scholarly journals A retrospective study of efficacy and cost efficiency of medical vs. surgical management of abortions in first trimester

2021 ◽  
Vol 10 (9) ◽  
pp. 3429
Author(s):  
Meetangi Agarwal ◽  
Sailatha Ramanujam ◽  
Anuradha C. Ramachandran
Keyword(s):  
Success Rate ◽  
Pregnancy Termination ◽  
Transvaginal Ultrasound ◽  
Cost Effective ◽  
Medical Abortion ◽  
First Trimester ◽  
Observational Research ◽  
Medical Termination ◽  
Significant Difference

Background: The aim of the study was to assess and comparatively evaluate the efficacy of different methods of first trimester abortions (medical, surgical) in terms of its safety, cost and effectiveness.Methods: We present a retrospective observational research study done at Chettinad hospital and research institute, Kelambakkam Chennai which included a total of 70 patients of first trimester abortions, in the period from June 2019 to June 2020. 55 patients were offered medical treatment (MTOP) and were followed up with a repeat scan after 2 weeks. In cases of failed medical abortion patient underwent curettage. Though, in some cases after an attempt at medical abortion, if the products didn’t expel at all within 48 hours, dilatation and evacuation was offered. Transvaginal ultrasound was performed to confirm the success of the treatment. In 15 cases who presented with incomplete abortion, surgical treatment (STOP) was offered. The outcomes considered were successful complete abortions, failed medical abortions, side effects and complications including blood transfusion.Results: The baseline characteristics of women were similar in both the groups like mean age, parity, history of previous termination of pregnancy (TOP). The success rate in MTOP was 67.2% and in STOP 100%.The amount of bleeding experienced was moderate to heavy in MTOP and minimal to moderate in STOP.37 women who underwent only medical termination who returned for the 2-week follow-up, the rate of complete pregnancy termination was 94% and for the remaining 2 women surgical intervention was required. In the surgical group, at the 2-week follow up, no woman underwent a repeat vacuum aspiration with an efficacy of 100%. No significant difference was found in the mean total cost for the medical and surgical groups after adding the subsequent costs (including additional manual vacuum evacuation).Conclusions: Medical termination of abortion should be preferred over surgical termination as it is safer, cost effective, with fewer complications and high success rate. 

scholarly journals Low dose Mifepristone (100 mg) for medical termination of pregnancy

2011 ◽  
Vol 3 (1) ◽  
Author(s):  
Shikha Seth ◽  
Arun Nagrath ◽  
Neeru Goel
Keyword(s):  
Side Effects ◽  
Success Rate ◽  
Low Dose ◽  
Medical Abortion ◽  
First Trimester ◽  
Effective Regimen ◽  
Minimal Dose ◽  
Medical Termination ◽  
Gestation Age ◽  
Post Abortion

Background: Abortion is the most common entity in the practice of obstetrics and gynaecology. Different methods and modes have been opted for until now to find an effective regimen with the least complications. We have tried the minimal dose (100 mg) of Mifepristone (PO) instead of the presently recommended 200 mg for medical abortion in early first trimester cases. Objectives: The objective of the study was to determine the efficacy of low dose (100 mg) Mifepristone for medical termination of early pregnancy with oral Misoprostol 800 μg, 24 hours later.Design: A prospective analytical study was conducted on a population of 82 early-pregnant patients who have requested medical abortions.Method: Pregnant women of less than 56 days gestation age from their last menstrual period, requesting medical abortion were selected over a period of 14 months from January 2007 to March 2008. They were given 100 mg Mifepristone orally on Day-1, followed by 800 μg Misoprostol orally 24 hours later on Day-2, keeping the patient in the ward for at least 6 hours. Abortion interval, success rate, post-abortion bleeding and side-effects were noted. Success was defined as complete uterine evacuation without the need for surgical intervention.Results: The total success rate of this minimal dose Mifepristone regimen was 96.25%. Pain and nausea were the predominant side-effects noted. In total 72 (90%) women had completely aborted within 5 hours of taking Misoprostol. Three (3.75%) women only required suction aspiration, hence termed as failed medical abortion. The abortion interval increased with the gestation age. All three failures were of the more-than-42-day gestational age group. The overall mean abortion interval was 4.68 ± 5.32 hours.Conclusion: Mifepristone 100 mg, followed 24 hours later by Misoprostol 800 μg orally, is a safe and effective regimen for medical abortion.

