Comparison of surgical versus medical termination of pregnancy between 13-20 weeks of gestation in Ethiopia: A quasi-experimental study

Background Dilation and evacuation is a method of second trimester pregnancy termination introduced recently in Ethiopia. However, little is known about the safety and effectiveness of this method in an Ethiopian setting. Therefore, the study is intended to determine the safety and effectiveness of dilation and evacuation for surgical abortion as compared to medical abortion between 13–20 weeks’ gestational age. Methods This is a quasi-experimental study of women receiving second trimester termination of pregnancy between 13–20 weeks. Patients were allocated to either medical or surgical abortion based on their preference. A structured questionnaire was used to collect demographic information and clinical data upon admission. Procedure related information was collected after the procedure was completed and before the patient was discharged. Additionally, women were contacted 2 weeks after the procedure to evaluate for post-procedural complications. The primary outcome of the study was a composite complication rate. Data were collected using Open Data Kit and then analyzed using Stata version 14.2. Univariate analyses were performed using means (standard deviation), or medians (interquartile range) when the distribution was not normal. Multiple logistic regression was also performed to control for confounders. Results Two hundred nineteen women chose medical abortion and 60 chose surgical abortion. The composite complication rate is not significantly different among medical and surgical abortion patients (15% versus 10%; p = 0.52). Nine patients (4.1%) in the medical arm required additional intervention to complete the abortion, while none of the surgical abortion patients required additional intervention. Median (IQR) hospital stay was significantly longer in the medical group at 24 (12–24) hours versus 6(4–6) hours in the surgical group p<0.001. Conclusion From the current study findings, we concluded that there is no difference in safety between surgical and medical methods of abortion. This study demonstrates that surgical abortion can be used as a safe and effective alternative to medical abortion and should be offered equivalently with medical abortion, per the patient’s preference.

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Comparison of surgical versus medical termination of pregnancy between 13-20 weeks of gestation in Ethiopia: A quasi-experimental study

10.1101/2020.10.23.20200527 ◽

2020 ◽

Author(s):

Tesfaye H. Tufa ◽

Sarah Prager ◽

Mekitie Wondafrash ◽

Shikur Mohammed ◽

Nicole Byl ◽

...

Keyword(s):

Experimental Study ◽

Complication Rate ◽

Pregnancy Termination ◽

Open Data ◽

Medical Abortion ◽

Termination Of Pregnancy ◽

Second Trimester ◽

Additional Intervention ◽

Quasi Experimental ◽

Surgical Abortion

AbstractBackgroundDilation and evacuation is a method of second trimester pregnancy termination introduced recently in Ethiopia. However, little is known about the safety and effectiveness of this method in an Ethiopian setting. Therefore, the study is intended to determine the safety and effectiveness of dilation and evacuation for surgical abortion as compared to medical abortion between 13-20 weeks’ gestational age.MethodsThis is a quasi-experimental study of women receiving second trimester termination of pregnancy between 13-20 weeks. Patients were allocated to either medical or surgical abortion based on their preference. A structured questionnaire was used to collect demographic information and clinical data upon admission. Procedure related information was collected after the procedure was completed and before the patient was discharged. Additionally, women were contacted 2 weeks after the procedure to evaluate for post-procedural complications. The primary outcome of the study was a composite complication rate. Data were collected using Open Data Kit and then analyzed using Stata version 14.2. Univariate analyses were performed using means (standard deviation), or medians (interquartile range) when the distribution was not normal. Multivariate logistic regression was also performed to control for confounders.ResultsTwo hundred nineteen women chose medical abortion and 60 chose surgical abortion. The composite complication rate is not significantly different among medical and surgical abortion patients (15% versus 10%; p=0.52). Nine patients (4.1%) in the medical arm required additional intervention to complete the abortion, while none of the surgical abortion patients required additional intervention. Median (IQR) hospital stay was significantly longer in the medical group at 24 (12-24) hours versus 6(4-6) hours in the surgical group p<0.001.ConclusionFrom the current study findings, we concluded that there is no difference in safety between surgical and medical methods of abortion. This study demonstrates that surgical abortion can be used as a safe and effective alternative to medical abortion and should be offered equivalently with medical abortion, per the patient’s preference.

