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PubMed2000

Making legal abortion available in Brazil: partnerships in practice.

This article describes the participation of feminist groups who work in the area of women's reproductive health and rights in campaigns for the provision of legal abortion in public hospitals in Brazil. Brazilian criminal law permits therapeutic abortion in cases where pregnancy is the result of rape or poses a serious risk to the life of the woman. Today, as a result of the combined efforts of feminists, health professionals and policymakers, more than 20 hospitals in Brazil are officially permitted to perform therapeutic abortions within the existing law. A model programme has also been developed to train service providers to do legal abortions, where the agreement of a hospital board can be obtained. This training has also improved care for illegally obtained, incomplete abortions in those hospitals but not in hospitals where doctors have not been trained. Problems with lack of access and concerns about the lack of public acceptance of abortion remain. Women not only need the right to abortion but also more services and health professionals who are trained to perform abortions across the whole country.

Abortion, Legal↗

PubMed1978

[Induced abortion using intrauterine, extra-amniotic administration of prostaglandin F2 alpha in primigravidae].

With 115 nulliparae abortion was induced through intermittend extraamniotic application of PG F2alpha. The intermittend PG-application was successful in 99.13% (81.73% incomplete abortions; 17.40% "missed abortions" with opening of the cervix uteri). In the opposite to others authors "missed abortion" looks as a good result. The mean PG-Dosis was 14,33 mg and the abortion time 15,40 hours.--The rate of morbidity was 6,1 per cent.

Abortifacient Agents↗

PubMed1994

Termination of early pregnancy by two regimens of mifepristone with misoprostol and mifepristone with PG05--a multicentre randomized clinical trial in China.

A multicentre randomized open clinical trial was conducted to compare the efficacy and side effects of two regimens of mifepristone with misoprostol, and mifepristone with PG05 for termination of early pregnancy (amenorrhoea < = 49 days). Six-hundred women in early pregnancy, 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 of 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 94.4%, 97.3%, and 94.6% for group 1, 2 and 3, respectively. 3.0, 2.0 and 2.7% of women had incomplete abortion, and 1.7, 0.7 and 2.0% of women in the 3 groups were treatment failures; in the remaining 1% in group 1 and 0.7% in group 3, treatment outcome could not be determined. There were no significant differences among the 3 groups. Lower abdominal pain was the main complaint which was reported by 82% of the subjects after PGs administration. The incidence of diarrhoea in PG05 group (38.7%) was significantly higher than that in the other two groups (21.6 and 20.1%) (P < 0.001), and so was vomiting. It was concluded that misoprostol, as an orally effective prostaglandin, in combination with mifepristone for induced abortion of early pregnancy was as effective as PG05 vaginal suppository. Besides, it has advantages of convenience of use, less side effects, easy storage and transfer, and low cost.

Abdominal Pain↗

PubMedDate not supplied

Post legalisation challenge: minimizing complications of abortion.

Abortion has been legalized in Nepal since September 2002 by 11th amendment to the Muluki Ain. The present study was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive analyses of the patients who were admitted with history of induced abortion from 16th Dec 2003 to 13th March 2004 was carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is 39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common method used was D and C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly doctors, performed most of the cases of induced abortion and D and C was the most commonly used method. However the patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries, performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural order.

Abortion, Induced↗

PubMed1977

A clinical comparison of prostaglandin F2alpha and intra-amniotic saline for induction of midtrimester abortion.

The relative safety and effectiveness of hypertonic saline and intra-amniotic prostaglandin F2alpha (PGF2alpha), when used under clinical rather than research conditions, were evaluated for 100 patients aborted with a 20% saline solution, and 100 patients aborted with PGF2alpha (40 mg initially and an additional 20 mg if abortion had not occurred in 24 hours). While the overall risk of morbidity was similar for the two procedures, rates of incomplete abortion were higher with prostaglandin (51.0%) than with hypertonic saline (35.0%). The prostaglandin procedure, however, was associated with a significantly shorter median time from instillation to abortion of the fetus (25.3 versus 34.5 hours).

