Analysis of failure in medical abortion
Princeton University, Princeton, New Jersey, United States Contraception
(Impact Factor: 2.34).
01/1997; 54(6):323-7. DOI: 10.1016/S0010-7824(96)00206-5
Medical abortion opens a new choice to women wishing to terminate a pregnancy. Increasingly, providers in the developing and developed world will begin to offer this option. Yet, the nomenclature and concepts used for measuring failure of surgical abortion are not directly adaptable because of important differences inherent in the method and in the way it is offered in a given setting. We propose that failures in medical abortion should be defined as a surgical intervention (whether vacuum aspiration or dilatation and curettage) performed for any reason. Such instances may be further classified into three types: user choice interventions, provider choice or error interventions, and true drug failures requiring intervention. Further description and examples of each type are given.
Available from: revho.fr
- "The results obtained by analyzing the REVHO database on 15,447 cases show that this method is effective and safe. The efficacy rate, defined by the absence of secondary vacuum aspiration  , was 97.4%, for all private physicians, which corresponds to the best international results for medical abortions before 49 days LMP  . A lack of precision remains, however, in so far as close to 20% of women did not attend their post-abortion visit. "
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The main aim of this study was to determine: (1) whether early medical abortion at home is a reliable and safe method when provided by physicians in their private practice outside abortion facilities, and (2) whether early medical abortions at home supervised by general practitioners (GPs) in their private practice have the same efficacy rate and the same safety as those supervised by gynecologists in their private practice.
The data are drawn from a prospective survey of 15,447 in-home medical abortions up to 49 days after the last menstrual period (LMP), provided within the Ile-de-France abortion network between privately practicing physicians and hospitals (REVHO: Réseau entre la ville et l'hôpital pour l'orthogénie), from 2005 to 2008.
Approximately 150 privately practicing physicians participate in the REVHO network, and over half of them are general practitioners. Three physicians, called the main providers, performed over half the medical abortions. The overall efficacy rate was 97.43% (96.48 % for the gynecologists, 96.44% for the general practitioners, and 98.31 % for the three main providers). The rate was higher when abortion completion was determined by a decline in serum human chorionic gonadotropin rather than ultrasound.
Early medical abortion at home supervised by gynecologists and GPs practicing in their private offices is a reliable and safe method. Promoting networks such as REVHO increases local accessibility to this type of abortion in France.
Available from: Ellen R Wiebe
- "A surgical intervention is classified as a failure of the medical technique. Uterine aspiration may be used to end a pregnancy that continues after a medical intervention, for an incomplete abortion or unspecified bleeding, or if it is the choice of the woman or her clinician . "
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ABSTRACT: To review published reports of first-trimester medical abortion regimens that do not include mifepristone.
Reports listed in Pubmed and Medline on prospective and controlled trials of the efficacy of misoprostol, alone or associated with methotrexate, for first-trimester abortion were analyzed if they included more than 100 participants and were published since 1990.
The efficacy of regimens using misoprostol alone ranged from 84% to 96%, and when misoprostol was used with methotrexate the efficacy ranged from 70% to 97%. Efficacy rates were influenced by follow-up interval. Treatment for infection, bleeding, and incomplete abortion were infrequent with both methods (0.3%-5%).
Alone or in combination with methotrexate, misoprostol is an efficacious alternative to mifepristone for the medical termination of pregnancy.
Available from: Paul Clarke
- "The late mid-trimester failure rate with the drug combination used in this case is unknown. Advancing gestational age is believed to increase the risk for failure of medical abortion (Winikoff et al., 1996). For terminations at 5 22 weeks' gestation, intracardiac potassium chloride is a recommendation to ensure that a fetus is born dead (RCOG, 2001). "
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