scholarly journals Safety, Efficacy and Acceptability of Early First Trimester Abortion using Oral Mifepristone and Sublingual Misoprostol

2018 ◽  
Vol 16 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Deepak Shrestha ◽  
Shreyashi Aryal ◽  
Binita Sharma
Keyword(s):  
Success Rate ◽  
Gestational Age ◽  
Unwanted Pregnancy ◽  
Medical Abortion ◽  
First Trimester ◽  
Tertiary Hospital ◽  
Common Side Effect ◽  
Open Label ◽  
Trimester Abortion ◽  
Sublingual Misoprostol

Background: With the legalization of medical abortion in Nepal, mifepristone-misoprostol combination via different routes has been widely used for early abortion. This study aims to evaluate the efficacy and acceptability of 200 milligrams mifepristone orally followed by 800 micrograms sublingual misoprostol in outpatient setting.Methods: It was an open-label prospective study conducted in outpatient department of a tertiary hospital over a period of 13 months. Clients upto nine weeks of pregnancy were enrolled. 200 milligrams of mifepristone orally followed by 800 micrograms of misoprostol sublingually 36 to 48 hours later were prescribed. They were followed up in 14 days sonologically or verbally through telephone. Side effects and satisfaction to the regimen were assessed through acceptability questionnaire. Mann-Whitney U test was used for analyzing categorical data.Results: A total of 47 clients were enrolled. The mean age and gestational age were 29.38 years (SD+5.914) and 6.2 weeks (SD+1.28) respectively. The commonest indications for termination were completed family and unwanted pregnancy (40.4% each). The average duration of bleeding was 5.76 days (SD +3.61). Abdominal cramping was the most common side effect (95.7%). The least acceptable parameter was the bleeding time (80.9%). For 97.9% clients, the adverse effects were acceptable. The overall success rate of the regimen was 87.2%.Conclusions: With a comparable success rate to vaginal use, home based sublingual use of misoprostol in low resource settings offers an acceptable and cost effective alternative for medical abortion upto nine weeks of pregnancy. Lesser gestational age is a useful predictor for successful abortion.

scholarly journals Safety, Efficacy and Acceptability of Early First Trimester Abortion using Oral Mifepristone and Sublingual Misoprostol

2018 ◽  
Vol 16 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Deepak Shrestha ◽  
Shreyashi Aryal ◽  
Binita Sharma
Keyword(s):  
Success Rate ◽  
Gestational Age ◽  
Unwanted Pregnancy ◽  
Medical Abortion ◽  
First Trimester ◽  
Tertiary Hospital ◽  
Common Side Effect ◽  
Open Label ◽  
Trimester Abortion ◽  
Sublingual Misoprostol

Background:With the legalization of medical abortion in Nepal, mifepristone-misoprostol combination via different routes has been widely used for early abortion. This study aims to evaluate the efficacy and acceptability of 200 milligrams mifepristone orally followed by 800 micrograms sublingual misoprostol in outpatient setting.Methods: It was an open-label prospective study conducted in outpatient department of a tertiary hospital over a period of 13 months. Clients upto nine weeks of pregnancy were enrolled. 200 milligrams of mifepristone orally followed by 800 micrograms of misoprostol sublingually 36 to 48 hours later were prescribed. They were followed up in 14 days sonologically or verbally through telephone. Side effects and satisfaction to the regimen were assessed through acceptability questionnaire. Mann-Whitney U test was used for analyzing categorical data.Results: A total of 47 clients were enrolled. The mean age and gestational age were 29.38 years (SD+5.914) and 6.2 weeks (SD+1.28) respectively. The commonest indications for termination were completed family and unwanted pregnancy (40.4% each). The average duration of bleeding was 5.76 days (SD +3.61). Abdominal cramping was the most common side effect (95.7%). The least acceptable parameter was the bleeding time (80.9%). For 97.9% clients, the adverse effects were acceptable. The overall success rate of the regimen was 87.2%. Conclusions: With a comparable success rate to vaginal use, home based sublingual use of misoprostol in low resource settings offers an acceptable and cost effective alternative for medical abortion upto nine weeks of pregnancy. Lesser gestational age is a useful predictor for successful abortion. Keywords: abortion; mifepristone; misoprostol; sublingual; termination.

UNSUCCESSFUL PRIOR ATTEMPTS TO TERMINATE PREGNANCY AMONG WOMEN SEEKING FIRST TRIMESTER ABORTION AT REGISTERED FACILITIES IN BIHAR AND JHARKHAND, INDIA

2012 ◽  
Vol 45 (2) ◽  
pp. 205-215 ◽  
Author(s):  
RAJESH KUMAR ◽  
A. J. FRANCIS ZAVIER ◽  
SHVETA KALYANWALA ◽  
SHIREEN J. JEJEEBHOY
Keyword(s):  
Rural Women ◽  
Urban Areas ◽  
Unwanted Pregnancy ◽  
Medical Abortion ◽  
First Trimester ◽  
Previous Attempt ◽  
Clinical Settings ◽  
Trimester Abortion ◽  
Unsuccessful Attempt ◽  
Oral Medications

