Sublingual sufentanil for patient-controlled analgesia during labor induction for pregnancy termination: an effective and well-tolerated approach.

BACKGROUND: Effective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy. METHODS: We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating "not satisfied" to 5, denoting "completely satisfied"), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed. RESULTS: The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine. CONCLUSIONS: Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.

Risk of teratogenicity in continued pregnancy after gestational exposure to mifepristone and/or misoprostol: a systematic review and meta-analysis.

PURPOSE: This meta-analysis aimed to comprehensively assess the teratogenic risk to offspring associated with continuing pregnancy after administering mifepristone and/or misoprostol during gestation. METHODS: We conducted a systematic search of multiple databases, including PubMed, Web of Science, Embase, Cochrane, CNKI, and CBM, from their inception to February 2024, with no language restrictions. We included cohort and case-control studies that analyzed the teratogenic effects of mifepristone and/or misoprostol on fetuses and newborns. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). The odds ratios (OR) from individual studies were combined using meta-analysis. Sensitivity testing and heterogeneity analysis were conducted. RESULTS: A total of 13 studies were eligible for inclusion, comprising 5193 cases of congenital malformations and 12,232 controls. CONCLUSION: Our findings indicated that the use of misoprostol during early pregnancy increased the risk of congenital abnormalities in offspring (OR = 2.69; 95% CI: 1.57-4.62). However, the potential teratogenic effect of mifepristone during pregnancy cannot be ruled out. Additionally, the use of mifepristone and/or misoprostol has been linked to a higher risk of certain congenital anomalies, such as hydrocephalus (OR = 3.41; 95% CI: 1.17-9.97), Möbius syndrome (OR = 26.48; 95% CI: 11.30-62.01), and terminal transverse limb defects (OR = 10.75; 95% CI: 3.93-29.41). (PROSPERO, CRD42024522093, 03182024).

Medical abortion in Ghana: A non-randomized, non-inferiority study of access through pharmacies compared with clinics.

OBJECTIVES: To compare self-reported clinical outcomes following medical abortion with mifepristone and misoprostol sourced from either a pharmacy or health clinic. STUDY DESIGN: We conducted a prospective, non-randomized, non-inferiority cohort study across four regions in Ghana, from high-volume pharmacies and health clinics. Participants seeking medical abortion (less than nine weeks' gestation) who met usual medical abortion eligibility criteria were recruited. Data collection included baseline surveys, follow-up phone interviews, and self-reported assessments of medical abortion outcomes. The study aimed to enroll 2000 medical abortion users (1000 from each source). RESULTS: Complete outcome data was available and analyzed from 1958 participants (of 2208 enrolled), with the adjusted risk difference of need for additional treatment to complete the abortion indicating non-inferiority of the pharmacy group compared to the clinic group [-2.3% (95% CI -5.3% to 0.7%)]. Both groups reported low rates of additional treatment (4.9%) and adhered similarly to the abortion regimen. Secondary outcomes showed no significant differences, with moderate acceptability in both groups (65.4% pharmacy, 52.3% facility). Adverse outcomes were rare: one ectopic pregnancy, one blood transfusion and no deaths or other major complications were reported. CONCLUSIONS: Accessing medical abortion pills directly from pharmacies without prior consultation from a provider demonstrated non-inferior self-reported clinical outcomes compared to seeking care from health clinics. The findings align with the growing global evidence supporting the safety and effectiveness of medical abortion self-care. IMPLICATIONS: This study contributes data which support future registration of over-the-counter use of medical abortion drugs up to nine weeks' gestation. Such measures could expand options for safe abortion care, especially in regions where unsafe abortion poses a substantial maternal health risk. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03727308).

Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study.

BACKGROUND: Abortion (also known as termination of pregnancy) is an essential element of women's reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women's needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. OBJECTIVE: This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. METHODS: A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. RESULTS: Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. CONCLUSIONS: Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women's feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion.

Strengthening regional commitment to ensuring access to medical abortion medicines in WHO's South-East Asia region: report of a participatory assessment and workshop.

