[Medical abortion at home and at hospital: a trial of efficacy and acceptability]. / Interruption volontaire de grossesse médicamenteuse à domicile et à l'hôpital : étude d'efficacité et d'acceptabilité

OBJECTIVES: To evaluate the efficacy and the acceptability of medical abortion at home and at hospital. PATIENTS AND METHODS: From 11 February 2008 to 16 July 2008, 399 patients were included in the study: 173 at home and 226 at hospital. RESULTS: Efficacy was evaluated for 305 patients because 94 were lost of follow-up (23.6%). Efficacy of medical abortion was 86.7% (124/143) at home and 95.8% (155/162) at hospital. There were one ongoing pregnancy and 25 surgical aspirations (8.6%). The family planning nurse received a phone call from five patients after mifepristone at home (2.9%) and seven patients after mifepristone at hospital (3.1%). Only one patient "at home" had an emergency consultation (0.6%) and nine patients "at hospital" (4%). Ten patients went back to their gynecologist before their appointment for follow-up (2.5%): five "at home" (2.9%) and five "at hospital" (2.2%). Thirteen patients were referred by the private provider to the hospital medical specialist. Acceptability is known for 70.2% of patients: 98% thought that medical abortion at home was acceptable and 92.9% at hospital. DISCUSSION AND CONCLUSION: The failure rate of medical abortion is higher at home and is due to aspirations for incomplete abortion. The procedure at home seems to be more acceptable than at hospital. It will be interesting to realize a prospective randomized study to compare the procedures at home and at hospital.

[Uterine artery embolisation to treat severe haemorrhage following legal abortion]. / Embolisation des artères utérines après hémorragie sévère compliquant une IVG à 12 SA.

The aim of this paper is to present a case of hemorrhagic complication following a legal abortion treated with uterine embolisation. A 45-year-old woman, with a history of one caesarean section and seven legal induced abortions, requested legal induced abortion at 12 weeks of amenorrhea. Legal induced abortion was performed as a day case using vacuum aspiration with a plastic cannula under general anaesthesia. Severe haemorrhage, with an estimated blood loss of 800 ml, occurred during the procedure. Bleeding was not related to cervical laceration, incomplete abortion, or uterine perforation. Surgical conservative procedures and intravenous use of sulprostone (Nalador) failed to control haemorrhage. The patient underwent uterine artery embolisation with Curaspon, a porcine-derived gelfoam, used for the temporary occlusion of the visceral arteries. Successful hemostasis was obtained. The patient presented no complication related to the procedure. Severe haemorrhage following legal induced procedure is rarely reported. Emergency arterial embolisation may offer an effective modality of treatment.