Audit of short term outcomes of surgical and medical second trimester termination of pregnancy

Mauelshagen, Annamarie; Sadler, Lynn; Roberts, Helen; Harilall, Mahesh; Farquhar, Cindy

doi:10.1186/1742-4755-6-16

Cited by 11 publications

(4 citation statements)

References 12 publications

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“…This is the first comparative study documenting D&E and medical induction services in a developing country setting, and the first in South Africa, where second trimester abortions are more prevalent than other countries. Despite the different context, our findings on the safety and efficacy of D&E and second trimester medical induction are similar to those reported in more developed country settings [ 4 - 8 , 17 ]. Both D&E and medical induction are being provided safely in this context, although induction frequently required curettage to complete the procedure and had a higher proportion of major immediate complications.…”

Section: Discussionsupporting

confidence: 87%

“…The few studies that have compared medical and surgical second trimester abortion techniques all have been conducted in developed country contexts [ 4 - 8 ]. One small randomized controlled trial (RCT) comparing D&E to the mifepristone regimen at 14-19 weeks' gestation in the United States (U.S.) found that women undergoing medical induction had a higher risk of complications (RR 6.0, 95% CI 0.9-40.3) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Another RCT in the United Kingdom found that complications were similar between the two methods, although women undergoing medical induction reported more pain and found the procedure less acceptable compared to those undergoing D&E [ 5 ]. A retrospective audit of second-trimester procedures at one facility in New Zealand found that evacuation for retained products of conception was significantly more common among women undergoing medical induction [ 4 ]. Another retrospective cohort study from the U.S. of women undergoing D&E or medical induction, mostly with misoprostol used alone, found that adverse events were significantly more common among medical induction patients (29% vs. 4%, p < 0.001) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical and medical second trimester abortion in South Africa: A cross-sectional study

Grossman

Constant

Lince

et al. 2011

BMC Health Serv Res

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BackgroundA high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province.MethodsWe performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery.ResultsMedian gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience.ConclusionsAs currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical and medical second trimester abortion in South Africa: A cross-sectional study

Grossman

Constant

Lince

et al. 2011

BMC Health Serv Res

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“…However, unless complications arise, it is midwives, and in particular core midwives, who administer the antiprogesterone and who manage labour and birth during TOP after 20 weeks gestation. Maternal risk factors increase with gestational age and can include postpartum haemorrhage, retained placenta, infection, fever, and even sepsis (Ellis et al, 2010;Gemzell-Danielsson & Lalitkumar, 2008;Mauelshagen, Sadler, Roberts, Harilall, & Farquhar, 2009). In cases of previous caesarean section uterine rupture is a risk factor.…”

Section: Termination Of Pregnancy After 20 Weeks Gestationmentioning

confidence: 99%

The lived experience of midwives caring for women facing termination of pregnancy in the late second and third trimester

2018

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Termination of pregnancy (TOP), in the late second and third trimester, is planned fetal loss that is medically and socially complex, and has lasting consequences for women. In New Zealand TOP after 20 weeks gestation may be performed to save a woman's life or to preserve her physical or mental health, which might be at risk of permanent damage due to fetal abnormality or severe intrauterine growth restriction. Core midwives in New Zealand are the main caregivers for women who face this procedure after 20 weeks gestation.A small number of international studies have demonstrated the ethical, moral and professional challenges midwives face when providing TOP care; however, the New Zealand maternity system, as well as its legal framework, cannot be compared to countries overseas. This hermeneutic phenomenological study aims to uncover the lifeworld of New Zealand midwives in the context of TOP and seeks to establish what enables midwives in their role, the effects of TOP care, if any, and the shortcomings in support networks that midwives would benefit from. Eight midwives from two District Health Boards in the North Island of NewZealand were interviewed about their experiences of caring for women who underwent TOP in the late second and third trimester. Data from the interviews were analysed using Max van Manen's methodological framework. The midwives' experience is described in three themes that emerged through reflection and writing: 'a different kind of midwife'; 'staying true to oneself'; and 'melting an iceberg'.The findings of this thesis suggest that TOP care is a different, specialised role within midwifery. Midwives facilitate death within the space of birth, not daily, yet on a regular basis. Addressing the mother-baby dyad the midwives support women in their decision, provide a positive childbirth experience, and address women's complex needs by meeting them in their emotional space. Midwives enable memory making, honour the life and death of the baby and provide the baby with dignity. Yet, the findings suggest that midwives are unprepared for Philosophical Traditions Shaping van Manen's Thinking .

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Safety of medical second trimester abortions for women with prior cesarean sections

Bahar

Alexandroni

Karavani

et al. 2021

Arch Gynecol Obstet

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Audit of short term outcomes of surgical and medical second trimester termination of pregnancy

Cited by 11 publications

References 12 publications

Surgical and medical second trimester abortion in South Africa: A cross-sectional study

Surgical and medical second trimester abortion in South Africa: A cross-sectional study

The lived experience of midwives caring for women facing termination of pregnancy in the late second and third trimester

Safety of medical second trimester abortions for women with prior cesarean sections

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