Abortion, Induced↗

PubMed1997

Efficacy of methotrexate and misoprostol for early abortion.

BACKGROUND: Medical termination of pregnancy (medical abortion) as an alternative to surgical abortion has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, we evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion. METHODS: The study population consisted of 32 women seeking abortion of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/m2 intramuscularly and the dose of misoprostol was 800 micrograms intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure. RESULTS: Abortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +/- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment. CONCLUSION: The use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this medical abortion, a comparison with RU 486 in prospective controlled randomized trials is necessary.

Abortifacient Agents, Nonsteroidal↗

PubMed1989

Spontaneous abortion.

As a result of improved investigation and treatment techniques, understanding of all aspects of spontaneous abortion has improved. The term "threatened abortion" is often a misnomer, for the fate of the pregnancy is decided when bleeding occurs. A dilated cervix indicates that abortion is inevitable. If the cervix is not dilated, pelvic ultrasonography will usually show the following: a live fetus, an anembryonic pregnancy, incomplete abortion or missed abortion. If fetal heart movement is seen, no further treatment is needed and the prognosis is excellent (98% fetal survival). In other cases, the uterus must be evacuated, with a Karman catheter if the uterus is small, with a suction curette if the uterus is large. Forceful dilation of the cervix is avoided through the use of Laminaria.

Abortion, Septic↗

PubMed2006

Misoprostol for termination of second trimester pregnancy in a scarred uterus.

OBJECTIVE: To investigate whether Misoprostol for mid-trimester pregnancy interruption in women with a scarred uterus has any adverse effects compared with those without a scar. METHODS: During 5-year period from 2000-2004 at Queen Alia Military Hospital, Royal Medical Services, Amman, Jordan, a consecutive series of 520 women of 15-28 weeks of gestation who underwent termination of pregnancy were studied. Sixty-three patients had undergone at least previous one cesarean section and 457 served as control. Termination was undertaken using Misoprostol 400 ug vaginally as a starting dose followed by 200 ug vaginally every 6 hours, complications for each group were recorded. RESULTS: The induction to abortion time was not significantly different in both groups (p=0.16); the median dosage was almost the same (p=0.31). The rate of incomplete abortion was significantly higher in the study group than control 82% versus 60% and 11.5% versus 6.1% for bleeding of more than 500 cc, while the rate of other complications was almost the same. CONCLUSION: In the second trimester termination of pregnancy, the use of Misoprostol in women with previous single or multiple cesarean sections was not associated with excess complications.

Abortifacient Agents, Nonsteroidal↗

PubMed1994

Syphilitic endometritis causing first trimester abortion: a potential infectious cause of fetal morbidity in early gestation.

This report describes a 30-year-old woman with a history of prostitution and "crack" cocaine use during pregnancy. After an incomplete abortion at 11 weeks' gestation, a suction dilatation and curettage of uterine contents was done. Histopathologic examination revealed lymphoplasmacytic deciduitis and decidual necrosis, as well as rare first trimester chorionic villi. Silver staining using the Steiner technique showed numerous spirochetes, morphologically consistent with Treponema pallidum, in the decidualized endometrial tissues. This case of syphilitic endometritis, which appears to be the first reported, suggests that treponemal infection can cause fetal morbidity during early gestation.

Abortion, Spontaneous↗

PubMed1999

Early pregnancy termination with intravaginally administered sodium chloride solution-moistened misoprostol tablets: historical comparison with mifepristone and oral misoprostol.

