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PubMed1990

Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography.

During a 25-month period, 193 women with the clinical diagnosis of suspected ectopic pregnancy had transabdominal and endovaginal sonograms. Most had quantitative determinations of serum human chorionic gonadotropin (HCG). Endovaginal sonography was diagnostic of ectopic pregnancy in 23 (38%) of the 60 patients with surgically proved ectopic pregnancies: transabdominal sonography was diagnostic in 13 patients (22%). All 83 intrauterine pregnancies were identified with endovaginal sonography, compared with 34 identified with transabdominal sonography. Endovaginal sonography was somewhat more helpful in the diagnosis of missed abortion and blighted ovum. Eighty endovaginal sonograms were classified as indeterminate as compared with 141 transabdominal studies. This indeterminate group included patients with complete abortions, ectopic pregnancies without sonographic evidence of an extrauterine gestation, incomplete abortions, and patients with subsequent negative serum levels. As in prior reports, endovaginal sonography was superior to transabdominal sonography in the evaluation of suspected ectopic pregnancies. Overall, endovaginal sonography was diagnostic in 113 patients, whereas transabdominal sonography was diagnostic in 52 patients. The finding of an extrauterine fetal pole or embryo was diagnostic for an ectopic pregnancy. Pelvic fluid, the appearance of the endometrium, and a single positive serum HCG determination were not helpful in making the diagnosis of ectopic pregnancy.

Abdomen↗

PubMed1991

Contraceptive use among women admitted with abortion in Nairobi.

In this study, a total of 519 patients were interviewed. 82.5% had incomplete abortion. The implication of abortion especially when induced is emphasised. Economic implications that are contributed by the youth are stressed. 83.6% of the patients had not used any contraception. The role of contraception in preventing unwanted pregnancy and therefore induced abortion is stressed. The role of the physician in providing contraception and appropriate contraceptive knowledge is discussed.

Abortion, Induced↗

PubMed1988

The antiprogestational agent RU 486 as an abortifacient in early human pregnancy: a comparison of three dose regimens.

Three different regimens of RU 486, a progesterone receptor blocking agent, were compared for their ability to terminate early human pregnancy. One-hundred-fifty-three healthy women with a gestational length less than 49 days from the last menstrual period were recruited to the study and randomly allocated to one of three treatment regimens: 1) RU 486 10 mg x 2 for seven days; 2) RU 486 25 mg x 2 for seven days; or 3) RU 486 50 mg x 2 for seven days. No significant difference in efficacy was seen between the three dose regimens. Treatment with 10 mg x 2 x VII resulted in 73 per cent complete abortions, 25 mg x 2 x VII in 66 per cent and 50 mg x 2 x VII in 64 per cent complete abortions. Response to treatment, measured as reported onset of bleeding and passage of products of conception, however, occurred significantly later on the 10 mg x 2 regimen than on the other two dose regimens. In each treatment group, women who subsequently aborted completely had significantly lower pretreatment levels of hCG than women with incomplete abortion or continuing pregnancy. The treatment was well tolerated by the women and except for one woman who experienced a profound bleeding necessitating a blood transfusion, no serious side effects were seen.

Abortion, Induced↗

PubMed1999

Methotrexate and misoprostol for early abortion in adolescent women.

STUDY OBJECTIVE: Investigate the potential effectiveness, side effects, and acceptability of medical abortion in female adolescents. DESIGN: Multicenter cohort study. SETTING: Magee-Womens Hospital (Pittsburgh, PA) and University of British Columbia (Vancouver, BC, Canada). PARTICIPANTS: Twenty-five pregnant adolescents less than 18 years old up to 49 days' gestation. INTERVENTIONS: Methotrexate, 50 mg/m2 intramuscularly, followed 5 to 6 days later by misoprostol, 800 micrograms vaginally, self-administered at home. Misoprostol administration was repeated by a doctor if abortion did not occur within 1 or 2 days. Acceptability was assessed before methotrexate injection and at follow-up 5 weeks later. MAIN OUTCOME MEASURES: Successful abortion (complete abortion without requiring a surgical procedure), immediate success (abortion within 24 hours of initial or repeat misoprostol administration), and acceptability. RESULTS: Complete abortion occurred in 24 of 25 (96%; 95% confidence interval [CI], 88%-100%) subjects. Immediate success abortion occurred in 23 (92%; 95% CI, 81%-100%) of these young women; the remaining subject who aborted did so on study day 10. The single failure was an incomplete abortion. Of the 23 participants who completed the follow-up acceptability evaluation, 4 (17%) believed that the process was a negative experience; 83% of participants would choose this same method again for a future abortion if needed and would recommend this method to a friend. Those who would not try this method again were without support of another individual at the time of the abortion. CONCLUSIONS: This medical abortion regimen is effective in adolescents. The overall acceptability in adolescents is similar to that reported for women 18 years of age or older. To minimize the likelihood of a negative experience with this abortion method in adolescents, home support for these patients should be evaluated during pretreatment counseling.

