misoprostol and Pregnancy--Ectopic

To summarize the effectiveness and safety outcomes of medication abortion performed without prior pelvic examination or ultrasonogram ("no-test medication abortion").. We searched the MEDLINE, Scopus, Web of Science, Cochrane (including ClinicalTrials.gov), CINAHL, Global Index Medicus, and CAB Direct databases to identify relevant studies published before April 2022 using a peer-reviewed search strategy including terms such as "medication abortion" and "ultrasonography." We contacted experts in the field for unpublished data and ongoing studies.. We reviewed 2,423 studies using Colandr. We included studies if they presented clinical outcomes of medication abortion performed with mifepristone and misoprostol and without prior pelvic examination or ultrasonogram. We excluded studies with duplicate data. We abstracted successful abortion rates overall, as well as rates by gestational age through 63 days, 70 days and past 84 days. We abstracted complication rates, including the need for surgical evacuation, additional medications, blood transfusion, and ectopic pregnancy.. We included 21 studies with a total of 10,693 patients with outcome data reported. The overall efficacy of no-test medication abortion was 96.4%; 93.8% (95% CI 92.8-94.6%) through 63 days of gestation and 95.2% (95% CI 94.7-95.7%) through 70 days of gestation. The overall rate of surgical evacuation was 4.4% (95% CI 4.0-4.9), need for additional misoprostol 2.2% (95% CI 1.8-2.6), blood transfusion 0.5% (95% CI 0.3-0.6), and ectopic pregnancy 0.06% (95% CI 0.02-0.15).. Medication abortion performed without prior pelvic examination or ultrasonogram is a safe and effective option for pregnancy termination.. PROSPERO, CRD42021240739.

Topics: Abortifacient Agents; Abortion, Induced; Female; Humans; Infant; Mifepristone; Misoprostol; Pregnancy; Pregnancy, Ectopic

This study aimed to review clinical practice outcomes of early pregnancy loss (EPL) medical management using mifepristone and misoprostol outside of a clinical trial setting.. In this retrospective cohort study, we reviewed a deidentified database of patients who received mifepristone-misoprostol for EPL from May 2018 to May 2021 at our academic center-based clinic, which was a study site for a multicenter mifepristone-misoprostol EPL trial completed in March 2018. All patients received mifepristone 200 mg orally and misoprostol 800 mcg vaginally or buccally, with clinic follow-up typically scheduled within 1 week. The primary outcome was successful medical management, defined as management without the need for aspiration, and the secondary outcomes included additional interventions and indications, follow-up ultrasonography findings, and adverse events requiring treatment.. We treated 90 patients with a median ultrasound-measured gestational size of 49 (range 30-80) days and median time from mifepristone to misoprostol of 24 (range 8-66) hours. Follow-up was completed in clinic by 80 (88.9%), completed remotely by five (5.6%), and not completed by five (5.6%) patients. Overall, 76 (95% CI 82.9%-96.0%) of 85 patients (89.4%) with follow-up were successfully managed without uterine aspiration. Eighty patients had initial follow-up ultrasonography interpreted as gestational sac expulsion; seven (8.8%) of these ultimately underwent aspiration, including one patient who had a previously undiagnosed cesarean scar ectopic pregnancy. Two patients had significant safety outcomes: one pelvic infection and one blood transfusion during aspiration in the patient with a cesarean scar ectopic pregnancy.. Outside of a clinical trial setting, medical management of EPL with mifepristone and misoprostol remains effective and safe.. Medical management of EPL with mifepristone and misoprostol is effective and safe outside of a clinical trial setting. A standardized protocol based on the best available clinical trial evidence can be used in clinical practice for the medical management of EPL.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Abortion, Spontaneous; Cicatrix; Female; Humans; Mifepristone; Misoprostol; Multicenter Studies as Topic; Pregnancy; Pregnancy, Ectopic; Retrospective Studies

"Very early medical abortion" (VEMA) refers to medical abortion (with mifepristone and misoprostol) before intrauterine pregnancy is visualized on ultrasound. Our aim is to present the current evidence on efficacy, safety (focused on ectopic pregnancies), and how to assess treatment success of VEMA. We conducted a systematic review of studies reporting outcomes of VEMA. The field is small and so our objective was to map all relevant literature, without conducting meta-analysis. We searched PubMed, Medline, and Embase on April 19, 2022. We conducted a narrative synthesis of the evidence. A total of 373 articles were identified. Six articles (representing four observational and one pilot trial) were included in the final review. Across all included studies, treatment efficacy ranged between 91 and 100%. Prevalence of ectopic pregnancy was low and very few cases (

