Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases

Ashok, Premila Wencesiaus; Templeton, Alexander Allan; Wagaarachchi, Prabhath Thanuja; Flett, Gillian

doi:10.1046/j.1471-0528.2002.02156.x

Cited by 132 publications

(52 citation statements)

References 19 publications

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“…Shorter induction abortion interval in vaginal group may be because of the long lasting and continuously increasing uterine contractility of vaginal misoprostol. 11 In both groups those with a history of previous abortion had a failure rate of 33.3% ( P=0.000 and P=0.007 respectively in oral and vaginal groups). Premila et al in a study of factors affecting outcome of early medical abortion with review of 4132 consecutive cases of have found out that those who had a previous abortion were more likely to have a failed medical abortion ( OR =2.09) 8 .…”

Section: Discussionmentioning

confidence: 91%

On Efficacy and Acceptability of Early Medical Abortion by Mifepristone With Oral or Vaginal Misoprostol

Nath¹,

Kumar²

2017

jemds

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BACKGROUNDUnsafe abortion is a major public health problem. Globally, 20 million unsafe abortions take place each year and account for 13% of all maternal deaths. According to WHO, 56% of abortions in developing countries are still unsafe even though medical abortion methods have been in use for more than a decade.The main objective of the present study is to compare the efficacy, acceptability, side effects and factors affecting outcome of early medical abortion with oral and vaginal misoprostol after oral mifepristone in inducing early medical abortion up to 49 days. MATERIALS AND METHODSIt was an interventional study (non-RCT) conducted on women requesting termination of early pregnancy at the outpatient department of family planning unit with ultrasound confirmed intrauterine gestation of  49 days allocated into two groups. Mifepristone 200 mg was administered on Day 1 followed by 400 mg of oral misoprostol for Group I and 800 mg of vaginal misoprostol for Group II. They were reviewed on Day 14 by ultrasound for completion of abortion and Hb. If abortion was incomplete or bleeding was excessive, curettage was done. RESULTSThe two groups were comparable with respect to age, parity and gestational age, socio-economic status and level of education. There was no significant difference in the complete abortion rates for oral (91.1%) and vaginal (92.0%). Mean induction abortion interval was 4.29 hours for oral and 3.5 hours for vaginal (p= 0.023). History of previous abortion was found to be a strong predictor of failure of early medical abortion (p= 0.007). Nausea (24%), vomiting (13%) and fatigue (50%) were more in the oral group. Mean duration of bleeding was 9.4 days in oral and 8.2 days in vaginal group (p= 0.000). Method satisfaction was more among oral group (92.2%) compared to 85.1% in vaginal, but not statistically significant (p > 0.05). CONCLUSIONMedical abortion with 200 mg of mifepristone in combination with 400 mg misoprostol orally or 800 mg vaginally after 48 hours was found to be safe, simple, effective, non-invasive and acceptable method. BACKGROUND Unsafe abortion is a major public health problem in developing countries. Globally, 20 million unsafe abortions take place each year and account for 13% of all maternal deaths. (1) The incidence of induced abortions is not definitely known, because estimates of illegal abortions are generally unreliable. This has led to the liberalisation of abortion laws and search for newer methods. KEYWORDSMedical abortion offers great potential for improving abortion access and safety. The drugs used were mainly mifepristone (RU 486), a potent antiprogestin in combination with prostaglandin E1 analogue misoprostol.

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Section: Discussionmentioning

confidence: 91%

On Efficacy and Acceptability of Early Medical Abortion by Mifepristone With Oral or Vaginal Misoprostol

Nath¹,

Kumar²

2017

jemds

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“…[5][6][7][8] In our study, mean Induction abortion interval was 51.2 hours i.e., 3.2 hours after 800 µg misoprostol and the range was 48.5 -54 hours. This was comparable to the studies by Schaff et al and Ashok et al 4,8 The route of administration of misoprostol had no effect on the initiation of bleeding and on the induction abortion interval. The mean Induction abortion interval was longer in women with gestational age>49 days but it was not statistically significant.…”

Section: Discussionmentioning

confidence: 51%

“…This is comparable to similiar other studies. 3,8,9 There were no major side effects like infection, sepsis or maternal death. The side effects were predominantly gastrointestinal symptoms.…”

Section: Discussionmentioning

confidence: 96%

“…4 Most of the studies have shown 97% complete abortion rate with 200mg mifepristone followed by 800µg vaginal misoprostol. [5][6][7][8][9] Although the peak concentration after vaginal administration is lower when compared to oral, the bioavailability is higher which results in a higher success rate with vaginal route. In the present study, only two women (2%) required additional intervention.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of oral and vaginal misoprostol after oral mifepristone in early medical abortion

Nithya

Rani

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Abortions are still a major problem in developing countries contributing to significant maternal morbidity and mortality. WHO has reported that 53 million unplanned pregnancies result in termination each year. One third of these are performed under unsafe conditions. Deaths related to these accounts for up to about 20% of the maternal deaths that occur each year throughout the world. the main objective of the present study is to compare the efficacy, side effects and acceptability of oral and vaginal misoprostol after single oral dose of mifepristone in induction of abortion in pregnancy up to 63 days.Methods: It was a prospective randomized trial of 100 healthy women opting for termination of pregnancy with ultrasound confirmed intrauterine gestation of less than or equal to 9 weeks who were randomized in to two groups. Mifepristone 200mg was administered on day one followed by 800µg of misoprostol orally or vaginally 48 hours later. They were reviewed on day 7 and day 14 by ultrasound for completeness of abortion. If abortion was incomplete or bleeding was excessive, surgical evacuation was performed.Results: The two groups were comparable with respect to age, parity and gestational age. The mean induction abortion interval was 51.2 hours.98% of the women in both the groups had complete abortion. Nausea (68%) and vomiting (58%) were more common in oral group. Diarrhoea (60%) was common in vaginal group. None of them had fever. Mean duration of bleeding was 9 days. 92% of the women found the procedure to be highly acceptable and would recommend it to others.Conclusions: Medical abortion with 200mg mifepristone in combination with 800µg of misoprostol either orally or vaginally 48 hours later was found to be safe, simple, effective, inexpensive, noninvasive and acceptable method.

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“…In 1% cases are diagnosed intact pregnancy (25,26,27,28).It cites more factors that influence the high level of failure, as the greater gestational age of 50 and 63 days, less expirience of doctors, specially in the cases of ample bleeding from uterus or strong patients` pains (27,29). If the gynecologist is trained well to recognize and set the ample bleeding, side effects and regularly explains ultrasounds findings, than the level of instrumental intervention was less.…”

Section: Mifepristone and Misoprostolementioning

confidence: 99%

Drug Methods for Arteficial Termination of Unwanted Pregnancy

Dimitrijević

2018

Serbian Journal of Experimental and Clinical Research

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Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases

Cited by 132 publications

References 19 publications

On Efficacy and Acceptability of Early Medical Abortion by Mifepristone With Oral or Vaginal Misoprostol

On Efficacy and Acceptability of Early Medical Abortion by Mifepristone With Oral or Vaginal Misoprostol

Comparison of oral and vaginal misoprostol after oral mifepristone in early medical abortion

Drug Methods for Arteficial Termination of Unwanted Pregnancy

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