Termination of pregnancy

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0054 ◽

2020 ◽

pp. 678-683

Author(s):

Hang Wun Raymond Li ◽

Pak Chung Ho

Keyword(s):

Pregnancy Termination ◽

Healthcare Providers ◽

Medical Abortion ◽

Evidence Based ◽

Safe Abortion ◽

Postabortion Care ◽

Surgical Methods ◽

Legal Constraints ◽

Evidence Based Guidelines ◽

Abortion Procedure

When an unintended pregnancy occurs secondary to contraceptive failure, the availability of safe means of pregnancy termination is important to minimize morbidities and mortalities associated with the abortion procedure. Where allowed within the legal constraints, access to safe abortion should be facilitated without prejudice and stigmatization. The healthcare providers should offer proper pre-abortion counselling and assessment, and choice of the abortion method should be made based on the gestational age and local expertise. Both medical and surgical methods are available for the effective termination of first- and second-trimester pregnancies. Most recommended regimens for medical abortion involve the use of misoprostol with or without mifepristone, whereas surgical abortions generally employ suction evacuation of the uterus. Providers of abortion service should be familiarized with the evidence-based guidelines and protocols published by various authorities on the abortion procedures and postabortion care, as well as means to prevent complications.

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Does supportive legislation guarantee access to pregnancy termination and postabortion care services? Findings from a facility census in Central Province, Zambia

BMJ Global Health ◽

10.1136/bmjgh-2018-000897 ◽

2018 ◽

Vol 3 (4) ◽

pp. e000897 ◽

Cited By ~ 1

Author(s):

Jenny A Cresswell ◽

Onikepe O Owolabi ◽

Nachela Chelwa ◽

Mardieh L Dennis ◽

Sabine Gabrysch ◽

...

Keyword(s):

Census Data ◽

Pregnancy Termination ◽

Medical Abortion ◽

Central Province ◽

Signal Functions ◽

Postabortion Care ◽

Surgical Methods ◽

Wide Range ◽

Midlevel Providers ◽

Emergency Scenarios

IntroductionZambia is one of the few countries in Africa to permit termination of pregnancy (TOP) on a wide range of grounds. However, substantial barriers remain to TOP and postabortion care (PAC).MethodsWe conducted a census of 153 facilities between March and May 2016. We defined facilities according to whether they met basic and/or comprehensive signal functions criteria for TOP and PAC. We linked our facility data to census data to estimate geographic accessibility under different policy scenarios.ResultsOverall, 16% of facilities reported they had performed a TOP and 39% performed a PAC in the last year. Facilities were twice as likely to use medical methods for TOP compared with surgical methods, and four times more likely for PAC. Considerably more facilities had performed TOP or PAC than met the basic or comprehensive signal functions criteria, indicating services were being performed in facilities below essential quality standards. Under current Zambian law for non-emergency scenarios, 21% of women in Central Province lived within 15 km of a facility with basic capability to provide TOP; if midlevel providers were trained to provide TOP, this would increase to 36%.ConclusionA supportive legislative framework is essential, but not in itself sufficient, for adequate access to services. Training midlevel providers, in line with WHO guidance, and ensuring equipment is available in primary care can increase accessibility of TOP and PAC. While both medical and surgical methods need to be available, medical abortion is a safe and effective method that can be provided in low-resource settings.

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Early pregnancy termination with a simplified mifepristone: Medical abortion outpatient regimen

Kathmandu University Medical Journal ◽

10.3126/kumj.v7i3.2725 ◽

1970 ◽

Vol 7 (3) ◽

pp. 209-212 ◽

Cited By ~ 3

Author(s):

N Chuni ◽

TS Chandrashekhar

Keyword(s):