Diagnosis of Placental Position by Early First-Trimester Ultrasound: A Pilot Study

2019 ◽  
Vol 26 (11) ◽  
pp. 1512-1518 ◽  
Author(s):  
Laura Detti ◽  
Jennifer C. Gordon ◽  
Mary E. Christiansen ◽  
Nicole A. Van de Velde ◽  
Ludwig Francillon ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
First Trimester ◽  
Significant Difference ◽  
Gestational Sac ◽  
Twin Pregnancies ◽  
Anterior Posterior ◽  
First Trimester Ultrasound

Objective: Conventional wisdom is that placental location cannot be identified before 8 weeks’ gestation when the placenta first becomes hyperechogenic on ultrasound. We sought to evaluate whether placental location could be reliably diagnosed between 5 and 6 weeks’ gestation. Materials and Methods: This was a retrospective analysis of prospectively acquired data. Early placental location was diagnosed by evaluation of the embryonal and yolk sac position inside the gestational sac on transvaginal ultrasound. Placental position was described as anterior, posterior, fundal, or lateral. Early and mid-pregnancy placental locations were compared and coded as being the same, having migrated to an adjacent surface, or being on an opposite surface. Results: A total of 111 patients met study criteria, providing 141 placental locations, comprising 85 singleton and reduced pregnancies and 28 dichorionic twin pregnancies. The most common placental location was anterior in both singleton and twin/triplet pregnancies. Placental location at the mid-pregnancy ultrasound was consistent with early pregnancy location in 100% of cases, with 79.5% (112/141) being on the same surface and 20.5% (29/141) having expanded onto an adjacent surface. Placental location was not associated with pregnancy outcome, although our study may have been underpowered to detect a significant difference. Conclusions: Placental location diagnosed at 5 to 6 weeks’ gestation is consistent with the location on mid-pregnancy ultrasound. Excluding the presence of an ectopic, cornual, or cesarean section scar and uterine subseptation pregnancy in early first trimester would allow a more effective tailoring of pregnancy follow-up.

scholarly journals Role of methotrexate in ectopic pregnancy

2020 ◽  
Vol 10 (1) ◽  
pp. 84
Author(s):  
Munjal J. Pandya ◽  
Neha V. Ninama ◽  
Chirag V. Thummar ◽  
Meet K. Patel
Keyword(s):  
Ectopic Pregnancy ◽  
Success Rate ◽  
Surgical Intervention ◽  
Cost Effective ◽  
First Trimester ◽  
Medical College ◽  
Beta Human Chorionic Gonadotropin ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is an acute emergency in obstetric if not timely diagnosed and timely treated. Ectopic pregnancy is leading cause of death in first trimester. Ectopic pregnancy can be managed surgically or medically. Medical management with Methotrexate administration avoids anesthesia in surgery, is cost effective and also offers success rate comparable to surgical management. Aim and objectives were to study the role of methotrexate in ectopic pregnancyMethods: This will be a retrospective observational study conducted in Obstetrics and Gynecology department of AMC MET medical college. Study group constitutes of 30 females with ectopic pregnancy. Preliminary blood investigations, ultrasonography and beta-human chorionic gonadotropin (b-hcg) level will be tested. Patients will be treated with single dose of methotrexate 50 mg/M2. Follow up b-hcg level will be done after 48 hours. Response and tolerance to methotrexate will be monitored.Results: The success rate of methotrexate therapy in our study was 83.33% (n=25) and 16.66% (n=5) required surgical intervention with tubal ruptured and abdominal pain.Conclusions: Methotrexate treatment of ectopic pregnancies is safe and effective with no major side effects. It has the advantage of tubal conservation and saves patients from surgical intervention.

