A versus 96.3% in group B), incomplete abortion (3.8% in group A, 3.3% in group B) and continued pregnancy (0.8% in group A, 0.4% in group B). No significant difference in the duration and amount of vaginal bleeding was observed. The incidence of side-effects, such as vomiting, nausea, headache, diarrhea and lower abdominal pain was similar in the two groups. CONCLUSIONS: Our results indicate that 75 mg mifepristone in capsule form combined with 600 microg misoprostol is as effective and safe as 150 mg mifepristone in tablet form for the termination of pregnancy up to 49 days.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

[The efficacy and acceptability of mifepristone medical abortion with home administration misoprostol provided by private providers linked with the hospital: a prospective study of 433 patients].

BACKGROUND: Until July 2001 medical abortion was only authorized in France in public hospitals or private clinics. A new law effective in July 2001 allows private practitioners (gynaecologists or general practitioners) to provide medical abortion in their offices as long as they are linked to a hospital official agreement. Unfortunately mifepristone was not available outside hospitals before September 2004, so the study was conducted still providing the drugs in the hospital family planning clinic. OBJECTIVE: To evaluate the efficacy and the acceptability of mifepristone medical abortion with home administration of misoprostol provided by private practitioners linked with the hospital. PATIENTS AND METHODS: Four hundred thirty-three women seeking medical abortion before 7 weeks LMP were included between 2 January 2003 and 7 July 2004. All consultations before abortion and 2 weeks after abortion took place in a private provider's office. Drugs were administrated in the hospital family planning clinic: patients were given 3 tablets of mifepristone (600 mg) orally by the midwife and received 2 tablets of misoprostol (400 microg) that they would take at home 48 hours later. In case of any problems or complications, patients could phone or meet their private providers, phone the hospital midwife or go to the hospital emergency service. Private providers received training in medical abortion training and could at any time reach a medical specialist in the hospital family planning clinic for information or to refer a patient. RESULTS: - Efficacy was evaluated for 339 women, because 94 patients were lost to follow-up (21.7%). Efficacy of medical abortion was 93.8% (318/339). There were 21 surgical aspirations (6.2%): for women's decision in 1.5% of cases, for medical decision without complications in 3.5% of cases, and for failure of the method in 1.2% of cases (2 ongoing pregnancies and 2 heavy haemorrhages with transfusion). The family planning midwife received a phone call from 21 patients after mifepristone (4.8%), Twenty-five patients had an emergency consultation (5.7%), and 22 patients went back to their private providers before their appointment for follow-up (5%). Twenty-two patients (5%) were referred by the private provider to the hospital medical specialist. Acceptability is known for 26% of patients; 96.2% thought that the abortion procedure was acceptable. DISCUSSION AND CONCLUSIONS: The failure rate of medical abortion in this study is largely due to aspirations for incomplete abortion. To improve the efficacy of medical abortion offered by private providers linked with the hospital, all the relevant professionals (private providers, residents in the emergency service, family planning providers) must be well trained in medical abortion, especially in how to interpret and react to ultrasound images obtained in the follow up visit. The procedure is very acceptable to women. Medical abortion offered via a network should be well accepted by practitioners, since only 5% of women will need more than two consultations and only 6.2% will need surgical aspiration in the hospital. This study allows us to be optimistic about the expansion of medical abortion in France outside the hospital via a provider-hospital network based on the fact that since September 2004 private providers can get mifepristone directly in the pharmacies of the city.

Abortifacient Agents, Nonsteroidal↗

PubMed2001

Mifepristone followed on the same day by vaginal misoprostol for early abortion.

We performed a pilot study to examine the clinical efficacy of mifepristone 200 mg followed on the same day by misoprostol 800 microg vaginally in women with pregnancies up to 49 days gestation. Forty women received mifepristone 200 mg after which they self-inserted misoprostol intravaginally 6 to 8 h later at home. Participants returned for an evaluation, including transvaginal ultrasonography, 24 +/- 1 h after using the misoprostol. Participants who had not aborted received a second dose of misoprostol to administer 48 h after the mifepristone. All participants returned approximately 2 weeks after receiving mifepristone. At 24 h after receiving misoprostol, 37/40 (92%, 95% CI 81-98%) had ultrasonographic evidence of complete abortion. By follow-up 2 weeks after the mifepristone, 40/40 (100%, 95% CI 92-100%) women were felt to have complete abortions. One subject subsequently had a suction aspiration for an incomplete abortion on study Day 44. Nausea, vomiting, diarrhea, and warmth/chills occurred in 38%, 13%, 13%, and 60%, respectively. This pilot study suggests that mifepristone 200 mg, followed on the same day by misoprostol 800 microg vaginally, effects abortion at rates comparable to regimens using the standard time interval of 48 h between medications.

Abortifacient Agents, Nonsteroidal↗

PubMed1979

Plasma HCG levels in patients with bleeding in the first and second trimesters of pregnancy.

The prognostic value of maternal plasma human chorionic gonadotrophin (hCG) determinations, measured by a specific beta-subunit radioimmunoassay, was studied in 188 patients with bleeding between 6 and 20 weeks gestation. The patients were arranged into different subgroups according to ultrasound findings as well as clinical and histopathological evidence. In threatened abortion with successful outcome (50 per cent of all patients studied), the weekly mean hCG values were normal or even slightly elevated. In patients with a blighted ovum, the first hCG level measured was in the normal range in 34 per cent of the patients. In patients who aborted embryo with former life signs hCG values were generally normal before the abortion. The hCG levels were usually low in patients with incomplete abortion and ectopic pregnancy. An initially subnormal level of hCG was associated with a poor outcome of pregnancy in 92 per cent of patients. If the first hCG level was within the normal range the outcome of pregnancy was favourable in 79 per cent of patients.

Abortion, Threatened↗