OBJECTIVE: The purpose of this study was to compare the abortifacient effect of intravaginally administered moistened misoprostol tablets with that of the combination regimen of mifepristone and oral misoprostol. STUDY DESIGN: One hundred women at </=56 days' gestation received 800 microg misoprostol intravaginally in the form of sodium chloride solution-moistened tablets. The dose was repeated 24 hours later if a gestational sac persisted on ultrasonographic examination. These 100 subjects (group 1) were then matched with 100 subjects who had received 600 mg mifepristone followed by 400 microg misoprostol orally as part of a large multicenter American trial (group 2). Subjects were monitored for abortion success, adverse side effects, and bleeding characteristics. Abortion failure was defined as persistence of an intrauterine sac or the need to perform a surgical evacuation of the uterus for hemorrhage, for incomplete abortion, or at the subject's request. RESULTS: In 88 of the 100 women in group 1 and 94 of the 100 women in group 2, abortion occurred and a surgical procedure was not required. Abortion rates were not influenced by gestational age in either group. Prostaglandin-related side effects of fever and chills, vomiting, diarrhea, and uterine pain were all significantly higher in group 1. Excessive uterine bleeding was uncommon in both groups, and no subjects received blood transfusions. CONCLUSION: The abortion rate with intravaginally administered moistened misoprostol tablets is similar to that with the combination of mifepristone and oral misoprostol. However, intravaginal administration of misoprostol is associated with significantly more prostaglandin-related side effects.

Abortifacient Agents, Nonsteroidal↗

PubMed2000

Safety of extraovular catheter insertion for second-trimester abortion.

OBJECTIVE: To evaluate the efficacy and safety of second-trimester abortions using transcervical catheter insertion and extraovular prostaglandin (PG) administration. METHODS: Ninety women admitted for terminations of pregnancy at 17-24 weeks' gestation had transcervical catheters inserted and extraovular PGE(2) administered. Success rates were recorded, measured by induction of abortion within 24 hours, need for a complement uterine curettage, and complications. RESULTS: The technique induced abortion in 67 women (74.4%). The induction-to-abortion median interval was 12 hours (7 and 22 hours, fifth and 95th percentiles, respectively). Thirty-seven women needed uterine curettages because of incomplete abortions or excessive uterine bleeding after fetal and placenta expulsion. One woman had shivering, weakness, and nausea attributed to systemic absorption of PG, and nine women developed systemic inflammatory response syndrome associated with transcervical catheter insertion. Two of those women had septic shock, one of whom deteriorated to a life-threatening situation. CONCLUSION: Transcervical catheter insertion for extraovular PG administration is effective for inducing second-trimester abortions. Although the method is considered safe, with generally few mild, treatable complications, we observed a high rate of systemic inflammatory response syndrome, bacteremia, and sepsis caused by transcervical catheter insertion before PG administration. A reconsideration of this method's safety is warranted.

Abortion, Induced↗

PubMed1999

[Early medical abortion. An update].

Early medical abortion was introduced in Denmark in 1998. In countries in which this practice has been in use for several years, clinical studies have identified an effective and at the same time gentle regimen. For the time being, this regimen is a combination of the antiprogestogen "mifepristone" and a prostaglandin E1 analogue. Among women with pregnancies up to eight weeks of gestation, 95% will have a complete abortion on a regimen of 600 mg oral mifepristone combined 24 hours later with 1 mg vaginal gemeprost. About five percent will undergo evacuation due to incomplete abortion or heavy bleeding. Although many women experience moderate or severe pain, nausea or vomiting, the tolerability is generally good. Complications wuch as infection or excessive bleeding occur in less than one percent. It is concluded that medical abortion is a good alternative to surgical abortion, and that women who wish an abortion have to be referred to hospital as early as possible in order not to pass the time limit of medical abortion.

Abortifacient Agents, Nonsteroidal↗

PubMed2004

Management of early pregnancy loss.