Endometrial Thickness- a Practical Prospective Marker for the Risk of Surgical Intervention after RU486 Induced Abortion

2008 ◽  
Vol 2 ◽  
pp. CMRH.S994 ◽  
Author(s):  
Zeev Blumenfeld ◽  
William Abdallah ◽  
Dalia Kaplan ◽  
Ori Nevo
Keyword(s):  
Single Dose ◽  
Failure Rate ◽  
Surgical Intervention ◽  
Endometrial Thickness ◽  
Pregnancy Termination ◽  
Medical Abortion ◽  
Medical Termination Of Pregnancy ◽  
Dilatation And Curettage ◽  
Medical Termination

Background Medical termination of pregnancy [TOP] during the early first trimester is commonly used. However, treatment failure which warrants surgical intervention occurs in small proportion of patients. Our objective was to examine the effectiveness and predictive value of sonographic measurement of endometrial thickness during a follow up visit after medical abortion as an accurate predictor of the necessity of curettage for completion of pregnancy termination. Methods Women who opted for medical TOP where treated by single dose of RU486 followed by a single dose of misoprostol. Endometrial thickness was evaluated by transvaginal U.S. at 14 days after misoprostol tretament. The data was collected prospectively for this cohort study which includes all the women undergoing medical abortion in the first seven weeks of gestation. Results In 34.7% of the patients the endometrial width was > 11 mm on the follow-up visit. Surgical intervention was performed in 18% of these patients, for a failure rate of the medical termination of pregnancy [TOP] of 6.25%, as compared with no failure rate in those with endometrium < 11 mm, P < 0.001. In the patients where the endometrium was 11-12 mm on follow-up, the failure rate was 5%, and if > 12 mm the failure was 5.9%. In cases where the endometrium was 12-13 mm the failure rate was 27.3%, and if >13 mm the failure was 18.9%. When the endometrium was 13-14 mm the failure rate was 10%, and when >14 mm the failure was 23.7%. Half of the 18 patients who had undergone dilatation and curettage [D&C] for completion of the TOP, had endometrium > 14 mm, one to two weeks after the medical abortion. Conclusion Measurement of endometrial width after medical TOP is beneficial in segregating patient to low or high risk for surgical treatment of retained product of conception [POC]. Using a cutoff of 11 mm during the follow-up visit after medical TOP, 18% of the patients may need dilatation and curettage to complete the pregnancy termination, and if it is >14 mm, half of them may need surgical intervention. There is no difference between 11 and 14 mm regarding the risk of surgical intervention after medical TOP.

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

1970 ◽  
Vol 7 (3) ◽  
pp. 209-212 ◽  
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

scholarly journals Effectiveness of misoprostol for induction of first and early second trimester spontaneous miscarriages in parous women

2018 ◽  
Vol 7 (11) ◽  
pp. 4512
Author(s):  
Tamima Al-Dughaishi ◽  
Amjad Hamed Al-Haddabi ◽  
Mussab Mussab Mubarak Hamed Al-Jabri ◽  
Vaidyanathan Gowri
Keyword(s):  
Success Rate ◽  
First Trimester ◽  
University Hospital ◽  
Second Trimester ◽  
Sultan Qaboos University ◽  
Dilatation And Curettage ◽  
Dilation And Curettage ◽  
Medical Termination ◽  
Surgical Evacuation ◽  
Incomplete Miscarriage