Topics: Abortion, Induced; Abortion, Spontaneous; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy, Ectopic

Methotrexate, a methyl derivative of aminopterin, is a folic acid antagonist and a known human teratogen; misoprostol is a synthetic prostaglandin E1 analog that causes uterine contractions. Recently, there has been resurgence in the use of methotrexate in combination with misoprostol or of methotrexate alone for the treatment of unwanted or ectopic pregnancies, respectively. This report documents the findings in four infants who were exposed prenatally to methotrexate alone or in combination with misoprostol in a failed attempt at medical abortion or treatment of ectopic pregnancy. All patients demonstrated growth deficiency, with growth parameters <10th centile, and all displayed features consistent with methotrexate and/or misoprostol embryopathy. Since an increasing number of medical abortions are being performed, it is important for physicians to recognize the associated teratogenic effects of these abortifacients. Data from the patients herein described should prompt obstetricians and other health care practitioners who prescribe these medications to counsel their patients regarding these risks, especially if the treatment regimen fails to induce an abortion.

Topics: Abnormalities, Multiple; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Female; Humans; Infant; Male; Methotrexate; Misoprostol; Pregnancy; Pregnancy, Ectopic

Vacuum aspiration, either manual or electric, has for many years been the most commonly used method for termination of an early pregnancy. More recently, new medical methods have been developed which for many women are attractive alternatives to the surgical procedure. The compounds mainly used are prostaglandin analogues, methotrexate, and mifepristone in combination with a suitable prostaglandin analogue. However, only the last method has been registered for routine clinical use. The treatment schedule mainly used is mifepristone 200 to 600 mg followed 36 to 48 hours later by oral misoprostol 0.4 to 0.6 mg in pregnancies up to 49 days and vaginal gemeprost 1.0mg or misoprostol 0.8 mg if the treatment period is extended to 63 days of amenorrhoea. The ability to compare medical and surgical methods is limited by the fact that there are few randomised studies and the definitions of successful outcome (complete abortion), adverse effects and complications vary from one study to the other. Experience with the method used is also important for the outcome. However, it seems adequate to state that the medical method is equally, or almost equally, as effective as vacuum aspiration. Duration of bleeding and amount of blood loss is greater following medical abortion. Also the frequency of uterine pain, vomiting and diarrhoea is higher following medical abortion than following vacuum aspiration. On the other hand, the frequency of major complications such as excessive bleeding, blood transfusion and pelvic infection does not seem to differ between the two procedures. Surgical complications, for example, uterine perforation and cervical tears, are obviously not a risk associated with medical abortion. Both methods are equally well accepted provided the woman is allowed to choose. It is not possible to state which method is best. Medical termination of early pregnancy will not replace, but is an alternative to, vacuum aspiration and ideally both methods should be available to give the woman a choice.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Therapeutic; Alprostadil; Drug Therapy, Combination; Female; Humans; Methotrexate; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Randomized Controlled Trials as Topic; Treatment Outcome; Vacuum Curettage

The study was conducted to determine whether the administration of mifepristone followed by vaginal misoprostol can induce an abortion in early pregnancy when no gestational sac is present on sonogram. This report presents a prospective, pilot study of 30 healthy adult women, pregnant and seeking an abortion, and with no gestational sac on sonogram. All women had a baseline serum chorionic gonadotropin (hCG) level measured prior to using mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally 48 h later, and then returned up to 4 days later for a repeat sonogram and serum hCG level. Women with initial hCG levels > 2000 IU/L were evaluated for ectopic pregnancy. At the first follow-up visit, if the hCG decreased by >50%, the women were followed with home pregnancy (25 IU/L) tests weekly until negative. If the levels did not decrease by 50%, a second dose of misoprostol was given. Surgical intervention was indicated for persistent hCG levels or excessive bleeding. Of the 30 women enrolled, the mean number of days of amenorrhea was 40 (SD 9) days. Two women had surgical intervention for continuing pregnancy, 2 had ectopic pregnancies, and 1 was lost to follow-up. Complete medical abortions occurred in 25/30 (88%) women, but when recalculated, in 25/27 (93%) women who completed the protocol and who did not have an ectopic pregnancy. There was 1 adverse event in a woman with an ongoing pregnancy who then received methotrexate. She was hospitalized a day later with a complicated pelvic infection and likely methotrexate-induced pneumonitis. Twenty-three women had a decrease in hCG at first follow-up visit of >50%. All 27 women who completed the protocol found the overall regimen acceptable. Mifepristone followed at 48 h by vaginal misoprostol were effective and acceptable in inducing an abortion in very early pregnancy. There may be a higher incidence of failure in very early pregnancies. Documentation of a complete abortion by hCG level is necessary to ensure the pregnancy is neither ongoing nor ectopic.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adult; Chorionic Gonadotropin; Female; Gestational Age; Humans; Mifepristone; Misoprostol; Patient Satisfaction; Pilot Projects; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Prospective Studies; Ultrasonography; Uterus