OBJECTIVES: In order to assess the available evidence on the management of early pregnancy loss, we performed a meta-analysis on the subject. METHODS: MEDLINE and EMBASE were searched for randomized studies reporting on the effectiveness of expectant management, misoprostol treatment or curettage. Outcomes considered were 'complete evacuation', complications, duration of bleeding, pain resulting from the procedure, side effects and women's satisfaction with the procedure. RESULTS: Thirteen studies were identified. Combined data in women with missed abortion managed expectantly or treated with misoprostol showed complete evacuation rates of 28% (49/173) (range 14-47%) and 81% (242/298) (range 60-83%), respectively. In women with incomplete abortion, these rates were 94% (31/33) (range 80-100%) and 99% (75/76) (range 99-100%), respectively. CONCLUSION: In the management of early pregnancy loss both expectant management and misoprostol treatment reduce the need for curettage, but misoprostol treatment seems to be more effective in women with missed abortion as compared to expectant management.

Abortifacient Agents, Nonsteroidal↗

PubMed1979

Experience with midtrimester abortion.

The midtrimester abortion program at a large community hospital was evaluated. During the 3-year study, 1839 patients aborted in the midtrimester by intraamniotic injection of hypertonic saline, prostaglandin F2alpha or a combination of saline and prostaglandin F2alpha. The method, using a combination of saline and prostaglandin F2alpha together with intracervical laminaria, showed significant reduction in the number of failures (4.3 to 1.0%), reduction in the injection-abortion interval from 33.9 to 14.6 hours, shortening of the hospital stay from 2 1/2 to 1 1/3 days, minimum incidence of live abortions (0.9%), infrequent need for oxytocin to effect delivery (7.7%); and low rates of hemorrhage (1.5%) and fever (2.8%). The main disadvantage was an increased rate of incomplete abortions (32.3%), which could be reduced to 27% by patient selection.

Abortion, Induced↗

PubMedDate not supplied

Midwives and postabortion care: experiences, opinions, and attitudes among participants at the 25th Triennial Congress of the International Confederation of Midwives.

Midwifery practice may not include caring for women experiencing complications from unsafe abortion, despite the importance of this care for the health and lives of millions of women around the world. This article summarizes data collected from midwives from 41 countries who attended the 25th Triennial Congress of the International Confederation of Midwives in 1999, focusing on their experiences with, and attitudes toward, the provision of postabortion care. Barriers to provision of postabortion care and factors for changes in postabortion care-related policies were explored. Midwives from developing countries, where complications from unsafe abortion present a serious public health problem, were cognizant of the need to authorize, train, and equip midwives in postabortion care, including the use of uterine evacuation of incomplete abortion with manual vacuum aspiration. Changes in policy and practice are needed throughout the world so that women will have access to quality, compassionate postabortion care services regardless of where they live. Ensuring that midwives are able to provide such services will help to reduce abortion-related morbidity and mortality.

Abortion, Induced↗

PubMed2002

Reducing unplanned pregnancy and abortion in Zimbabwe through postabortion contraception.

In many countries, women treated for complications from spontaneous or unsafely induced abortion lack access to contraceptive services. As a result, many of them soon have a subsequent unplanned pregnancy or a repeat abortion, placing their health at increased risk. This report presents the results of a prospective intervention study on postabortion family planning conducted in the two largest public hospitals in Zimbabwe. Women at Harare Central Hospital, in the capital, received a postabortion family planning intervention, and Mpilo Central Hospital, in Bulawayo, served as the control site. The study cohort was 982 women, 527 of whom were followed for a 12-month period. During the follow-up period, significantly more women used highly effective methods of contraception, significantly fewer unplanned pregnancies occurred, and fewer repeat abortions were performed at the intervention site than at the control site. These results offer compelling evidence that ward-based contraceptive services provided to women treated for incomplete abortion can significantly reduce subsequent unplanned pregnancies. The results also suggest that postabortion family planning services can reduce the incidence of repeat abortion.

Abortion, Induced↗

PubMed2004

How research can affect policy and programme advocacy: example from a three-country study on abortion complications in sub-Saharan Africa.