BACKGROUND: In 2019, the World Health Organization identified improving access to safe abortion as an important priority toward improving sexual and reproductive health and rights and achieving Sustainable Development Goals. One strategy for addressing this priority is strengthening access to medicines for medical abortion. All 11 countries in the South-East Asia Region have some indications for legal abortion and permit post-abortion care. Therefore, strengthening access to medical abortion medicines is a reasonable strategy for improving access to safe abortion for the Region. METHODOLOGY: We applied an adapted version of an existing World Health Organization landscape assessment protocol for the availability of medical abortion medicines at the country-level in the South-East Asia Region. We collected publicly available data on the existence of national health laws, policies, and standard treatment guidelines; inclusion of medical abortion medicines in the national essential medicines list; and marketing authorization status for medical abortion medicines for each country and verified by Ministries of health. The findings were once more presented, discussed and recommendations were formulated during regional technical consultation workshop. Each country teams participated in the process, and subsequently, the suggestions were validated by representatives from Ministries of Health.. RESULTS: Few countries in the Region currently have national policies and guidelines for comprehensive safe abortion. However, either mifepristone-misoprostol in combination or misoprostol alone (for other indications) is included in national essential medicines lists in all countries except Indonesia and Sri Lanka. Few countries earmark specific public funds for procuring and distributing medical abortion commodities. In countries where abortion is legal, the private sector and NGOs support access to medical abortion information and medicines. Several countries only allow registered medical practitioners or specialists to administer medical abortion. CONCLUSION: Following this rapid participatory assessment and technical consultation workshop, the World Health Organization South-East Asia Regional Technical Advisory and Sexual and Reproductive Health and Rights technical committee recommended priority actions for policy and advocacy, service delivery, and monitoring and evaluation, and indicated areas for support.

Evaluation of telemedicine medical abortion using a no-test protocol in the Eastern Europe and Central Asian region: Evidence from Ukraine, Uzbekistan, and Azerbaijan.

OBJECTIVE: To evaluate safety, feasibility, and acceptability of a telemedicine medical abortion service without pre-treatment in-person tests in Ukraine, Uzbekistan, and Azerbaijan. METHODS: We conducted an open-label, prospective, observational clinical study at five clinics in the three countries. Interested and eligible participants scheduled a telemedicine consultation with a study provider by phone or video. Medical abortion pills could be obtained by mail or courier or picked up at the study clinic or a pharmacy. Study providers contacted participants 1 week after mifepristone ingestion to assess abortion outcomes based on symptoms, and 3 weeks later to review the result of an at-home, high-sensitivity, urine pregnancy test. Participants were referred to in-person visit based on symptoms, urine pregnancy test results, or initiative by the participant. RESULTS: In all, 300 women participated in the study. Almost all participants received medical abortion medications the same day as their first contact with the study clinic, and the majority (n = 297, 99.0%) did not experience any problems receiving them. All except two women (0.67%) followed provider instructions on administration of medications. The majority of participants had a complete abortion without a procedure (Ukraine: n = 115, 95.8%; Uzbekistan: n = 127, 97.7%; Azerbaijan: n = 49, 98.0%), few had in-person visits (Ukraine: n = 30, 25.0%; Uzbekistan: n = 3, 2.3%; Azerbaijan: n = 4, 8.0%), and most were very satisfied or satisfied with the service (Ukraine: n = 116, 96%; Uzbekistan: n = 128, 98%; Azerbaijan: n = 45, 90%). No serious adverse events occurred. CONCLUSION: Telemedicine medical abortion using the no-test protocol is safe, feasible and acceptable for women in Ukraine, Uzbekistan, and Azerbaijan.

Can mid-level providers manage medical abortion after 12 weeks' gestation as safely and effectively as physicians? A non-inferiority, randomized controlled trial in Addis Ababa, Ethiopia.

