Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention

Reeves, Matthew F.; Fox, Michelle C.; Lohr, Patricia A.; Creinin, Mitchell D.

doi:10.1002/uog.6404

Cited by 55 publications

(30 citation statements)

References 21 publications

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“…This figure is higher than usually reported elsewhere where additional treatment for ongoing pregnancy, persistent gestational sac or unacceptable, persistent bleeding is usually 5−10%. 10,23 For the public sector sites in the study, one provider was new to the service and may have needed more experience with assessing outcome, but this was not so for the other providers. In the interviews conducted in the formative part of this study, providers clearly described their management protocol with respect to assessment and decision for additional MVA at follow-up.…”

Section: Discussionmentioning

confidence: 99%

Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa

Constant

Tolly²,

Harries³

et al. 2014

Reproductive Health Matters

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In-clinic follow-up to assess completion of medical abortion is no longer a requirement according to World Health Organization guidance, provided adequate counselling is given. However, timely recognition of ongoing pregnancy, complications or incomplete abortion, which require treatment, is important. As part of a larger trial, this study aimed to establish whether women having a medical abortion could self-assess whether their abortion was complete using an automated, interactive questionnaire on their mobile phones. All 469 participants received standard abortion care and all returnees filled in a self-assessment on paper at clinic follow-up 2-3 weeks later. The 234 women allocated to receive the phone messages were also asked to do a mobile phone assessment at home ten days post-misoprostol. Completion of the mobile assessment was tracked by computer and all completed assessments, paper and mobile, were compared to providers' assessments at clinic follow-up. Of the 226 women able to access the mobile phone assessment, 176 (78%) completed it; 161 of them (93%) reported it was easy to do so. Neither mobile nor paper self-assessments predicted all cases needing additional treatment at follow-up. Prediction of complete procedures was good; 71% of mobile assessments and 91% of paper assessments were accurate. We conclude that an interactive questionnaire assessing completion of medical abortion on mobile phones is feasible in the South African setting; however, it should be done later than day 10 and combined with an appropriate pregnancy test to accurately detect incomplete procedures.

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Section: Discussionmentioning

confidence: 99%

Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa

Constant

Tolly²,

Harries³

et al. 2014

Reproductive Health Matters

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show abstract

“…Both uterine sagittal and transverse views were visualized to identify the largest thickness to be measured in both planes. The diameters were measured including all contents of the endometrial cavity (Figure 1), 9 and in cases with more than a 1‐mm discrepancy, the average of the two measurements was recorded. Where the endometrial line was not clearly visible, the margins of the intrauterine mass were measured, identifying the endometrial‐myometrial junction (junctional zone), a hypoechoic area surrounding the endometrial layer separating the endometrium from the outer myometrium (inner myometrium) 11 .…”

Section: Methodsmentioning

confidence: 99%

“…[5][6][7] Some authors suggest that sonography could be part of the decision-making approach to identify women with postprocedure bleeding for surgical intervention. 5 However, the role of sonography as an indication for surgery has recently been questioned, [6][7][8][9] and its association with bleeding has not been extensively investigated.…”

mentioning

confidence: 99%

Three‐Dimensional Doppler Sonography in Asymptomatic and Symptomatic Women After Medical Termination of Pregnancy

Napolitano

Ghosh

Gillott

et al. 2014

J of Ultrasound Medicine

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The necessity of surgery after medical termination of pregnancy cannot be predicted by sonography. In cases with sonographic evidence of suspected retained products of conception, endometrial thickness, 2D Doppler findings, and the 3D vascularization indices correlated poorly with bleeding symptoms. Long-term follow-up should be considered in symptomatic women, and it can avoid any unnecessary surgical intervention.

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“…Studies have had women return to clinic 1-2 weeks post-mifepristone administration to confirm pregnancy expulsion, often by ultrasonography. Ultrasound should only be used to assess the presence or absence of a gestational sac, since the thickness of the endometrial stripe does not predict the need for a subsequent surgical procedure [52]. Since ultrasound is not readily available in many areas of the world, history and physical exam alone are often used.…”

Section: Follow-upmentioning

confidence: 99%

Medical Abortion: Use of Mifepristone and Misoprostol in First and Second Trimesters of Pregnancy

Patil

Edelman

2015

Curr Obstet Gynecol Rep

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Medical abortion in the first and second trimesters of pregnancy offers women a safe and effective alternative to surgical termination. The World Health Organization supports a combination of mifepristone and misoprostol as the optimal regimen in both the first and second trimesters of pregnancy, but doses, routes, and timing of administration vary with gestational age. Most methods of contraception can be initiated at the time of medical abortion in women wishing to delay fertility, with the exception of the intrauterine device, which can be initiated as soon as a woman is no longer pregnant.

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Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention

Abstract: Objectives To evaluate the ability of endometrial thickness after medical abortion to predict the need for subsequent dilatation and curettage (D&C). Methods

Cited by 55 publications

References 21 publications

Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa

Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa

Three‐Dimensional Doppler Sonography in Asymptomatic and Symptomatic Women After Medical Termination of Pregnancy

Medical Abortion: Use of Mifepristone and Misoprostol in First and Second Trimesters of Pregnancy

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