The management of failed second-trimester termination of pregnancy

Basu, Jayati Kusari; Basu, Debashis

doi:10.1016/j.contraception.2009.01.015

Cited by 11 publications

(10 citation statements)

References 6 publications

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“…Some institutions choose various methods depending on the baseline experience and skill of the attending physicians. In a retrospective study, 15 women with failed second trimester pregnancy termination by misoprostol were readmitted to repeat the same protocol and surgical options were offered if the termination still failed. Three (7%) women required hysterotomy.…”

Section: Discussionsupporting

confidence: 91%

How to manage unresponsiveness to misoprostol in failed second trimester pregnancy termination

Pongsatha

Tongsong

2012

J of Obstet and Gynaecol

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Section: Discussionsupporting

confidence: 91%

How to manage unresponsiveness to misoprostol in failed second trimester pregnancy termination

Pongsatha

Tongsong

2012

J of Obstet and Gynaecol

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“…D&E using MVA has been introduced successfully in Vietnam [20] and Nepal [21]. However, there is a critical shortage of trained D&E providers in South Africa, and doctors are reluctant to be involved in D&E services [14,22]. Investments in training, including pre-service training in medical school, as well as values clarification exercises with physicians [23] are needed to create a cadre of skilled D&E providers in this country.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 25% of abortions in South Africa are performed after 12 weeks [11], whereas in most developed countries approximately 10% of abortions are in the second trimester [12,13]. Most second trimester abortions in South Africa are performed by medical induction with misoprostol alone, although in Western Cape Province, a roving team of three doctors provides D&E in the public sector [14] Due to the lack of trained D&E providers in other areas of the country, hysterotomy is sometimes performed in cases of failed induction [15]. …”

Section: Introductionmentioning

confidence: 99%

Surgical and medical second trimester abortion in South Africa: A cross-sectional study

Grossman

Constant

Lince

et al. 2011

BMC Health Serv Res

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BackgroundA high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province.MethodsWe performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery.ResultsMedian gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience.ConclusionsAs currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.

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“…Extra-amniotic instillation of ethacridine lactate is used in India [25], and hysterotomy is not infrequently performed for later abortion when medical methods fail [26]. Ineffective misoprostol regimens are used, often requiring hospitalization for several days [26]. Mifepristone is rarely used in the second trimester, largely because it is not available in many countries or because it is not registered for such use if it is available.…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

“…Even where secondtrimester services are available, evidence regarding the safest and most effective abortion procedures has not been widely translated into practice. Extra-amniotic instillation of ethacridine lactate is used in India [25], and hysterotomy is not infrequently performed for later abortion when medical methods fail [26]. Ineffective misoprostol regimens are used, often requiring hospitalization for several days [26].…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

Confronting the challenge of unsafe second‐trimester abortion

Harris

Grossman

2011

Intl J Gynecology & Obste

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Unsafe abortion accounts for approximately 13% of maternal deaths worldwide-roughly 47,000 deaths per year. Most deaths from unsafe abortion occur in low-resource countries. Second-trimester abortion carries a higher risk of morbidity and mortality compared with first-trimester abortion and, although the former comprises the minority of abortion procedures worldwide, it is responsible for the majority of serious complications and death where unsafe abortion is prevalent. Therefore, improving access to safe second-trimester abortion must be a priority in low-income regions of the world if the majority of deaths from unsafe abortion are to be prevented. In the present paper, we consider a variety of barriers to second-trimester care, including healthcare provider training and abortion stigma, which may lead to neglect of unmet need for second-trimester services.

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The management of failed second-trimester termination of pregnancy

Cited by 11 publications

References 6 publications

How to manage unresponsiveness to misoprostol in failed second trimester pregnancy termination

How to manage unresponsiveness to misoprostol in failed second trimester pregnancy termination

Surgical and medical second trimester abortion in South Africa: A cross-sectional study

Confronting the challenge of unsafe second‐trimester abortion

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