The efficacy and tolerability of mifepristone in combination with misoprostol for termination of early pregnancy (up to 49 days of amenorrhea) are established. We studied the efficacy and tolerability of this combination therapy for termination of pregnancy in women up to 63 days of amenorrhea. We also examined the effect of an additional dose of misoprostol in cases of nonexpulsion within 3 hours after the first dose. The multicenter trial included 1,108 women, mean age 27.9 +/- 6.2 years. The mean duration of pregnancy was 51.7 +/- 9.2 days. On day 1, the women received an oral dose of mifepristone, 600 mg. On day 3, they received an oral dose of misoprostol, 400 micrograms, and were monitored for up to 3 hours. If they did not expel the conceptus within 3 hours, an additional dose of 200 micrograms of misoprostol was given and they were monitored for 2 more hours. From days 10 to 18, the women were followed up with clinical examination, human chorionic gonadotropin measurement, or ultrasound examination. Overall, the procedure was successful in 92.9% of women. Efficacy decreased with the duration of pregnancy, especially after 56 days of amenorrhea. Up to 42 days of amenorrhea, the success rate was 97.6%; between days 42 and 49, 94.8%; between days 50 and 56, 93.4%; between days 57 and 63, 86.8%; and after day 63, 83.3%. The most common side effects were moderate uterine cramps (80.5%) and gastrointestinal (GI) symptoms (34.9%), especially vomiting (18.3%) and diarrhea (10.5%). GI symptoms were generally mild. A second dose of misoprostol was given to 61.6% of the women. In a subgroup analysis, we assessed the efficacy of 600 mg of mifepristone plus 400 or 600 micrograms of misoprostol (one or two doses) in women with up to 49 days of amenorrhea and compared it with the efficacy in women who received mifepristone plus only 400 micrograms (one dose) of misoprostol in a previous study. The overall rate of success (termination of pregnancy) was 95.5% in the current study compared with 95.4% in the previous study. The additional dose of misoprostol did not significantly increase the overall rate of success, but did increase the rate of termination within the monitoring period (69.7% versus 64.9% (and within 72 hours after administration of mifepristone (92.7% versus 90.4%). We have confirmed that the combination of mifepristone and misoprostol was effective, safe, and well tolerated for termination of pregnancies at 49 or fewer days of amenorrhea. The effi

Topics: Abortifacient Agents; Adolescent; Adult; Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; France; Hemostatic Techniques; Humans; Incidence; Menstruation-Inducing Agents; Mifepristone; Misoprostol; Pregnancy; Pregnancy, Ectopic; Time Factors; Ultrasonography; Uterine Hemorrhage; Uterus

Abortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was introduced at an abortion service in Edinburgh, UK. Following ultrasound, patients without confirmed IUP, and without symptoms or risk factors for ectopic pregnancy, could commence treatment immediately after baseline serum-human chorionic gonadotrophin (hCG) measurement, and return for follow-up serum-hCG a week later to determine treatment success (≥80% decline from baseline). This study aimed to compare clinical outcomes between two pathways: (1) VEMA; and (2) standard-of-care delayed treatment where treatment is only commenced on IUP confirmation by serial serum-hCG monitoring and/or repeat ultrasound.. A retrospective database review was conducted of VEMA eligible patients from July 2017 to December 2021. Study groups were determined by patient preference. Records were searched for abortion outcomes, duration of care, number of appointments (clinic visits, ultrasounds, serum-hCG) and clinical data entries.. Of 181 patients included, 77 (43%) chose VEMA and 104 (57%) chose delayed treatment. 11/181 (6.1%) were lost to follow-up. Cohort ectopic prevalence was 4.4% and was not statistically different between groups (2.6% vs 5.8%, VEMA vs delayed group, respectively, p=0.305), as with complete abortion rates (93.3% vs 97.6%, p=0.256). All VEMA group ectopics were detected on the seventh day (from initial visit) while time-to-diagnosis for delayed group ectopics ranged from 7 days to 3 weeks. VEMA patients had significantly reduced duration of care (12 vs 21 days, p<0.001), number of visits (2 vs 3, p<0.001), ultrasounds (1 vs 2, p<0.001) and data entries (6 vs 9, p<0.001).. VEMA is safe, effective and reduces the duration of care, number of appointments and clinical administrative time. It should be offered to medically eligible patients.

Topics: Abortion, Induced; Abortion, Spontaneous; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy, Ectopic; Retrospective Studies

To compare immediate initiation with delayed initiation of medication abortion among patients with an undesired pregnancy of unknown location.. This retrospective cohort study used electronic medical record data from the Planned Parenthood League of Massachusetts (2014-2019) for patients who requested medication abortion with a last menstrual period (LMP) of 42 days or less and pregnancy of unknown location (no gestational sac) on initial ultrasonogram. Clinicians could initiate medication abortion with mifepristone followed by misoprostol while simultaneously excluding ectopic pregnancy with serial serum human chorionic gonadotropin (hCG) testing (same-day-start group) or establish a diagnosis with serial hCG tests and repeat ultrasonogram before initiating treatment (delay-for-diagnosis group). We compared primary safety outcomes (time to diagnosis of pregnancy location [rule out ectopic], emergency department visits, adverse events, and nonadherence with follow-up) between groups. We also reported secondary efficacy outcomes: time to complete abortion, successful medication abortion (no uterine aspiration), and ongoing pregnancy.. Of 5,619 medication abortion visits for patients with an LMP of 42 days or less, 452 patients had pregnancy of unknown location (8.0%). Three patients underwent immediate uterine aspiration, 55 had same-day start, and 394 had delay for diagnosis. Thirty-one patients (7.9%), all in the delay-for-diagnosis group, were treated for ectopic pregnancy, including four that were ruptured. Among patients with no major ectopic pregnancy risk factors (n=432), same-day start had shorter time to diagnosis (median 5.0 days vs 9.0 days; P=.005), with no significant difference in emergency department visits (adjusted odds ratio [aOR] 0.90, 95% CI 0.43-1.88) or nonadherence with follow-up (aOR 0.92, 95% CI 0.39-2.15). Among patients who proceeded with abortion (n=270), same-day start had shorter time to complete abortion (median 5.0 days vs 19.0 days; P<.001). Of those who had medication abortion with known outcome (n=170), the rate of successful medication abortion was lower (85.4% vs 96.7%; P=.013) and the rate of ongoing pregnancy was higher (10.4% vs 2.5%; P=.041) among patients in the same-day-start group.. In patients with undesired pregnancy of unknown location, immediate initiation of medication abortion is associated with more rapid exclusion of ectopic pregnancy and pregnancy termination but lower abortion efficacy.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Chorionic Gonadotropin; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy, Ectopic; Retrospective Studies

To evaluate the approach to diagnosis and management of caesarean scar pregnancy (CSP) at a regional New Zealand hospital.. A retrospective case series of ten patients between June 2015 and May 2020. The data review included demographic information, ultrasound findings, human chorionic gonadotropin (HCG) levels, primary and subsequent treatment, outcomes and complications.. Nine women were diagnosed with CSP at a gestational age between four and ten weeks. One of these women was treated twice for two separate CSP within the study period. Treatment varied according to clinical presentation, HCG levels, gestational age, ultrasound findings and patient preference. Two thirds of women were successfully treated with primary management, with one third requiring multiple treatment modalities. We report one severe life-threatening haemorrhage and three cases resulting in hysterectomy. We also show a disproportionate number of Māori women presenting with CSP.. We present a series of ten cases of CSP and demonstrate similar challenges in regional New Zealand to those reported elsewhere. Management is heterogeneous with little guidance from the literature, and primary management was successful in seven out of ten cases. We report a disproportionately high number of cases in Māori women. Our results would support the development of a national register for caesarean scar pregnancy to improve diagnosis and management across New Zealand.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Adult; Cesarean Section; Cicatrix; Dilatation and Curettage; Female; Humans; Hysterectomy; Methotrexate; Misoprostol; Native Hawaiian or Other Pacific Islander; New Zealand; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Ultrasonography, Prenatal; Uterine Hemorrhage