OBJECTIVE: To determine whether clinical outcomes among clients undergoing medical abortion after 12 weeks' gestation differ by provider cadre. METHODS: Randomized controlled trial conducted among eligible clients seeking abortion between 13 and 20 weeks' gestation. Participants seeking in-facility abortion were randomized to receive care from a mid-level provider (nurse/midwife) or physician. The primary outcome was median time to expulsion with non-inferiority margin of -1.5 h between provider groups. Quantile median regression models assessed non-inferiority. Secondary outcomes included retained placenta, complications, and patient acceptability. RESULTS: After randomization and eligibility assessment by the provider, 171 women participated in the study: 81 in the physician group and 90 in the mid-level provider group. Their average age was 24 years, the mean gestational age was 16 weeks, and 65% were nulliparous in both groups. The median time to expulsion did not differ significantly, being 8.1 h for the mid-level group and 6.6 h for the physician group. The adjusted median difference was 0.8 h (95% confidence interval [CI] -1.15 to 2.66), within the non-inferiority margin. Retained placenta occurred similarly: 30.0% (n = 24) of the physician group and 20.5% (n = 18) of the mid-level provider group (adjusted risk difference [ARD] 7.6%, 95% CI -2.81 to 18.06). Complications occurred in 7% of cases, including 5.0% (n = 4) of patients in the physician group and 8.9% (n = 8) in the mid-level provider group (ARD -4.7%, 95% CI -12.43 to 3.12). Patient acceptability did not differ by group. CONCLUSIONS: Training mid-level providers to provide abortion services after 12 weeks' gestation independently of physicians is feasible and may result in comparable clinical outcomes.

Systematic review and Meta-analysis on efficacy and safety of Gongxuening Capsules in treatment of abnormal vaginal bleeding after medical abortion / 中国中药杂志

To systematically evaluate the efficacy and safety of Gongxuening Capsules in the treatment of abnormal vaginal bleeding after medical abortion. CNKI, Wanfang, SinoMed, VIP, PubMed, Cochrane Library and EMbase databases were retrieved to comprehensively collect the clinical randomized controlled trials(RCTs) of Gongxuening Capsules for treatment of abnormal vaginal bleeding after medical abortion from the establishment of the databases to October 10, 2020. Literature screening, data extraction and quality evaluation were conducted independently by two system reviewers according to the inclusion and exclusion criteria. Cochrane Handbook bias risk assessment tool was used for the literature methodology quality evaluation, RevMan 5.3 software was used for Meta-analysis, and the evidence quality of outcomes was evaluated by the evidence quality grading system(GRADE). A total of 16 RCTs were inclu-ded. The results of Meta-analysis showed that as compared with the western medicine treatment alone, the addition of Gongxuening Capsules to the western medicine treatment can reduce the amount of vaginal bleeding(RR=1.23, 95%CI[1.19, 1.27], P<0.000 01), shorten vaginal bleeding time(RR_(≤15 d number of people)=1.39, 95%CI[1.31, 1.48], P<0.000 01; MD_(number ofdays)=-1.20, 95%CI[-1.66,-0.74],P<0.000 01). However, there was no obvious advantage in abortion effect(RR=1.02, 95%CI[0.99, 1.06], P=0.14) and menstrual recovery(MD=-0.35, 95%CI[-0.96, 0.25], P=0.25). The results of GRADE showed that the grading level was low for vaginal bleeding volume and vaginal bleeding time, and extremely low for abortion effect and mens-trual recovery. In terms of safety, 16 studies reported adverse events. Only one study showed no adverse events and the rest showed transient nausea, vomiting, stomach burning, upper abdominal discomfort and other gastrointestinal symptoms. The results show that the addition of Gongxuening Capsules to the application of western medicine in treatment of drug abortion can reduce the amount of vaginal bleeding and shorten vaginal bleeding time, but the abortion effect and menstrual recovery have no obvious advantages. The use of Gongxuening Capsules helps to achieve less adverse reactions and higher safety. Due to the small sample size of the included studies and many methodological quality problems, no conclusions with clinical guidance value can be obtained. Large sample-zise, high-qua-lity randomized controlled trials are still needed for further verification.

Risk Management Study for Preventing Population Decline in the Low Fertility Age

PURPOSE: The purpose of this study is to identify variation in pregnancy wastage prevalence by type and age among married women aged 15~44 in Korea. METHODS: The study data is based on 3% patient sample data extracted from the Health Insurance Review & Assessment Service in 2011 and 2014. For analysis, ANOVA and t-tests were performed using the SAS program. All data was weighted. RESULT: The number of women experiencing pregnancy wastage in Korea was approximately 110,000 and 114,000 in 2011 and 2014 respectively, figures 20% higher than the equivalent numbers of births in both cases. Of wastage types, spontaneous abortion was shown to have the highest prevalence, while the 30 to 34 years category represented the highest prevalence among age groups. Test outcomes regarding age difference demonstrated that, in 2011, the average maternal age in the “other abortion” type was older than that for spontaneous abortion. Age was shown to have a significant effect on surgery status; surgery experience was associated positively with maternal age. CONCLUSION: In this study, we defined terms for pregnancy wastages, derived the diseases codes related to pregnancy wastages, and ascertained the status of pregnancy wastage among women in Korea. Consequently, we suggest that the problem of pregnancy wastage in Korea should be recognized not only as a personal, but also a community, social, and national issue.

