Mid-trimester induced abortion: a review

Abstract

Mid-trimester abortion constitutes 10-15% of all induced abortion. The aim of this article is to provide a review of the current literature of mid-trimester methods of abortion with respect to efficacy, side effects and acceptability. There have been continuing efforts to improve the abortion technology in terms of effectiveness, technical ease of performance, acceptability and reduction of side effects and complications. During the last decade, medical methods for mid-trimester induced abortion have shown a considerable development and have become safe and more accessible. The combination of mifepristone and misoprostol is now an established and highly effective method for termination of pregnancy (TOP). Advantages and disadvantages of medical versus surgical methods are discussed. Randomized studies are lacking, and more studies on pain treatment and the safety of any method used in patients with a previous uterine scar are debated, and data are scarce. Pain management in abortion requires special attention. This review highlights the need for randomized studies to set guidelines for mid-trimester abortion methods in terms of safety and acceptability as well as for better analgesic regimens.

Study of efficacy of mifepristone as inducing agent for mid trimester medical termination of pregnancy in women with previous cesarean section

“…[12][13][14][15][16] For second trimester abortion (13-24 weeks of gestation), medical abortion with mifepristone followed by a prostaglandin analogue is an appropriate method and has been shown to be safe and effective, according to WHO and the RCOG. [17][18][19][20][21][22] It has been well proven that pretreatment with mifepristone 24-48 hours before prostaglandin administration increases the success rate, shortens the induction-to-abortion interval and reduces the amount of prostaglandins required in the second trimester in unscarred uteri. 23,24 In our series women with previous LSCS ,mifepristone 200 mg was given 36 hours prior to the misoprostol or oxytocin and found that none of the cases had incomplete abortion or rupture probably because we had ensured improvement in Bishop's score even by putting Foley's bulb before administration of prostaglandins.…”

Complications after Second Trimester Surgical and Medical Abortion

“…3 The regimen that has been most widely studied 4 involves administering mifepristone 200 mg orally on an outpatient basis, followed 36-48 hours later by admission to the clinic or hospital and administration of misoprostol 800 mcg vaginally. The woman is then given further doses of misoprostol 400 mcg orally as necessary, every three hours, until abortion occurs, to a maximum of four doses.…”

A Comparative Study of Mifepristone and Misoprostol Versus Misoprostol Alone in Mid Trimester Termination of Pregnancy

“…Different studies have shown success rates varying from 73-97% with combination of mifepristone and misoprostol. 16,17,18 The mean doses of misoprostol required in group 1 was 1081.48 µg. Other studies found dosage requirements varying from nil to 2200 µg.…”