The objectives were to evaluate the safety and acceptability of outpatient medical abortion in selected women without a pretreatment ultrasound or pelvic examination.. We conducted a prospective case-series study to estimate the incidence of serious adverse events (death, life-threatening event, hospitalization, transfusion or any other medical problem that we judged to be significant), surgical completion of the abortion and satisfaction in women provided with medical abortion without a pretreatment ultrasound or pelvic examination. We enrolled 406 women requesting medical abortion in Moldova, Mexico and the United States. To be eligible, a woman must have been certain that her last menstrual period started within the prior 56days, have had regular menses before the pregnancy, not have used hormonal contraceptives in the prior 2months (in the United States and Mexico) or 3months (in Moldova), have no risk factors for or symptoms of ectopic pregnancy, and not have had an ultrasound or pelvic exam in this pregnancy. One site also excluded women with uterine enlargement on abdominal palpation. Each participant received mifepristone (200mg orally) and misoprostol (400 mcg sublingually in Moldova; 800 mcg buccally at all other sites) and was followed until complete abortion, defined as requiring no further treatment.. Of the 365 (90%) participants who provided sufficient follow-up information for analysis, 347 (95%) had complete abortion without additional treatment, 5 (1%) had surgical aspiration, and 10 (3%) had extra misoprostol. Three participants (1%) had serious adverse events; these included two hospital admissions for heavy bleeding managed with aspiration and one diagnosis of persistent gestational sac 19days after enrollment. Most (317, 90%) participants were pleased with omitting the pretreatment ultrasound and pelvic exam.. In this study, medical abortion without screening ultrasound or pelvic exam resulted in no serious adverse events that were likely to have been prevented by those tests and was highly acceptable.. Screening for medical abortion without exam or ultrasound shows promise as a means for increasing access to this service. More research is needed to develop screening criteria that are more inclusive and simpler for clinical use.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Oral; Administration, Sublingual; Adolescent; Adult; Female; Humans; Mexico; Mifepristone; Misoprostol; Moldova; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Prospective Studies; Ultrasonography; United States; Uterus; Young Adult

To report a case of ruptured uterus in the first trimester with the use of misoprostol for early pregnancy tailure in a woman with unrecognized cesarean section scar pregnancy.. A 27-year-old woman, gravida 5 para 3+1, presented with abdominal pain and vaginal bleeding. Transvaginal ultrasonography revealed a fetus without fetal heart activity at nine weeks gestation, making the diagnosis of early pregnancy failure. Her previous deliveries were by cesarean section. She was managed medically with misoprostol. Seven hours after misoprostol administration, she developed sudden onset of severe abdominal pain. Repeat transvaginal ultrasonography diagnosed cesarean section scar pregnancy. Laparotomy revealed hemoperitoneum with rupture of cesarean section scar pregnancy. Subtotal hysterectomy was performed.. Failure to recognize cesarean section scar pregnancy can result in a ruptured uterus in the first trimester with the use of misoprostol for early pregnancy failure. Increased awareness of the unexpected consequences of cesarean section is of paramount importance.

Topics: Adult; Cesarean Section; Cicatrix; Female; Gravidity; Humans; Hysterectomy; Misoprostol; Oxytocics; Parturition; Pregnancy; Pregnancy Trimester, Second; Pregnancy, Ectopic; Uterine Rupture

Topics: Abortifacient Agents, Nonsteroidal; Adult; Cervix Uteri; Cesarean Section; Cicatrix; Female; Humans; Misoprostol; Pregnancy; Pregnancy, Ectopic; Ultrasonography

