Mifepristone‐ and misoprostol‐induced mid‐trimester termination of pregnancy: A review of 272 cases

Rose, Sally B.; Shand, Carol; Simmons, Ann

doi:10.1111/j.1479-828x.2006.00646.x

Cited by 28 publications

(15 citation statements)

References 30 publications

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“…The proportion in the mifepristone group (4.3%) was comparable to the 4% rate reported previously for all deliveries in a South African hospital in 2010 [38], but higher than other studies on second-trimester medical abortion, which vary from 0.7–3% [16, 23, 24]. The transfusion threshold is context- and provider-dependent, and most women having transfusions had a documented drop in hemoglobin with signs and/or symptoms of anemia.…”

Section: Discussionsupporting

confidence: 77%

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

et al. 2016

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ObjectiveTo document clinical outcomes and women’s experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only.MethodsRepeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2–4 weeks after discharge for the 2014 cohort.ResultsThe 2014 cohort received 200 mg mifepristone, which was self-administered 24–48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3–4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts.ConclusionThe introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.

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Section: Discussionsupporting

confidence: 77%

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

et al. 2016

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“…The majority of the women required one to four doses of misoprostol, the median being two doses (1,200 μg), which is in line with previous reports (12,29). As multiparous women and women with shorter gestation were more likely to complete the termination faster, they required less prostaglandin.…”

Section: Discussionsupporting

confidence: 91%

Clinical efficacy of mifepristone and misoprostol in second trimester pregnancy termination

Joensuu-Manninen

Kuvaja

Talvensaari-Mattila

2010

Acta Obstet Gynecol Scand

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“…Misoprostol is a prostaglandin E 1 analogue causing increased uterine tonus thus helping expulsion of the placenta 4 . Mifepristone as a pre‐treatment to Misoprostol results in shorter induction to delivery interval with 95% success within 24 hour 5 . Maximum effect of this regimen is achieved when Misoprostol is administered 36–48 hour after Mifepristone.…”

Section: Discussionmentioning

confidence: 99%

“…4 Mifepristone as a pre-treatment to Misoprostol results in shorter induc-tion to delivery interval with 95% success within 24 hour. 5 Maximum effect of this regimen is achieved when Misoprostol is administered 36-48 hour after Mifepristone. This regimen is used for termination of pregnancy in our unit.…”

Section: Discussionmentioning

confidence: 99%

Mifepristone and Misoprostol for the management of placenta accreta – a new alternative approach

Morgan

Atalla

2009

BJOG

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Mifepristone‐ and misoprostol‐induced mid‐trimester termination of pregnancy: A review of 272 cases

Cited by 28 publications

References 30 publications

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

Clinical efficacy of mifepristone and misoprostol in second trimester pregnancy termination

Mifepristone and Misoprostol for the management of placenta accreta – a new alternative approach

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