Arch Gynecol Obstet. 2016 Aug 13.

Mifepristone and misoprostol is safe and effective method in the second-trimester pregnancy termination

Nissi R, Santala M, Immonen E and Talvensaari-Mattila A

Abstract

Purpose: The second-trimester medical abortions constitute 10-15 % of all induced abortions worldwide, but are responsible for two-thirds of major abortion related complications. During the last decade, medical methods for the second-trimester-induced abortion have been become safer and more accessible. The aim of this study is to evaluate factors affecting clinical effectiveness of the second-trimester medical terminations using mifepristone and misoprostol combination.

Methods: In this retrospective observational study, 142 consecutive women underwent medical abortion on 12-24 weeks of gestation. Clinical data were collected from Oulu University Hospital patients' records for the period between January 2008 and June 2011. The associations between patient characteristics and different outcomes were evaluated using the standard statistical test for correlation.

Results:The majority (92 %) of women aborted successfully within 24 h and were considered as day cases with small complication rate, as compared to hospitalized patients. In nulliparous patients, the time for complete abortion was longer than in other groups (P < 0.0019). Nulliparous women and women with gestation more than 16 weeks required opiate analgesia more often (P = 0.003 and <0.001, respectively).

Conclusion: Women with previous live births aborted more often within 8 h than women with no previous births. Mifepristone and misoprostol is safe and effective method for the second-trimester pregnancy termination. The second-trimester medical abortion can be provided by a nurse-midwife with the back-up of a gynecologist.

Comment: Second trimester abortion, almost exclusively done for the indication severe congenital malformations, can now safely and effectively be undertaken with a mifepristone/misoprostol combination, although one often needs more misoprostol than in the first trimester. A large multicenter study with MedabonR for this indication will be finished this month and published soon. (HMV)