Serum β-hCG concentration is a predictive factor for successful early medical abortion with vaginal misoprostol within 24 hours

OBJECTIVE: To evaluate the predictive factors associated with the success of medical abortion by misoprostol monotherapy within 24 hours in the first trimester of pregnancy. METHODS: The records of 228 women with miscarriage up to 11 weeks of gestational age who underwent medical abortion by intravaginal misoprostol monotherapy were reviewed. Success of abortion was defined as complete expulsion of the conceptus without the need for surgical intervention. Outcomes of interest were success of abortion within 24 hours following administration of misoprostol. RESULTS: Among 222 women who continued the process of medical abortion for 24 hours, 209 (94.1%) had a successfully completed abortion. Multivariate logistic regression showed that serum β-human chorionic gonadotropin (β-hCG) above 40,000 mIU/mL is significantly associated with failed medical abortion within 24 hours (odds ratio [OR], 7.13; 95% confidence interval [CI], 1.60–37.32; P=0.011). The area under the receiver operating characteristic curve of β-hCG level associated with successful abortion within 24 hours was 0.705 (95% CI, 0.63–0.77; P=0.007). Previous vaginal delivery seems to be significantly associated with successful abortion within 24 hours on univariate analysis (P=0.037), but the association was lost in multivariate analysis. CONCLUSION: Misoprostol monotherapy has a high success rate for first trimester abortion. Women with serum β-hCG less than 40,000 mIU/mL are likely to achieve a successful abortion within 24 hours after intravaginal administration of misoprostol.

Effects of Compound Leonurus artemisia Ointment Combined with Drospirenone and Ethinylestradiol Tablets on Serum Progesterone and Th1/Th2 Cytokine after Medical Abortion / 中国药房

OBJECTIVE:To investigate the effects of Compound Leonurus artemisia ointment combined with Drospirenone and ethinylestradiol tablets on serum progesterone and T helper (Th) 1/Th2 cytokine after medical abortion.METHODS:A total of 228 patients underwent medical abortion selected from obstetrical outpatient of our hospital during our hospital during Mar.2013 to Jul.2015 as research object were divided into control group (109 cases) and observation group (119 cases) according to random number table.Control group was given Cefuroxime axetil tablets 0.25 g,po,bid,for consecutive 6 d for anti-infective treatment+ Drospirenone and ethinylestradiol tablets one tablet,po,qd,21 d as a treatment course,8 d later receiving second course,3 courses in total after fetal sac exclusion.Observation group was additionally given Compound L.artemisia ointment 10 g,po,bid,7 d as a treatment course,2 courses in total on the basis of control group.The levels of serum progesterone and Th1 (TNF-α,IFN-γ,IL-2)/Th2 cytokine (IL-4,IL-6,IL-10) were observed in 2 groups,and the occurrence of ADR was recorded.RESULTS:Before treatment,there was no statistical significance in serum progesterone or Th1/Th2 cytokine levels between 2 groups (P＞0.05).After treatment,serum progesterone,TNF-α,IL-2 and IL-6 levels of 2 groups were decreased significantly,and above indexes of observation group were significantly lower than those of control group.The levels of IL-4 and IL-10 in 2 groups were increased significantly,and above indexes of observation group were significantly higher than control group,with statistical significance (P＜0.05).After treatment,IFN-γ levels of 2 groups were decreased significantly,but there was no statistical significance between 2 groups (P＞0.05).No obvious ADR was found in 2 groups during treatment.CONCLUSIONS:Compound L.artemisia ointment combined with Drospirenone and ethinylestradiol tablets can regulate immune function of patients after medical abortion,and promote dynamic balance of Th1/Th2 cytokines with good safety.

