gemeprost and Postoperative-Complications

To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) < or = 63 days receiving either a medical (600 mg mifepristone and 1 mg gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p < .01] and also with a higher risk of antibiotic treatment than medical abortion [7.8% (37/467) vs. 3.7% (13/356), p < .05]. The median leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p < .05. On average, one third of all the women requested at least one extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA < or = 63 days is higher after a surgical abortion in general anesthesia compared to a medical abortion induced with 600 mg mifepristone and 1 mg gemeprost. A surgical abortion is associated with an increased risk of antibiotic treatment compared to medical abortion. The women's need for follow-up might be higher than we expect.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Alprostadil; Denmark; Female; Humans; Mifepristone; Postoperative Complications; Pregnancy; Sick Leave; Surveys and Questionnaires; Treatment Outcome; Vacuum Curettage

A total of 363 women undergoing legal abortion at < 63 days of amenorrhoea were allocated by a patient-centered, partially randomized study design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration (performed under general anaesthesia). The aim of the study was to compare the efficacy and complications of the two procedures. Main outcome measures included efficacy rates, medical complications within 21 days of abortion and unplanned family doctor consultation rates within 8 weeks following abortion. Sequelae such as pain, vaginal bleeding and recovery time were assessed by the change in haemoglobin level, the time taken to return to work or normal activity and the analgesic use. Results were gestation-related; at 50 days of amenorrhoea there was little to choose between the two procedures. At 50-63 days of amenorrhoea medical abortion becomes more painful and less effective, whereas vacuum aspiration retains high tolerance and efficacy. Women who are unsure which method to use are likely to find vacuum aspiration more acceptable at longer gestations.. In Aberdeen, Scotland, researchers compared the efficacy rate of medical abortion with that of vacuum aspiration and examined their complications and the nature and incidence of short-term sequelae. All 363 pregnant women had amenorrhea for less than 63 days. The medical abortion procedure consisted of administration of 600 mg mifepristone followed by 1 mg gemeprost (vaginal pessary) 48 hours later. Women who underwent medical abortion at less than 50 days gestation were less likely to experience pain than those who underwent medical abortion between 50 and 63 days gestation (mean pain related index [PRI] scores, 20.5 vs. 25.5, p = 0.04 and analgesia during inpatient treatment, 43% vs. 63%; p = 0.02). Medical abortion was less effective at 50-63 days gestation than at less than 50 days gestation (complete abortion, 98% vs. 92.6%). 90% of women requiring curettage after medical abortion were at 50-63 days gestation. Gestation affected neither pain nor efficacy rates of vacuum aspiration, however. At follow-up 16 days after the procedure, the significant differences in the medical sequelae of the 2 procedures during and immediately after abortion disappeared. The short-lived sequelae did not greatly affect recovery times. For example, even though women who underwent vacuum aspiration required more time off work than those who underwent medical abortion (2.5 vs. 1.2 days; p = 0.007), the return of normal daily activities was essentially the same for both groups (0.6-1.3 vs. 0.8-1.5 days). These results suggest that at gestations of less than 50 days, the 2 procedures are equally effective and have similar 0-21 day complication rates. On the other hand, at 50-63 days gestation, medical abortion becomes more unpleasant and its efficacy begins to diminish. In conclusion, at higher gestations, women who do not prefer one method over another will probably find vacuum aspiration more acceptable than medical abortion.

Topics: Abortion, Induced; Alprostadil; Female; Humans; Mifepristone; Postoperative Complications; Pregnancy; Vacuum Curettage

To compare the efficacy and side-effects of intravaginal gemeprost with those of oral misoprostol for cervical ripening prior to first-trimester pregnancy termination in nulliparous women.. Retrospective analysis of surgical terminations of pregnancy performed before 90 days of gestation. Intravaginal gemeprost 1 mg or oral misoprostol 800 micro g was administered 2 h before the procedure.. In total, 746 women were enrolled into the study, 84 received intravaginal gemeprost and 662 oral misoprostol. Median baseline cervical dilatation was significantly greater in women who received misoprostol before the operation than in those who received gemeprost (7 mm vs. 3 mm; p < 0.0001). The incidence of fever, vomiting and diarrhea was not different between the two groups. The incidence of abdominal pain with request for pain medication, emergency admission to operating room due to vaginal bleeding, hospital stay longer than 24 h and surgical repair of cervical injury due to Hegar dilatation was significantly higher among the gemeprost group than the misoprostol group.. In cervical priming prior to first-trimester pregnancy termination in nulliparous women, oral misoprostol is more effective and is associated with fewer side-effects and complications than intravaginal gemeprost.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adult; Alprostadil; Female; Humans; Israel; Medical Records; Misoprostol; Postoperative Complications; Pregnancy; Pregnancy Trimester, First; Retrospective Studies

The results of a study of 101 consecutive second trimester terminations by Dilatation and Evacuation (D & E) under ultrasound control is presented. All had a Cervagem pessary inserted into the vagina prior to the procedure. The PGE1 analogue was assessed as 'effective' in 97% of patients. Concomitant ultrasound resulted in no patient leaving the operating table with retained products. The high efficacy of the single pessary associated with a low incidence of side-effects makes this combination the method of choice for nearly all second trimester terminations.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Alprostadil; Dilatation and Curettage; Female; Humans; Intraoperative Complications; Pessaries; Postoperative Complications; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Prostaglandins E, Synthetic

Topics: Abortion, Induced; Adult; Alprostadil; Cervix Uteri; Dilatation; Female; Humans; Postoperative Complications; Pregnancy; Pregnancy Trimester, First; Premedication; Prostaglandins E, Synthetic