Abortifacient Agents, Nonsteroidal↗

PubMed1990

Induction of abortion in early pregnancy with mifepristone.

Seventy women requesting first trimester abortion and with amenorrhea of less than 42 days were treated with a single 600-mg dose of mifepristone. Mifepristone is a synthetic 19-norsteroid with strong progesterone receptor antagonist properties. Complete abortion was achieved in 56 women (80%), 2 women (3%) had an incomplete abortion and 12 women (17%) had a continuing pregnancy. No relationship between rate of success and gestational age could be demonstrated. There was no serious side effects and the treatment was favorably received by the women concerned. It is concluded that this treatment is a safe and very acceptable alternative to vacuum aspiration for termination of early pregnancy.

Abortion, Induced↗

PubMed1982

Termination of second trimester pregnancy by intramuscular injection of 16-phenoxy-omega-17,18,19,20-tetranor-PGE2 methyl sulphonylamide.

Two doses of the prostaglandin analogue 16-phenoxy-omega-17,18,19,20,-tetranor-PGE2 methyl sulphonylamide were compared in a randomized multicentre trial in 6 centres for the termination of second trimester pregnancy. A total of 295 patients were treated with either 0.5 mg or 1.0 mg given by intramuscular injection every 4 h or 8 h, respectively. The 1-mg dose was more effective in inducing an abortion than the lower dose but the difference was not statistically significant. Eighty-four per cent of the patients aborted within 30 h from the onset of treatment. The induction-abortion interval was approximately 15 h in both groups. The incidence of incomplete abortion, heavy blood loss and blood transfusion was similar for both treatments. Cervical lacerations occurred in 1.3% of patients given the smaller dose and 2.1% of the larger dose. In one patient belonging to the latter group an anterior rupture of the lower uterine segment was diagnosed necessitating hysterectomy. Fifty per cent of the patients had no vomiting and 90% no diarrhea. The frequency of gastrointestinal side effects was slightly higher with the 1-mg dose. The major advantages of this treatment are the simplicity of administration and the low frequency of gastrointestinal side effects in comparison with prostaglandin F analogues.

Abortifacient Agents↗

PubMed1997

A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second-trimester abortion.

OBJECTIVE: To compare the abortifacient efficacies of two intravaginally administered misoprostol doses and gemeprost in termination of second-trimester pregnancy. METHODS: Eighty-one women between 12 and 24 weeks' gestation requesting abortion were randomized to receive intravaginally either 100 micrograms of misoprostol at 6-hour intervals (n = 27), 200 micrograms of misoprostol at 12-hour intervals (n = 26), or 1.0 mg of gemeprost at 3-hour intervals (n = 28). The regimen was continued until abortion, or for 36 hours, with assessment of the rate of complete and incomplete abortions as well as side effects within 48 hours from the start of the treatment. RESULTS: The final rates of terminations were 74% in the 100-microgram misoprostol group, 92% in the 200-microgram misoprostol group, and 89% in the gemeprost group. Abortion was complete in 37%, 61%, and 32% in each group, respectively (P = .03, when the 200-microgram misoprostol group was compared with the two other groups). The induction-to-abortion interval was longer (P = .001) in the misoprostol groups (mean 23.1 hours for the 100-microgram and 27.8 hours for the 200-microgram dose) than in the gemeprost group (14.5 hours). There was less pain (P = .01), diarrhea (P = .001), and vomiting (P = .01) in the misoprostol groups than in the gemeprost group. The mean blood loss in the misoprostol groups was lower than in the gemeprost group (P = .001). CONCLUSION: Intravaginal application of 200 micrograms of misoprostol at 12-hour intervals in induction of second-trimester abortion is equally effective to a standard gemeprost regimen. Misoprostol causes fewer side effects and is cheaper and more practical to use.