To discuss the early diagnosis and effective treatment strategy of cesarean scar pregnancy (CSP)..  We reviewed 17 patients in our department diagnosed with CSP between 2005 and 2010, including clinical characteristics, early diagnosis, treatment methods, side-effects and prognosis.. The average duration of gestation at diagnosis was 46 days (range 37-82) and the interval between CSP and last cesarean scar was 6 years (range 2-15). Fourteen (82%) patients presented with slight vaginal bleeding and two (12%) complained of abdominal discomfort. Fourteen patients were diagnosed with CSP by transvaginal color Doppler ultrasonography (TVCDUS). Magnetic resonance imaging (MRI) was performed in two cases of CSP when the diagnosis by TVCDUS was difficult. One patient was diagnosed by histological examination of hysterectomy specimens due to life-threatening bleeding during curettage. Seven patients initially diagnosed with CSP before pregnancy termination were treated conservatively to preserve the uterus without causing maternal complications, ten patients underwent curettage due to incorrect diagnosis, eight patients had excessive vaginal bleeding during curettage and three patients underwent emergency hysterectomy due to hypovolemic shock.. CSP does not have any specific symptoms and can be easily diagnosed incorrectly. Confirmation of a portion of gestational sac in the uterus is important and TVCDUS is the first-line tool for early diagnosis of CSP. Physicians never perform curettage at diagnosis with CSP, but curettage after uterine artery embolism or methotrexate are better treatments of choice to terminate CSP.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Cesarean Section; Cicatrix; Curettage; Female; Humans; Misoprostol; Pregnancy; Pregnancy, Ectopic; Treatment Outcome; Ultrasonography; Uterine Artery Embolization

The study was conducted to assess the effectiveness of early medical abortion (EMA) in women with early pregnancy and no defined intrauterine gestational sac (IUGS) on ultrasound.. Retrospective, multicenter, observational study of oral mifepristone 200 mg and buccal misoprostol 800 mcg administered 24-48 h later for EMA (gestations ≤ 63 days). Odds ratios (ORs) [95% confidence intervals (CIs)] of EMA failure and continuing pregnancy for women with no defined IUGS vs. those with confirmed IUGS were calculated.. Women with no defined IUGS were more likely to experience EMA failure [9.0% (6/67) vs. 3.5% (465/13,345); OR (95% CI)=2.72 (1.17-6.33), p=.041] and continuing pregnancy [7.5% (5/67) vs. 0.6% (83/13,345); OR (95% CI)=12.72 (4.98-32.46), p<.001].. EMA failure is more likely in women with early pregnancy and no defined IUGS than those with gestations ≤ 63 days and confirmed IUGS.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Therapeutic; Administration, Buccal; Administration, Oral; Adolescent; Adult; Female; Follow-Up Studies; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Retrospective Studies; Treatment Failure; Ultrasonography, Prenatal; Uterus; Young Adult

To analyze rates of significant adverse events and outcomes in women having a medical abortion at Planned Parenthood health centers in 2009 and 2010 and to identify changes in the rates of adverse events and outcomes between the 2 years.. In this database review we analyzed data from Planned Parenthood affiliates that provided medical abortion in 2009 and 2010 almost exclusively using an evidence-based buccal misoprostol regimen. We evaluated the incidence of six clinically significant adverse events (hospital admission, blood transfusion, emergency department treatment, intravenous antibiotics administration, infection, and death) and two significant outcomes (ongoing pregnancy and ectopic pregnancy diagnosed after medical abortion treatment was initiated). We calculated an overall rate as well as rates for each event and identified changes between the 2 years.. Among 233,805 medical abortions provided in 2009 and 2010, significant adverse events or outcomes were reported in 1,530 cases (0.65%). There was no statistically significant difference in overall rates between years. The most common significant outcome was ongoing intrauterine pregnancy (0.50%); significant adverse events occurred in 0.16% of cases. One patient death occurred as a result of an undiagnosed ectopic pregnancy. Only rates for emergency department treatment and blood transfusion differed by year and were slightly higher in 2010.. Review of this large data set reinforces the safety of the evidence-based medical abortion regimen.. III.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Induced; Anti-Bacterial Agents; Blood Transfusion; Communicable Diseases; Emergency Treatment; Evidence-Based Medicine; Female; Humans; Maternal Mortality; Mifepristone; Misoprostol; Patient Admission; Pregnancy; Pregnancy, Ectopic

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Missed; Abortion, Spontaneous; Administration, Intravaginal; Chorionic Gonadotropin; Fallopian Tubes; Female; Humans; Laparoscopy; Misoprostol; Practice Guidelines as Topic; Pregnancy; Pregnancy Tests; Pregnancy, Ectopic; Salpingectomy; Ultrasonography, Prenatal; Vacuum Curettage

