Surgical abortion in second trimester: Initial experiences in Nepal

Introduction: In spite of legalising abortion and making safe abortion available at affordable price at accessible distance to almost everyone, unsafe abortion especially second trimester abortion is still a big health problem in Nepal. Objective: The objective of the study is to find the demographic profile, reasons for seeking abortion and to see the effectiveness of Misoprostol in preparing the cervix. Materials and methods: A prospective study was done in the two second trimester abortion trainings conducted in Maternity hospital, Kathmandu. Total 57 clients had second trimester abortion performed. Information was collected from structured questionnaire and then data was analysed. Results: Commonest reason for seeking abortion was, multiparity (61.4%). Common reasons for second trimester abortion were, completed family size with unwanted pregnancy (61.4%), unwanted pregnancy in married (10.52%) unwanted pregnancy in unmarried (5.26%). Conclusions: Second trimester abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries, if it is well supported by change in policy of the country and acceptability of the people. Key words: Maternal death; Safe abortion; Second trimester abortion DOI: 10.3126/kumj.v8i2.3552 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 169-172

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Induction of Abortion in the Second Trimester by Misoprostol or Misoprostol with Letrozole

QJM ◽

10.1093/qjmed/hcab115.010 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Ashraf Mohamed Farouk Kortam ◽

Tarek Aly Raafat ◽

Rehab Mohamed Abd El Rahman ◽

Amir Hamdy Abd El Hady Mahfouz

Keyword(s):

Maternity Hospital ◽

Abortion Rate ◽

Termination Of Pregnancy ◽

Control Group ◽

Second Trimester ◽

Exclusion Criteria ◽

Trimester Abortion ◽

Second Trimester Abortion ◽

Vaginal Misoprostol ◽

Peripheral Conversion

Abstract Background Abortion is the termination of pregnancy by any means (surgical or medical) before the age of viability. The definition varies in duration of gestational age according to the countries and available facilities. Estrogen is important in the maintenance of pregnancy. Aromatase inhibitors such as letrozole, suppress the peripheral conversion of androgen to estrogen, the use of letrozole combined with vaginal misoprostol was more effective than misoprostol alone in termination of pregnancy. Objective Assessing the efficacy of addition of letrozole to Misoprostol in medically induced abortion in the second trimester of pregnancy in the Maternity hospital of Ain Shams University. Methods This clinical trial was conducted at Ain Shams University Maternity hospital in the period between December 2018 and May 2019. Patients that seem to be fulfilling the inclusion criteria were recruited, then informed written consent was taken from every patient before starting the examination That was followed by detailed history and examination of all patients to confirm fulfilling the inclusion and exclusion criteria. Results This study demonstrated that 10 mg letrozole for three days followed by 800 mcg of vaginal misoprostol is more effective than misoprostol alone for second trimester abortion. In the total of 72 women were recruited the complete abortion rate of the letrozole group was significantly higher than that of the control group (61,1% in the letrozole group compared with 33,3% in the control group). Conclusion s: The use of letrozole in addition to misoprostol was associated with a higher complete abortion rate, shorter induction to abortion interval and shorter curettage rates compared to a placebo followed by misoprostol in patients undergoing induction of abortion between 12 & 24 weeks gestation.

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Factors associated with induced second trimester abortion at a tertiary level hospital of Uttarakhand region: a 6-year retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202307 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2333

Author(s):

Shweta Nimonkar ◽

Priyanka Chaudhari ◽

Vineeta Gupta ◽

Namrata Saxena ◽

Shivangi Agarwal

Keyword(s):

Retrospective Study ◽

Gestational Age ◽

Rural Areas ◽

Congenital Anomalies ◽

Second Trimester ◽

Contraceptive Methods ◽

Trimester Abortion ◽

Safe Abortion ◽

Number Of Patients ◽

Second Trimester Abortion

Background: Despite the liberalization of the abortion services since the early 1970s in India, access to safe abortion services remains limited for the vast majority of Indian women particularly from rural areas. Second trimester abortions have different indications and associated with increased maternal morbidity and mortality as compared to the first trimester abortions.Methods: This study was a retrospective study conducted from the January 2014 to December 2019 at obstetrics and genecology department of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. All patients of 12 weeks to 20 weeks of confirmed gestational age were given medical method of second trimester abortion. Data was collected and analyzed regarding demographic features, gestational age, indications, and induction-abortion interval and post abortion contraceptive methods accepted by patient.Results: During this study period a total of 180 patients had second trimester abortion at study institute. Maximum number of patients 69 (38.3%) were of 25-30 years of age group and 161 (85%) patients were of Hindu religion. Major indication was failure of contraception (42.8%) and congenital anomalies in the fetus (45.6%). There was one case of failed medical abortion in which emergency hysterectomy was done for undiagnosed adherent placenta. All patients were compliant of using contraceptive methods after the abortion because of recent medical and mental stress and majority 82 (45.6%) of the patients preferred oral combined contraceptive pills.Conclusions: Apart from congenital anomalies rest all indications can be reduced if women in our country are empowered to control their fertility, get education to become more aware and provided with social security.

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Second Trimester Abortion practices in Eastern Hilly District of Nepal: A Cross-Sectional Study

Nepal Medical Journal ◽

10.37080/nmj.171 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Prabhu Sah ◽

Sangita Mishra ◽

Binod Singh ◽

Anju Deo ◽

Rinku Shah

Keyword(s):

Cross Sectional Study ◽

Termination Of Pregnancy ◽

Fiscal Year ◽

Health Management Information System ◽

Second Trimester ◽

Sectional Study ◽

Trimester Abortion ◽

Cross Sectional ◽

Safe Abortion ◽

Second Trimester Abortion

Introduction: Second-trimester abortion comprises 10-15% of total cases worldwide because of maternal disease, fetal anomalies, and delay in obtaining first trimester services during unintended pregnancies. The availability of legal safe abortion services with skilled hands is limited in rural hilly areas of Nepal. Unsafe and delays in seeking abortion services in resources poor countries like Nepal are contributing to maternal mortality and morbidity. This study aims to describe the demographic profile of patients, indications, and methods of second-trimester abortion with possible complications and family planning acceptance in the rural hilly areas of Nepal. Methods: A retrospective cross-sectional study was conducted at Ilam District Hospital in Province 1 of Nepal. The study sample comprises 75 patients who were admitted for abortion services in 1 fiscal year period from 16th July 2017 to 15th July 2018. Data for all the patients who received second-trimester abortion services were retrieved from Health Management Information System (HMIS) logbook maintained by the Hospital. Descriptive analysis was performed. Ethical approval for this study was obtained from the Nepal Health Research Council (Ref. No- 1921). Results: Most common age group seeking second-trimester abortion were 20-24 years(26.66%) and the majority of women who participated in this study were literate up to secondary level education(58.66%). Most participants belonged to janajati/adibasi caste(73.33%) and were from Ilam districts(72%).Most of the cases were in the early second trimester (62.66%) and were multiparous (60%). Common indications for termination of pregnancy were mental/maternal cause(82.66%) and medical induction was most (69.33%) common method. No major complications were found following abortion. The majority of participants chose short-term contraception (36%) following the termination of pregnancy. Conclusions: Awareness and availability of legal safe abortion services at local health facilities can reduce delays in seeking abortion services, prevent unsafe abortion practices, and reduce maternal morbidity and mortality.

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