Background: Medical termination of missed miscarriage and incomplete miscarriage with misoprostol, are an alternative to surgical evacuation (dilatation and curettage). This study aimed to evaluate the effectiveness of misoprostol in highly parous woman for incomplete and missed miscarriage.Methods: This was a retrospective study was conducted in two different time lines (2010 and 2014). All patients admitted to the Sultan Qaboos University hospital, Muscat, Oman, for the management of first-trimester miscarriages (missed and incomplete types) during the study period were included. Some women were moved to dilation and curettage even after misoprostol. The effect of gravidity and parity on those women in whom misoprostol was not effective was studied.Results: The overall success rate of misoprostol for the management was 62.14% in 2010 and 53.8% 2014. In nulliparous woman the success rate of misoprostol was slightly higher than parous women. There was no apparent effect of gravidity and parity of ≥ 5 or ≥ 5 on the success of misoprostol.Conclusions: Misoprostol reduced the rate of surgical evacuation among the study subjects. In highly parous and multigravid women (≥ para 5 and gravida ≥5) the success was not significantly different compared to less parous women.

First-trimester medical abortion

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.

Randomized Controlled Trial of Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel Biomaterial

2018 ◽  
Vol 42 (5) ◽  
pp. 361-366 ◽  
Author(s):  
Zahra Jamali ◽  
Vajiheh Alavi ◽  
Ebrahim Najafpour ◽  
Naser Asl Aminabadi ◽  
Sajjad Shirazi
Keyword(s):  
Success Rate ◽  
Primary Teeth ◽  
Root Resorption ◽  
Controlled Trial ◽  
Sinus Tract ◽  
Primary Molars ◽  
Periapical Lesion ◽  
External Root Resorption ◽  
Significant Difference

Objective: This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars. Study design: 114 children aged 3–6 years old with 150 primary molars were randomly allocated to three groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Hard setting zinc oxide eugenol was used to cover these materials. The teeth were restored with amalgam. Blinded radiographic and clinical examinations were conducted at 6, 12 and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical lesion. Results: 122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success rate among the groups after 24-month follow-up (X2=2.43, df = 2, P =0.27). Conclusion: Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of primary teeth because of its successful results.

Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study

1998 ◽  
Vol 89 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Manucher J. Javid ◽  
Eldad J. Hadar
Keyword(s):  
Success Rate ◽  
Herniated Disc ◽  
Lumbar Stenosis ◽  
Content Type ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Significant Difference ◽  
Fine Print

Object. Decompressive laminectomy for stenosis is the most common operation performed in the lumbar spine in older patients. This prospective study was designed to evaluate long-term results in patients with symptomatic lumbar stenosis. Methods. Between January 1984 and January 1995, 170 patients underwent surgery for lumbar stenosis (86 patients), lumbar stenosis and herniated disc (61 patients), or lateral recess stenosis (23 patients). The male/female ratio for each group was 43:43, 39:22, and 14:9, respectively. The average age for all groups was 61.4 years. For patients with lumbar stenosis, the success rate was 88.1% at 6 weeks and 86.7% at 6 months. For patients with lumbar stenosis and herniated disc, the success rate was 80% at 6 weeks and 77.6% at 6 months, with no statistically significant difference between the two groups. For patients with lateral recess stenosis, the success rate was 58.7% at 6 weeks and 63.6% at 6 months; however, the sample was not large enough to be statistically significant. One year after surgery a questionnaire was sent to all patients; 163 (95.9%) responded. The success rate in patients with stenosis had declined to 69.6%, which was significant (p = 0.012); the rate for patients with stenosis and herniated disc was 77.2%; and that for lateral recess stenosis was 65.2%. Another follow-up questionnaire was sent to patients 1 to 11 years after surgery (average 5.1 years); 146 patients (85.9%) responded, 10 (5.9%) were deceased, and 14 (8.2%) were lost to follow-up review. At 1 to 11 years the success rate was 70.8% for patients with stenosis, 66.6% for those with stenosis and herniated disc, and 63.6% for those with lateral recess stenosis. Eleven patients who underwent reoperation were included in the group of patients whose surgeries proved unsuccessful, regardless of their ultimate outcome. There was no statistically significant difference in outcome between 1 year and 1 to 11 years with respect to stenosis, stenosis with herniated disc, and lateral recess stenosis. Conclusions. In conclusion, long-term improvement after laminectomy was maintained in two-thirds of these patients.

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