Preventive action of Gongxuening capsule combined with oxytocin in treatment of bleeding after medical abortion / 中国生化药物杂志

Objective To investigate the preventive action of Gongxuening capsule combined with oxytocin in treatment of bleeding after medical abortion.Methods 71 casess with medical abortion from March 2014 to May 2015,were randomly divided into observation group of 34 patients and control group of 37 patients.Conventional medical abortion forpregnant women as a control group, giving Gongxuening capsule drug for pregnant women in observation group.After medical abortion, the efficacy of the drug flow between two groups of patients, pregnant women, complete abortion drug flow vaginal bleeding, incomplete abortion pregnant drug flow duration and recovery time of menstruation comparative analysis.Results After medical abortion,medical abortion effect of the two groups of pregnant women were analyzed, the results showed that the proportion of complete abortion patients in the observation group, the proportion of incomplete abortion, abortion failure rates and the control group was not significant.Vaginal bleeding after two complete abortion drug flow comparing pregnant women in observation group and less than an amount equal to the total number of menstruation was significantly lower than control group (χ2 =5.318,P<0.05).Observation group after the drug flow vaginal bleeding lasted significantly phrases in the control group (P<0.05); the recovery time of menstruation after medical abortion were compared two groups of patients.Observation group completely abortion menstrual period the number of days than the control group (P<0.05);similar to the menstrual cycle days, the difference was not statistically significant.Conclusion Gongxuening capsule combined with oxytocin on bleeding after medicinal abortion has a significant preventive effect, can effectively reduce the amount of bleeding and bleeding time in patients after the drug flow, which is a safe and effective medical abortion methods should be promoted and used in clinical.

Clinical Observation of Adjunctive Treatment of Shenghua Decoction for Abortion in the Early Pregnancy / 中国药房

OBJECTIVE:To observe therapeutic efficacy of adjunctive treatment of Shenghua decoction for abortion in the ear-ly pregnancy. METHODS:228 patients with abortion in the early pregnancy collected from our hospital were randomly divided into control group and observation group with 114 cases in each group. Control group was given mifepristone 25 mg,bid,and addition-al misoprostol 600 μg on the forth day,qd,for 4 days. Observation group was additionally given misoprostol orally on the forth day,2 h later,Shenghua decoction,bid,for consecutive 7 days. The rate of abortion,bleeding time,amount of bleeding,normal activity time after abortion,and the incidence of ADR were observed in 2 groups. RESULTS:The rate of abortion in observation group was 96.5%,which was higher than that of control group (85.1%),with statistical significance (P<0.05). The bleeding time,amount of bleeding and normal activity time of observation group were significantly lower or shorter then those of control group,with statistical significance (P<0.05). The incidence of ADR in observation group was significantly lower than control group,with statistical significance(P<0.05). CONCLUSIONS:The adjunctive treatment of Shenghua decoction have good effect on abortion in the early pregnancy with less ADR.

Contraception and induced abortion in the West Indies: a review / Contracepción y aborto inducido en West Indies: una revisión

BACKGROUND: Most islands in the West Indies do not have liberal laws on abortion, nor laws on pregnancy prevention programmes (contraception). We present results of a literature review about the attitude of healthcare providers and women toward (emergency) contraception and induced abortion, prevalence, methods and juridical aspects of induced abortion and prevention policies. METHODS: Articles were obtained from PubMed, EMBASE, MEDLINE, PsychINFO and SocIndex (1999 to 2010) using as keywords contraception, induced abortion, termination of pregnancy, medical abortion and West Indies. RESULTS: Thirty-seven articles met the inclusion criteria: 18 on contraception, 17 on induced abortion and two on both subjects. Main results indicated that healthcare providers' knowledge of emergency contraception was low. Studies showed a poor knowledge of contraception, but counselling increased its effective use. Exact numbers about prevalence of abortion were not found. The total annual number of abortions in the West Indies is estimated at 300 000; one in four pregnancies ends in an abortion. The use of misoprostol diminished the complications of unsafe abortions. Legislation of abortion varies widely in the different islands in the West Indies: Cuba, Puerto Rico, Martinique, Guadeloupe and St Martin have legal abortions. Barbados was the first English-speaking island with liberal legislation on abortion. All other islands have restrictive laws. CONCLUSION: Despite high estimated numbers of abortion, research on prevalence of abortion is missing. Studies showed a poor knowledge of contraception and low use among adolescents. Most West Indian islands have restrictive laws on abortion.

