RESUMO
BACKGROUND: Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester. OBJECTIVES: To establish evidence-based recommendations for PAC in the second trimester. SEARCH STRATEGY: Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched. SELECTION CRITERIA: Clinical trials and comparative studies of women presenting in the second trimester (12-28weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately. DATA COLLECTION AND ANALYSIS: Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed. MAIN RESULTS: Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200µg of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin. CONCLUSION: Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200µg vaginally, sublingually, or buccally every 6-12hours.
Assuntos
Abortivos não Esteroides , Aborto Incompleto/tratamento farmacológico , Assistência ao Convalescente/métodos , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Segundo Trimestre da Gravidez , Estudos de Coortes , Feminino , Morte Fetal , Humanos , Mifepristona , Misoprostol , Ocitócicos , Ocitocina , Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Unsafe abortion causes approximately 13% of all maternal deaths worldwide, with higher rates in areas where abortion access is restricted. Because safe abortion is so low risk, if all women who needed an abortion could access safe care, this rate would drop dramatically. As women's health providers and advocates, obstetrician/gynecologists can support abortion access. By delivering high-quality, evidence-based care ourselves, supporting other providers who perform abortion, helping women who access abortion in the community, providing second-trimester care, and improving contraceptive uptake, we can decrease morbidity and mortality from unsafe abortion.