Pregnancy Termination ◽

Medical Abortion ◽

Global Public Health ◽

Public Health Importance ◽

Safe Abortion ◽

Nulliparous Women ◽

Oral Misoprostol ◽

Medical Termination ◽

A Prospective Study ◽

Home Administration

Background: An estimated 30 million abortions are performed worldwide every year. Many women do not have access to abortion and die of complications after illegal abortions. Medical abortion could provide greater access to safe abortion services; availability of the procedure is, therefore, of global public health importance. Aim: The aim was to study the efficacy of lowered dose of Mifepristone in medical abortion. Materials and methods: One hundred and twelve cases with a pregnancy of 63 days duration or less were enrolled in a prospective study using a lowered dose of 200mg Mifepristone followed, 48 hours later, by home administration of 400μg Misoprostol orally. At the second visit, on day 15, outcome and adverse effects were analysed. Women who failed to undergo a complete abortion were further managed by surgical evacuation of uterus. Results: The mean gestational age was 50.6 days. The rates of complete abortion were 92.8%, 83 % and 80 % in the ≤49 days group, 50 to 56 days and 57 to 63 days group respectively. Vaginal bleeding emerged as the biggest reason for medically indicated termination. Nulliparous women had a greater frequency of side effects, though values did not reach statistical signifi cance. Conclusion: This regimen of a lower dose of 200mg Mifepristone, followed by home administration of 400μg oral Misoprostol 48 hours later is safe and highly effective especially in pregnancies of up to 49 days duration. Key words: Mifepristone; Medical termination of pregnancy (MTP) DOI: 10.3126/kumj.v7i3.2725 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 209-212

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Pregnancy Safety and Termination

10.1093/med/9780190667351.003.0002 ◽

2018 ◽

Author(s):

Natalie S. Whaley ◽

Adam Evans

Keyword(s):

High Risk ◽

Pregnancy Termination ◽

Obstetric Care ◽

Evidence Based ◽

Neurologic Disease ◽

Safe Abortion ◽

Or Management ◽

Pregnancy Failure ◽

High Risk Women ◽

Abortion Care

Access to compassionate, nonjudgmental, and safe abortion care for medically complex women is an important component of obstetric care for high-risk women. The care of women with neurologic disease who seek pregnancy termination or management of pregnancy failure includes consideration of their particular medical, anesthesia, and surgical needs. Counseling regarding pregnancy options is an important first step in helping women achieve their family planning goals. Understanding the safety of abortion, as well as options for medical, surgical, or labor induction termination can help providers discuss pregnancy options with women. Resources are available to help non-obstetric providers ensure their patients have access to medically sound, evidence-based information about pregnancy termination.

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First-trimester medical abortion

Journal of obstetrics and women s diseases ◽

10.17816/jowd63666-86 ◽

2014 ◽

Vol 63 (6) ◽

pp. 66-86

Author(s):

Gennadiy Tikhonovich Sukhikh ◽

Vladimir Nikolaevich Serov ◽

Vera Nikolaeva Prilepskaya ◽

Natal'ya Eknikovna Khan ◽

Viktor Leonidovich Tutunnik ◽

...

Keyword(s):

Russian Federation ◽

Work Group ◽

Pregnancy Termination ◽

Medical Abortion ◽

First Trimester ◽

Cochrane Library ◽

Clinical Protocol ◽

Safe Abortion ◽

The Russian Federation ◽

The Cochrane Library

The Clinical Protocol “First-Trimester Medical Abortion” is written in accordance with the Russian laws on health protection, Procedure on medical care provision to women seeking for artificial termination of pregnancy, Law on drug circulation. The evidential base for the clinical protocol was constituted by the publications included in the Cochrane Library, PUBMED and MEDLINE databases, by the results of the Russian clinical studies on the medical abortion carried out with the permission of the Ethical Committee of the Ministry of Healthcare of the Russian Federation, by the Russian and international regulatory documents on safe abortion (FDA, HAS). The objective of these clinical protocol is to improve the quality of medical aid in the Russian Federation provided during early pregnancy termination. The comments were discussed jointly by the work group members; a consensus was reached on the key questions of the clinical protocol and practical recommendations were developed.

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Abortion

10.2310/obg.19003 ◽

2019 ◽

Author(s):

Nisha Verma ◽

Siripanth Nippita

Keyword(s):

Pregnancy Termination ◽

Healthcare Providers ◽

Medical Abortion ◽

First Trimester ◽

The United States ◽

Decision Making Process ◽

Basic Information ◽

Second Trimester ◽

Dilation And Curettage ◽

Cervical Preparation

Individuals may have a variety of reasons to end a pregnancy. Healthcare providers should provide support during the decision-making process and should be able to give patients basic information about their options depending on gestational age. In the United States, clinicians can offer first-trimester medical abortion with mifepristone and misoprostol up to 10 weeks’ gestation. Uterine aspiration or dilation and curettage are options throughout the first trimester. Options in the second trimester include induction abortion with medications, or a surgical procedure (dilation and evacuation) which may require cervical preparation at later gestational ages. Clinicians should assess the patient’s desire for fertility following an abortion and may offer contraception or preconception advice, as appropriate. This review contains 13 figures, 6 tables, and 61 references. Key Words: abortion, dilation and curettage, dilation and evacuation, mifepristone, misoprostol, pregnancy termination

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