Document Detail

Medical methods for mid-trimester termination of pregnancy.
MedLine Citation:
PMID:  21249669     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: With the improvement of ultrasound technology, the likelihood of detection of major fetal structural anomalies in mid-pregnancy has increased considerably. Upon the detection of serious anomalies, women typically are offered the option of pregnancy termination. Additionally, there are still many reasons other than fetal anomalies why women seek abortion in the mid-trimester.
OBJECTIVES: To compare different methods of second trimester medical termination of pregnancy for their efficacy and side-effects.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, Popline and reference lists of retrieved papers and other sources.
SELECTION CRITERIA: All randomised controlled trials (RCTs) examining medical regimens for termination of pregnancy of a singleton living fetus between 12-28 weeks' gestation were analysed. The outcome measures were the induction to abortion interval, abortion rate within 24 hours, need for surgical evacuation, blood loss, uterine rupture, pain, and side-effects.Trials including >20% fetal death, multiple pregnancies, previous uterine scars and regimens which involved cervical preparation were excluded.
DATA COLLECTION AND ANALYSIS: Two authors selected the trials and three authors extracted data.
MAIN RESULTS: Fourty RCTs were included, addressing various agents for pregnancy termination and methods of administration. When used alone, misoprostol was an effective inductive agent, though it appeared to be more effective in combination with mifepristone. However, the evidence from RCTs is limited.Misoprostol was preferably administered vaginally, although among multiparous women sublingual administration appeared equally effective. A range of doses of vaginally administered misoprostol has been used. No randomised trials comparing doses of misoprostol were identified; however low doses of misoprostol appear to be associated with fewer side-effects while moderate doses appear to be more efficient in completing abortion. Four RCTs showed that the induction to abortion interval with 3-hourly vaginal administration of prostaglandins is shorter than 6-hourly administration without an increase in side-effects.Many studies reported the need for surgical evacuation. Indications for surgical evacuation include retained products of the placenta and heavy vaginal bleeding. Fewer women required surgical evacuation when misoprostol was administrated vaginally compared with women receiving intra-amniotical PGF(2a) . Mild, self-limiting diarrhoea was more common among women who received misoprostol compared to other agents.
AUTHORS' CONCLUSIONS: Medical abortion in the second trimester using the combination of mifepristone and misoprostol appeared to have the highest efficacy and shortest abortion time interval. Where mifepristone is not available, misoprostol alone is a reasonable alternative. The optimal route for administering misoprostol is vaginally, preferably using tablets at 3-hourly intervals. Apart from pain, the side-effects of vaginal misoprostol are usually mild and self limiting. Conclusions from this review are limited by the gestational age ranges and variable medical regimens, including dosing, administrative routes and intervals of medication, of the included trials.
Hajo Wildschut; Marieke I Both; Suzanne Medema; Eeke Thomee; Mark F Wildhagen; Nathalie Kapp
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2011-01-19
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2011  
Date Detail:
Created Date:  2011-01-20     Completed Date:  2011-02-28     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD005216     Citation Subset:  IM    
Department of Obstetrics and Gynaecology, Erasmus Medical Center, PO Box 2040, Rotterdam, Netherlands, 3000 CA.
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MeSH Terms
Abortifacient Agents / administration & dosage*,  adverse effects
Abortion, Induced / methods*
Administration, Intravaginal
Drug Administration Schedule
Drug Therapy, Combination
Mifepristone / administration & dosage*
Misoprostol / administration & dosage*,  adverse effects
Pregnancy Trimester, Second
Prostaglandins A / administration & dosage
Randomized Controlled Trials as Topic
Reg. No./Substance:
0/Abortifacient Agents; 0/Prostaglandins A; 59122-46-2/Misoprostol; 84371-65-3/Mifepristone

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