ABSTRACT
OBJECTIVE: To evaluate a new protocol for mid and third trimester medical termination of pregnancy using RU 486-misoprostol-epidural analgesia. DESIGN AND SETTING: Monocentric, prospective and descriptive study in a teaching hospital. MATERIALS AND METHODS: Eighty-three women undergoing legal induced abortion during the second and third trimester. Administration of 600 mg mifepristone 36 hours prior to laminaria tents. 48 hours after RU 486, misoprostol was orally given on a 3 hours basis. Epidural analgesia was systematically performed. MAIN OUTCOME MEASURES: Induction-abortion interval, median dose of misoprostol, maternal complications, number of fetal autopsies obtained within 24 hours. RESULTS: The mean induction abortion interval was 3 h for multiparas and 4.45 h for nulliparas. The median dose of misoprostol was 800 micrograms. A uterine rupture on a scarred uterus occurred. The rate of fetal autopsies in cases of malformations within 24 hours reached 96%. CONCLUSIONS: This protocol allows a safe, rapid, cheap and painless late termination of pregnancy, when compared to other protocols.
Subject(s)
Abortifacient Agents , Abortion, Induced/methods , Analgesia, Epidural/methods , Laminaria , Mifepristone , Misoprostol , Abortion, Induced/adverse effects , Adolescent , Adult , Clinical Protocols , Drug Therapy, Combination , Female , Humans , Pregnancy , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Prospective Studies , Time FactorsABSTRACT
OBJECTIVE: This study was performed in order to evaluate indications, techniques and maternal risks of medical abortions, and technical difficulties encountered in these procedures. TYPE OF THE STUDY: A monocentric, descriptive and retrospective study. MATERIALS AND METHODS: Four hundred seventeen medical abortions (MA) were performed in our fetal medicine Unit between 1986 and 1994, including 117 (28%) performed for maternal reasons and 300 (72%) for fetal reasons. Each indication was discussed in a collegial system and varied protocols of labor induction were used, mainly prostaglandins, RU 486, or feticide. MAIN PARAMETERS MEASURED: They were duration of the labor, maternal accidents, number of the fetal post-mortem examinations, counselling given to the couples. We considered that a MA is correctly managed when the intervention corresponded to the following criteria: expulsion by natural route without uterine damage, an examinable fetus and examination by a foetopathologist. MAIN RESULTS: Mean rate of MA satisfying our definition was about 45% in 1988 and reached to 74% in 1994. Our results show that the procedure is rarely complicated and that vaginal expulsion can be obtained. The foetopathologist examination rate increased regularly over the period. The mean gestational age of MA due to maternal indications was 14.5 weeks vs 23.9 weeks when dealing with fetal indications. The infection rate is about 6.2%, hemorrhage rate following expulsion was about 5.9% and the rate of uterine rupture was about 0.48%. CONCLUSIONS: These data suggest that medical abortion need to be evaluated regularly.