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TERMINATION OF PREGNANCY

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.02.2930 ◽

2009 ◽

Vol 16 (02) ◽

pp. 252-257

Author(s):

UZMA HUSSAIN ◽

FARZANA LATIF ◽

TEHSEEN AKHTER

Keyword(s):

Experimental Study ◽

Side Effects ◽

Dosage Regimen ◽

Pregnancy Termination ◽

Termination Of Pregnancy ◽

Trimester Pregnancy ◽

Sublingual Misoprostol ◽

Quasi Experimental ◽

Vaginal Misoprostol ◽

Failed Induction

O b j e c t i v e : To compare the efficacy of vaginal misoprostal with that of sublingual misoprostol in 2n d trimester of pregnancyby comparing the induction-expulsion interval between two groups of patients induced with vaginal and sublingual misoprostol. S t u dyd e s i g n : Interventional, quasi experimental study. Settings: Obstetrics & Gynaecology Unit 1, Sir Ganga Ram Hospital, Lahore. Durationof s t u d y : Thirteen months from October 2006 to November 2007. S u b j e c t s a n d M e t h o d s : Sixty women at 12-26 weeks of gestation whichwere selected for termination of pregnancy were assigned into two groups. Thirty women received sublingual misoprostol and thirty womenreceived vaginal misoprostol. Dosage regimen was tablet Misoprostol 200fjg 4 hours apart till expulsion of fetus (maximum 5 doses). Mainoutcome measures were: 1. Induction-expulsion intervals 2. Maternal side effects 3. Fever 4. Nausea/vomiting 5.Diarrhea. R e s u l t s : Meaninduction-expulsion interval in vaginal group was 11.8±8.3 hours and in the sublingual group was 12.8±8.5 hours. Percentage of completeexpulsion was 53.3% in both groups. Cases of failed induction in vaginal group were 10% and in sublingual group were 13.3%. One case(3.3%) of fever and two cases (6.6%) of vomiting were observed in sublingual group and one case (3.3%) of vomiting was observed invaginal group. C o n c l u s i o n : Both routes appear to be equally efficacious for mid trimester pregnancy termination, without significant sideeffects.

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DEGLOVING BOWEL INJURY FOLLOWING SECOND TRIMESTER PREGNANCY TERMINATION IN THE ERA OF MODERN OBSTETRICS: A CASE REPORT

10.36106/ijar/0207793 ◽

2021 ◽

pp. 5-6

Author(s):

Shree Bharathi ◽

Deepthi Nayak ◽

Vinodhini Kadir ◽

Niveditha Jha ◽

Haritha Sagili

Keyword(s):

Pregnancy Termination ◽

Rare Complication ◽

Medical Abortion ◽

Bowel Injury ◽

Second Trimester ◽

Fetal Head ◽

Trimester Abortion ◽

Mortality And Morbidity ◽

Breech Delivery ◽

Degloving Injury

Degloving injury to the bowel following uterine instrumentation is a rare complication of second trimester abortion. Unsafe abortion practices can lead to such complications adding on the maternal mortality and morbidity. Here we present a case of 19-year-old unmarried girl who had undergone medical abortion and sustained decapitation of the fetal head during breech delivery which necessitated instrumentation for its retrieval leading to perforation and degloving bowel injury

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A comparative study of sublingual versus oral misoprostol following oral mifepristone for second trimester termination of pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190274 ◽

2019 ◽

Vol 8 (2) ◽

pp. 498

Author(s):

Ruchi Gupta ◽

Krishna Priya Banerjee ◽

Reena Pant

Keyword(s):