ANTECEDENTES: La mayoría de las islas en West Indies no tienen leyes liberales sobre el aborto, ni programas para la prevención del embarazo (contracepción). El presente trabajo presenta los resultados de una revisión de la literatura sobre la actitud de los proveedores del cuidado de la salud y las mujeres hacia la contracepción y el aborto inducido (emergencia), prevalencia, métodos y aspectos jurídicos del aborto inducido y políticas de prevención. MÉTODOS: Se obtuvieron artículos de PubMed, EMBASE, MEDLINE, PsychINFO y SocIndex (1999 a 2010) que usaban como palabras claves contracepción, aborto inducido, terminación de embarazo, aborto médico y West Indies. RESULTADOS: Treinta y siete artículos correspondían al criterio de inclusión: 18 sobre contracepción, 17 sobre aborto inducido y 2 sobre ambos asuntos. Los resultados principales indicaron que los conocimientos de los proveedores de cuidado de la salud acerca de la contracepción de emergencia, eran pobres. Los estudios mostraron un conocimiento pobre de la contracepción, pero las sesiones de counseling aumentaron su efectividad. No se encontraron números exactos sobre la prevalencia del aborto. Se estima que el número total de abortos por año en West Indies es de 300 000. Uno de cada cuatro embarazos termina en aborto. El uso de misoprostol disminuyó las complicaciones de abortos inseguros.La legislación sobre el aborto varía ampliamente en las diferentes islas del Caribe: Cuba, Puerto Rico, Martinica, Guadalupe y San Martín tienen abortos legales. Barbados fue la primera isla angloparlante con legislación liberal para el aborto. Todas las otras islas tienen leyes restrictivas. CONCLUSIÓN: A pesar del alto número de abortos, según se estima, no hay investigaciones sobre la prevalencia del aborto. Los estudios mostraron un pobre conocimiento de la contracepción y un uso bajo entre los adolescentes. La mayoría de las islas del Caribe tienen leyes restrictivas contra el aborto.

Aborto no Brasil: uma pesquisa domiciliar com técnica de urna / Abortion in Brazil: a household survey using the ballot box technique

O artigo apresenta os primeiros resultados da Pesquisa Nacional de Aborto (PNA), um levantamento por amostragem aleatória de domicílios, realizado em 2010, cuja cobertura abrangeu as mulheres com idades entre 18 e 39 anos em todo o Brasil urbano. A PNA combinou duas técnicas de sondagem: a técnica de urna e questionários preenchidos por entrevistadoras. Seus resultados indicam que, ao final da vida reprodutiva, mais de uma em cada cinco mulheres já fez aborto, ocorrendo os abortos em geral nas idades que compõem o centro do período reprodutivo das mulheres, isto é, entre 18 e 29 anos. Não se observou diferenciação relevante na prática em função de crença religiosa, mas o aborto se mostrou mais comum entre mulheres de menor escolaridade. O uso de medicamentos para a indução do último aborto ocorreu em metade dos casos e a internação pós-aborto foi observada em cerca de metade dos abortos. Tais resultados levam a concluir que o aborto deve ser prioridade na agenda de saúde pública nacional.

This study presents the first results of the National Abortion Survey (PNA, Pesquisa Nacional de Aborto), a household random sample survey fielded in 2010 covering urban women in Brazil aged 18 to 39 years. The PNA combined two techniques, interviewer-administered questionnaires and self-administered ballot box questionnaires. The results of PNA show that at the end of their reproductive health one in five women has performed an abortion, with abortions being more frequent in the main reproductive ages, that is, from 18 to 29 years old. No relevant differentiation was observed in the practice of abortion among religious groups, but abortion was found to be more common among people with lower education. The use of medical drugs to induce abortion occurred in half of the abortions, and post-abortion hospitalization was observed among approximately half of the women who aborted. Such results lead to conclude that abortion is a priority in the Brazilian public health agenda.

Effects of mifepristone on fibronectin in human villus and deciduas / 上海第二医科大学学报

Objective To investigate the effects of mifepristone on the expression of fibronectin (FN) in human villus and deciduas after termination of pregnancy. Methods Women with choice of termination of pregnancy(< 49 d) were divided into medical abortion complete group (n=15), medical abortion incomplete group(n=15) and control group (with dilatation and curettage, n=15). The villus and deciduas were collected at the third day of medical abortion or at the day of dilatation and curettage. Immunohistochemical technique was used to examine the expression of FN in villus and deciduas of these three groups. Results The positive expression rates of FN in villus and deciduas of control group were significantly higher than those of two medical abortion groups(P < 0.017), and the positive expression rates of FN of medical abortion incomplete group were significantly higher than those of medical abortion complete group (P < 0. 017). Conclusion Mifepristone can decrease the expression of FN in human villus and deciduas and interfere the condition of embryonic growth, exerting the anti-gestational effect at extracellular matrix level.