SummaryMany abortion seekers in India attempt to induce abortion on their own, by accessing oral medication/preparations from a chemist without a prescription or from an unauthorized provider, and present at registered facilities if these attempts fail. However, little is known about those whose efforts fail or the ways in which programmes and policies may address the needs of such women. This paper explores the experiences of women whose efforts failed, including their socio-demographic profile, the preparations they used, and the extent to which they experienced serious complications, delayed seeking care from an authorized provider, or delayed abortion until the second trimester of pregnancy. Data come from a larger study assessing the feasibility of the provision of medical abortion by non-physicians; a total of 3394 women who sought medical abortion from selected clinical settings in Bihar and Jharkhand between 2008 and 2010 constitute the sample. Prior to visiting the clinic, nearly a third of these women (31%) had made at least one unsuccessful attempt to terminate the unwanted pregnancy by using a range of oral medications/preparations available over-the-counter in medical shops. Logistic regression analysis suggests that educated women (OR 1.6–1.7), those from urban areas (OR 6.2) and those from Bihar (OR 1.6) were significantly more likely than women with no education, rural women and those from Jharkhand to have used such medication. Also notable is that the average gestational age of women who had made a previous attempt to terminate their pregnancy was almost identical to that of women who had not done so when they presented at the registered facility. These findings may inform policies and programmes that seek to identify and reduce the potential risks associated with unauthorized abortion-seeking practices, and highlight the need to fully inform women, chemists and providers about oral medications, what works and what does not, and how effective medication must be taken.

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.

A prospective study of mifepristone and unlimited dosing of sublingual misoprostol for termination of second-trimester pregnancy in Uzbekistan and Ukraine

2019 ◽  
Vol 45 (3) ◽  
pp. 177-182
Author(s):  
Ingrida Platais ◽  
Tamar Tsereteli ◽  
Galyna Maystruk ◽  
Dilfuza Kurbanbekova ◽  
Beverly Winikoff
Keyword(s):  
Side Effects ◽  
Medical Abortion ◽  
Second Trimester ◽  
Open Label ◽  
Link Type ◽  
Sublingual Misoprostol ◽  
Registration Number ◽  
Second Trimester Pregnancy ◽  
A Prospective Study ◽  
At Home

IntroductionWe aimed to assess the feasibility and acceptability of a second-trimester medical abortion regimen using mifepristone and sublingual misoprostol with no maximum number of misoprostol doses in Uzbekistan and Ukraine.MethodsThis prospective open-label study enrolled 306 women with pregnancies of 13–22 weeks in Uzbekistan (n=134) and Ukraine (n=172). Women took 200 mg mifepristone at a place of their choosing, and 24–48 hours later received 400 μg sublingual misoprostol every 3 hours until the expulsion of both fetus and placenta. Study staff interviewed women about the intensity of pain, side effects, and satisfaction with the procedure. The primary outcome was the rate of complete uterine evacuation without surgical intervention or oxytocin at 15 hours after the first dose of misoprostol.ResultsThe median gestational age was 18.1 weeks, and half of the women (n=149, 48.9%) chose to take mifepristone at home. The majority of women (n=266, 86.9%, 95% CI 82.6% to 90.5%) expelled by 15 hours after the start of misoprostol treatment, and by 48 hours complete uterine evacuation was achieved in 296 (96.7%) women. Most women found pain (76.1%) and side effects (89.0%) to be acceptable or very acceptable, and reported high satisfaction (89.8%) with the procedure.ConclusionMedical abortion in pregnancies of 13–22 weeks with 200 mg mifepristone followed 24–48 hours later by 400 μg sublingual misoprostol administered every 3 hours until complete expulsion is effective, safe and acceptable to women. Women can be given the option to take mifepristone at home and return to the hospital.Clinical trials registration numberClinicalTrials.gov, www.clinicaltrials.gov, NCT02415894, NCT02235155.

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

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.

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. 

Social Context of Child Development

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 705-712
Author(s):  
Leon Eisenberg
Keyword(s):  
Public Schools ◽  
Social Context ◽  
Child Development ◽  
Contraceptive Use ◽  
A Priori ◽  
Unwanted Pregnancy ◽  
Work Force ◽  
First Trimester ◽  
Data Sets ◽  
Trimester Abortion

Theories of child development, no less than the ways in which children develop, are influenced by social context. This thesis is illustrated by examples drawn from three areas relevant to pediatrics. First, given the data demonstrating that fewer biologic and social hazards result from first trimester abortion than from carrying an unwanted pregnancy to term, the current controversy about abortion can only be understood in relation to concerns about contemporary patterns of sexual behavior, contraceptive use, and preferred family size. Second, now that the majority of mothers are employed in the work force, stress on the importance of "bonding" in early infancy, on the basis of dubious evidence, leads to unwarranted implications for social policy. Third, in contrast to the traditional American belief in public schools as instruments for the democratization of our society, public education is now being assailed as useless (and thus undeserving of funding) despite data indicating that schools make a difference to both academic and behavioral outcomes. In these controversies, differing value commitments lead to the choice of different data sets to justify a priori conclusions. Social theories are, by their very nature, value-laden but they can nonetheless be effective guides to action if those values are made explicit.

scholarly journals A two-pill sublingual misoprostol outpatient regimen following mifepristone for medical abortion through 70 days' LMP: a prospective comparative open-label trial

Contraception ◽  
2014 ◽  
Vol 89 (3) ◽  
pp. 181-186 ◽  
Author(s):  
Hillary Bracken ◽  
Rasha Dabash ◽  
George Tsertsvadze ◽  
Svetlana Posohova ◽  
Milind Shah ◽  
...  
Keyword(s):  
Medical Abortion ◽  
Open Label ◽  
Sublingual Misoprostol ◽  
Open Label Trial

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

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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