Success Rate ◽

Medical Abortion ◽

Oral Route ◽

Termination Of Pregnancy ◽

Second Trimester ◽

Oral Misoprostol ◽

Sublingual Misoprostol ◽

Group A ◽

The Mean ◽

Group B

Background: The objective of this study is to assess the effectualness and safety of sublingual versus oral misoprostol following oral mifepristone for second trimester termination of pregnancy.Methods: This institution based contingent study was conducted on 220 women requesting for mid-trimester termination of pregnancy between 12-20 weeks with legal indication as per Govt. MTP act. After excluding the women as per exclusion criteria, they were randomly allocated into two groups (Group A Sublingual, Group B Oral), the women received 200 mg oral mifepristone followed by sublingual or oral misoprostol 400µg three hourly for a maximum of 5 doses 48 hours later. The course of misoprostol was reiterated if women failed to abort in 24 hours.Results: The mean induction-abortion interval of Group-A and Group -B was 4.02±1.39 hours and 6.44±1.79 hours respectively. The mean dose of misoprostol in Group–A and Group-B was 680±220.4µg and 1003.6±274.9µg. Hence mean Induction-abortion interval and dose were shortened in Group-A as compare to Group-B (p <0.05). There was 100% success rate noticed via both routes. Evacuation was done in 4 (3.64%) women in Group-B as compare to only 1 (0.91%) in Group-A . The acceptability was significantly more in Group-B (100%) as compare Group-A (52.73%), probably because of unpleasant taste of sublingual misoprostol. All side effects (Nausea, pain, headache, and diarrhea) were common in both the Groups, only fever was significantly more common in sublingual group as compare to oral group (p<0.05).Conclusions: From present study authors conclude that, sublingual misoprostol when combined with mifepristone is effective for medical abortion in second trimester in terms of effectualness, endurability and success rate than oral route.

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SECOND TRIMESTER MEDICAL TERMINATION OF PREGNANCY. CHALLENGES OF IMPLEMENTATION

Medical Council ◽

10.21518/2079-701x-2017-2-20-25 ◽

2017 ◽

pp. 20-25

Author(s):

S. V. Apresyan ◽

V. I. Dimitrova ◽

O. A. Slyusareva

Keyword(s):

Side Effects ◽

Medical Abortion ◽

Late Complications ◽

Termination Of Pregnancy ◽

Economic Feasibility ◽

Second Trimester ◽

High Efficacy ◽

Medical Termination Of Pregnancy ◽

Medical Termination ◽

Low Incidence

The article describes the specific features of termination of progressive uterine pregnancy in the II trimester. It was found that the efficacy of medical abortion in the II trimester of pregnancy is 94–98%. High efficacy, low incidence of side effects or early and late complications and economic feasibility demonstrate that the method is promising and safe; therefore, it can be recommended as a priority when choosing a method for medical termination of pregnancy in the II trimester.

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Complete Cervical Avulsion with Intravaginal Misoprostol for Second Trimester Pregnancy Termination

Case Reports in Obstetrics and Gynecology ◽

10.1155/2012/931497 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

G. R. Sajjan ◽

Neelamma Patil ◽

Manpreet Kaur ◽

Shobha Shirgur ◽

Suvarna Nandi ◽

...

Keyword(s):

Prenatal Diagnosis ◽

Pregnancy Termination ◽

Termination Of Pregnancy ◽

Second Trimester ◽

Fetal Abnormalities ◽

Skeletal Malformations ◽

Trimester Pregnancy ◽

Second Trimester Pregnancy ◽

Life Threatening

Intravaginal misoprostol, a synthetic PGE1 analogue, has largely replaced all other techniques for pregnancy termination in II trimester, because of its successful results. Incidence of II trimester pregnancy termination has also increased in the present days, because of prenatal diagnosis of pregnancies with serious fetal abnormalities like cardiovascular and skeletal malformations. But there are serious and life threatening complications reported with the use of intravaginal misoprostol. Here we are reporting a case of complete avulsion of cervix from lower part of the uterus, with the use of intravaginal misoprostol, for II trimester termination of pregnancy. So, clinicians dealing with II trimester termination of pregnancy should be aware of such complications.

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MID TRIMESTER TERMINATION;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.06.2239 ◽

2014 ◽

Vol 21 (06) ◽

pp. 1082-1086

Author(s):

Ghazala Niaz ◽

Rubina Ali ◽

Shazia Shaheen

Keyword(s):

Experimental Study ◽

Success Rate ◽

Pregnancy Outcome ◽

Termination Of Pregnancy ◽

Medical College ◽

Prostaglandin F2 Alpha ◽

Trimester Pregnancy ◽

Quasi Experimental ◽

Vaginal Misoprostol ◽

One Year

Objective: The objective of study was to compare the efficacy of extra amniotic prostaglandin F2 alpha and vaginal misoprostol for termination of 2nd trimester pregnancy. Study design: It was quasi experimental study. Place and duration of study: The study was conducted at Gynae Unit II, DHQ Hospital affiliated with Punjab Medical College, Faisalabad for a period of one year from July 2012 to June 2013. Material and methods: This study included 100 patients who presented with congenitally anomalous foetus or IUD during 2nd trimester for termination of pregnancy. Outcome was evaluated by percentage of successful cases for TOP and induction to delivery interval. Result: As regards the efficacy of misoprostol, success rate for termination of pregnancy was 86% and mean induction to delivery interval was 13.16±1.987 hours. Regarding PGF2 alpha success rate for TOP was 88% and mean induction to delivery interval was 16.07±3.202 hours. Conclusions: Misoprostol is comparable in its efficacy to PGF2 alpha for mid trimester termination and can be used as a cheaper alternative.