Clinical study of the treatment of colporrhagia after medical abortion with medroxyprogesterone acetate by oral use / 重庆医科大学学报

Objective:To investigate the effect of low dose progesterone on colporrhagia after medical abortion and compare it with curettage.Methods:Divide 120 cases of medical abortion into observation group,curettage group and control group.Medroxyprogesterone Acetate was administered to observation group for oral use.Results:Comparing with control group,duration and amount of bleeding decreased significantly by given low dosage of medroxyprogesterone acetate in observation group,but it was higher than curettage group.From control group,observation group to curettage group,the cases of bleeding duration less than 7d increased by 5.41%,16.67% to 93.62%,and the cases of bleeding amount less than menstruation increased by 8.11%,61.11%,82.98%.The difference was particularly significant between each 2 groups.Conclusion:Oral administration of medroxyprogesterone acetate could decrease the duration and amount of bleeding after medical abortion.It was very convenient to comply and spread widely.

Expression of TGF-? in Villus and Deciduas after Medical Abortion / 上海第二医科大学学报

Objective To investigate the expression of transforming growth factor-?(TGF-?) in the villus and deciduas of different outcomes after administration with mifepristone and misoprostol in the termination of early pregnancy. Methods From May 2004 to March 2005,50 women who were comfirmed early pregnancy and requested termination of pregnancy in the outpatient department were recruited.Patients with medical abortion were divided into two groups according to the final outcomes: group of complete abortion(n=15) and group of incomplete abortion((n=)15).Another 20 patients with surgical abortion were served as control.The villus and deciduas were collected at the third day of medical abortion,whereas the same was done at the day of surgical abortion.The expression of TGF-? in villus and deciduas of the three groups were measured by immunohistochemical method. Results The age,gestational age,diameter of gestational sac and levels of serum E_(2),P and ?-HCG before abortion were similar in these groups.Compared with the other two groups,the expressions of TGF-? in the villus and deciduas in the group of complete abortion were significantly decreased(P

Acceptability of medical abortion in women living in Ho Chi Minh city

594 women underwent medical abortion in Tu Du Hospital of Ho Chi Minh city were interviewed from March to December 2004. Mean age of these women was 24.3. Among them, medical abortion to terminate pregnancy is 52.2%, abortion 47.8%, miscarriage 12.1%. Reasons for choosing medical abortion included: this is a new method (52%), reducing dangerous complications (73%), fear of pain due to surgical abortion (94%), available (96.3%), confidence (97.5%). 68% of them like to use medication at home, 38% did it in health facilities. Multivariable analysis showed that there were correlation between use medication at home or in health facilities with age and the success or unsuccess of recent medical abortion

Effects of medical abortion using methotrexate and misoprostol in early pregnancy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to accumulate the knowledge about medical abortion by assessment of the efficacy of medical abortion using methotrexate and misoprostol versus misoprostol in early pregnancy. METHODS: The 35 women at less than 56 days' gestation underwent medical abortion were reviewed prospectively. Seventeen women (group 1) underwent medical abortion using methotrexate with misoprostol and eighteen women (group 2) underwent using misoprostol alone. We measured percent change of serum beta-hCG, successful abortion, duration of vaginal bleeding, side effects. RESULTS: Overall success rate was 91.4%: success rate in group 1 was 100%, 84.2% in group 2. Vaginal bleeding lasted for a mean of 12 days (group 1), and 10 days (group 2). Percent change of serum beta-hCG level from day 1 to day 4 was 93.1 (group1), and -68.0 (group 2), that from day 1 to day 7 was -90.6 (group 1), and -97.6 (group 2). Side effects were minimal. CONCLUSION: No significant difference between group 1 (methotrexate and misoprostol) and group 2 (misoprostol alone) was found. Medical abortion is considered to be the therapy that is safe, and effective procedure in early pregnancy.