Medical abortion after 9 weeks
ESC Congress Library. Ferreira F. May 28, 2014; 50459; A-042
Dr. Filipa Ferreira
Dr. Filipa Ferreira
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Abstract
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1. Objective: To assess the efficacy and safety of the medical method of abortion using mifepristone 200 mg followed by misoprostol 800 mcg vaginally administered after 48 hours, between 9 and 10 weeks.
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2. Design & Methods: Retrospective and comparative analysis of 4669 women who requested an abortion between 2007 and 2012. We considered two groups: pregnancies with ≥ 9 weeks (group 1) and pregnancies with < 9 weeks (group 2 - control group). We compared the success and complication rates between the two groups. The efficacy rate was defined as complete expulsion of gestational sac at ultrasound exam. Complications were categorized as incomplete abortion (presence of hyperechogenic structures at ultrasound), haemorrhage that implied blood transfusion, infection, uterine rupture and others (thromboembolism and anxiety or other psychiatric problems that implied therapy. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20. Chi square and Fisher's exact tests were used for categorical outcomes. Student's t test was used to compare means of continuous outcomes.
3. Results: There were 711 (15.4%) women in group 1 and 3895 (84.6%) in group 2. The mean maternal age was higher in group 2 (28.1vs 28.8, p=0.014).There were no differences between groups in previous abortion, as well as in number of gestations, with 13.6% of primiparas in group 1 and 15.1% in group 2. . The efficacy rate was 96.4% in group 1 and 98.9% in group 2 (p<0.0001). Odds of failure to achieve abortion (OR= 1.3; 95% CI: 1.11-1.62) were higher in group 1. The complication rate was higher in group 1 (10.8%vs7.2%, p<0.01). Incomplete abortion was the only complication responsible for this difference (OR= 1.1; 95% CI: 1.02-1.15). Groups were similar in haemorrhagic complications (0.6%vs0.5%), infections (0.3%vs0.1%), uterine rupture (no cases), and other complications, including thromboembolic and post-traumatic symptoms related with the procedure (0.3%vs0.2%).
4. Conclusions: The efficacy of medical abortion was lower in the group with ≥ 9 weeks which could presumably be improved using a higher dose and/or in a different schedule of misoprostol.The safety was similar in both groups..

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