Outcomes of legal induced abortion at 9-10 weeks' gestation in adult women
ESC Congress Library. Aguilar S. May 28, 2014; 50431; A-013
Dr. Sofia Aguilar
Dr. Sofia Aguilar
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Objectives: Gestational age is the one of the most important factor affecting the risk of abortion. The objective of our study was two-fold: to compare abortion outcomes before and after 9 weeks' gestation; and to review medical abortion ≥9 weeks' (wks) practices, in order to determine our protocol's effectiveness and security.

Method: Retrospective analysis of all voluntary pregnancy terminations up to 10wks of pregnancy, in adult women, between June/2011-December/2012 at Maternidade Dr. Alfredo da Costa. Outcomes assessed included gestational age (GA) at pregnancy termination, abortion method and failure to achieve complete abortion; for medical abortion ≥9wks we also assessed mean expulsion time, misoprostol doses necessary to induce expulsion and vaginal hemorrhage frequency.

Results: 1856 legal abortions requested by women were included, 1472 (79%) before and 384 (21%) after 9wks. Before 9wks the abortion method was medical in 73% of the cases versus 76% ≥9wks. Before 9wks most medical abortions (95%) were conducted at home, as opposed to ≥9wks, when 98% of the women were hospitalized.
Failure to achieve complete abortion occurred in 3,06% versus 7,44% of the cases before and after 9wks respectively; this difference was statistically significant (p<0.05); vaginal hemorrhage was also statistically significantly higher ≥9 wks (2,27% vs 0,27%, p<0.05).

For medical abortion ≥9 wks, a combined regimen was used (200mg of oral mifepristone followed 24-72 hours after by 800+400+400mcg of buccal or vaginal misoprostol given during hospitalization). In this sub-group, mean time of hospitalization was 1 day (1-4 days) and mean doses of misoprostol administered were 3,49. Success rate was 89%. Reasons for taking >3 doses of misoprostol were: as prescribed(19%), no expulsion yet observed(23%), considerable remnants of fetal tissue in uterus(52%), persistent nonviable pregnancy(3%) and ongoing pregnancy(3%). When pregnancy products expulsion was documented, 50% occurred after 2 doses of misoprostol, 11% after 1, 31% after 3 and 8% after 4 doses. Mean and median hours from first dose of misoprostol until pregnancy expulsion were 5,67 (1-13) and 5 respectively. 3% experienced vaginal hemorrhage. After 9wks, the group with successful versus the group with failed medical abortion, were similar when it comes to maternal age, GA, previous induced abortion, previous vaginal birth or time interval between mifepristone intake and first misoprostol administration.

Conclusions: Incomplete abortion and vaginal hemorrhage were significantly more frequent after 9wks of pregnancy; after that gestational age, none of the characteristics analyzed were associated with the probability of medical abortion failure.

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