Abortifacient Agents, Nonsteroidal↗

PubMed1975

Termination of second trimester pregnancy with intra-amniotic 15 (S) 15 methyl prostaglandin F-2alpha - a two dose schedule study.

Termination of second trimester pregnancy with intra-amniotic administration of 15 (S) 15 methyl prostaglandin F-alpha (15 me F-alpha) was attempted in fifty patients. One group (26 patients) was given 1 mg of the analogue and the other group received 2.5 mg. The abortifacient efficacy of 15 me F-2alpha was similar in both groups; over 90% of the patients aborted with a single dose. There was a higher incidence of vomiting, diarrhoea and incomplete abortions in the group treated with 2.5 mg 15 me F-2alpha. Although the mean injection-abortion interval in the 2.5 mg group was shorter, it is concluded that intra-amniotic administration of 1 mg 15 me F-2alpha provides a better regime, giving high efficacy with a single dose, a low incidence of side effects and greater safety in case of inadvertent entry of the intra-amniotic dose into systemic circulation.

Abortion, Induced↗

PubMed2006

Induction of second trimester abortion (12-20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases.

DESIGN: A retrospective analysis of 386 women who underwent termination of pregnancy between 12 and 24 weeks' gestation. METHODS: Each woman received 200 mg mifepristone orally followed by vaginal misoprostol 800 microg 36 to 48 h later. Three hours after the initial misoprostol administration, 400-microg doses of vaginal misoprostol were administered every 3 h, to a maximum of four doses in 24 h. If abortion failed, 200 mg mifepristone is given again 3 h after the last misoprostol dose, followed by 12 h of rest before vaginal misoprostol administration is repeated as per previous course of treatment. RESULTS: Overall, 97.9% and 99.5% of the women aborted within 24 and 36 h, respectively. The median induction-to-abortion interval was 6.7 h (range: 1.4-73.8 h), and nulliparous women took significantly longer time to abort (6.0 h in multiparous women compared to 7.6 h in nulliparous women; p<.0001). One woman failed to abort within 48 h. Surgical evacuation of the uterus was performed in 5% of women for incomplete abortion or retained placenta. Multiparous women were less likely to need analgesic administration for pain relief, and to experience vomiting and diarrhea, than nulliparous women. CONCLUSION: The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and noninvasive regimen for termination of pregnancy between 12 and 20 weeks.

Abortifacient Agents, Nonsteroidal↗

PubMed1979

The comparative efficacy and safety of intraamniotic prostaglandin F2 alpha and hypertonic saline for second-trimester abortion. A review and critique.

Intraamniotic instillation of prostaglandin F2 alpha (PGF2 alpha) is considered by many to be safer than instillation of hypertonic saline for second-trimester abortion. To evaluate the validity of this hypothesis, we reviewed 15 comparisons of these two abortifacients published in the English literature since 1973. These reports suggest that while PGF2 alpha induces abortion faster than saline, PGF2 alpha is associated with higher rates of unpleasant gastrointestinal side effects, incomplete abortion, hemorrhage and surgical reevacuation. In addition, the rate of live-born fetuses after PGF2 alpha-induced abortion may be 5 to 40 times that of saline. The existing literature does not substantiate the claim that PGF2 alpha is superior to saline as an abortifacient.

Abortifacient Agents↗

PubMed1978

[Extraamniotic induction of abortion with a new prostaglandin E-2 derivative].

First clinical results are reported of a new prostaglandin-E2-derivative (16-phenoxy-prostaglandin-E2-methylsulfonylamide = SHB 286) as abortifacient using the extraamniotic route of application. Upon investigation in animals this prostaglandin-E2-derivative proved to be more tissue-selective and more potent in inducing abortion than the naturally occurring prostaglandins. Prostaglandin SHB 286(50 or 100 microgram) was applicated to 31 patients for legal abortion and to 7 patients with a missed abortion. The mean instillation-abortion time was 14.2 and 13.7 h respectively. 96% of the patients had a complete or incomplete abortion after 24 hours. Severe local or systemic side effects did not occur and the patients did not need any further medication.