Vaginal bleeding in the first trimester occurs in about one fourth of pregnancies. About one half of those who bleed will miscarry. Guarded reassurance and watchful waiting are appropriate if fetal heart sounds are detected, if the patient is medically stable, and if there is no adnexal mass or clinical sign of intraperitoneal bleeding. Discriminatory criteria using transvaginal ultrasonography and beta subunit of human chorionic gonadotropin testing aid in distinguishing among the many conditions of first trimester bleeding. Possible causes of bleeding include subchorionic hemorrhage, embryonic demise, anembryonic pregnancy, incomplete abortion, ectopic pregnancy, and gestational trophoblastic disease. When beta subunit of human chorionic gonadotropin reaches levels of 1,500 to 2,000 mIU per mL (1,500 to 2,000 IU per L), a normal pregnancy should exhibit a gestational sac by transvaginal ultrasonography. When the gestational sac is greater than 10 mm in diameter, a yolk sac must be present. A live embryo must exhibit cardiac activity when the crown-rump length is greater than 5 mm. In a normal pregnancy, beta subunit of human chorionic gonadotropin levels increase by 80 percent every 48 hours. The absence of any normal discriminatory findings is consistent with early pregnancy failure, but does not distinguish between ectopic pregnancy and failed intrauterine pregnancy. The presence of an adnexal mass or free pelvic fluid represents ectopic pregnancy until proven otherwise. Medical management with misoprostol is highly effective for early intrauterine pregnancy failure with the exception of gestational trophoblastic disease, which must be surgically evacuated. Expectant treatment is effective for many patients with incomplete abortion. Medical management with methotrexate is highly effective for properly selected patients with ectopic pregnancy. Follow-up after early pregnancy loss should include attention to future pregnancy planning, contraception, and psychological aspects of care.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Chorionic Gonadotropin; Counseling; Diagnosis, Differential; Evidence-Based Medicine; Female; Gestational Trophoblastic Disease; Grief; Humans; Methotrexate; Misoprostol; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Ectopic; Risk Factors; Ultrasonography, Prenatal; Uterine Hemorrhage

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Female; Humans; Misoprostol; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy, Ectopic; Retrospective Studies; South Africa; Uterus

Topics: Abortifacient Agents, Nonsteroidal; Administration, Oral; Diagnosis, Differential; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Uterine Rupture

Uterine anomalies are often first suspected after bimanual or ultrasonographic examination. Currently there are no specific recommendations for further evaluation of asymptomatic women with suspected uterine anomalies in pregnancy.. A young primigravida with a history of an ultrasound diagnosis of bicornuate uterus presented with mild abdominal pain. An ultrasound examination showed a viable 18-week fetus with anhydramnios in the left uterine horn. Labor induction with misoprostol culminated in uterine rupture. At laparotomy, a ruptured left noncommunicating rudimentary uterine horn of a unicornuate uterus was noted.. Pregnancies within noncommunicating uterine horns significantly increase the risk of potentially catastrophic outcome, therefore, consideration should be given to performing 3-dimensonal ultrasonography and/or magnetic resonance imaging examinations to determine the nature of uterine anomalies. Caution should be exercised if prostaglandins are considered for use in this setting.

Topics: Abdomen, Acute; Abortifacient Agents, Nonsteroidal; Adult; Female; Humans; Labor, Induced; Laparotomy; Misoprostol; Placenta Accreta; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Second; Pregnancy, Ectopic; Ultrasonography, Prenatal; Uterine Rupture; Uterus

Topics: Abortifacient Agents, Nonsteroidal; Adult; Cervix Uteri; Female; Humans; Misoprostol; Pregnancy; Pregnancy, Ectopic

To determine if there is a safe and effective treatment for cervical pregnancy.. There is no study presently which shows whether the medical vs surgical vs medical and surgical treatment combined for cervical pregnancy is more efficient. Continued studies are necessary to validate any treatment and confirm which would increase survival with fewer complications.. There is no definitive treatment for cervical ectopic pregnancies. The risk and benefits of each treatment must be entertained before a decision is made on either medical or surgical treatment.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Cervix Uteri; Female; Humans; Methotrexate; Misoprostol; Pregnancy; Pregnancy, Ectopic