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Randomized comparison of vaginal and sublingual misoprostol with mifepristone priming in termination of second trimester pregnancy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194323 ◽

2019 ◽

Vol 7 (10) ◽

pp. 3869

Author(s):

Shrikrushna Vasant Chavan ◽

Niraj Nilkanth Mahajan ◽

Arundhati Gundu Tilve

Keyword(s):

Side Effects ◽

Pregnancy Termination ◽

Medical Abortion ◽

P Value ◽

Second Trimester ◽

Open Label ◽

Sublingual Misoprostol ◽

Group A ◽

Vaginal Misoprostol ◽

Group B

Background: Sublingual Misoprostol 200 ug 4 hrly is as effective or less effective than vaginal Misoprostol 200ug 4hrly with 200mg oral Mifepristone in termination of second trimester pregnancy.To compare effectiveness, side-effects, and patient satisfaction of sublingual vs vaginal misoprostol administration.Methods: It was prospective randomized open label study. 60 women 13-20 weeks of gestation with a valid legal indication for termination of pregnancy as per MTP act in INDIA were enrolled for study, randomly divided into Group A- Sublingual (n=30) group B-Vaginal (n=30). For group A, 200 mg of Mifepristone was given, 48h later Misoprostol 200 µg was given sublingually 4hrly up to a maximum of 5 doses. If abortion does not occur, the pregnancy was terminated with vaginal misoprostol, in group A. Same procedure repeated in group B. If abortion fails to occur after 5 doses, then second course of vaginal misoprostol was given in group B. Failure of procedure was defined as failed expulsion of foetus at 48 hrs. Results: Mean induction-abortion interval in vaginal group was 12.8±4.38h and 11.47±4.42h in sublingual group was comparable with insignificant p value (p=0.136). All the side effects were comparable in both groups. The overall success rate was 93.3% in the sublingual group while it was 100% in the vaginal group.Conclusion: Vaginal misoprostol with oral mifepristone priming in second -trimester medical abortion has a shorter time to pregnancy termination compared with a sublingual regimen. However, both the routes are equally effective for induction of abortion.

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Voluntary termination of pregnancy (medical or surgical abortion): forensic medicine issues

Open Medicine ◽

10.1515/med-2016-0062 ◽

2016 ◽

Vol 11 (1) ◽

pp. 321-326 ◽

Cited By ~ 8

Author(s):

Mauro Piras ◽

Paola Delbon ◽

Paola Bin ◽

Claudia Casella ◽

Emanuele Capasso ◽

...

Keyword(s):

Medical Abortion ◽

Termination Of Pregnancy ◽

Point Of View ◽

Ru 486 ◽

Time Period ◽

Drug Agency ◽

Legal Databases ◽

Pharmacological Method ◽

Surgical Abortion ◽

Voluntary Termination

AbstractIn Italy, Law 194 of 22 May 1978 provides for and regulates the voluntary termination of pregnancy (VTP). Medical abortion became popular nationwide after Mifepristone (RU-486) was authorized for the market by AIFA (Italian Drug Agency) in July 2009. We searched articles in medical literature database with these terms: “medical abortion”, “RU486”, “surgical abortion”. We also searched laws and judgments concerning abortion in national legal databases. Ministerial guidelines were searched on official website of Italian Ministry of Health. We found many medical studies about medical and surgical abortion. We found also ministerial and regional guidelines, which were analyzed. From the point of view of legal medicine, the issues related to abortion with the pharmacological method consist in verifying compatibility and consistency with the safety principles and the parameters imposed by Law n. 194 of 1978, using off-label Misoprostol, what inpatient care should be used and informed consent. The doctor’s job is to provide the patient with comprehensive and clear information about how the procedure will be performed, any complications and the time period needed for both procedures.

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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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