OBJECTIVE: To provide a basis for continued policy dialogue and reform to address the problem of death due to abortion complications among the ECSA Health Community countries. The anticipated short-term outcome of this study was increased awareness among African health officials about the problem of incomplete abortion in SSA, especially CRHCS/ECSA countries. DESIGN: The study undertaken in 1993/1994, involved primary data collection of abortion-related morbidity and mortality statistics, the cost of treating patients with abortion complications and provider and abortion patient perspectives. Data were collected via one on one interviews and reviews of logbook data. A computerized literature review on abortion in the region covering the years 1980-1994 complemented the primary data collection. STUDY SETTING: Primary data collection was conducted in three countries (Zambia, Uganda and Malawi) at selected districts and tertiary care hospitals. SUBJECTS: Nurses and physicians providing care to women with complications of abortion in participating hospitals were interviewed as well as hospital administrators. Women receiving care in the selected hospitals during the data collection period also were interviewed. MAIN OUTCOME MEASURES: This analysis focused on cross-country comparisons of nurse and doctor attitudes and knowledge about abortion and family planning-related issues. INTERVENTIONS: At a 1994 CHRCS conference, Health Ministers from 12 Commonwealth countries reviewed and endorsed the results of this study. In a 1995 ECSA Director Joint Consultative Committee meeting, participants discussed the study findings and developed regional action plans which were subsequently endorsed by the Health Ministers' at their 1995 annual conference. RESULTS: Abortion complication patients in the three countries were on average 24-26 years old with two children. Patients experienced long hospital stays while receiving care for complications. The average monthly number of post-abortion patients was substantially higher in urban facilities as compared to mixed/rural ones. Opinions regarding factors that led to the abortion, access to abortion services and the legal provisions surrounding abortion were inconsistent between doctors and nurses. Patients were aware that complications of abortion were a major cause of maternal mortality. Overall, provider opinion about access to family planning (FP) information among abortion complication patients was also inconsistent between doctors and nurses but there was agreement on factors influencing use of FP. Opinions regarding access to FP services both before and after the abortion varied from easy to very difficult to obtain. CONCLUSIONS: These data represent the situation as it was in the region some years ago and the paper describes important implications of the findings for policy and programme development. This research provided some impetus for stakeholders in these countries to put safe abortion and management of abortion complications on their health agenda. Ensuring that research results will be shared with appropriate decision-makers is key to maximizing the extent to which research findings may affect policy and programme advocacy.

Abortion, Illegal↗

PubMed2002

Demographic characteristics of women with self use of misoprostol for pregnancy interruption attending Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To ascess the demographic characteristics of pregnant women and their partners including details of self use of misoprostol for pregnancy interruption. STUDY DESIGN: Prospective descriptive study. SETTING: Department of Obstetrics and Gynecology, Maharaj Nakorn Chiang Mai Hospital. SUBJECTS: 103 pregnant women with self use of misoprostol for pregnancy interruption from June 1999 to June 2001. METHOD: All subjects were interviewed use the same set of questionnaires. RESULTS: The mean age of the women and their partners were 20.81 +/- 4.10 and 22.46 +/- 5.05 years old respectively. The mean gestational age was 13.85 +/- 5.37 weeks. The most common reason for pregnancy interruption was that they wanted to continue studying. The number of misoprostol tablets used ranged from 1-11 and 87.4 per cent of the women applied this drug via the vaginal route. The main source of drug purchasing was from friends, while the mean total cost was 663.16 +/- 711.32 Baht. No major side effect was detected in the present study. CONCLUSION: Misoprostol, the agent primarily used for gastric and duodenal ulcer prevention, is now used by pregnant women to interrupt their pregnancies. The present study is only the evidence reflecting the tip of the iceberg in this society, changing in sexual behavior, change in abortion techniques, and knowledge on contraception. Though major complications were not found in this study, misoprostol should not be considered safe, because several patients have encountered bleeding or incomplete abortion and required hospital stay.

Abortifacient Agents, Nonsteroidal↗