Abortion, Induced↗

PubMed2006

Success rate of second-trimester termination of pregnancy using misoprostol.

OBJECTIVE: To evaluate the efficacy and maternal side effects of misoprostol usage for second trimester termination in Siriraj Hospital. STUDY DESIGN: Descriptive cross sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: The medical records of 94 pregnant women, between 14-28 weeks of gestation, who were admitted for medical termination of pregnancy, were reviewed. Each patient received 400 microg of misoprostol vaginally every 12 hours as recommended by RTCOG for termination of pregnancy. Main outcome measures included success rate of abortion within 48 hours, induction to abortion interval and maternal side effects. RESULTS: The success rate of abortion within 48 hours was 89.46%. Mean induction to abortion interval was 22.1 hours. The most common maternal side effect was fever (24.5%). The rate of incomplete abortion was 28.6% of successful cases. No factor, including age, parity and viability of fetus affected the success rate significantly. No serious maternal complication was detected. CONCLUSION: Misoprostol 400 microg vaginally every 12 hours can be used effectively and safely for second trimester pregnancy termination.

Abortifacient Agents, Nonsteroidal↗

PubMed2001

[Clinical observation on effect of xuejie jiawei decoction on vaginal hemorrhagic amount and duration in patients after drug-abortion].

OBJECTIVE: To observe the effect of Xuejie Jiawei Decoction (XJJWD) in reducing vaginal hemorrhagic amount, shortening hemorrhagic duration and lowering the curettage rate of incomplete abortion in patients after drug-abortion. METHODS: Group A was treated with XJJWD No. I from the 2nd day after abortion, one dose per day for 7 days. Group B was treated with XJJWD No. II from the 11th day after abortion, one dose per day for 5 days. The therapeutic effect of the two groups was compared with that of the untreated control group. RESULTS: In the Group A, the total score on vaginal hemorrhagic amount was markedly less than that in the control group (P < 0.01), and the vaginal hemorrhagic duration in patients with menostasis less than 45 days was shorter than that in the control group (P < 0.01). In the Group B, the total score on vaginal hemorrhagic amount in patients with menostasis less than 45 days was lower than that in the control group (P < 0.05). CONCLUSION: XJJWD could reduce the vaginal hemorrhagic amount and duration in patients after drug-abortion. It should be applied early after abortion, the less the duration of menostasis, the more effective the treatment.

Abortifacient Agents, Steroidal↗

PubMed1978

The role of methylergonovine maleate in augmenting extraamniotic saline for midtrimester abortion.

This study was conducted in Bombay, India, to evaluate the role of oral methylergonovine maleate (Methergine, Sandoz Pharmaceuticals, East Hanover, N.J., USA) in augmenting the effect of intermittent extraamniotic instillation of 20% saline for midtrimester abortion in 200 patients. Methylergonovine maleate (MEM) administration was randomly allocated to half the study subjects. All the study procedures were performed by a single operator, and to minimize evaluator bias, another physician evaluated all the study patients after abortion. This study showed that a statistically significant higher percentage of patients in the MEM treated group aborted within 24 hours. At 36 and 48 hours, the differences were not statistically significant, although the cumulative abortion rates were higher for subjects who received the drug than for those who did not. The incidence of incomplete abortions was lower for those treated with MEM than for those not treated with the drug, but the difference was not statistically significant. The rates of complications and side effects were similar for both study groups.

Abortion, Induced↗

PubMed1993

The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol.

