Society of Family Planning Clinical Recommendation: Medication abortion between 14 0/7 and 27 6/7 weeks of gestation

Zwerling, Blake; Edelman, Alison; Jackson, Anwar; Burke, Anne; Prabhu, with the assistance of Malavika

doi:10.1016/j.contraception.2023.110143

Cited by 2 publications

(2 citation statements)

References 83 publications

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“…8-10 Currently, the recommended mifepristone-misoprostol interval by national and international guidelines is 24-48 hours. 7,[11][12][13][14][15] Observational studies of variable mifepristone-tomisoprostol intervals, including 12 hours or less, 12-24 hours, and more than 24 hours, have assessed mifepristone-to-abortion (total abortion) time with these shorter intervals. 2,16 Importantly, induction times remained clinically comparable between the different regimens, and safety was not compromised when shorter interval regimens were used.…”

Section: Methodsmentioning

confidence: 99%

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24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion

Meyer,

Toussia-Cohen,

Shats

et al. 2024

Obstetrics &Amp; Gynecology

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OBJECTIVE: To compare 24-hour and 12-hour mifepristone-to-misoprostol intervals for second-trimester medication abortion. METHODS: We conducted a prospective randomized controlled trial. Participants were allocated to receive mifepristone either 24 hours or 12 hours before misoprostol administration. The primary outcome was the time from the first misoprostol administration to abortion (induction time). Secondary outcomes included the time from mifepristone to abortion (total abortion time); fetal expulsion percentages at 12, 24, and 48 hours after the first misoprostol dose; side effects proportion; and pain and satisfaction scores. A sample size of 40 per group (N=80) was planned to compare the 24- and 12-hour regimens. RESULTS: Eighty patients were enrolled between July 2020 and June 2023, with 40 patients per group. Baseline characteristics were comparable between groups. Median induction time was 9.5 hours (95% CI, 10.3–17.8 hours) and 12.5 hours (95% CI, 13.5–20.2 hours) in the 24- and 12-hour interval arms, respectively (P=.028). Median total abortion time was 33.0 hours (95% CI, 34.2–41.9 hours) and 24.5 hours (95% CI, 25.7–32.4 hours) in the 24- and 12-hour interval groups, respectively (P<.001). At 12 hours from misoprostol administration, 25 patients (62.5%) in the 24-hour arm and 18 patients (45.0%) in the 12-hour arm completed abortion (P=.178). At 24 hours from misoprostol administration, 36 patients (90.0%) in the 24-hour arm and 30 patients (75.0%) in the 12-hour arm had complete abortion (P=.139). The need for additional medication or surgical treatment for uterine evacuation, pain scores, side effects, and satisfaction levels were not different between groups. CONCLUSION: A 24-hour mifepristone-to-misoprostol regimen for medication abortion in the second trimester provides a median 3-hour shorter induction time compared with the 12-hour interval. However, the median total abortion time was 8.5-hours longer in the 24-hour interval regimen. These findings can aid in shared decision making before medication abortion in the second trimester. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04160221.

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Section: Methodsmentioning

confidence: 99%

“…8–10 Currently, the recommended mifepristone–misoprostol interval by national and international guidelines is 24–48 hours. 7,11–15…”

mentioning

confidence: 99%

24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion

Meyer,

Toussia-Cohen,

Shats

et al. 2024

Obstetrics &Amp; Gynecology

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Duration of Induction of Labor for Second-Trimester Medication Abortion and Adverse Outcomes

Premkumar,

Manthena,

Wascher

et al. 2024

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the relationship between duration of labor during second-trimester medication abortion and adverse outcomes. METHODS: We conducted a retrospective cohort study including all individuals with a singleton gestation undergoing second-trimester medication abortion without evidence of advanced cervical dilation, rupture of membranes, or preterm labor at four centers. The primary exposure was duration of labor (ie, hours spent from receiving misoprostol to fetal expulsion). The primary outcome was composite morbidity, defined as uterine rupture, need for blood transfusion, clinical chorioamnionitis, intensive care unit admission, or need for readmission. We performed bivariate and multivariate negative binomial analyses. A post hoc subgroup analysis was performed to assess for the risk of the primary outcome by gestational age. We performed tests of homogeneity based on history of uterine scarring and parity. RESULTS: Six hundred eighty-one individuals were included. The median duration of labor was 11 hours (interquartile range 8–17 hours). One hundred thirty-one (19.2%) experienced the primary outcome. When duration of labor was evaluated continuously, a longer duration of labor was associated with an increased frequency of morbidity (adjusted β=0.68, 95% CI, 0.32–1.04). When duration of labor was evaluated categorically, those experiencing the highest quartile of duration (ie, 17 hours or more) had a statistically higher risk for experiencing morbidity compared with individuals in all other quartiles (adjusted relative risk 1.99, 95% CI, 1.34–2.96). When we focused on components of the composite outcome, clinical chorioamnionitis was significantly different between those experiencing a longer duration and those experiencing a shorter duration of labor (26.2% vs 10.6%, P<.001). On subgroup analysis, gestational age was not associated with the risk of composite morbidity. Tests of homogeneity demonstrated no significant difference in the risk for morbidity among individuals with a history of uterine scarring or based on parity. CONCLUSION: Duration of labor was independently associated with risks for adverse maternal outcomes during second-trimester medication abortion, specifically clinical chorioamnionitis.

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Society of Family Planning Clinical Recommendation: Medication abortion between 14 0/7 and 27 6/7 weeks of gestation

Cited by 2 publications

References 83 publications

24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion

24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion

Duration of Induction of Labor for Second-Trimester Medication Abortion and Adverse Outcomes

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