Although it has been demonstrated that a combination of mifepristone and a prostaglandin is an effective method of inducing abortion in early pregnancy, the optimum dose of the antigestogen is unknown. Women (n = 220) requesting abortion in early pregnancy (< or = 63 days amenorrhoea) were randomized to receive a single dose of either 600 or 200 mg mifepristone followed 48 h later by a single dose of 600 micrograms misoprostol by mouth. The percentage of women who had a complete abortion (93.6% confidence interval 90.4-95.5%) was identical in the two groups. There was no significant difference in the number of women who passed the fetus within 4 h of receiving the prostaglandin (64 versus 74%), the days of bleeding (14.6 +/- 1.1 versus 15.3 +/- 0.9) nor in the onset of the next period (39.7 +/- 1.3 versus 36.7 +/- 1.3) respectively between the groups receiving 200 or 600 mg mifepristone. However, the complete abortion rate was significantly higher in women < or = 49 days compared to women 50-63 days amenorrhoea (97.5 versus 89.1% respectively; P < 0.02). There was no difference in any of the other parameters at different weeks of gestation. We conclude: (i) that the recommended dose of mifepristone could be reduced from 600 to 200 mg without loss of clinical efficacy, (ii) that the combination of mifepristone and 600 micrograms misoprostol is a highly effective alternative to vacuum aspiration for inducing abortion in women < 50 days amenorrhoea and (iii) at gestation > 56 days, this combination may result in too many incomplete abortions to be clinically acceptable.

Abortion, Induced↗

PubMed2000

Vaginal misoprostol in termination of second trimester pregnancy.

OBJECTIVE: To study the effectiveness and complications of 600 micrograms of intravaginal misoprostol for terminating second trimester pregnancies. STUDY DESIGN: One hundred and seventy-two patients undergoing termination of pregnancy between March 1997 and April 1999 were studied. Each patient received 600 micrograms of intravaginal misoprostol every 12 hours until abortion occurred. RESULTS: The mean induction to abortion time was 24.1 +/- 21.6 hours. The percentage of women aborting within 24 and 48 hours was 68.6 and 89.5 respectively. There was no significant difference in the mean induction to abortion time and the percentage of women aborted within 48 hours between nulliparous and multiparous women. The mean amount of misoprostol used was 1405.5 +/- 1084.6 micrograms. Incomplete abortion occurred in 23.3% of women. The most common complication was temperature of more than 38 degrees C occurred in 41% followed by diarrhoea (20%), nausea and vomiting (15%). CONCLUSION: Six hundred micrograms of vaginal misoprostol is effective, but whether the 48 hours abortion rate can be improved with a large dose or shortened the time interval between doses, requires further study.

Abortifacient Agents, Nonsteroidal↗

PubMed2003

[Medical termination of pregnancy with mifepristone--initial experience at the Sheba Medical Center].

OBJECTIVE: To assess the early implementation of medical termination of pregnancy as an alternative treatment option for women in early pregnancy who wish to avoid a surgical procedure. METHODS: The use of mifepristone (RU-486) for medical termination was recently approved in Israel. We performed a prospective follow-up study of the 189 women who underwent medical termination of pregnancy with mifepristone and misoprostol in our center between January 2000 and April 2001. RESULTS: Complete outcome data was obtained for 176 women. Within this group 152 women (86.4%) did not need any surgical procedure to complete the abortion. Uterine curettage was performed in 17 (9.6%) and operative hysteroscopy in 7 (4.0%) of the women because of incomplete abortion or suspected residua of pregnancy. CONCLUSION: Medical abortion offers an efficient and safe treatment option to women who wish to avoid surgical evacuation.

Abortifacient Agents, Steroidal↗

PubMed1996

Abortion induced with methotrexate and misoprostol.

OBJECTIVE: To determine the outcome and side effects of a new drug protocol to induce abortion. DESIGN: Case series. SETTING: An urban primary care practice. PATIENTS: One hundred consecutive patients who requested elective termination of pregnancies of less than 8 weeks' gestation. INTERVENTION: Subjects received methotrexate (50 mg/m2 body surface area, administered intramuscularly) and, 3 days afterward, misoprostol (800 micrograms, given vaginally). OUTCOME MEASURES: Number of abortions induced within 24 hours and within 10 days of misoprostol administration, number of surgical aspirations conducted because of incomplete abortion, mean amount of bleeding and pain and the number of women who, if faced with the same situation, said they would again choose a drug-induced abortion over a surgical one. RESULTS: Abortion occurred within 24 hours of misoprostol administration among 48 women and within 10 days among 69 women. In total, 89 women had an abortion without surgical aspiration. Of these women, 71 said they would choose a drug-induced abortion if faced with the choice again. CONCLUSION: Abortion induced with methotrexate and misoprostol appears to be a feasible alternative to surgical abortion and deserves further study.

Abortifacient Agents, Nonsteroidal↗